Definición de indicadores para una atención centrada en el paciente diabético tipo II. Estudio de consenso.

OBJECTIVE: Define a minimum set of indicators for person-focused-care applying for type 2 diabetes mellitus (DM2), as a complementary metric to current clinical-healthcare indicators. METHODS: Qualitative consensus-building study (involving professionals and patients) structured in three stages: Metaplan to capture information, Delphi to agree on criteria and indicators, and consensus conference to ensure feasibility and relevance of the proposal. RESULTS: Consensus was reached on a total of nine indicators upon: shared decision-making, self-care, adherence, renal function screening, activities of daily living, individualized therapeutic plan, vascular risk assessment, working life and human treatment. These indicators were grouped into three dimensions: the person with oneself, the person with one's family, and the person with the health system. CONCLUSIONS: These indicators make it possible to establish alternative metrics to determine the degree of progress in a person-centered attention in case of DM2.

[Proposals by the Spanish Society of Quality in Healthcare (SECA) for the recovery of the National Health Service after the COVID-19 pandemic]. / Propuestas de la SECA para la recuperación del Sistema Nacional de Salud tras la pandemia por SARS-CoV-2.

BACKGROUND: The SARS-CoV-2 pandemic has demanded responses for which the National Health System (NHS) was not prepared. The Spanish Society for Quality in Healthcare (SECA) has the mission of promoting quality in healthcare and contributing to its proper functioning. OBJECTIVE: To present SECA recommendations to ensure the quality and safety of patients in the recovery of the NHS following the impact of the SARS-CoV-2 pandemic and the possibility of a resurgence. METHODS: Qualitative study to seek consensus with the participation of 49 representatives of the different stakeholders (patients, managers, professionals, academics and researchers). The areas to be explored were: lessons learned, management of new care demands from COVID-19 patients, recompositing of templates, strengthening the resilience of professionals, new role of patients and contingency plans. RESULTS: Four hundred and twenty-eight proposals were submitted. Once duplicates were deleted and similar proposals were merged, their number was reduced to 120. Of these, 60 proposals were prioritized and grouped into two categories of measures: (1) to recover the Health System (equity, accessibility, effectiveness, efficiency, safety, patient experience and work morale) and (2) to deal with possible outbreaks. CONCLUSION: SECA responds to its commitment to society with recommendations to ensure quality of healthcare and patient safety in the COVID-19 Era.

Stroke treatment outcomes in hospitals with and without Stroke Units. / Resultados en el tratamiento del ictus en hospitales con y sin Unidad de Ictus.

INTRODUCTION: Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. METHODS: We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. RESULTS: Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. CONCLUSION: Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department.

[Implemented actions in the Spanish National Health System to improve patient safety culture]. / Acciones desarrolladas para avanzar en seguridad del paciente en el Sistema Nacional de Salud español.

BACKGROUND: The Ministry of Health, Consumption and Social Welfare (MHCSW) since 2005 has been promoting, in collaboration with the Autonomous Communities (AC) and the Scientific Societies (SC), among them the Spanish Society for Healthcare Quality (SSHCQ), the Patient Safety Strategy (PSS). PSS 2015-2020 develops relevant aspects of patient safety (PS), such as risk management, reporting and learning systems (RLS), as well as promoting an adequate response when an adverse event (AE) unexpectedly occurs. The present work describes the current situation of the different AC in relation to these topics. MATERIAL AND METHODS: A Descriptive study, based on a survey developed ad hoc within the framework of the agreement between the MHCSW and SSHCQ, was conducted at national level. The questions' topics, prepared by consensus of the work team, considered the implementation of RLS and AE analysis, and legal protection for professionals involved in an AE in the AC. RESULTS: A total of 17 surveys were collected (16 AC and INGESA). All ACs had a RLS, a structure to support PS activities but very heterogeneous. Some ACs had a response plan to an AE and had established a coordination protocol with legal services to support patients and professionals involved in an AE. Some ACs had enacted some laws and regulations to facilitate PS culture. CONCLUSIONS: The ACs have risk management structures that lead the plans in PS, reporting and learning systems and have experience in the analysis of near miss and AE. However, a regulatory change that increases the legal safety of professionals to provide an adequate response to the AEs is a priority. This challenge should involve leaders of health organizations, scientific societies and professional associations, national and regional health authorities as it has been done in other European countries.

A set of care quality indicators for stroke management. / Conjunto de indicadores de calidad asistencial en el abordaje del ictus.

OBJECTIVE: This study proposes a set of quality indicators for care outcomes in patients with acute cerebral infarction. These indicators are understandable and relevant from a clinical viewpoint, as well as being acceptable and feasible in terms of time required, ease of data capture, and interpretability. METHOD: The method consisted of reaching consensus among doctors after having reviewed the literature on quality indicators in stroke. We then designed and conducted a field study to assess the understandability and feasibility of the set of indicators. RESULTS: Consensus yielded 8 structural indicators, 5 process indicators, and 12 result indicators. Additionally, standards of reference were established for each indicator. CONCLUSION: This set of indicators can be used to monitor the quality care for stroke patients, identify strengths, and potentially to identify areas needing improvement.

[In case of an adverse event don´t forget to say sorry]. / Si ocurrió un evento adverso piense en decir "lo siento".

BACKGROUND: Disclosing information to a patient who is a victim of an adverse event (AE) presents some particularities depending on the legal framework in the country where the AE occurred. The aim of this study is to identify the limits and conditions when apologizing to a patient who has suffered an AE. METHODS: A consensus conference involving 26 professionals from different autonomous communities, institutions, and profiles (health, insurance, inspection, academic) with accredited experience in patient safety management systems and criminal law. RESULTS: Open disclosure should include an apology expressed in neutral terms (showing empathy and regret for what has happened) without the informant being identified as responsible for the damage, blaming third parties, or offering compensation on behalf of the insurance company. The professional who feels most directly involved in the incident is usually the least likely to report it and apologise. The informant profile must conform to the type and severity of the AE. The rules and conditions of liability insurance advise against providing specific information on the amount of compensation. CONCLUSIONS: The apology should be offered in terms of the regulatory framework in force in each country. In Spain, an appropriate response of empathy for the patient is warranted, expressing regret for what happened (apologising), which can facilitate the relationship with the patient, mitigate their mistrust, and reduce the number of disputes.

[Efficiency indicators to contribute to sustainability of health services in Spain]. / Indicadores de eficiencia para contribuir a la sostenibilidad de los servicios de salud en España.

OBJECTIVE: Identifying a minimum set of efficiency indicators calculated from current information sources. Interventions adopted from the analysis of these indicators could contribute to health services sustainability. METHOD: We applied the discussion group technique. A total of 23 quality coordinators from around the country and the representatives of the regional quality societies in SECA (Spanish Society for Quality in Healthcare) participated. RESULTS: Ten efficiency indicators useful for integrated management areas were identified and accepted, 5 in the area of primary care and 5 for hospital management. CONCLUSION: The efficiency indicators agreed upon could contribute to the sustainability of the health system without this affecting the quality of care.

Indicadores de eficiencia para contribuir a la sostenibilidad de los servicios de salud en España / Efficiency indicators to contribute to sustainability of health services in Spain

Objetivo. Identificar un conjunto mínimo de indicadores de eficiencia que puedan ser calculados a partir de las fuentes de información actuales a partir de los cuales puedan adoptarse medidas que contribuyan a la sostenibilidad de los servicios de salud. Método. Grupos de discusión con participación de 23 coordinadores de calidad de centros e institucionales sanitarias de todo el país y los representantes de las sociedades autonómicas de calidad en Sociedad Española de Calidad Asistencial (SECA). Resultados. Se identificaron y priorizaron por consenso 10 indicadores de eficiencia útiles para áreas integradas de gestión, 5 en el ámbito de la atención primaria y 5 en el ámbito de la gestión hospitalaria. Conclusión. Los indicadores de eficiencia consensuados pueden contribuir a la sostenibilidad del sistema de salud sin por ello mermar la calidad de la atención prestada (AU)

Objective. Identifying a minimum set of efficiency indicators calculated from current information sources. Interventions adopted from the analysis of these indicators could contribute to health services sustainability. Method. We applied the discussion group technique. A total of 23 quality coordinators from around the country and the representatives of the regional quality societies in SECA (Spanish Society for Quality in Healthcare) participated. Results. Ten efficiency indicators useful for integrated management areas were identified and accepted, 5 in the area of primary care and 5 for hospital management. Conclusion. The efficiency indicators agreed upon could contribute to the sustainability of the health system without this affecting the quality of care (AU)

[Evaluation of the new integrated care approach in the Basque Country]. / Evaluación del nuevo enfoque en atención a la cronicidad en las organizaciones sanitarias integradas en el País Vasco.

BACKGROUND: In 2010 the Basque Government launched its "Strategy for tackling the challenge of chronicity in the Basque Country", in order to transform healthcare organisations into more integrated care models, with the aim of improving quality and efficiency in chronicity management. Four Integrated Healthcare Organisations (IHOs) were created to unify primary and specialised care into one single organisation. The aim of this study is to measure the degree of readiness of these IHOs to cope with chronicity, using the Chronic Care Model (CCM) as a reference. MATERIAL AND METHODS: Self-assessment processes using ARCHO (Assessment of Readiness for Chronicity in Health Care Organisations) were carried out in four IHOs by the management teams. RESULTS: The average score was 16 out of 100 points, which signals that healthcare organisations are undertaking action plans in the realm of integrated care, but with limited deployment and without a systematic process for evaluating outcomes. The dimension that ranks best is "Organization of the health system", while "Community health" has the lowest ranking. CONCLUSIONS: IHOs are the key for achieving integrated care for chronic illnesses. Integration of community resources and evaluation of results are two of the fields that need to be improved in order to achieve the set of interventions proposed in ARCHO. The organisational changes involved in the CCM require periods longer than two years.

[A set of quality and safety indicators for hospitals of the "Agencia Valenciana de Salud"]. / Conjunto de indicadores de calidad y seguridad para hospitales de la Agencia Valenciana de Salud.

OBJECTIVES: To prepare a set of quality and safety indicators for Hospitals of the «Agencia Valenciana de Salud¼. MATERIAL AND METHODS: The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare¼ was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking into account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. RESULTS: Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. CONCLUSIONS: A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems.

La necesidad de reinvertarse ante el reto de la cronicidad / The need to redirect oneself facing the challenge of chronicity

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Evitar errores a veces compete a los profesionales, a veces a los pacientes, pero a veces a los directivos / Sometimes avoiding errors is the responsibility of professionals, at others of patients, but sometimes it falls to managers

No disponible

Cómo valoran los pacientes en situación de baja laboral al médico inspector: la experiencia del Institut Català d’Avaluacions Mèdiques (ICAM) en Cataluña / How the patients on sick leave assess the Medical Inspector: The Institut Català d’Avaluacions Mèdiques (ICAM) experience in Catalonia

Objetivo. Analizar la opinión que tienen los pacientes en incapacidad laboral de los médicos evaluadores/inspectores y explorar si esta valoración está condicionada por el resultado del dictamen médico. Material y métodos. Estudio descriptivo, transversal, basado en encuestas telefónicas a una muestra aleatoria de pacientes atendidos en Cataluña por incapacidad laboral temporal (IT) o permanente (IP). El estudio de campo ha sido realizado en noviembre de 2011. Muestreo por conglomerados considerando: tiempo desde la consulta y provincia donde fue atendido. Se utilizó una escala valorada mediante coeficiente de Correlación Intraclase (0,93, IC 95% 0,92-0,94) y prueba de Spearman-Brown de la división por mitades (0,93). Resultados. Respondieron 609 pacientes, de los que 400 (65,7%) realizaron una valoración positiva de la atención del médico. Cuando la IP fue denegada la valoración del médico fue peor (p=0,002); no sucedió igual en la IT. Los pacientes en IP que no continuaron en esta situación manifestaron que las decisiones del médico respondían a otros intereses distintos a la salvaguarda de los derechos del paciente (Odds Ratio 2,8; IC95% 1,7-4,8). Cuando el dictamen es negativo los pacientes centraron sus críticas en el médico evaluador (p<0,001) y no en la organización. Conclusiones. Un dictamen negativo en el caso de IP se asocia a una valoración negativa de la actuación, capacidad e independencia de criterio del médico. No sucede lo mismo en el caso de la IT (AU)

Objective. To analyse the patient perception of the medical inspector, and to examine whether this perception is related with the outcome of the medical report. Material and Methods. A cross-sectional study based on telephone interviews with a random sample of patients visited in Catalonia in 2010 for temporary (TSL) or permanent (PSL) sick leave. The study was conducted in November 2011. A stratified sample considering the time from the consultation and province where patients were visited was used. The scale was assessed by Intraclass Correlation coefficient (0.93, 95% CI; 0.92-0.94) and testing with the Spearman-Brown split-half coefficient (0.93). Results. A total of 609 patients were surveyed. A majority of them (400; 65.7%) had a positive opinion of the medical inspector. When PSL was denied, the assessment was worse (P=.002), this was different when TSL was cancelled. Patients who did not continue in PSL stated that doctor's decisions were determined by non-medical interests, and not oriented to the defence of the patient's rights (odds ratio 2.8, 95% CI; 1.7 to 4.8). When the perceptions were negative, patients focus their criticism on the role of medical inspector (P<.001), and not about the organisational aspects. Conclusions. When inspectors cancel PSL, patient's perception is strongly associated with a negative assessment of their performance, capacity and independence of the physician. This is not so in the case of TSL (AU)

[How the patients on sick leave assess the Medical Inspector: The Institut Català d'Avaluacions Mèdiques (ICAM) experience in Catalonia]. / Cómo valoran los pacientes en situación de baja laboral al médico inspector: la experiencia del Institut Català d'Avaluacions Mèdiques (ICAM) en Cataluña.

OBJECTIVE: To analyse the patient perception of the medical inspector, and to examine whether this perception is related with the outcome of the medical report. MATERIAL AND METHODS: A cross-sectional study based on telephone interviews with a random sample of patients visited in Catalonia in 2010 for temporary (TSL) or permanent (PSL) sick leave. The study was conducted in November 2011. A stratified sample considering the time from the consultation and province where patients were visited was used. The scale was assessed by Intraclass Correlation coefficient (0.93, 95% CI; 0.92-0.94) and testing with the Spearman-Brown split-half coefficient (0.93). RESULTS: A total of 609 patients were surveyed. A majority of them (400; 65.7%) had a positive opinion of the medical inspector. When PSL was denied, the assessment was worse (P=.002), this was different when TSL was cancelled. Patients who did not continue in PSL stated that doctor's decisions were determined by non-medical interests, and not oriented to the defence of the patient's rights (odds ratio 2.8, 95% CI; 1.7 to 4.8). When the perceptions were negative, patients focus their criticism on the role of medical inspector (P<.001), and not about the organisational aspects. CONCLUSIONS: When inspectors cancel PSL, patient's perception is strongly associated with a negative assessment of their performance, capacity and independence of the physician. This is not so in the case of TSL.

Validez y fiabilidad de un indicador sintético de calidad de la atención hospitalaria / Validity and reliability of a synthetic hospital health care quality indicator

Objetivo. El benchmarking entre diferentes organizaciones sanitarias es una herramienta útil para la mejora de la calidad, pero requiere contar con indicadores válidos y fiables para que las comparaciones se basen en datos objetivos. El objetivo de este trabajo es contrastar la validez y la fiabilidad de un indicador sintético de calidad de la atención hospitalaria. Material y métodos. Estudio transversal, sobre los indicadores del Plan de Calidad de 10 hospitales, bajo el modelo de la European Fondation of Quality Management (EFQM) en un periodo de 5 años. Se contrasta la fiabilidad, mediante el coeficiente alfa de Cronbach. La validez se contrasta mediante un análisis de conglomerados (dendograma), explorando asociaciones entre resultados de indicadores diferentes, y mediante un análisis exploratorio de las correlaciones entre los indicadores de proceso y los indicadores de resultados propuestos por la Agencia Norteamericana de Investigación en Calidad (AHRQ). Resultados. Se ha encontrado una fiabilidad «aceptable» (α=0,759). No se han hallado conglomerados que respondan a la agrupación de criterios del modelo EFQM ni correlaciones significativas con los indicadores de resultados. Conclusiones. Se propone continuar elaborando indicadores que se muestren empíricamente válidos para integrarse en indicadores sintéticos, de forma que pueda compararse la eficiencia de la gestión sanitaria en todos los hospitales(AU)

Objective. Benchmarking between different health organisations is a useful tool for improving quality, but it requires using valid and reliable indicators so that comparisons may be based on objective data. The aim of this work is to verify the validity and reliability of a synthetic hospital health care quality indicator. Material and methods. A cross-sectional study was conducted over a five-year period on the Quality Plan indicators of 10 hospitals, under the model of the European Foundation of Quality Management (EFQM). Reliability was checked using the Cronbach's alpha coefficient. The validity was determined using a cluster analyses (dendrogram), examining relationships between different indicator results, and by means of an exploratory analysis of the correlations between the process indicators and results indicators proposed by the US Agency for Healthcare Research and Quality (AHRQ). Results. An «acceptable» reliability was found (α=0.759). No clusters were found that corresponded to the set of criteria of the EFQM model, or any significant correlations with the results indicators. Conclusions. It is proposed to continue devising indicators that could empirically be shown to be valid in order to be incorporated into synthetic indicators, in such a way that the efficiency of health care management in all hospitals may be compared(AU)

[Validity and reliability of a synthetic hospital health care quality indicator]. / Validez y fiabilidad de un indicador sintético de calidad de la atención hospitalaria.

OBJECTIVE: Benchmarking between different health organisations is a useful tool for improving quality, but it requires using valid and reliable indicators so that comparisons may be based on objective data. The aim of this work is to verify the validity and reliability of a synthetic hospital health care quality indicator. MATERIAL AND METHODS: A cross-sectional study was conducted over a five-year period on the Quality Plan indicators of 10 hospitals, under the model of the European Foundation of Quality Management (EFQM). Reliability was checked using the Cronbach's alpha coefficient. The validity was determined using a cluster analyses (dendrogram), examining relationships between different indicator results, and by means of an exploratory analysis of the correlations between the process indicators and results indicators proposed by the US Agency for Healthcare Research and Quality (AHRQ). RESULTS: An «acceptable¼ reliability was found (α=0.759). No clusters were found that corresponded to the set of criteria of the EFQM model, or any significant correlations with the results indicators. CONCLUSIONS: It is proposed to continue devising indicators that could empirically be shown to be valid in order to be incorporated into synthetic indicators, in such a way that the efficiency of health care management in all hospitals may be compared.

La técnica cualitativa en la mejora de la satisfacción en urgencias / The qualitative technique in the improvement of satisfaction at the emergency clinic

Objetivo: Conocer las necesidades de salud que influyen en la satisfacción de los usuarios del Servicio de Urgencias Hospitalario (SUH) del Hospital de Elda. Métodos: El estudio se ha desarrollado mediante la técnica cualitativa de grupo focal. El análisis de la información obtenida en las dinámicas de grupo se realizó en base a dos variables: espontaneidad y coincidencia. Resultados: La mayor coincidencia de los grupos (100 por ciento) está en la importancia de un trato amable y cortés, una atención rápida inicial y la carencia de "especialistas" en Urgencias. Los usuarios pretenden recibir una atención sanitaria idónea y, a la vez, evitar las interminables listas de espera en los centros de especialidades. Las razones argumentadas para acudir, ante un proceso urgente, directamente al SUH fueron: fiabilidad en el diagnóstico de Urgencias, acceso a más medios técnicos y el hecho de que casi siempre les envien al hospital. Conclusiones: Se ha puesto de manifiesto que las expectativas, en general, son comunes a todos los grupos (pacientes, familiares y población general), pero que el orden o prioridad en que éstas se manifiestan es distinto según el grado de implicación en el proceso de enfermar y la posición del usuario dentro del sistema. Mientras que en el grupo de pacientes se mencionaba como principal necesidad el trato amable, cordial y humano, seguido de la información a familiares, las expectativas de la población general fueron ser atendido por especialistas, un cuidado de la intimidad y una rápida atención (AU)

Evaluación de la calidad de la asistencia en el servicio de urgencias hospitalario a través de la revisión de informes clínicos / Assessment of assistance quality at the in-Hospital Emergency Service through a review of the clinical reports

Objetivos: Realizar una evaluación externa de la calidad de la actuación de los médicos de Urgencia Hospitalaria de Elda reflejada en los informes de asistencia en Urgencias, teniendo en cuenta: la necesidad de acudir al Servicio de Urgencias Hospitalario (SUH), necesidad de observación, la necesidad de ingreso, la adecuación del diagnóstico y del tratamiento. Metodología: Estudio transversal, descriptivo. Desarrollo de análisis bivariantes, respetando los supuestos en los que se basan las técnicas estadísticas. Algunas de las variables estudiadas fueron: gravedad, pruebas realizadas, sociodemográficas, necesidad de acudir a Urgencias, de observación, de ingreso, adecuación del diagnóstico y tratamiento. Resultados: El acuerdo entre revisores de los informes de asistencia en Urgencias osciló entre un 82,5 por ciento en la variable adecuación del tratamiento, hasta el 100 por ciento en la necesidad de ingreso. A criterio de los observadores externos encargados de la revisión de los informes clínicos (relectores), en el 51,7 por ciento de los casos no existía necesidad de acudir a Urgencias. Tampoco se apreció necesidad de observación en un 82,2 por ciento, ni de ingreso en un 82,5 por ciento de los casos (X2: -4,95; 84 gl; p= 0,0004).Conclusiones: Se comprobó un alto grado de acuerdo entre las actuaciones realizadas por los médicos de Urgencias Hospitalarias y los relectores. La mejor orientación, diagnóstico y tratamiento se relacionó con la gravedad del caso y con la responsabilidad que implica dar de alta a un paciente. Es evidente que las actuaciones realizadas a nivel del SUH no son tan distantes a las que realizarían otros especialistas que estuvieran en la misma situación. La evaluación periódica externa del Servicio de Urgencias puede favorecer la detección de debilidades y oportunidades de mejora sobre las que actuar, además de poner en evidencia la correcta actuación del Servicio (AU)