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1.
Ann Am Thorac Soc ; 17(1): 1-10, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31891300

RESUMO

The objective of this workshop was to determine current nursing research priorities in critical care, adult pulmonary, and sleep conditions through input from consumer (patient, family, and formal and informal caregivers) and nursing experts around the world. Working groups composed of nurses and patients selected potential research priorities based on patient insight and a literature review of patient-reported outcomes, patient-reported experiences, and processes and clinical outcomes in the focal areas. A Delphi consensus approach, using a qualitative survey method to elicit expert opinion from nurses and consumers was conducted. Two rounds of online surveys available in English, Spanish, and Chinese were completed. A 75% or greater threshold for endorsement (combined responses from nursing and consumer participants) was determined a priori to retain survey items. A total of 837 participants (649 nurses and 188 patients, family, and/or caregivers) from 45 countries responded. Survey data were analyzed and nursing research priorities that comprise 23 critical care, 45 adult pulmonary, and 16 sleep items were identified. This project was successful in engaging a wide variety of nursing and consumer experts, applying a patient-reported outcome/patient-reported experience framework for organizing and understanding research priorities. The project outcome was a research agenda to inform, guide, and aid nurse scientists, educators, and providers, and to advise agencies that provide research and program funding in these fields.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31834826

RESUMO

Background: Adherence to pharmacological treatment is a fundamental factor in the control of chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). Poor disease control is associated with increased morbidity and mortality and higher health costs. Methods: A multicenter, observational cross-sectional study was performed. Four hundred patients with a diagnosis of asthma or COPD were recruited from 18 Spanish hospitals. A total of 15 different inhalation devices used in the treatment of these diseases and grouped depending on their characteristics were analyzed. Patients underwent a clinical interview, and questionnaires were completed on inhaler adherence, satisfaction, and disease control. Results: Satisfaction was lower when adherence was intermediate or poor than when it was good (good vs. intermediate p = 0.035; poor vs. good p = 0.009). Multivariate analyses of feeling of satisfaction with inhaler (FSI) showed statistically significant effects for the level of adherence and academic degree in both chronic respiratory diseases and for the Asthma Control Test in the case of asthma, but not for COPD. Conclusions: High degree of satisfaction with the inhalers was observed in asthma and COPD patients, with no difference among device types. A positive association was found between satisfaction and both adherence and the degree of disease control in asthma, but not in COPD. Nevertheless, further investigations are needed to better clarify these associations.

3.
BMC Health Serv Res ; 19(1): 370, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185997

RESUMO

BACKGROUND: Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016-2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011-2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation. They reflect different implementation maturity levels. While full coverage of the entire urban health district of Barcelona-Esquerra (520 k inhabitants) is the main aim of home hospitalization, demonstration of sustainability at Hospital Clinic of Barcelona constitutes the core goal of the prehabilitation service. Likewise, full coverage of integrated care services addressed to frail chronic patients is aimed at the city of Badalona (216 k inhabitants). METHODS: The population-based analysis, as well as the three service-based protocols, follow observational and experimental study designs using a non-randomized intervention group (integrated care) compared with a control group (usual care) with a propensity score matching method. Evaluation of cost-effectiveness of the interventions using a Quadruple aim approach is a central outcome in all protocols. Moreover, multi-criteria decision analysis is explored as an innovative method for health delivery assessment. The following additional dimensions will also be addressed: i) Determinants of sustainability and scalability of the services; ii) Assessment of the technological support; iii) Enhanced health risk assessment; and, iv) Factors modulating service transferability. DISCUSSION: The current study offers a unique opportunity to undertake a comprehensive assessment of integrated care fostering deployment of services at regional level. The study outcomes will contribute refining service workflows, improving health risk assessment and generating recommendations for service selection. TRIALS REGISTRATION: NCT03130283 (date released 04/06/2018), NCT03768050 (date released 12/05/2018), NCT03767387 (date released 12/05/2018).


Assuntos
Análise Custo-Benefício/normas , Prestação Integrada de Cuidados de Saúde/normas , Idoso , Protocolos Clínicos , Prestação Integrada de Cuidados de Saúde/economia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Estudos Observacionais como Assunto , Espanha
4.
Conf Proc IEEE Eng Med Biol Soc ; 2019: 3446-3449, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31946620

RESUMO

Home hospitalization (HH) is presented as a healthcare alternative capable of providing high standards of care when patients no longer need hospital facilities. Although HH seems to lower healthcare costs by shortening hospital stays and improving patient's quality of life, the lack of continuous observation at home may lead to complications in some patients. Since blood tests have been proven to provide relevant prognosis information in many diseases, this paper analyzes the impact of different sampling methods on the prediction of HH outcomes. After a first exploratory analysis, some variables extracted from routine blood tests performed at the moment of HH admission, such as hemoglobin, lymphocytes or creatinine, were found to unmask statistically significant differences between patients undergoing successful and unsucessful HH stays. Then, predictive models were built with these data, in order to identify unsuccessful cases eventually needing hospital facilities. However, since these hospital admissions during HH programs are rare, their identification through conventional machine-learning approaches is challenging. Thus, several sampling strategies designed to face class imbalance were herein overviewed and compared. Among the analyzed approaches, over-sampling strategies, such as ROSE (Random Over-Sampling Examples) and conventional random over-sampling, showed the best performances. Nevertheless, further improvements should be proposed in the future so as to better identify those patients not benefiting from HH.


Assuntos
Serviços Hospitalares de Assistência Domiciliar , Hospitalização , Aprendizado de Máquina , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Assistência à Saúde , Feminino , Custos de Cuidados de Saúde , Testes Hematológicos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade
5.
Ann Am Thorac Soc ; 15(12): 1369-1381, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30499721

RESUMO

More than 1.5 million adults in the United States use supplemental oxygen for a variety of respiratory disorders to improve their quality of life and prolong survival. This document describes recommendations from a multidisciplinary workshop convened at the ATS International Conference in 2017 with the goal of optimizing home oxygen therapy for adults. Ideal supplemental oxygen therapy is patient-specific, provided by a qualified clinician, includes an individualized prescription and therapeutic education program, and offers oxygen systems that are safe, promote mobility, and treat hypoxemia. Recently, patients and clinicians report a growing number of problems with home oxygen in the United States. Oxygen users experience significant functional, mechanical, and financial problems and a lack of education related to their oxygen equipment-problems that impact their quality of life. Health care providers report a lack of readily accessible resources needed to prescribe oxygen systems correctly and efficiently. Patients with certain lung diseases are affected more than others because of physically unmanageable or inadequate portable systems. Analysis is needed to quantify the unintended impact that the Centers for Medicare and Medicaid Services Competitive Bidding Program has had on patients receiving supplemental oxygen from durable medical equipment providers. Studies using effectiveness and implementation research designs are needed to develop and evaluate new models for patient education, identify effective ways for stakeholders to interface, determine the economic benefit of having respiratory therapists perform in-home education and follow-up testing, and collaborate with technology companies to improve portable oxygen devices. Generation of additional evidence of the benefit of supplemental oxygen across the spectrum of advanced lung diseases and the development of clinical practice guidelines should both be prioritized.


Assuntos
Assistência à Saúde/organização & administração , Política de Saúde , Serviços de Assistência Domiciliar , Oxigenoterapia , Educação , Humanos , Defesa do Paciente , Estados Unidos
6.
Int J Integr Care ; 18(2): 12, 2018 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-30127696

RESUMO

Home Hospitalization has proven efficacy, but its effectiveness and potential as an Integrated Care Service in a real world setting deserves to be explored. Objective: To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona. Methods: Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic patients requiring admission into a highly specialized hospital, from 2006 to 2015. Intervention: Home-based individualized care plan, administered as a hospital-based outreach service, aiming at substituting hospitalization and implementing a transitional care strategy for optimal discharge. Main measurements: Emergency Department, readmissions and mortality. Patients' and professionals' perspectives, technologies and costs were evaluated. Results: 4,165 admissions (71 ± 15 yrs; Charlson Index 4 ± 3). In-hospital stay was 1 (0-3) days and the length of home-based stay was 6 (5-7) days. The 30-day readmission rate was 11% and mortality was 2%. Patients, careers and health professionals expressed high levels of satisfaction (98%). At the start, the service was reimbursed at a flat rate of 918€ per patient discharged, significantly lower than conventional hospitalization (2,879€) but still allowing the hospital to keep a balanced budget. At present, there is no difference in the payment schemes for both types of services. Conclusions: The service freed an average of 6 in-hospital days per patient. The program showed health value generation, as well as potential for synergies with community-based Integrated Care Services.

8.
BMJ Open ; 8(3): e017283, 2018 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-29511004

RESUMO

BACKGROUND: Clinical management of patients with chronic obstructive pulmonary disease (COPD) shows potential for improvement provided that patients' heterogeneities are better understood. The study addresses the impact of comorbidities and its role in health risk assessment. OBJECTIVE: To explore the potential of health registry information to enhance clinical risk assessment and stratification. DESIGN: Fixed cohort study including all registered patients with COPD in Catalonia (Spain) (7.5 million citizens) at 31 December 2014 with 1-year (2015) follow-up. METHODS: A total of 264 830 patients with COPD diagnosis, based on the International Classification of Diseases (Ninth Revision) coding, were assessed. Performance of multiple logistic regression models for the six main dependent variables of the study: mortality, hospitalisations (patients with one or more admissions; all cases and COPD-related), multiple hospitalisations (patients with at least two admissions; all causes and COPD-related) and users with high healthcare costs. Neither clinical nor forced spirometry data were available. RESULTS: Multimorbidity, assessed with the adjusted morbidity grouper, was the covariate with the highest impact in the predictive models, which in turn showed high performance measured by the C-statistics: (1) mortality (0.83), (2 and 3) hospitalisations (all causes: 0.77; COPD-related: 0.81), (4 and 5) multiple hospitalisations (all causes: 0.80; COPD-related: 0.87) and (6) users with high healthcare costs (0.76). Fifteen per cent of individuals with highest healthcare costs to year ratio represented 59% of the overall costs of patients with COPD. CONCLUSIONS: The results stress the impact of assessing multimorbidity with the adjusted morbidity grouper on considered health indicators, which has implications for enhanced COPD staging and clinical management. TRIAL REGISTRATION NUMBER: NCT02956395.


Assuntos
Doença Crônica , Custos de Cuidados de Saúde , Hospitalização , Multimorbidade , Doença Pulmonar Obstrutiva Crônica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Feminino , Humanos , Classificação Internacional de Doenças , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Sistema de Registros , Risco , Medição de Risco , Espanha/epidemiologia
9.
Ann Am Thorac Soc ; 15(1): 24-32, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29048941

RESUMO

RATIONALE: Pulmonary clinicians and patients anecdotally report barriers to home supplemental oxygen services including inadequate supply, unacceptable portable options, and equipment malfunction. Limited evidence exists to describe or quantify these problems. OBJECTIVES: To describe the frequency and type of problems experienced by supplemental oxygen users in the United States. METHODS: The Patient Supplemental Oxygen Survey, a self-report questionnaire, was posted on the American Thoracic Society Public Advisory Roundtable and patient and health care-affiliated websites. Respondents were invited to complete the questionnaire, using targeted e-mail notifications. Data were analyzed using descriptive statistics, paired t tests, and χ2 analysis. RESULTS: In total, 1,926 responses were analyzed. Most respondents reported using oxygen 24 h/d, for 1-5 years, and 31% used high flow with exertion. Oxygen use varied, with only 29% adjusting flow rates based on oximeter readings. The majority (65%) reported not having their oxygen saturation checked when equipment was delivered. Sources of instruction included the delivery person (64%), clinician (8%), and no instruction (10%). Approximately one-third reported feeling "very" or "somewhat" unprepared to operate their equipment. Fifty-one percent of the patients reported oxygen problems, with the most frequent being equipment malfunction, lack of physically manageable portable systems, and lack of portable systems with high flow rates. Most respondents identified multiple problems (average, 3.6 ± 2.3; range, 1-12) in addition to limitations in activities outside the home because of inadequate portable oxygen systems (44%). Patients living in Competitive Bidding Program areas reported oxygen problems more often than those who did not (55% [389] vs. 45% [318]; P = 0.025). Differences in sample characteristics and oxygen problems were noted across diagnostic categories, with younger, dyspneic, high-flow users, and respondents who did not receive oxygen education, relating more oxygen problems. Respondents reporting oxygen problems also experienced increased health care resource utilization. CONCLUSIONS: Supplemental oxygen users experience frequent and varied problems, particularly a lack of access to effective instruction and adequate portable systems. Initiatives by professional and patient organizations are needed to improve patient education, and to promote access to equipment and services tailored to each patient's needs.


Assuntos
Dispneia/terapia , Conhecimentos, Atitudes e Prática em Saúde , Oxigenoterapia/economia , Oxigenoterapia/métodos , Qualidade da Assistência à Saúde/organização & administração , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Percepção , Qualidade de Vida , Estados Unidos
11.
Arch. bronconeumol. (Ed. impr.) ; 52(5): 256-261, mayo 2016. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-151809

RESUMO

Introducción: La prueba de actividades de la vida diaria de Glittre (prueba ADL) es, en un entorno de laboratorio, una medida fiable del estado funcional de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. Nos propusimos adaptar la prueba para poder llevarla a cabo en el entorno domiciliario (test ADLm) y supervisar la recuperación del estado funcional de pacientes con EPOC después de una exacerbación atendida en un programa de hospitalización domiciliaria (HD). Método: Evaluamos a 17 pacientes con EPOC moderada a muy grave después de una exacerbación en 3 visitas domiciliarias: el día del alta de HD (V0), al cabo de 10días (V10post) y un mes después del alta (V30post). Los pacientes realizaron la prueba ADLm (vueltas VO2 y VE), impacto de la EPOC (CAT), el Cuestionario de disnea para las ADV London Chest (LCADL), la escala de disnea Medical Research Council modificada (MRCm) y una dinamometría de las extremidades superiores (fuerza de prensión). Resultados: el número de vueltas al circuito en la prueba ADLm (4, 5 y 5, p < 0,05), el CAT (19, 12 y 12, p < 0,01), la MRCm (2, 1,5 y 1, p < 0,01) y el dominio de cuidado personal del LCADL (6, 5 y 5, p < 0,01) mejoraron durante el seguimiento (V0, V10post y V30post, respectivamente). No se constataron cambios significativos en el VO2, el VE o la fuerza de prensión. Conclusión: Nuestros resultados indican que, tras una exacerbación de la EPOC, es factible realizar la prueba ADLm en el entorno domiciliario, y que el estado funcional continúa mejorando 10 días después del alta de HD


Introduction: The Glittre Activities of Daily Living Test (ADL-Test) is a reliable functional status measurement for stable chronic obstructive pulmonary disease (COPD) patients in a laboratory setting. We aimed to adapt the test to the home setting (mADL-Test) and to follow-up the functional status recovery of post-exacerbation COPD patients included in a home hospitalization (HH) program. Method: We assessed 17 exacerbated moderate-to-very-severe COPD patients in 3 home visits: at discharge to HH (V0), 10days (V10post) and 1month after discharge (V30post). Patients completed the mADL-Test (laps, VO2 and VE), COPD assessment test (CAT), London Chest ADL Test (LCADL), modified Medical Research Council (mMRC) and upper limb strength (handgrip). Results: The number of laps of the mADL-Test (4, 5 and 5, P < .05), CAT (19, 12 and 12, P < .01), mMRC (2, 1.5 and 1, P < .01) and the self-care domain of the LCADL (6, 5 and 5, P < .01) improved during follow-up (V0, V10post and V30post, respectively). No significant changes were evidenced in VO2, VE or handgrip. Conclusion: Our results suggest that the mADL-test can be performed in the home setting after a COPD exacerbation, and that functional status continues to improve 10 days after discharge to HH


Assuntos
Humanos , Masculino , Feminino , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Recidiva , Atividades Cotidianas , Serviços de Assistência Domiciliar , Serviços Hospitalares de Assistência Domiciliar , Estudo Observacional , Estudos Prospectivos , Espanha
12.
Arch Bronconeumol ; 52(5): 256-61, 2016 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26822266

RESUMO

INTRODUCTION: The Glittre Activities of Daily Living Test (ADL-Test) is a reliable functional status measurement for stable chronic obstructive pulmonary disease (COPD) patients in a laboratory setting. We aimed to adapt the test to the home setting (mADL-Test) and to follow-up the functional status recovery of post-exacerbation COPD patients included in a home hospitalization (HH) program. METHOD: We assessed 17 exacerbated moderate-to-very-severe COPD patients in 3 home visits: at discharge to HH (V0), 10days (V10post) and 1month after discharge (V30post). Patients completed the mADL-Test (laps, VO2 and VE), COPD assessment test (CAT), London Chest ADL Test (LCADL), modified Medical Research Council (mMRC) and upper limb strength (handgrip). RESULTS: The number of laps of the mADL-Test (4, 5 and 5, P<.05), CAT (19, 12 and 12, P<.01), mMRC (2, 1.5 and 1, P<.01) and the self-care domain of the LCADL (6, 5 and 5, P<.01) improved during follow-up (V0, V10post and V30post, respectively). No significant changes were evidenced in VO2, VE or handgrip. CONCLUSION: Our results suggest that the mADL-test can be performed in the home setting after a COPD exacerbation, and that functional status continues to improve 10days after discharge to HH.


Assuntos
Atividades Cotidianas , Teste de Esforço , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Convalescença , Progressão da Doença , Dispneia/etiologia , Fadiga/etiologia , Estudos de Viabilidade , Feminino , Volume Expiratório Forçado , Visita Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Recuperação de Função Fisiológica , Subida de Escada , Capacidade Vital
13.
J Aerosol Med Pulm Drug Deliv ; 29(1): 86-93, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26168021

RESUMO

BACKGROUND: The main problem with inhalation therapy is incorrect use of inhalers. Nurses' limited knowledge may contribute to this situation. This study aimed to assess the level of knowledge and attitudes of respiratory nurses about inhaled therapy. METHODS: A 12-item multiple-choice questionnaire was sent to members in the Nursing Area of the Spanish Society of Pneumology and Thorax Surgery and to nurses working with respiratory patients using inhalers devices. The survey was voluntary, self-administered, and anonymous. It collected demographic characteristics, preferences, and knowledge and education about devices and inhalation technique. RESULTS: A total of 1496 nurses completed the questionnaire correctly. Results showed 65.4% preferred dry powder inhalers (DPI), 8.7% were familiar with all 12 devices listed, 59.6% identified "firing the device after beginning inspiration" as the most important step when using the pressurized metered dose inhaler (pMDI), 53.5% identified ''inhale deeply and forcefully'' as the most significant step using DPI, and 20.4% "always checked a patient's inhalation technique when a new inhaler was prescribed." A composite, variable, general inhaled therapy knowledge pooled the correct answers related to knowledge and showed only 14% of nurses had adequate knowledge of inhaled therapy. CONCLUSIONS: In spite of recent training activities, knowledge concerning use of inhaler devices among Spanish nurses managing patients with respiratory diseases continues to be poor. Improvements are also needed in patient education and follow-up of inhalation techniques. Undergraduate and postgraduate educational programs need to be further developed.

14.
PLoS One ; 10(10): e0140202, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26460907

RESUMO

BACKGROUND: Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP) and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge. METHODS: A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed. RESULTS: We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003). CONCLUSIONS: The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN39531840.


Assuntos
Infecções Comunitárias Adquiridas/economia , Educação em Saúde , Recursos em Saúde , Pneumonia/economia , Infecções Comunitárias Adquiridas/terapia , Humanos , Pneumonia/terapia
15.
Arch. bronconeumol. (Ed. impr.) ; 51(10): 483-489, oct. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-142396

RESUMO

Las hospitalizaciones por exacerbación aguda de EPOC (EAEPOC) generan un elevado consumo de recursos sanitarios, frecuentes reingresos y una alta mortalidad. El estudio MAG-1 pretende identificar aquellos puntos críticos y mejorables en el proceso asistencial de la EAEPOC que requiere ingreso hospitalario. Metodología: Estudio observacional, de revisión de historias clínicas de pacientes ingresados en hospitales de la red pública por EAEPOC. Los centros se clasificaron en 3 grupos según el número de altas/año. Se analizaron datos demográficos y descriptivos del año previo, tratamiento farmacológico, atención durante la hospitalización y proceso de alta, así como mortalidad y reingresos a los 30 y 90 días. Resultados: Se estudió a 910 pacientes (83% varones), con una edad media de 74,3 (+10,1) años y una tasa de respuesta del 70%. Solo constaba el hábito tabáquico actual en un 45% de los casos y de estos un 9,8% eran fumadores activos. En un 31% de los casos no constaban datos espirométricos previos. La mediana de la estancia fue de 7 días (RIQ: 4-10), aumentando con la complejidad del centro. La mortalidad observada desde el ingreso a los 90 días fue del 12,4% con una tasa de reingresos del 49%. Se observó una relación inversa entre los días de estancia hospitalaria y las readmisiones a 90 días. Conclusiones: En un elevado número de historias clínicas no consta adecuadamente el hábito tabáquico ni las pruebas de función pulmonar. La estancia media aumenta con la complejidad del hospital, aunque mayores estancias parecen asociarse con menor mortalidad en el seguimiento


Hospitalizations for acute exacerbation of COPD (AECOPD) generate high consumption of health resources,frequent readmissions andhighmortality. TheMAG -1 study aims to identify criticalpoints to improve the care process of severe AECOPD requiring hospitalization. Methods: Observational study, with review of clinical records of patients admitted to hospitals of the Catalan public network for AECOPD. The centers were classified into 3 groups according to the number of discharges/year. Demographic and descriptive data of the previous year, pharmacological treatment, care during hospitalization and discharge process and follow-up, mortality and readmission at 30 and 90 days were analyzed. Results: A total of 910 patients (83% male) with a mean age of 74.3 (+10.1) years and a response rate of 70% were included. Smoking habit was determined in only 45% of cases, of which 9% were active smokers. In 31% of cases, no previous lung function data were available. Median hospital stay was 7 days (IQR 4-10), increasing according the complexity of the hospital. Mortality from admission to 90 days was 12.4% with a readmission rate of 49%. An inverse relationship between length of hospital stay and readmission within 90 days was observed. Conclusions: In a large number of medical records, smoking habit and lung function tests were not appropriately reported. Average hospital stay increases with the complexity of the hospital, but longer stays appear to be associated with lower mortality at follow-up


Assuntos
Idoso , Humanos , Masculino , Auditoria Clínica/organização & administração , Auditoria Clínica/normas , Auditoria Clínica , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Aguda/epidemiologia , Hospitalização/tendências , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Tempo de Internação/economia , Readmissão do Paciente
16.
Artigo em Inglês | MEDLINE | ID: mdl-26056439

RESUMO

BACKGROUND: Excluding the tropics, exacerbations of chronic obstructive pulmonary disease (COPD) are more frequent in winter. However, studies that directly relate hospitalizations for exacerbation of COPD to ambient temperature are lacking. The aim of this study was to assess the influence of temperature on the number of hospitalizations for COPD. METHODS: This was a population-based study in a metropolitan area. All hospital discharges for acute exacerbation of COPD during 2009 in Barcelona and its metropolitan area were analyzed. The relationship between the number of hospitalizations for COPD and the mean, minimum, and maximum temperatures alongside comorbidity, humidity, influenza rate, and environmental pollution were studied. RESULTS: A total of 9,804 hospitalization discharges coded with COPD exacerbation as a primary diagnosis were included; 75.4% of cases were male with a mean age of 74.9±10.5 years and an average length of stay of 6.5±6.1 days. The highest number of admissions (3,644 [37.2%]) occurred during winter, followed by autumn with 2,367 (24.1%), spring with 2,347 (23.9%), and summer with 1,446 (14.7%; P<0.001). The maximum, minimum, and mean temperatures were associated similarly with the number of hospitalizations. On average, we found that for each degree Celsius decrease in mean weekly temperature, hospital admissions increased by 5.04% (r(2)=0.591; P<0.001). After adjustment for humidity, comorbidity, air pollution, and influenza-like illness, only mean temperatures retained statistical significance, with a mean increase of 4.7% in weekly admissions for each degree Celsius of temperature (r(2)=0.599, P<0.001). CONCLUSION: Mean temperatures are closely and independently related to the number of hospitalizations for COPD.


Assuntos
Admissão do Paciente , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estações do Ano , Temperatura , Saúde da População Urbana , Idoso , Idoso de 80 Anos ou mais , Poluição do Ar/efeitos adversos , Comorbidade , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Umidade , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
17.
Int J Integr Care ; 15: e006, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26034465

RESUMO

OBJECTIVES: To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus. SETTING: One health care sector in Spain (Barcelona) (n = 11.382); six municipalities in Norway (Trondheim) (n = 450); and one hospital in Greece (Athens) (n = 388). METHOD: The four services were: (i) Home-based long-term maintenance of rehabilitation effects (n = 337); (ii) Enhanced Care for frail patients, n = 1340); (iii) Home Hospitalization and Early Discharge (n = 2404); and Support for remote diagnosis (forced spirometry testing) in primary care (Support) (n = 8139). Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted. RESULTS: The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05); (iii) Reduced in-hospital days for all types of patients (p < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (p < 0.01) for patients with respiratory symptoms in Support, with marked differences among sites. CONCLUSIONS: The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.

18.
NPJ Prim Care Respir Med ; 25: 15022, 2015 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-25856791

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) generates a high burden on health care, and hospital admissions represent a substantial proportion of the overall costs of the disease. Integrated care (IC) has shown efficacy to reduce hospitalisations in COPD patients at a pilot level. Deployment strategies for IC services require assessment of effectiveness at the health care system level. AIMS: The aim of this study was to explore the effectiveness of a community-based IC service in preventing hospitalisations and emergency department (ED) visits in stable frail COPD patients. METHODS: From April to December 2005, 155 frail community-dwelling COPD patients were randomly allocated either to IC (n=76, age 73 (8) years, forced expiratory volume during the first second, FEV1 41(19) % predicted) or usual care (n=84, age 75(9) years, FEV1 44 (20) % predicted) and followed up for 12 months. The IC intervention consisted of the following: (a) patient's empowerment for self-management; (b) an individualised care plan; (c) access to a call centre; and (d) coordination between the levels of care. Thereafter, hospital admissions, ED visits and mortality were monitored for 6 years. RESULTS: IC enhanced self-management (P=0.02), reduced anxiety-depression (P=0.001) and improved health-related quality of life (P=0.02). IC reduced both ED visits (P=0.02) and mortality (P=0.03) but not hospital admission. No differences between the two groups were seen after 6 years. CONCLUSION: The intervention improved clinical outcomes including survival and decreased the ED visits, but it did not reduce hospital admissions. The study facilitated the identification of two key requirements for adoption of IC services in the community: appropriate risk stratification of patients, and preparation of the community-based work force.


Assuntos
Equipe de Assistência ao Paciente/organização & administração , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Idoso Fragilizado , Hospitalização/estatística & dados numéricos , Humanos , Análise de Intenção de Tratamento , Masculino , Doença Pulmonar Obstrutiva Crônica/mortalidade , Qualidade da Assistência à Saúde , Medição de Risco
19.
J Biomed Inform ; 55: 11-22, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25796455

RESUMO

BACKGROUND: Extensive deployment and sustainability of integrated care services (ICS) constitute an unmet need to reduce the burden of chronic conditions. The European Union project NEXES (2008-2013) assessed the deployment of four ICS encompassing the spectrum of severity of chronic patients. OBJECTIVE: The current study aims to (i) describe the open source Adaptive Case Management (ACM) system (Linkcare®) developed to support the deployment of ICS at the level of healthcare district; (ii) to evaluate its performance; and, (iii) to identify key challenges for regional deployment of ICS. METHODS: We first defined a conceptual model for ICS management and execution composed of five main stages. We then specified an associated logical model considering the dynamic runtime of ACM. Finally, we implemented the four ICS as a physical model with an ICS editor to allow professionals (case managers) to play active roles in adapting the system to their needs. Instances of ICS were then run in Linkcare®. Four ICS provided a framework for evaluating the system: Wellness and Rehabilitation (W&R) (number of patients enrolled in the study (n)=173); Enhanced Care (EC) in frail chronic patients to prevent hospital admissions, (n=848); Home Hospitalization and Early Discharge (HH/ED) (n=2314); and, Support to remote diagnosis (Support) (n=7793). The method for assessment of telemedicine applications (MAST) was used for iterative evaluation. RESULTS: Linkcare® supports ACM with shared-care plans across healthcare tiers and offers integration with provider-specific electronic health records. Linkcare® successfully contributed to the deployment of the four ICS: W&R facilitated long-term sustainability of training effects (p<0.01) and active life style (p<0.03); EC showed significant positive outcomes (p<0.05); HH/ED reduced on average 5 in-hospital days per patient with a 30-d re-admission rate of 10%; and, Support, enhanced community-based quality forced spirometry testing (p<0.01). Key challenges for regional deployment of personalized care were identified. CONCLUSIONS: Linkcare® provided the required functionalities to support integrated care adopting an ACM model, and it showed adaptive potential for its implementation in different health scenarios. The research generated strategies that contributed to face the challenges of the transition toward personalized medicine for chronic patients.


Assuntos
Administração de Caso/organização & administração , Doença Crônica/terapia , Sistemas de Apoio a Decisões Clínicas/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Registros Eletrônicos de Saúde/organização & administração , Registro Médico Coordenado/métodos , Europa (Continente) , Humanos , Internet/organização & administração , Modelos Organizacionais , Software , Design de Software , Interface Usuário-Computador
20.
Respir Med ; 109(4): 500-9, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25771036

RESUMO

BACKGROUND: Despite well established clinical guidelines, performance of long-term oxygen therapy (LTOT) programs shows marked variability among territories. The current study assessed the LTOT program and the health status of patients on LTOT prior to the deployment of community-based integrated care in an urban health district of Barcelona (Spain). AIMS: To assess: i) the LTOT program and health status of the patients on LTOT in the health district; ii) their frailty profile; and, iii) the requirements for effective deployment of integrated care services for these patients. METHODS: Cross-sectional observational study design including all patients (n = 406) on LTOT living in the health district. Health status, frailty, arterial blood gases, forced spirometry and hand-grip muscle strength were measured. Network analysis of frailty was carried out. RESULTS: Adequacy of LTOT prescription (n = 362): 47% and 31% of the patients had PaO2 ≤ 60 mmHg and ≤55 mmHg, respectively. Adherence to LTOT: 31% of all patients used LTOT ≥15 h/d; this figure increased to 67% in those with PaO2≤60 mmHg. Assessment of frailty: Overall, LTOT patients presented moderate to severe frailty. Care complexity was observed in 42% of the patients. CONCLUSIONS: Adequacy and adherence to LTOT was poor and many patients were frail and complex. The outcomes of the network analysis may contribute to enhance assessment of frailty in LTOT patients. These observations suggest that an integrated care strategy has the potential to improve the health outcomes of these patients.


Assuntos
Oxigenoterapia , Doença Pulmonar Obstrutiva Crônica , Idoso , Idoso de 80 Anos ou mais , Gasometria/métodos , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/efeitos adversos , Oxigenoterapia/métodos , Oxigenoterapia/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Espanha/epidemiologia , Espirometria/métodos , Tempo
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