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1.
Eur J Cancer Prev ; 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32039928

RESUMO

Lung cancer screening programs with computed tomography of the chest reduce mortality by more than 20%. Yet, they have not been implemented widely because of logistic and cost implications. Here, we sought to: (1) use real-life data to compare the outcomes and cost of lung cancer patients with treated medically or surgically in our region and (2) from this data, estimate the cost-benefit ratio of a lung cancer screening program (CRIBAR) soon to be deployed in our region (Catalunya, Spain). We accessed the Catalan Health Surveillance System (CHSS) and analysed data of all patients with a first diagnosis of lung cancer between 1 January 2014 and 31 December 2016. Analysis was carried forward until 30 months (t = 30) after lung cancer diagnosis. Main results showed that: (1) surgically treated lung cancer patients have better survival and return earlier to regular home activities, use less healthcare related resources and cost less tax-payer money and (2) depending on incidence of lung cancer identified and treated in the program (1-2%), the return on investment for CRIBAR is expected to break even at 3-6 years, respectively, after its launch. Surgical treatment of lung cancer is cheaper and offers better outcomes. CRIBAR is estimated to be cost-effective soon after launch.

2.
Aten Primaria ; 52(2): 96-103, 2020 02.
Artigo em Espanhol | MEDLINE | ID: mdl-30765102

RESUMO

INTRODUCTION: Adjusted Morbidity Groups (GMAs) and the Clinical Risk Groups (CRGs) are population morbidity based stratification tools which classify patients into mutually exclusive categories. OBJETIVE: To compare the stratification provided by the GMAs, CRGs and that carried out by the evaluators according to the levels of complexity. DESIGN: Random sample stratified by morbidity risk. LOCATION: Catalonia. PARTICIPANTS: Forty paired general practitioners in the primary care, matched pairs. INTERVENTIONS: Each pair of evaluators had to review 25 clinical records. MAIN OUTPUTS: The concordance by evaluators, and between the evaluators and the results obtained by the 2 morbidity tools were evaluated according to the kappa index, sensitivity, specificity, and positive and negative predicted values. RESULTS: The concordance between general practitioners pairs was around the kappa value 0.75 (mean value=0.67), between the GMA and the evaluators was similar (mean value=0.63), and higher than for the CRG (mean value=0.35). The general practitioners gave a score of 7.5 over 10 to both tools, although for the most complex strata, according to the professionals' assignment, the GMA obtained better scores than the CRGs. The professionals preferred the GMAs over the CRGs. These differences increased with the complexity level of the patients according to clinical criteria. Overall, less than 2% of serious classification errors were found by both groupers. CONCLUSION: The evaluators considered that both grouping systems classified the studied population satisfactorily, although the GMAs showed a better performance for more complex strata. In addition, the clinical raters preferred the GMAs in most cases.

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.
Heart ; 105(15): 1168-1174, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30819763

RESUMO

OBJECTIVE: To describe the prevalence and incidence of cardiovascular risk factors, established cardiovascular disease (CVD) and cardiovascular medication use, among immigrant individuals of diverse national origins living in Catalonia (Spain), a region receiving large groups of immigrants from all around the world, and with universal access to healthcare. METHODS: We conducted a population-based analysis including >6 million adult individuals living in Catalonia, using the local administrative healthcare databases. Immigrants were classified in 6 World Bank geographic areas: Latin America/Caribbean, North Africa/Middle East, sub-Saharan Africa, East Asia and South Asia. Prevalence calculations were set as of 31 December 2017. RESULTS: Immigrant groups were younger than the local population; despite this, the prevalence of CVD risk factors and of established CVD was very high in some immigrant subgroups compared with local individuals. South Asians had the highest prevalence of diabetes, and of hyperlipidemia among adults aged <55 years; hypertension was highly prevalent among sub-Saharan Africans, and obesity was most common among women of African and South Asian ancestry. In this context, South Asians had the highest prevalence of coronary heart disease across all groups, and of heart failure among women. Heart failure was also highly prevalent in African women. CONCLUSIONS: The high prevalence of risk factors and established CVD among South Asians and sub-Saharan Africans stresses the need for tailored, aggressive health promotion interventions. These are likely to be beneficial in Catalonia, and in countries receiving similar migratory fluxes, as well as in their countries of origin.

5.
Prev Med ; 123: 91-94, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30853378

RESUMO

We evaluated the association between individual-level socioeconomic status (SES), life expectancy, and mortality, in adult men and women from the general population living in Catalonia, a universal healthcare coverage setting. We used the Catalan Health Surveillance System database, which includes individual-level information on sociodemographic characteristics and mortality for all residents of Catalonia (Spain). We categorized individuals as high, medium, low or very low SES based on annual personal income and welfare receipt. We used 2016 mortality data to estimate life expectancy at age 18, and the probability of death by age, sex and SES categories. We followed a total of 6,027,424 Catalan residents in 2016. Men and women of very low SES had 12.0 and 9.4 years lower life expectancy compared to men and women of high SES, respectively. Low SES was also strongly associated with mortality in both men and women of any age. In the entire adult population of Catalonia, despite the availability of universal, high quality healthcare coverage, low SES is associated with lower life expectancy and higher mortality. Solutions to these large inequalities may combine tailored health promotion and management interventions, with solutions coming from outside of the health sector.

7.
Aten. prim. (Barc., Ed. impr.) ; 51(3): 153-161, mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182928

RESUMO

Objetivo: Comparar el rendimiento referente a la bondad de ajuste y el poder explicativo de 2agrupadores de morbilidad en el ámbito de la atención primaria (AP): los grupos de morbilidad ajustados (GMA) y los clinical risk groups (CRG). Diseño: Estudio transversal. Emplazamiento: Ámbito de la AP del Instituto Catalán de la Salud (ICS), Cataluña, España. Participantes: Población asignada a centros de AP del ICS para el año 2014. Mediciones principales: Se analizan 3 indicadores de interés, como son el ingreso urgente, el número de visitas y el gasto en farmacia. Se aplica un análisis estratificado por centros ajustando modelos lineales generalizados a partir de las variables edad, sexo y agrupador de morbilidad para explicar cada una de las 3 variables de interés. Las medidas estadísticas para analizar el rendimiento de los distintos modelos aplicados son el índice de Akaike, el índice de Bayes y la seudovariabilidad explicada mediante cambio de deviance. Resultados: Los resultados muestran que en el ámbito de la AP del ICS el poder explicativo de los GMA es superior al ofrecido por los CRG, especialmente para el caso de las visitas y el gasto en farmacia. Conclusiones: El rendimiento de los GMA en el ámbito de la AP del ICS es superior al mostrado por los CRG


Objective: To compare the performance in terms of goodness of fit and explanatory power of 2 morbidity groupers in primary care (PC): adjusted morbidity groups (AMG) and clinical risk groups (CRG). Design: Cross-sectional study. Location: PC in the Catalan Institute for the Health (CIH), Catalonia, Spain. Participants: Population allocated in primary care centers of the CIH for the year 2014. Main measurements: Three indicators of interest are analyzed such as urgent hospitalization, number of visits and spending in pharmacy. A stratified analysis by centers is applied adjusting generalized lineal models from the variables age, sex and morbidity grouping to explain each one of the 3 variables of interest. The statistical measures to analyze the performance of the different models applied are the Akaike index, the Bayes index and the pseudo-variability explained by deviance change. Results: The results show that in the area of the primary care the explanatory power of the AMGs is higher to that offered by the CRGs, especially for the case of the visits and the pharmacy. Conclusions: The performance of GMAs in the area of the CIH PC is higher than that shown by the CRGs


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Atenção Primária à Saúde , Grupos de Risco , Morbidade , Estudos Transversais
8.
Gac. sanit. (Barc., Ed. impr.) ; 33(1): 24-31, ene.-feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183623

RESUMO

Objetivo: Analizar la distribución del gasto sanitario según el ámbito asistencial y las características de los pacientes, utilizando microdatos del uso de servicios sanitarios del total de la población de Cataluña (España). Método: Se ha aplicado una tarifa o un gasto indirecto a todos los actos sanitarios financiados por CatSalut durante 2014, computando el gasto sanitario realizado por cada persona y sumando para todos los habitantes de Cataluña. Resultados: La suma del gasto sanitario realizado por todos los habitantes de Cataluña representa el 97,0% del presupuesto de CatSalut. La mitad de la población origina el 3,6% del gasto sanitario total (71 Euros por persona); un 1% de la población gastó el 23% del gasto (22.852 Euros por persona). El gasto medio más elevado, tanto en mujeres como en hombres, se da entre los 80 y los 89 años de edad. La población con una enfermedad crónica tiene un gasto medio anual de 413 Euros; con cinco, de 2413 Euros; y con 10, de 9626 Euros. El gasto medio varía según patologías, desde los 2854 Euros en los pacientes con depresión grave a los 8097 Euros de los pacientes con infección por el virus de la inmunodeficiencia humana/sida. Conclusiones: Los resultados son sumamente útiles para la planificación de los servicios sanitarios y para la priorización de intervenciones de política sanitaria en los colectivos con más necesidades


Objective: To analyse the distribution of the expenditure according to the healthcare services and characteristics of patients, using the microdata of the Catalan population's use of healthcare services. Methods: A fee or an indirect cost has been applied to all healthcare activities financed by CatSalut during 2014, computing the health expenditure made up by each person and adding it all up for the inhabitants of Catalonia (Spain). Results: The sum of the healthcare expenditure made by all the inhabitants of Catalonia represents 97.0% of the CatSalut budget. Half of the population accounts for 3.6% of total healthcare expenditure (71Euros per person); 1% of the population spends 23% of the expenditure (22,852€ per person). The highest average expenditure, in both women and men, occurs between the age of 80 and 89. The population with a chronic disease has an average annual expenditure of 413 Euros, with 5 of 2,413 Euros, and 10 of 9,626 Euros. The average cost varies according to pathologies, from 2,854 Euros in patients with severe depression to 8,097 Euros in patients with HIV-AIDS. Conclusions: The results are extremely useful for healthcare planning and for the prioritization of health policy interventions in groups with most needs


Assuntos
Humanos , Assistência à Saúde/economia , Gastos em Saúde/tendências , Alocação de Recursos para a Atenção à Saúde/tendências , Recursos Financeiros em Saúde/tendências , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos , Estudos Populacionais em Saúde Pública , Nível de Saúde , Espanha/epidemiologia , Políticas Públicas de Saúde
9.
Aten Primaria ; 51(3): 153-161, 2019 03.
Artigo em Espanhol | MEDLINE | ID: mdl-29433758

RESUMO

OBJECTIVE: To compare the performance in terms of goodness of fit and explanatory power of 2morbidity groupers in primary care (PC): adjusted morbidity groups (AMG) and clinical risk groups (CRG). DESIGN: Cross-sectional study. LOCATION: PC in the Catalan Institute for the Health (CIH), Catalonia, Spain. PARTICIPANTS: Population allocated in primary care centers of the CIH for the year 2014. MAIN MEASUREMENTS: Three indicators of interest are analyzed such as urgent hospitalization, number of visits and spending in pharmacy. A stratified analysis by centers is applied adjusting generalized lineal models from the variables age, sex and morbidity grouping to explain each one of the 3variables of interest. The statistical measures to analyze the performance of the different models applied are the Akaike index, the Bayes index and the pseudo-variability explained by deviance change. RESULTS: The results show that in the area of the primary care the explanatory power of the AMGs is higher to that offered by the CRGs, especially for the case of the visits and the pharmacy. CONCLUSIONS: The performance of GMAs in the area of the CIH PC is higher than that shown by the CRGs.

11.
J Am Med Dir Assoc ; 20(4): 456-461, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30287263

RESUMO

OBJECTIVES: To assess the impact of hip fracture (HF) on health care expenditures and resource use. DESIGN: Observational, retrospective study. An administrative registry was used to obtain sociodemographic, clinical, and expenditure data of patients treated in centers all over Catalonia (North-East Spain). SETTING AND PARTICIPANTS: Male and female patients aged 65 years or older admitted to a Catalonian hospital due to hip fracture (HF) between January 1 2012, and December 31, 2016. MEASURES: The study data set included the expenditure and frequency of using nonemergency transport, rehabilitation, skilled nursing facility, specialist visits, admissions to the emergency department, hospitalization, pharmacy, and primary care. The patient status at each time point included living at home, staying in hospital, staying in a skilled nursing facility, institutionalized in a nursing home, and death. RESULTS: The record included 38,628 patients (74.4% female) with a mean [standard deviation (SD)] age of 84.9 (7.07) years. The average expenditure per patient during the first year after hospital admission was €11,721.06, the index hospitalization being the leading expenditure (€4740.29). Expenditures related to hospitalization and skilled nursing facility remained higher than preinjury throughout the 3 years following HF. Three years after the index admission, 44.9% of patients had died, 39.7% were living in their homes, 14.2% were in a nursing home, 0.9% were in a skilled nursing facility, and 0.3% were in hospital. The expenditure of hospitalizations, primary care, and visits to the emergency department increased few months before the HF. CONCLUSIONS: In patients hospitalized for HF, the expenditure per patient decreases after hospital discharge but the use of healthcare resources is not restored to preinjury values. The increase of expenditures associated with primary care services, hospitalization, and emergency department services during the few months preceding hospital admission suggests a decline of health status in these patients.

12.
Gac Sanit ; 33(1): 24-31, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-29129491

RESUMO

OBJECTIVE: To analyse the distribution of the expenditure according to the healthcare services and characteristics of patients, using the microdata of the Catalan population's use of healthcare services. METHODS: A fee or an indirect cost has been applied to all healthcare activities financed by CatSalut during 2014, computing the health expenditure made up by each person and adding it all up for the inhabitants of Catalonia (Spain). RESULTS: The sum of the healthcare expenditure made by all the inhabitants of Catalonia represents 97.0% of the CatSalut budget. Half of the population accounts for 3.6% of total healthcare expenditure (71€ per person); 1% of the population spends 23% of the expenditure (22,852€ per person). The highest average expenditure, in both women and men, occurs between the age of 80 and 89. The population with a chronic disease has an average annual expenditure of 413€, with 5 of 2,413€, and 10 of 9,626€. The average cost varies according to pathologies, from 2,854€ in patients with severe depression to 8,097€ in patients with HIV-AIDS. CONCLUSIONS: The results are extremely useful for healthcare planning and for the prioritization of health policy interventions in groups with most needs.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Espanha , Adulto Jovem
13.
Int J Cardiol ; 277: 250-257, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30413306

RESUMO

BACKGROUND: To evaluate the associations between individual income, all-cause mortality and use of healthcare resources in a very large population of chronic heart failure (CHF) patients living in Catalonia (Spain), where access to public healthcare is granted by law. METHODS AND RESULTS: We used 2016 data from the Catalan Health Surveillance System, a large, exhaustive, administrative healthcare database which includes information on medical diagnoses, healthcare resource use, and individual income for all Catalan residents (N = 7,638,524). Individual annual income was categorized as high (>100,000€), medium (18,000-100,000€), low (<18,000€), and very low (welfare support). Among 155,883 CHF patients, lower individual income was associated with a shorter life expectancy at age 50 (life expectancy for high income patients 22.2 years, for very low income patients 12.8), and were independently associated with higher all-cause mortality adjusting for age, sex, comorbidities, and duration of the CHF diagnosis (odds ratio very low vs. medium income 1.21 [95% CI 1.11, 1.33]). Also, in patients with lower income levels the burden of public healthcare resource use was displaced towards urgent hospitalizations and frequent emergency department visits, as opposed to regular, specialized CHF ambulatory-based care. CONCLUSION: In a very large population of CHF patients with access to universal healthcare, lower income was independently associated with higher mortality and with lower use of ambulatory-based healthcare resources. Our findings suggest that CHF patients may benefit from systematic assessment of their socioeconomic status, as this may aid the identification of vulnerable subgroups who may benefit from tailored health education and management.


Assuntos
Insuficiência Cardíaca/economia , Insuficiência Cardíaca/mortalidade , Renda , Aceitação pelo Paciente de Cuidados de Saúde , Vigilância da População , Cobertura Universal do Seguro de Saúde/economia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Insuficiência Cardíaca/terapia , Humanos , Renda/tendências , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Cobertura Universal do Seguro de Saúde/tendências
14.
Eur Addict Res ; 24(5): 234-244, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30282079

RESUMO

OBJECTIVE: To examine health services use on the basis of alcohol consumption. MATERIAL AND METHODS: A cross-sectional study was carried out on patients visiting the Primary Health Care (PHC) settings in Catalonia during 2011 and 2012; these patients had a history of alcohol consumption. Information about outpatient visits in the PHC setting, hospitalizations, specialists' visits and emergency room visits for the year 2013 was obtained from 2 databases (the Information System for the Development of Research in PHC and the Catalan Health Surveillance System). Risky drinkers were defined as those who consumed more than 280 g per week for men or more than 170 g per week for women, or any amount of alcohol while being involved in a high risk work activity, or taking medication that significantly interferes with alcohol or when being pregnant. Binge drinkers (> 60 g in men or > 50 g in women in a short amount of time more than once a month) were also considered risky drinkers. RESULTS: A total of 606,948 patients reported consuming alcohol (of which 10.5% were risky drinkers). Risky drinkers were more likely to be admitted to hospitals or emergency departments (range of ORs 1.08-1.18) compared to light drinkers. Male risky drinkers used fewer PHC services than male light drinkers (OR 0.89, 95% CI 0.87-0.92). In general, risky alcohol users used services more and had longer hospital stays. When stratifying by socioeconomic level of the residential area, we found that risky drinking failed significance, while current or past cigarette smoking was associated with higher healthcare use. CONCLUSIONS: Risky drinkers use more expensive services, such as hospitals and emergency rooms, but not PHC services, which may suggest that prevention strategies and alcohol interventions should also be implemented in those settings.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Assunção de Riscos , Bebedeira/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia
15.
Ann Med ; 50(7): 613-619, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30247071

RESUMO

INTRODUCTION: Few recent data on the epidemiology of inflammatory bowel disease (IBD) are available, especially in Southern Europe. AIM: To evaluate the prevalence, incidence and mortality of IBD in Catalonia during the period 2011-2016. MATERIAL AND METHODS: Data on the prevalence, incidence and mortality of IBD were obtained from the Catalan Health Surveillance System (CHSS). Crude incidence and prevalence rates were calculated for all the Catalan population. Trends in age-sex-adjusted rates were also estimated, and logistic regression was used to calculate the adjusted mortality odds ratio (OR). Data for Crohn's disease (CD) and ulcerative colitis (UC) were analyzed separately. RESULTS: The prevalence per 100,000 inhabitants in 2016 was 353.9 for UC and 191.4 for CD. The total number of IBD patients rose from 29543 in 2011 to 40614 in 2016. IBD was associated with significantly elevated adjusted mortality ratios: 1.28 (95% CI: 1.6-1.4) for UC and 1.85 (95% CI: 1.62-2.12) for CD. CONCLUSIONS: IBD prevalence is very high and is increasing rapidly in Catalonia. Both CD and UC are associated with significantly higher mortality rates. Key message Crohn disease and ulcerative colitis present a small but significant increase in mortality compared to non-inflammatory bowel disease. The prevalence of inflammatory bowel disease is increasing rapidly in Catalonia. Data on prevalence and incidence suggest that the number of patients may double in approximately 10 years.


Assuntos
Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Mortalidade/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Espanha/epidemiologia , Adulto Jovem
16.
Bone ; 117: 123-129, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30223133

RESUMO

IMPORTANCE: The increased mortality after hip fracture (HF) is caused by multiple factors, and large samples are needed to assess the weight of each factor. To date, few studies have investigated these factors through a total cohort approach, and the complexity of underlying medical conditions has not been considered. OBJECTIVE: To investigate the influence of demographic and clinical characteristics on increased mortality risk in elderly patients with hip fracture (HF). DESIGN: Retrospective, total cohort study collecting 4-year data. SETTING: All hospitals and primary care units owned by, or associated with, Catalonia's local health department (CatSalut) (north-east Spain). PARTICIPANTS: All patients aged ≥65 years, admitted to Catalan hospitals from CatSalut because of a HF between 1st January 2012 and 31st December 2015. EXPOSURE: Hip fracture. MAIN OUTCOME MEASURES: The main outcome was survival. Measures regarding demographic and clinical characteristics at the moment of hospital admission included age, sex, osteoporosis treatment, previous fractures, type of intervention, nutritional status, and comorbidities. Patients were stratified using the Adjusted Morbidity Groups (GMA) risk assessment tool. RESULTS: Of the 30,552 patients included in the study sample, 10,439 (34%) died during follow-up, 6821 (22%) within the first year after hospital admission. Mean (SD) age was 84 (7) years; 75% were female. Baseline factors with greater influence on survival were age (HRs 1.44 [95% CI 1.22-1.70], 2.38 [2.03-2.79], and 4.38 [3.73-5.15] for age groups 70-79, 80-89, and >89, respectively), underweight (HR 1.65 [1.36-2.01]), lack of surgical intervention (HR 2.64 [2.47-2.83]), and very high risk stratum of GMA risk (HR 1.58 [1.45-1.73]). Vitamin D/calcium supplementation and osteoporosis treatment showed a significant but moderate influence on mortality (HRs 0.84 (0.79-0.88) and 0.92 [0.85-0.99], respectively). CONCLUSIONS AND RELEVANCE: In elderly patients with HF, age and health status factors at hospital admission have the greatest impact on mortality risk after hospital admission. Our findings encourage a comprehensive intervention aimed at improving underlying medical conditions of HF patients.


Assuntos
Demografia , Fraturas do Quadril/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Espanha/epidemiologia , Análise de Sobrevida
17.
Am Heart J ; 202: 76-83, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29902694

RESUMO

Epidemiological studies on heart failure (HF) using large health care databases are becoming increasingly frequent, as they represent an invaluable opportunity to characterize the importance and risk factors of HF from a population perspective. Nevertheless, because of its complex diagnosis and natural history, the heterogeneous use of the relevant terminology in routine clinical practice, and the limitations of some disease coding systems, HF can be a challenging condition to assess using large health care databases as the main source of information. In this narrative review, we discuss some of the challenges that researchers may face, with a special focus on the identification and validation of chronic HF cases and acute HF decompensations. For each of these challenges, we present some potential solutions inspired by the literature and/or based on our research experience, aimed at increasing the internal validity of research and at informing its interpretation. We also discuss future directions on the field, presenting constructive recommendations aimed at facilitating the conduct of valid epidemiological studies on HF in the coming years.


Assuntos
Pesquisa Biomédica/métodos , Bases de Dados Factuais , Insuficiência Cardíaca/diagnóstico , Armazenamento e Recuperação da Informação/métodos , Doença Aguda , Doença Crônica , Humanos , Terminologia como Assunto
18.
BMJ Open Respir Res ; 5(1): e000302, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29955364

RESUMO

Introduction: Comorbidities in patients with chronic obstructive pulmonary disease (COPD) generate a major burden on healthcare. Identification of cost-effective strategies aiming at preventing and enhancing management of comorbid conditions in patients with COPD requires deeper knowledge on epidemiological patterns and on shared biological pathways explaining co-occurrence of diseases. Methods: The study assesses the co-occurrence of several chronic conditions in patients with COPD using two different datasets: Catalan Healthcare Surveillance System (CHSS) (ES, 1.4 million registries) and Medicare (USA, 13 million registries). Temporal order of disease diagnosis was analysed in the CHSS dataset. Results: The results demonstrate higher prevalence of most of the diseases, as comorbid conditions, in elderly (>65) patients with COPD compared with non-COPD subjects, an effect observed in both CHSS and Medicare datasets. Analysis of temporal order of disease diagnosis showed that comorbid conditions in elderly patients with COPD tend to appear after the diagnosis of the obstructive disease, rather than before it. Conclusion: The results provide a population health perspective of the comorbidity challenge in patients with COPD, indicating the increased risk of developing comorbid conditions in these patients. The research reinforces the need for novel approaches in the prevention and management of comorbidities in patients with COPD to effectively reduce the overall burden of the disease on these patients.

19.
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
20.
BMJ Open ; 8(3): e018012, 2018 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-29502082

RESUMO

BACKGROUND: Cirrhosis is a chronic disease with high morbidity and mortality. Few studies have evaluated healthcare resource use in patients with cirrhosis. OBJECTIVE: We aimed to describe the point prevalence of cirrhosis on 31 December 2012 and the population-level distribution of healthcare resource use and expenditures in a non-selected population of patients with cirrhosis, stratified by whether their disease was compensated or decompensated, and by comorbidity burden. METHODS: This population study included all known patients aged >18 years with cirrhosis (according to International Classification of Diseases, ninth revision) in Catalonia, Spain, on 31 December 2012. We evaluated healthcare resource use and expenditure during 2013, taking into account the presence of decompensation before or during 2012. RESULTS: We documented 34 740 patients diagnosed with cirrhosis (58.7% men; mean age 61.8±14 years), yielding a point prevalence of 460 per 100 000 inhabitants on 31 December 2012. Annual mortality was 9.1%. During 2013, healthcare expenditures on patients with cirrhosis totalled €142.1 million (€4234 per patient), representing 1.8% of the total 2013 healthcare budget of Catalonia. Hospitalisation costs accounted for 35.1% of the total expenditure and outpatient care accounted for 22.4%. MultivariateMultivariate logistic regression identified morbidity burden, HIV infection, hospitalisation and emergency room visits during 2012 as independent predictors of expenditure above the 85th centile (area under the receiver operating curve, 0.88 (95% CI 0.883 to 0.893, P<0.001)). CONCLUSIONS: Cirrhosis accounts for a high proportion of healthcare resource usage and expenditures; hospitalisation accounted for the highest expenditures.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Cirrose Hepática/economia , Cirrose Hepática/mortalidade , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Comorbidade , Serviço Hospitalar de Emergência/economia , Feminino , Hospitalização/economia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Espanha/epidemiologia
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