[Vaccines against varicella-zoster virus (VZV)]. / Vacunas frente al virus de la varicela zóster.

In Western countries, two attenuated varicella vaccines derived from the OKA strain are licensed: Varilrix® GlaxoSmithKline (OKA/RIT strain) and Varivax® Merck Sharp and Dohme (OKA/Merck strain). Currently, in Spain, varicella vaccination is only included in the Ministry of Health, Social Services and Equality official vaccination calendar for administration in adolescents who have not had the disease. Given the good results obtained in Navarra and Madrid with universal administration of the vaccine in children, it would be desirable to include the vaccine in the routine immunization schedule, with the administration of two doses at 15-18 months of age in the future. The protective efficacy of the attenuated herpes zoster vaccine was evaluated in the Shingles Prevention Study, which showed that in the short term (0-4 years) the vaccine reduced the incidence of herpes zoster by 53%, post-herpetic neuralgia by 66%, and the disease burden in immunocompetent persons aged ≥60 years by 61%. Another study demonstrated protective efficacy in persons aged 50-59 years. Over time, the protective efficacy decreases, but remains at acceptable levels, especially for post-herpetic neuralgia and the disease burden. Recently, the results of a controlled clinical trial (phase III) conducted in 18 countries to assess the protective efficacy of the inactivated subunit vaccine (glycoprotein E) adjuvanted with the adjuvant AS01B were published. The study inferred that the vaccine significantly reduced the incidence of herpes zoster in the short term (3.2 years) in people aged ≥50 years. Vaccine protection did not decrease with age at vaccination, ranging between 96.8% and 97.9% in all age groups.

SARS-CoV2 hospital surveillance and control system with contact tracing for patients and health care workers at a large reference hospital in Spain during the first wave: An observational descriptive study.

BACKGROUND AND AIMS: During the first peak of the COVID-19 pandemic, the Preventive Medicine Department and the Occupational Health Department at Hospital Clinic de Barcelona (HCB), a large Spanish referral hospital, developed an innovative comprehensive SARS-CoV2 Surveillance and Control System (CoSy-19) in order to preserve patients' and health care workers' (HCWs) safety. We aim to describe the CoSy-19 and to assess the impact in the number of contacts that new cases generated along this time. METHODS: Observational descriptive study of the findings of the activity of contact tracing of all cases received at the HCB during the first peak of COVID-19 in Spain (February 25th-May 3rd, 2020). RESULTS: A team of 204 professionals and volunteers performed 384 in-hospital contact-tracing studies which generated contacts, detecting 298 transmission chains which suggested preventive measures, generated around 22 000 follow-ups and more than 30 000 days of work leave. The number of contacts that new cases generated decreased during the study period. CONCLUSION: Coordination between Preventive Medicine and Occupational Health departments and agile information systems were necessary to preserve non-COVID activity and workers safety.

[Not Available]. / Organización en institutos de gestión clínica (centros orientados al paciente): descripción de la utilización hospitalaria.

OBJECTIVES: To assess the main features and determining factors of inappropriate admission and hospital stay in relationship with a new clinical management model. METHODS: Study population included all patients discharged from the Hospital Clinic-University of Barcelona. The review tool was the medical and surgical Appropriateness Evaluation Protocol (AEP). We reviewed the clinical records of a representative sample of all discharged patients. Two independent and well trained AEP reviewers were used for each record review. A multivariate analysis was performed, using admission and inappropriate hospital stay as independent variables. RESULTS: A total of 401 admissions were reviewed. Twenty-eight (6.9%) were deemed to be inappropriate. Elective admission, admission over the week-end and being admitted to a medical ward were the predictive variables identified for inappropriate admissions. Of all 2,187 hospital stays reviewed, 267 (12.2%) were deemed to be inappropriate. An inappropriate admission, total length of stay, type of insurance coverage and discharge type were the predictive variables identified for inappropriate hospital stays. CONCLUSIONS: The new organization and clinical management model, developed by the Patient Focused Care Institutes, showed very acceptable levels of inappropriate admissions and hospital stays. Surgical services have benefited most from this new organization. Care provided to patients with medical conditions, notably those patients with multiple and chronic conditions, make up most of the inappropriateness identified.

[Cost analysis of cardiac transplantation in a Spanish hospital]. / Análisis del coste del trasplante cardíaco en un hospital español.

BACKGROUND AND OBJECTIVE: Heart transplant requires a heavy use of high cost resources. Economic data related to this procedure had not been specifically addressed and there are very few publications which analyze this topic. The aim of this study was to analyze the costs related to heart transplant in a series of patients from a single institution. PATIENTS AND METHOD: Data from all patients included in the Hospital Clínic heart transplant programme in which a cardiac transplant was effectively performed between 1999 and 2000 were analyzed, including one year of follow-up. Patients who died within this first year were also included. Organ procurement costs were excluded. Cost analysis was performed by micro-costing techniques. RESULTS: A total of 21 patients undergoing a heart transplant were included. One year survival rate was 76%. Mean (standard deviation) of total cost (procedure costs + one year follow-up cost) was 59,349 (18,881) euros (range: 29,380-113,470 euros). Procedure mean cost was 41,724 (17,584) euros (70% of total costs) and one year follow up mean cost was 17,625 (10,096) euros (30% of total costs) per patient. When the initial episode (heart transplant procedure) was analyzed, main cost drivers were personnel costs euros 59% of all costs; mean: 24,795 (7,633) euros and treatment costs -20% of all costs; mean: 8,386 (7,250) euros. CONCLUSIONS: Costs of heart transplant in Barcelona (Spain) are similar to those published for other European Union countries, and well below the costs related to the procedure in the United States.

[Analysis of Spanish hospital's reputation: relationship with their scientific production in different subspecialities]. / Análisis de la reputación de los hospitales españoles: relación con su producción científica en cuatro especialidades.

BACKGROUND AND OBJECTIVE: To assess the relationship between reputation of hospitals, as determined by specialists' opinion, and their scientific production. MATERIAL AND METHOD: A questionnaire was sent to a sample of members of the Spanish Societies of Cardiology, Digestive Diseases, Neurology and Otorhinolaryngology. Each member had the possibility to nominate 5 hospitals with the greatest reputation amongst his/her specialty. Final score for those hospitals with more than 5% of all votes was used for the development of a reputation index. We assess the scientific production (number of publications and citations) for nominated hospitals and analyze the possible correlation between the reputation index and the scientific production. RESULTS: We received 151 (30%) answers for cardiology, 227 (27%) for digestive diseases, 148 (30%) for neurology and 177 (18%) for otorhinolaryngology. The number of published articles and the number of citations for each nominated hospital showed a positive and statistically significant correlation with the reputation index. CONCLUSIONS: This is the first approach to analyze reputation parameters for Spanish hospitals. Scientific production and reputation index showed a positive correlation.

Herpes zoster and postherpetic neuralgia in Catalonia (Spain).

The objective of the study was to analyze the descriptive epidemiology and costs of herpes zoster (HZ) and postherpetic neuralgia (PHN) in people aged ≥50 years in Catalonia (Spain). The incidence of HZ in Catalonia was estimated by extrapolating the incidence data from Navarre (Spain) to the population of Catalonia. The incidence of PHN was estimated according to the proportion of cases of HZ in the case series of the Hospital del Sagrado Corazón de Barcelona that evolved to PHN. Drug costs were obtained directly from the prescriptions included in the medical record (according to official prices published by the General Council of the College of Pharmacists). The cost of care was obtained by applying the tariffs of the Catalan Health Institute to the number of outpatient visits and the number and duration of hospital admissions. The estimated annual incidence of HZ was 31 763, of which 21 532 (67.79%) were in patients aged ≥50 years. The respective figures for PHN were 3194 and 3085 (96.59) per annum, respectively. The mean cost per patient was markedly higher in cases of PHN (916.66 euros per patient) than in cases of HZ alone (301.52 euros per patient). The cost increased with age in both groups of patients. The estimated total annual cost of HZ and its complications in Catalonia was € 9.31 million, of which 6.54 corresponded to HZ and 2.77 to PHN. This is the first Spanish study of the disease burden of HZ in which epidemiological data and costs were collected directly from medical records. The estimated incidence of HZ is probably similar to the real incidence. In contrast, the incidence of PHN may be an underestimate, as around 25% of patients in Catalonia attend private clinics financed by insurance companies. It is also probable that the costs may be an underestimate as the costs derived from the prodromal phase were not included. In Catalonia, HZ and PHN cause an important disease burden (21 532 cases of HZ and 3085 de PHN with an annual cost of € 9.31 million) in people aged ≥50 years, in whom vaccination is indicated.

[Influence of the time factor on hospitalised patient's opinion]. / Influencia del factor tiempo en la opinión del paciente hospitalizado.

BACKGROUND AND OBJECTIVE: An important controversy at the time of studying the perceived quality is which is the best time to know the patient's opinion. The objective of this work was to find out whether this opinion is different at the time of discharge and one month later. PATIENTS AND METHOD: We included patients who were discharged between October 1999 and March 2000. We designed a specific opinion survey with 44 items. The survey was administered at the time of discharge. Individuals who responded to the first survey were sent the same one by e-mail 30 days after the discharge. RESULTS: The first survey was responded by 1,061 subjects and the second one by 485 (45.71%). Overall, answers from subjects who responded the survey in both phases showed a 65% agreement rate and a 35% disagreement rate. On the other hand, 84% of questions showed answers with a low agreement's Kappa index, while 6% had a good agreement. CONCLUSION: Globally considered, the average satisfaction expressed by subjects was equivalent in the two phases of the study, yet the individual degree of satisfaction varied.

Economic benefits of inactivated influenza vaccines in the prevention of seasonal influenza in children.

The aim of this study was to systematically review published studies that evaluated the efficiency of inactivated influenza vaccination in preventing seasonal influenza in children. The vaccine evaluated was the influenza-inactivated vaccine in 10 studies and the virosomal inactivated vaccine in 3 studies. The results show that yearly vaccination of children with the inactivated influenza vaccine saves money from the societal and family perspectives but not from the public or private provider perspective. When vaccination does not save money, the cost-effectiveness ratios were very acceptable. It can be concluded, that inactivated influenza vaccination of children is a very efficient intervention.

Organización en institutos de gestión clínica (centros orientados al paciente): descripción de la utilización hospitalaria / Clinical management institutes (patient focused centers): description of hospital utilization

Objetivos: Conocer las características determinantes de la inadecuación de los ingresos y las estancias presentada al aplicar un nuevo modelo de gestión clínica. Métodos: La población objeto de estudio han sido los enfermos dados de alta en el Hospital Clínico Universitario de Barcelona. El instrumento de revisión utilizado ha sido el protocolo AEP médico-quirúrgico. El proceso de evaluación ha consistido en la revisión retrospectiva de la historia clínica por parte de dos evaluadores médicos. Se ha realizado un análisis multivariable de regresión logística múltiple para las variables dependientes ingreso y estancia inadecuada. Resultados: De los 401 ingresos, 28 (6,9%) se consideraron inadecuados. La admisión programada, durante el fin de semana y en las áreas médicas han sido las variables predictivas identificadas para el ingreso inadecuado. De las 2.187 estancias estudiadas, a 267 (12,2%) se las evaluó como inadecuadas. La propia inadecuación del ingreso, la duración de la estancia, la cobertura asistencial y el tipo de alta han sido las variables predictivas identificadas para la estancia inadecuada. Conclusiones: El modelo organizativo desarrollado por los institutos de gestión clínica presenta unos niveles de inadecuación de ingresos y estancias muy aceptables. La actividad asistencial quirúrgica se ha encontrado influida favorablemente por la mayor actuación protocolizada del modelo. La actividad asistencial dirigida a pacientes con enfermedades médicas, asociadas y crónicas, sintetiza el patrón principal de la inadecuación

Objectives: To assess the main features and determining factors of inappropriate admission and hospital stay in relationship with a new clinical management model. Methods: Study population included all patients discharged from the Hospital Clinic-University of Barcelona. The review tool was the medical and surgical Appropriateness Evaluation Protocol (AEP). We reviewed the clinical records of a representative sample of all discharged patients. Two independent and well trained AEP reviewers were used for each record review. A multivariate analysis was performed, using admission and inappropriate hospital stay as independent variables. Results: A total of 401 admissions were reviewed. Twenty-eight (6.9%) were deemed to be inappropriate. Elective admission, admission over the week-end and being admitted to a medical ward were the predictive variables identified for inappropriate admissions. Of all 2,187 hospital stays reviewed, 267 (12.2%) were deemed to be inappropriate. An inappropriate admission, total length of stay, type of insurance coverage and discharge type were the predictive variables identified for inappropriate hospital stays. Conclusions: The new organization and clinical management model, developed by the Patient Focused Care Institutes, showed very acceptable levels of inappropriate admissions and hospital stays. Surgical services have benefited most from this new organization. Care provided to patients with medical conditions, notably those patients with multiple and chronic conditions, make up most of the inappropriateness identified

Monitorización de reingresos hospitalarios prematuros en el plan de calidad: ventajas y limitaciones de un protocolo específico / Monitoring early readmissions in the hospital quality plan: advantages and limitations of a specific protocol

Objetivo: Comprobar la utilidad del Protocolo de Evaluación de Reingresos Prematuros (PERP) en un hospital universitario. Material y método: Aplicación del protocolo previamente validado y consensuado a una muestra representativa de los reingresos prematuros (ocurridos antes de 31 días del alta del ingreso primario) durante el año 1997 en el Hospital Clínico de Barcelona. Resultados: Con el PERP ha sido posible la clasificación de la práctica totalidad de los 729 reingresos (99,5%) según su causa, así como la identificación de los reingresos potencialmente evitables, que suponen un 12% del total. Conclusiones: El PERP es un instrumento válido, fiable y de aplicación sencilla y factible para la clasificación y la monitorización periódica de los reingresos prematuros, y especialmente de aquellos que traducen problemas de calidad asistencial y deberían ser evitados

Objective: To assess the feasibility of the Early Readmissions Assessment Protocol (ERAP) in a teaching hospital. Material and method: A previously approved and tested protocol was applied in a random sample of patients discharged and readmitted within 30 days in 1997 to Hospital Clínic (Barcelona, Spain). Results: The protocol classified nearly all the 729 early readmissions (99.5%) depending on their cause and identified potentially avoidable readmissions (12%). Conclusions: The ERAP is a valid, reliable and easy to use instrument to classify and periodically monitor early readmissions, especially those that are due to quality of care problems, which are potentially avoidable

Mejora del acceso a la artroplastia total de rodilla: experiencia de una unidad monográfica / Improved accessibility in total knee arthroplasty: experience of a specialized unit

Introducción: En mayo de 2004 se implantó un programa específico para la cirugía protésica de rodilla, dada la alta demanda para este tipo de cirugía. El objetivo de este trabajo es evaluar los resultados de los indicadores asistenciales y de calidad obtenidos en una unidad monográfica de prótesis de rodilla (UEPR), y compararlos con los obtenidos previamente en una unidad asistencial convencional de cirugía ortopédica y traumatología (UCOT). Material y metodo: La población objeto de este ensayo comunitario no controlado (antes-después) han sido los primeros 124 pacientes atendidos en la UEPR y los últimos 124 pacientes a quienes se había realizado este mismo tipo de intervención en la UCOT. Edad, sexo, días de estancia, dolor, deambulación al alta, flexión de la rodilla, comorbilidades y complicaciones han sido las variables analizadas. Resultados: Los pacientes atendidos en la UEPR estaban menos tiempo ingresados (p < 0,0001) y presentaban una mayor flexión de la rodilla intervenida al alta (p < 0,0001). En general la UEPR atendió a enfermos con un mayor número de comorbilidades que la UCOT. Conclusiones: El diseño y la puesta en funcionamiento de unidades monográficas y especializadas en la atención de pacientes quirúrgicos de alta prevalencia puede ser una alternativa satisfactoria en la resolución de este problema endémico de la sanidad pública. Estas unidades deben desarrollar su actividad según una guía clínica específica y evaluar la calidad asistencial conforme a una serie de indicadores y objetivos que posibiliten su mejora continua

Introduction: In May 2004 a specific program for knee prosthesis surgery was established, due to the high demand for this type of surgery. The aim of this study was to assess the outcomes of clinical and quality indicators obtained in a monographic hospitalization unit specialized in knee prosthesis surgery compared with the outcomes previously obtained in a standard orthopedic surgery hospitalization unit. Material and method: The sample of this non-controlled community trial (before-after) consisted of the first 124 patients treated in the specialized unit and the last 124 patients treated in the standard unit for the same type of surgery. Age, gender, pain, length of hospital stay in days, movement at discharge, knee bending, comorbidity and complications were analyzed. Results: Patients admitted to the specialized unit spent less time in the hospital (p < 0.0001) and showed better knee bending at discharge (p < 0.0001). In general the specialized unit attended patients with a greater number of comorbidities than the standard unit. Conclusions: Creating a monographic unit specialized in the care of surgical patients with high prevalence could be a possible solution to this chronic problem in public hospitals. These units should follow a specific clinical pathway and should assess quality according to a group of indicators and objectives that allow continuous improvement

Vacuna de la hepatitis B y esclerosis múltiple: una asociación no probada / Hepatitis B vaccine and multiple sclerosis: an unproved association

No disponible

Análisis de la reputación de los hospitales españoles: relación con su producción científica en cuatro especialidades / Analysis of Spanish hospital's reputation: relationship with their scientific production in different subspecialities

Fundamento y objetivo: Evaluar la reputación de los hospitales y analizar su posible relación con la producción científica (artículos y citaciones) de dichos hospitales. Material y método: Encuesta a miembros de las Sociedades Españolas de Cardiología, Patología Digestiva, Neurología y Otorrinolaringología. Cada socio podía votar 5 hospitales que consideraba de mayor reputación asistencial en su especialidad. La puntuación final de los 15 hospitales con más del 5% de los votos constituye el índice de reputación. Se evaluó la producción científica (publicaciones y citaciones) en cada especialidad y para cada hospital más votado y se analizó la posible relación entre ambos parámetros. Resultados: Se obtuvieron 151 (30%) respuestas en cardiología, 227 (27%) en patología digestiva, 148 (30%) en neurología y 177 (18%) en otorrinolaringología. Los índices de publicaciones y de citaciones mostraron mayoritariamente una relación positiva y estadísticamente significativa con el índice de reputación. Conclusiones: El trabajo presentado realiza una primera aproximación al estudio de la reputación como medida indirecta de la calidad de los hospitales españoles. La producción científica de éstos mostró una relación positiva con el índice de reputación

Background and objective: To assess the relationship between reputation of hospitals, as determined by specialists' opinion, and their scientific production. Material and method: A questionnaire was sent to a sample of members of the Spanish Societies of Cardiology, Digestive Diseases, Neurology and Otorhinolaryngology. Each member had the possibility to nominate 5 hospitals with the greatest reputation amongst his/her specialty. Final score for those hospitals with more than 5% of all votes was used for the development of a reputation index. We assess the scientific production (number of publications and citations) for nominated hospitals and analyze the possible correlation between the reputation index and the scientific production. Results: We received 151 (30%) answers for cardiology, 227 (27%) for digestive diseases, 148 (30%) for neurology and 177 (18%) for otorhinolaryngology. The number of published articles and the number of citations for each nominated hospital showed a positive and statistically significant correlation with the reputation index. Conclusions: This is the first approach to analyze reputation parameters for Spanish hospitals. Scientific production and reputation index showed a positive correlation

Influencia del factor tiempo en la opinión del paciente hospitalizado / Influence of factor time over hospitalised patient's opinion

FUNDAMENTO Y OBJETIVO: Una de las controversias en los estudios de calidad percibida es determinar cuál es el momento más adecuado para conocer la opinión del usuario. El objetivo de este trabajo es averiguar si esta opinión varía entre el momento del alta y después de un mes. PACIENTES Y MÉTODO: La población objeto del trabajo son los enfermos dados de alta entre octubre de 1999 y marzo de 2000. Se diseñó una encuesta de opinión de 44 ítems. La encuesta se entregó en el momento del alta y 30 días más tarde se volvió a remitir por correo a las personas que habían contestado a la primera encuesta. RESULTADOS: En la primera fase respondieron 1.061 sujetos, y en la segunda, 485 (45,71 por ciento).Globalmente las respuestas de los sujetos que respondieron a la encuesta en las dos fases del estudio coinciden en un 65 por ciento de los casos y discrepan en un 35 por ciento. Un 84 por ciento de las preguntas presentan respuestas con un índice kappa de baja concordancia y un 6 por ciento de concordancia buena. El coeficiente de correlación de Lin entre la satisfacción media en las dos fases del estudio es de 0,468, y la recta ortogonal indica que a medida que aumenta la puntuación global en el primer cuestionario, aumenta de igual forma en el segundo. CONCLUSIÓN: Globalmente considerada, la satisfacción media expresada por los individuos es equivalente en las dos fases del estudio, pero el grado de satisfacción individuo a individuo varía (AU)

Calidad percibida y sexo de los pacientes atendidos en un hospital universitario / Perception of health care quality and gender in an University hospital

Objetivo: Conocer si el sexo de los pacientes ingresados en un hospital universitario de tercer nivel asistencial influye en la percepción de la atención recibida en el mismo. Material y método: Estudio epidemiológico descriptivo de tipo transversal con una orientación retrospectiva, en el que se han analizado los resultados obtenidos en las 3.829 encuestas de opinión al usuario recogidas entre los años 1998 y 2000, mediante los estadísticos de la prueba de la t de Student-Fisher, en el caso de las variables cuantitativas, y de la prueba de la 2, en el caso de las cualitativas. Resultados: El análisis de la comparación de las respuestas proporcionadas por los varones y por las mujeres ha puesto de manifiesto significación estadística en la mayor parte de las mismas. Los varones dan respuestas más positivas que las mujeres. Destacan, por su mayor grado de significación (p < 0,000), el trato de enfermería, el conocimiento del nombre del médico y de la enfermera, poder hablar con el médico, la limpieza, la comida, la comodidad de la habitación, la nueva elección del centro para volver a ingresar y la puntuación global dada a los servicios del hospital. Conclusiones: En este estudio, varones y mujeres manifiestan diferentes puntos de vista sobre las distintas variables que configuran la calidad asistencial. El análisis de sus opiniones debería realizarse de forma separada. Ello permitiría plantear enfoques organizativos diferenciados en función de quién recibe el servicio, puesto que el objetivo de un hospital centrado en el paciente ha de ser proporcionar la asistencia que éste precise, en unas condiciones que satisfagan sus necesidades (AU)

Las encuestas por correo: una alternativa a considerar

No disponible

Influencia de la edad del paciente en la percepción de la calidad asistencial / Influence of patient age on perceived quality of care

Objetivo: Conocer si la edad de los pacientes ingresados en un hospital universitario de tercer nivel asistencial es un factor que influye en la percepción de la atención recibida. Material y método: Estudio epidemiológico descriptivo de tipo transversal, en el que se ha hecho un análisis de los resultados obtenidos en las 6.016 encuestas de opinión al usuario recogidas en el período 1998-2002. Se ha utilizado la prueba de la 2 en el caso de las variables cualitativas, y el análisis de la varianza en el caso de las variables cuantitativas. Resultados: El análisis de la comparación de las respuestas dadas por los pacientes de diferentes edades (18 >= × = × = × = 70) presenta en todas las variables estudiadas, salvo en una, significación estadística (p < 0,001). Conclusiones: El trabajo de investigación desarrollado muestra que los jóvenes y las personas mayores difieren en las opiniones y valoraciones aportadas sobre las variables de calidad asistencial que se han analizado. Los resultados obtenidos en este estudio ponen de manifiesto la necesidad de realizar estudios de opinión por grupos de edad, con el objetivo de adecuar los servicios a las necesidades y expectativas de cada grupo poblacional (AU)

Valoración de las sugerencias formuladas en la encuesta de opinion de un hospital universitario / Evaluation of the suggestions expressed in the opinion survey in a university hospital

El objetivo de este trabajo ha sido el de valorar las sugerencias reflejadas en la encuesta de opinión anual realizada en un área asistencial del Hospital Clínic de Barcelona (AU)

La Gestión de las reclamaciones en el Plan de Calidad Hospitalario / No disponible

Introducción: Las reclamaciones de los clientes representan una oportunidad de mejora en la calidad del servicio proporcionado. El desarrollo de Institutos de gestión clínica configura un modelo organizativo que puede ser utilizado para cambiar el papel de estas entidades en los planes de calidad hospitalarios. Material y métodos: El diseño del trabajo corresponde con un estudio epidemiológico descriptivo que integra las reclamaciones presentadas durante 1997, 1998 y 1999 en la Unidad de Atención al Cliente (Dirección Técnica) del Hospital Clínico Universitario de Barcelona. Para los diferentes tipos de reclamación considerados se ha tenido en cuenta la clasificación establecida por el Servicio Catalán de la Salud. Se ha cuantificado la tasa de reclamación por actividad asistencial desarrollada y la media del tiempo de respuesta a la reclamación como parámetros de evaluación. Resultados: Se han presentado un total de 2.479 reclamaciones durante el período considerado. La tasa de reclamación ha evolucionado de 2,54 por mil actos asistenciales en 1997 a un 1,53 por mil en 1999. La media de 20 días de respuesta correspondiente a 1997 se ha reducido a 13 en 1999. Conclusiones: La implicación de los Institutos en el proceso de gestión de las reclamaciones, así como la utilización de parámetros cuantificables y objetivos que faciliten la integración de estas nuevas unidades organizativas en el Plan de Calidad, ha permitido mejorar los resultados relacionados con esta importante temática (AU)

Introduction: Clients complaints represent an important opportunity for quality improvement of the given services. The development of Institutes for clinical administration can become a model of organization capable of changing the role that these entities have in hospitals plans for quality improvement. Materials and methods: This is an epidemiological descriptive study that includes the complaints presented by patients during 1997, 1998 and 1999 in the Patient Attention Unit (Technical Direction) of Hospital Clínico Universitario de Barcelona. To classify the different type of complaints we have used the definitions established by the Servicio Catalán de la Salud. The rate of complaints per clinical activity performed has been quantified and the median response time has been measured as evaluation parameters. Results: A total of 2.479 complaints have been placed during the study period. The rate of complaints has diminished from 2,54 per thousand clinical activities in 1997 to 1,53 per thousand in 1999. Also the median response time of 20 days in 1997 has diminished to 13 in 1999. Conclusions: The implication of these Institutes in the process of complaint resolution and the use of precise and measurable parameters that facilitate the integration of the new units in the quality program, allowed us to improve the results of this important matter (AU)