Revista de Calidad Asistencial最新文献

英文中文

Abordaje de la evaluación económica de dispositivos de bioseguridad desde la gestión sanitaria y la perspectiva social 从健康管理和社会角度对生物安全装置进行经济评价的方法

Revista de Calidad Asistencial

Pub Date : 2017-09-01 DOI: 10.1016/j.cali.2017.03.002

M. López Gobernado , J. Hernández Bartolomé , D. Villalba Gil , J.M. Eiros Bouza

引用次数: 2

Adecuación de las derivaciones desde atención primaria a un servicio de neumología 从初级保健转介到肺病服务的充分性

Revista de Calidad Asistencial

Pub Date : 2017-09-01 DOI: 10.1016/j.cali.2017.02.002

J.M. Figueira Gonçalves

引用次数: 0

Identificación de eventos centinela en atención primaria 初级保健哨兵事件的识别

Revista de Calidad Asistencial

Pub Date : 2017-09-01 DOI: 10.1016/j.cali.2017.03.003

G. Olivera Cañadas , A. Cañada Dorado , M. Drake Canela , B. Fernández-Martínez , G. Ordóñez León , M. Cimas Ballesteros

Objective

To identify and describe a list of sentinel events (SEs) for Primary Care (PC).

Methododology

A structured experts’ consensus was obtained by using two online questionnaires. The participants were selected because of their expertise in PC and patient safety. The first questionnaire assessed the suitability of the hospital SEs established in the National Quality Forum 2006 for use in PC via responses of “yes”, “no”, or “yes but with modification”. In the latter case, a re-wording of the SE was requested. Additionally, inclusion of new SEs was also allowed. The second questionnaire included those SEs with positive responses (“yes”, “yes with modification”), so that the experts could choose between the original and alternative drafts, and evaluate the newly described SEs.

Results

The questionnaires were completed by 44 out of a total of the 47 experts asked to participate, and a total of 17 SEs were identified as suitable for PC. For the first questionnaire, 12 of the 28 hospital SEs were considered adaptable to PC, of which 11 were re-drafts. Thirty-seven experts proposed new SEs. These mainly concerned problems with medication and vaccines, delay, or lack of assistance, diagnostic delays, and problems with diagnostic tests, and were finally summarised in 5 SEs. In the second questionnaire, ≥ 65% of the experts chose the alternative wording against the original cases for the 11 SEs suitable for PC. The 5 newly included SEs were considered adequate with a positive response of 70-85%.

Conclusion

Having a list of SEs available in PC will help to improve the management of health care risks.

目的识别和描述初级保健(PC)的哨点事件(SEs)列表。方法采用两份在线问卷，获得结构化的专家共识。选择参与者是因为他们在PC和患者安全方面的专业知识。第一份问卷通过回答“是”、“否”或“是，但有修改”来评估2006年全国质量论坛中建立的医院SEs是否适合用于PC。在后一种情况下，有人要求重新措词。此外，还允许包含新的se。第二份问卷包括那些正面回答(“是”、“是，但有修改”)的社会经济指标，以便专家在原始草案和备选草案之间进行选择，并对新描述的社会经济指标进行评估。结果47位专家中有44位完成了问卷调查，共有17位专家被确定适合PC。在第一份问卷中，28家医院的se中有12家被认为适合PC，其中11家是重新起草的。37位专家提出了新的se。这些问题主要涉及药物和疫苗问题、延误或缺乏援助、诊断延误以及诊断测试问题，最后总结为5个紧急情况。在第二份问卷中，≥65%的专家对11个适用于PC的se选择了替代的措辞。新纳入的5个se被认为是足够的，阳性反应为70-85%。结论建立健康风险管理系统有助于提高健康风险管理水平。

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引用次数: 2

Análisis de 51.996 opiniones online sobre profesionales sanitarios en una web comercial 分析了一个商业网站上51.996个关于医疗专业人员的在线意见

Revista de Calidad Asistencial

Pub Date : 2017-09-01 DOI: 10.1016/j.cali.2017.03.001

R. Ibáñez , F. Lupiañez-Villanueva

引用次数: 0

Identificación de indicadores de resultado en salud en atención primaria. Una revisión de revisiones sistemáticas 确定初级保健保健结果指标。系统综述的综述

Revista de Calidad Asistencial

Pub Date : 2017-09-01 DOI: 10.1016/j.cali.2017.08.001

A. Olry de Labry Lima , L. García Mochón , C. Bermúdez Tamayo

Introduction

Outcome measures are being widely used by health services to assess the quality of health care. It is important to have a battery of useful performance indicators with high validity and feasibility. Thus, the objective of this study is to perform a review of reviews in order to identify outcome indicators for use in Primary Care.

Methodology

A review of systematic reviews (umbrella review) was carried out. The following databases were consulted: MedLine, EMBASE, and CINAHL, using descriptors and free terms, limiting searches to documents published in English or Spanish. In addition, a search was made for free terms in different web pages. Those reviews that offered indicators that could be used in the Primary Care environment were included.

Results

This review included a total of 5 reviews on performance indicators in Primary Care, which consisted of indicators in the following areas or clinical care processes: in osteoarthritis, chronicity, childhood asthma, clinical effectiveness, and prescription safety indicators. A total of 69 performance indicators were identified, with the percentage of performance indicators ranging from 0% to 92.8%. None of the reviews identified performed an analysis of the measurement control (feasibility or sensitivity to change of indicators).

Conclusions

This paper offers a set of 69 performance indicators that have been identified and subsequently validated and prioritised by a panel of experts.

卫生服务机构正在广泛使用结果指标来评估卫生保健的质量。重要的是要有一组有用的、高有效性和可行性的性能指标。因此，本研究的目的是进行综述，以确定用于初级保健的结果指标。方法对系统评价(总括性评价)进行综述。参考了以下数据库:MedLine、EMBASE和CINAHL，使用描述符和自由术语，将搜索限制在以英语或西班牙语发表的文档。此外，还在不同的网页上搜索免费术语。那些提供可用于初级保健环境的指标的评价被包括在内。结果本综述共纳入5篇关于初级保健绩效指标的综述，包括以下领域或临床护理过程的指标:骨关节炎、慢性、儿童哮喘、临床有效性和处方安全性指标。共确定了69个绩效指标，绩效指标占比从0%到92.8%不等。所有已确定的评价均未对测量控制(对指标变化的可行性或敏感性)进行分析。本文提供了一套69个绩效指标，这些指标已被确定并随后由专家小组验证和确定优先级。

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引用次数: 4

Utilidad del límite inferior de normalidad de la espirometría en pacientes diagnosticados de EPOC 肺活量测定正常下限在慢性阻塞性肺病患者中的应用

Revista de Calidad Asistencial

Pub Date : 2017-09-01 DOI: 10.1016/j.cali.2017.05.001

J.C. Naveiro-Rilo , S. García García , L. Flores-Zurutuza , L. Carazo Fernández , C. Domínguez Fernández , J.L. Palomo García

Aim

To evaluate the differences in COPD patients below the lower limit of normal (LLN) of the fixed ratio FEV1/FVC < 0.70 and those above this limit.

Patients and methods

Cross-sectional study. COPD patients between 40 and 85 years old included in primary care clinical record database were randomly selected. Baseline and postbronchodilator spirometries were performed. Two groups of patients were established: FEV1/FVC < 0.70 and ≤LIN (group1) and FEV/FVC < 0.70 and >LIN (group 2). Sociodemographic, clinical, pulmonary obstruction, quality of life and attendance to health services variables were measured. The results of both groups were compared.

Results

22.3% of the subjects were misdiagnosed FEV1/FVC < 0,70. Patients in group 2 (FEV1/FVC < 0.70 y > LLN) are diagnosed at an older age, they have a lower exposure to tobacco and better pulmonary function (FEV1: 74.9% vs 54.6%). 35.5% of those patients belong to stage i of GOLD, vs 8.5%, this patients have an increased comorbidity. Patients in group 1 have more COPD exacerbations, worse quality of life, a higher BODEx index 2,3 (1.8) vs 1.1 (1.5); 55.1% of those patients were high risk patients (Gold C or Gold D). Diagnose before being 56 years old, an increased exposure to tobacco, the FEV > 50%, and a lower comorbidity are associated with a greater chance of suffering COPD with LLN criteria.

Conclusion

We obtain two groups of patients with differentiated clinical characteristics if we use LLN. Subjects with FEV1/FVC < 0.7 and >LLN have less obstruction, less severity and more comorbidity, suggesting the possibility of overdiagnosis or misdiagnosis. On the other hand, younger age at the time of diagnosis, higher tobacco consumption and more severe obstruction are related with FEV1/FVC >0.70 and < LLN (group 1).

目的评价慢性阻塞性肺病患者FEV1/FVC <固定比值低于正常下限(LLN)的差异;0.70和高于这个极限的。患者与方法横断面研究。随机选择纳入初级保健临床记录数据库的40 ~ 85岁COPD患者。进行了基线和支气管扩张剂后肺活量测定。将患者分为两组:FEV1/FVC <0.70和≤LIN(第一组)，FEV/FVC <0.70和>LIN(第二组)。测量了社会人口学、临床、肺阻塞、生活质量和卫生服务出勤率等变量。结果误诊FEV1/FVC <者占22.3%;0, 70。2组患者(FEV1/FVC <0.70 y >LLN)在年龄较大时被诊断，他们接触烟草较少，肺功能较好(FEV1: 74.9%对54.6%)。35.5%的患者属于GOLD i期，而8.5%的患者有更高的合并症。1组患者COPD加重较多，生活质量较差，BODEx指数2,3 (1.8)vs 1.1(1.5)较高;55.1%的患者为高危患者(Gold C或Gold D)。诊断年龄在56岁之前，烟草暴露增加，FEV和gt;50%，较低的合并症与患具有LLN标准的COPD的可能性较大相关。结论采用LLN治疗可获得两组临床特征不同的患者。FEV1/FVC <0.7和LLN的梗阻较小，严重程度较轻，合并症较多，提示有过度诊断或误诊的可能。另一方面，诊断时年龄越小、烟草消费越高、梗阻越严重与FEV1/FVC >0.70和<LLN(第一组)。

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引用次数: 0

Desabastecimientos de medicamentos en un hospital de tercer nivel en España 西班牙一家三级医院的药品短缺

Revista de Calidad Asistencial

Pub Date : 2017-09-01 DOI: 10.1016/j.cali.2017.07.005

C. González-Martín , V. Saavedra-Quirós , J. Ruiz-Gutiérrez , E. García-Sanz , A. Sánchez-Guerrero

引用次数: 0

Cambio de modelo asistencial en la atención al parto normal: aplicación en el paritorio de La Ribera 正常分娩护理护理模式的改变:在河滨产房的应用

Revista de Calidad Asistencial

Pub Date : 2017-09-01 DOI: 10.1016/j.cali.2017.04.002

F. Camacho-Morell , M.J. Romero-Martín

Objective

To assess knowledge, wish for inclusion and implementation of normal childbirth care protocols at La Ribera University Hospital, the reason why they are not applied, and to assess the attendance at antepartum training activities.

Material and method

Cross-sectional descriptive study. They were carried out 186 surveys by convenience sampling to pregnant women attending fetal well-being control at hospital between 2014 and 2015. They were collected data about knowledge, wish for inclusion, compliance of protocols and reasons for non-compliance, and attendance at antepartum training activities. Percentages and confidence intervals were calculated. Chi-square test was used to compare categorical variables.

Results

They were collected percentages of knowledge (77%, CI95%: 75,5-78,5) and wish for inclusion (84,6%, CI_95%: 82,5-86,7). Protocol compliance ranged from 6% (nitrous oxide administration) to 91% (skin-to-skin contact). The main reasons for non-compliance were due to circumstances of childbirth process (56,3%, CI_95%: 51,1-61,5). Attendance at maternal education classes was 62%, mainly primiparous women (p = 0,0001) with medium or high education level (p = 0,001).

Conclusions

Pregnant women have a high knowledge and wish for inclusion of normal childbirth care protocols. Attendance at antepartum training activities could by improved and the main reason for non-attendance is lack of information. Compliance is good enough in most protocols; when they are not applied is due to childbirth circumstances. Remaining tasks include the introduction of additional protocols and to involve pregnant women in decision-making.

目的了解拉里贝拉大学医院对正常分娩护理方案的了解程度、纳入意愿和实施情况、不适用的原因，并对产前培训活动的参加情况进行评估。材料与方法横断面描述性研究。对2014 - 2015年在医院接受胎儿健康控制的孕妇进行了186次方便抽样调查。收集她们的知识、纳入意愿、遵守方案和不遵守的原因以及参加产前培训活动的情况。计算百分比和置信区间。分类变量比较采用卡方检验。结果收集到的知识百分比(77%，CI95%: 75,5-78,5)和纳入意愿百分比(84,6%，CI95%: 82,5-86,7)。方案依从性从6%(一氧化二氮管理)到91%(皮肤与皮肤接触)不等。不遵医嘱的主要原因是分娩过程中的情况(56,3%，CI95%: 51,1-61,5)。参加产妇教育班的人数为62%，主要是初产妇(p = 0.0001)，具有中等或高等教育水平(p = 0.001)。结论孕妇对纳入正常分娩护理方案有较高的认知度和意愿。产前培训活动的出勤率可以提高，不出勤率的主要原因是缺乏信息。大多数协议的遵从性已经足够好了;当他们不适用是由于分娩情况。剩下的任务包括制订附加议定书和使孕妇参与决策。

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引用次数: 2

Mortalidad y atención a pacientes hospitalizados durante los fines de semana 周末住院病人的死亡率和护理

Revista de Calidad Asistencial

Pub Date : 2017-09-01 DOI: 10.1016/j.cali.2017.07.001

J.L. Zambrana-García , C.J. Granados , J.L. Zambrana-Luque

Background and objectives

It has been shown that patients admitted to hospital during the weekends tend to have less favourable outcomes, including higher mortality rates, compared with those admitted during weekdays. The main objective of this study is to evaluate the impact of on the health outcomes of patients admitted during the weekend.

Material and methods

A retrospective observational study was conducted on all patients admitted to Montilla Hospital (Córdoba).. All hospitalised patients were attended to daily, including weekends and holidays. An analysis was performed on the epidemiological variables and health outcomes (total mortality).

Results

The study included a total of 2,565 hospital admissions, of whom 653 (25.6%) were discharged during the weekend. Patients discharged during the weekend were significantly younger [53 (27) versus 56 (27) years, P < .002], had fewer diagnoses on discharge [6.2 (3.7) versus 6.7 (3.9), P < .003], and had fewer procedures performed [(3 (1.9) versus 3.2 (1.8), P < .005]. The mean length of stay was shorter for weekend discharges than the weekday discharges [3 (2.6) days versus 3.7 (3.9) days, P < .001). The total mortality was 4%, and there were no differences between weekday and weekend admissions (4.3% versus 3.7%). Home discharges on the weekend were related to a reduction in the mean length of stay by 0.3 days (from 3.6 to 3.9 days, P < .001).

Conclusions

Hospitalised patient care has led to the disappearance of increased mortality during weekends.

背景和目的研究表明，与工作日住院的患者相比，周末住院的患者往往预后不佳，包括死亡率更高。本研究的主要目的是评估对周末入院患者健康结果的影响。材料与方法对Montilla医院(Córdoba)收治的所有患者进行回顾性观察研究。所有住院病人每天都得到照顾，包括周末和节假日。对流行病学变量和健康结果(总死亡率)进行了分析。结果本研究共纳入2565例住院患者，其中653例(25.6%)在周末出院。周末出院的患者明显更年轻[53(27)比56(27)岁，P <.002]，出院时诊断较少[6.2(3.7)对6.7 (3.9)，P <.003]，并且进行的手术较少[(3(1.9)对3.2 (1.8)]，P <.005]。周末出院的平均住院时间比工作日短[3(2.6)天比3.7(3.9)天，P <措施)。总死亡率为4%，工作日和周末入院没有差异(4.3%对3.7%)。周末出院与平均住院时间减少0.3天(从3.6天减少到3.9天)有关，P <措施)。结论住院病人护理使周末死亡率增高的现象消失。

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引用次数: 1

Humanizar la sanidad para mejorar la calidad de sus servicios 使医疗保健人性化，提高服务质量

Revista de Calidad Asistencial

Pub Date : 2017-09-01 DOI: 10.1016/j.cali.2017.10.001

J.C. March

引用次数: 7

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