Revista de Calidad Asistencial最新文献

英文中文

Concordancia entre sistemas de estratificación e identificación de pacientes crónicos complejos en Atención Primaria 初级保健中复杂慢性患者分层与识别系统的一致性

Revista de Calidad Asistencial

Pub Date : 2017-01-01 DOI: 10.1016/j.cali.2016.07.006

M. Sánchez Mollá , I. Candela García , F.J. Gómez-Romero , D. Orozco Beltrán , M. Ollero Baturone

Objective

To determine the prevalence of patients with multiple chronic diseases in Primary Care using the multiple morbidity criteria and Clinical Risk Groups, and the agreement in identifying high-risk patients that require case management with both methods.

Material and method

A cross-sectional study was conducted on 240 patients, selected by random sampling of 16 care quotas from two Primary Health Care centres of a health area. Informed consent was obtained to access their electronic medical records for the study, and a record was made of age, sex, health status of Clinical Risk Groups, severity, multiple morbidity criteria, and Charlson index by physicians during clinical practice. Three patients were excluded due to incomplete data.

Results

The prevalence of patients with multiple chronic diseases following the criteria of the Ministry of Health among users was 4.11 (95% CI; 2.13-7.30). The frequency of patients with high risk Clinical Risk Groups (G3) in the chronicity strategy of Valencian Community was 7.59 (95% CI; 4.70-11.70), which includes patients with health status 6 and complexity level 5-6, and health status 7, 8, and 9. Agreement between the two classifications was low, with a kappa index 0.17 (95% CI; 0-0.5)

Conclusions

The prevalence did not differ significantly from that expected, and the agreement between the two stratifications was very weak, not selecting the same patients for highly complex case management.

目的采用多发病标准和临床风险分组确定基层医疗中多种慢性疾病患者的患病率，并分析两种方法在确定需要病例管理的高危患者方面的一致性。材料和方法对240名患者进行了横断面研究，这些患者是通过从一个卫生地区的两个初级卫生保健中心的16个护理配额随机抽样选出的。在获得知情同意的情况下访问其电子病历，并由医生在临床实践中记录其年龄、性别、临床风险组健康状况、严重程度、多重发病标准和Charlson指数。3例患者因资料不完整而被排除。结果用户中符合卫生部标准的多种慢性疾病患者患病率为4.11 (95% CI;2.13 - -7.30)。瓦伦西亚社区慢性策略中高危临床风险组(G3)患者的频率为7.59 (95% CI;4.70-11.70)，包括健康状况为6、复杂程度为5-6、健康状况为7、8和9的患者。两种分类之间的一致性较低，kappa指数为0.17 (95% CI;0-0.5)结论患病率与预期没有显著差异，两个分层之间的一致性非常弱，没有选择相同的患者进行高度复杂的病例管理。

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引用次数: 5

Fe de errores de «Estudio Regional de Incidentes Derivados de la Atención (ERIDA) en Urgencias» 《紧急情况中护理事件区域研究(ERIDA)》的错误信念

Revista de Calidad Asistencial

Pub Date : 2017-01-01 DOI: 10.1016/J.CALI.2016.09.001

J. Alcaraz-Martínez, J. Aranaz-Andrés, C. Martínez-Ros, S. Moreno-Reina, L. Escobar-Álvaro, J. V. Ortega-Liarte

引用次数: 0

Concordancia entre sistemas de estratificación e identificación de pacientes crónicos complejos en Atención Primaria 初级保健中复杂慢性患者分层与识别系统的一致性

Revista de Calidad Asistencial

Pub Date : 2017-01-01 DOI: 10.1016/J.CALI.2016.07.006

M. S. Molla, I. C. García, F. J. Gómez-Romero, D. O. Beltrán, M. O. Baturone

引用次数: 5

Desarrollo y evolución de un cuadro de mando integral en atención primaria: lecciones aprendidas 初级保健综合记分卡的发展和演变:经验教训

Revista de Calidad Asistencial

Pub Date : 2017-01-01 DOI: 10.1016/j.cali.2016.04.005

E. Bartolomé-Benito , J. Jiménez-Carramiñana , L. Sánchez-Perruca , M.S. Bartolomé-Casado , A.B. Dominguez-Mandueño , M. Marti-Argandoña , M. Hernández-Pascual , A. Miquel-Gómez

Objectives

To describe the design, implementation, and monitoring of eSOAP (Primary Health Care Balanced Scorecard) and its role in the deployment of strategic objectives and clinical management, as well as to show the lessons learned during six years of follow-up.

Method

Descriptive study areas: methodology (conceptual framework, strategic matrix, strategic map, and processes map), technology and standardisation.

Results

As of December 2014, 9,046 (78%) professionals are registered in eSOAP. A total of 381 indicators were measured from 16 data sources, of which 36% were of results (EFQM model), 39.1% of clinical management, and 20% were included in the Program Centre Contract. The Balanced Scorecard has enabled to deploy all strategic lines of Primary Health Care, and has enabled the healthcare professionals to evaluate the evolution of results over time, and at patient level (e.g. 16% increase in control of diabetic patients). A total of 295,779 reports were generated and 13,080 professionals were evaluated by goals.

Conclusions

There was an increased use of the eSOAP application by the professionals. The Balanced Scorecard was the key in deploying Primary Health Care strategies. It has helped clinical management and improved relevant indicators (health, patient experience, and costs), such as the management models that we used as references (EFQM Kaplan and Norton), and new emerging scenarios (Triple aim).

目的描述esap(初级卫生保健平衡计分卡)的设计、实施和监测及其在战略目标部署和临床管理中的作用，并展示六年随访期间的经验教训。方法描述性研究领域:方法论(概念框架、战略矩阵、战略图和过程图)、技术和标准化。结果截至2014年12月，共有9046名(78%)专业人员在esap注册。共测量了来自16个数据源的381项指标，其中36%为结果(EFQM模型)，39.1%为临床管理，20%为项目中心合同。平衡计分卡能够部署初级卫生保健的所有战略路线，并使卫生保健专业人员能够评估结果随时间和患者水平的演变(例如，糖尿病患者的控制增加了16%)。总共产生了295,779份报告，并对13,080名专业人员进行了目标评估。结论专业人员对eSOAP应用程序的使用有所增加。平衡计分卡是部署初级卫生保健战略的关键。它有助于临床管理并改善了相关指标(健康、患者体验和成本)，例如我们用作参考的管理模型(EFQM Kaplan和Norton)以及新出现的情景(Triple aim)。

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引用次数: 8

Adherencia al tratamiento tras trasplante renal como indicador de calidad de la información recibida: estudio longitudinal con un seguimiento de 2 años 肾移植后治疗依从性作为信息质量指标:2年随访的纵向研究

Revista de Calidad Asistencial

Pub Date : 2017-01-01 DOI: 10.1016/j.cali.2016.05.004

G. Costa-Requena , M.C. Cantarell , F. Moreso , G. Parramon , D. Seron

Introduction

Transplantation is an optimal form of treatment for end-stage renal disease, but requires lifelong adherence to immunosuppressive therapy. The aim of this study was to longitudinally assess the adherence to treatment after kidney transplant, as well as to compare the amount of information about the treatment received at one month and 18 months post-transplantation, and its influence on adherence to treatment.

Material and methods

The Self-Reported Measure of Medication Adherence was administered at month (T1), 6 months (T2), 12 months (T3), 18 months (T4), and 24 months (T5) post-transplantation. Survey about aspects of knowledge and attitudes about medication, was administered at one month and 18 months post-transplant. Measures of central tendency and non-parametric tests were used to compare the data.

Results

The study included a total of 73 patients with a median age of 57 years. The percentage of patients non-adherent to medication was 9.6% (T1), 22.5% (T2), 29.2% (T3), 29.8% (T4), and 28.1% (T5). One month after transplantation “not consulting with the doctor on forgetting to take medication (P=.034) significantly influenced the non-adherence to treatment. At 18 months post- transplantation, none of the issues raised on medication knowledge had an influence on non-adherence to treatment.

Conclusions

Longer times since transplantation increased the non-adherence to treatment. Some issues regarding the information of treatment influenced the non-adherence in the immediate transplant period, but not in the follow-up.

移植是终末期肾脏疾病的最佳治疗形式，但需要终生坚持免疫抑制治疗。本研究的目的是纵向评估肾移植后的治疗依从性，并比较移植后1个月和18个月接受治疗的信息量及其对治疗依从性的影响。材料与方法在移植后1个月(T1)、6个月(T2)、12个月(T3)、18个月(T4)和24个月(T5)进行药物依从性自我报告测量。分别于移植后1个月和18个月对患者的用药知识和态度进行调查。采用集中趋势测量和非参数检验对数据进行比较。结果本研究共纳入73例患者，中位年龄为57岁。用药不依从率分别为9.6% (T1)、22.5% (T2)、29.2% (T3)、29.8% (T4)、28.1% (T5)。移植后1个月“未咨询医生是否忘记服药”(P= 0.034)对治疗依从性有显著影响。在移植后18个月，没有任何关于药物知识的问题对不坚持治疗产生影响。结论移植后较长的时间增加了治疗不依从性。一些关于治疗信息的问题影响了移植期的不依从，但在随访中没有影响。

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引用次数: 2

Efectividad de una intervención para mejorar la calidad de la cumplimentación del listado de verificación de seguridad quirúrgica en un servicio de cirugía general 在普通外科服务中，干预提高手术安全检查表完成质量的有效性

Revista de Calidad Asistencial

Pub Date : 2017-01-01 DOI: 10.1016/J.CALI.2015.12.005

I. Hernández-García, M. Giménez-Júlvez, M. Moreno

引用次数: 2

Bacteriemia relacionada con el catéter: evaluación de los resultados clínicos como plan de mejora de la calidad en el diagnóstico microbiológico 导管相关菌血症:评价临床结果作为提高微生物诊断质量的计划

Revista de Calidad Asistencial

Pub Date : 2017-01-01 DOI: 10.1016/j.cali.2016.02.004

M.J. González-Abad, M. Alonso Sanz

引用次数: 0

La socialización de los profesionales sanitarios y el papel de la resiliencia en el desarrollo de conductas de bienestar en el trabajo 卫生专业人员的社会化和复原力在工作场所健康行为发展中的作用

Revista de Calidad Asistencial

Pub Date : 2017-01-01 DOI: 10.1016/j.cali.2016.06.004

J. Cerezo , M. Bernabé , A. Lisbona , F.J. Palací

Introduction

Socialization during the training of specialists is a key step in the subsequent adjustment and occupational well-being of health professionals in the hospital organisation.

Objective

To analyse the relationship of socialization and resilience with the engagement responses of specialists in training.

Method

Convenience sampling was used, with 110 professionals from six teaching units of different hospitals participating in the study. Descriptive and mediational analysis of the study variables were performed using SPSS 21 and Macro Preacher and Hayes (2004).

Results

The results show statistically significant relationships between socialization, resilience, and engagement. The mediating role of resilience is also shown (β = 0.10; se = 0.12; p<0.05, 95% CI: [0.02-0.23]) to generate engagement in health professionals.

Conclusions

An interaction effect is observed between socialization, and specialty moderates resilience. Therefore it can be seen that positive socialization and resilience can promote good performance.

专家培训期间的社会化是医院组织中卫生专业人员随后调整和职业福祉的关键步骤。目的分析专科医生培训过程中社会化、心理弹性与敬业度的关系。方法采用方便抽样法，选取来自不同医院6个教学单位的110名专业人员参与研究。使用SPSS 21和Macro Preacher and Hayes(2004)对研究变量进行描述性和中介性分析。结果社会化、心理弹性和敬业度之间存在显著的统计学关系。心理弹性也具有中介作用(β = 0.10;se = 0.12;p<0.05, 95% CI:[0.02-0.23])，以提高卫生专业人员的参与度。结论社交、专业对心理弹性有调节作用。由此可见，积极的社会化和弹性可以促进良好的绩效。

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引用次数: 2

¿Por qué se retrasa el tratamiento de reperfusión en pacientes con código ictus? Un análisis cualitativo 为什么中风患者的再灌注治疗延迟?定性分析

Revista de Calidad Asistencial

Pub Date : 2016-11-01 DOI: 10.1016/j.cali.2016.01.006

B. Palazón-Cabanes , J.J. López-Picazo-Ferrer , A. Morales-Ortiz , N. Tomás-García

Background

Efficacy and safety of reperfusion therapy in acute ischaemic stroke is time-dependent and has a limited therapeutic window, which is, in fact, the main exclusion criterion. Initiatives to evaluate the quality of care are essential to design future interventions and ensure the shortest management times and application of such treatments.

Objective

The aim of the study is to identify and classify potential causes of delay in the administration of reperfusion therapy in a tertiary hospital, a reference for the comprehensive treatment of acute ischaemic stroke.

Material and methods

The project was developed in Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. A total of 337 patients with acute ischaemic stroke treated with reperfusion therapies were evaluated. For qualitative analysis, 2 working groups were formed: an advocacy group that designed and directed the entire project, and a multidisciplinary one, which served as a source of information and a mechanism for active involvement of all professionals in the stroke-care chain. Information was collected in 3 meetings and then, both the flowcharts and the cause-effect diagram were prepared.

Results

Based on the above tools, potential causes of delay were identified and classified according to an operational criterion into unmodified structures, and modifiable ones with known evidence and hypothetical repercussions. Modifiable ones are noted for their importance in the design of future improvement interventions in stroke care. Some of them are: Variability in following established protocols, lack of procedures in some parts of the stroke-care chain, etc.

Conclusion

Knowledge of the current situation has just been the starting point, but it has been an essential requisite for the design and implementation of a quality improvement program to shorten in-hospital stroke code times.

背景:急性缺血性脑卒中再灌注治疗的疗效和安全性具有时间依赖性，治疗窗口期有限，这实际上是主要的排除标准。评估护理质量的举措对于设计未来的干预措施和确保最短的管理时间和此类治疗的应用至关重要。目的探讨三级医院再灌注治疗延迟的潜在原因，为急性缺血性脑卒中的综合治疗提供参考。材料和方法该项目由西班牙穆尔西亚的圣母大学医院(Hospital Universitario virgin de la Arrixaca)开发。对337例急性缺血性脑卒中患者进行再灌注治疗。为了进行定性分析，我们成立了两个工作组:一个是倡导小组，负责设计和指导整个项目;另一个是多学科小组，作为信息来源，并为卒中护理链中所有专业人员的积极参与提供机制。通过3次会议收集信息，制作流程图和因果关系图。结果基于上述工具，根据操作标准确定了潜在的延误原因，并将其分为未修改的结构和已知证据和假设后果的可修改结构。可修改的是注意到他们的重要性，在设计未来的改善干预措施，在中风护理。其中一些是:在遵循既定方案方面的差异，卒中护理链的某些部分缺乏程序等。结论了解现状只是起点，但它已经成为设计和实施质量改进计划以缩短院内卒中编码时间的必要条件。

{"title":"¿Por qué se retrasa el tratamiento de reperfusión en pacientes con código ictus? Un análisis cualitativo","authors":"B. Palazón-Cabanes , J.J. López-Picazo-Ferrer , A. Morales-Ortiz , N. Tomás-García","doi":"10.1016/j.cali.2016.01.006","DOIUrl":"10.1016/j.cali.2016.01.006","url":null,"abstract":"<div><h3>Background</h3><p>Efficacy and safety of reperfusion therapy in acute ischaemic stroke is time-dependent and has a limited therapeutic window, which is, in fact, the main exclusion criterion. Initiatives to evaluate the quality of care are essential to design future interventions and ensure the shortest management times and application of such treatments.</p></div><div><h3>Objective</h3><p>The aim of the study is to identify and classify potential causes of delay in the administration of reperfusion therapy in a tertiary hospital, a reference for the comprehensive treatment of acute ischaemic stroke.</p></div><div><h3>Material and methods</h3><p>The project was developed in Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. A total of 337 patients with acute ischaemic stroke treated with reperfusion therapies were evaluated. For qualitative analysis, 2 working groups were formed: an advocacy group that designed and directed the entire project, and a multidisciplinary one, which served as a source of information and a mechanism for active involvement of all professionals in the stroke-care chain. Information was collected in 3 meetings and then, both the flowcharts and the cause-effect diagram were prepared.</p></div><div><h3>Results</h3><p>Based on the above tools, potential causes of delay were identified and classified according to an operational criterion into unmodified structures, and modifiable ones with known evidence and hypothetical repercussions. Modifiable ones are noted for their importance in the design of future improvement interventions in stroke care. Some of them are: Variability in following established protocols, lack of procedures in some parts of the stroke-care chain, etc.</p></div><div><h3>Conclusion</h3><p>Knowledge of the current situation has just been the starting point, but it has been an essential requisite for the design and implementation of a quality improvement program to shorten in-hospital stroke code times.</p></div>","PeriodicalId":101101,"journal":{"name":"Revista de Calidad Asistencial","volume":"31 6","pages":"Pages 347-355"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cali.2016.01.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34408407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Percepción de los médicos de atención primaria sobre la receta electrónica en el Servicio Madrileño de Salud 马德里卫生服务中初级保健医生对电子处方的看法

Revista de Calidad Asistencial

Pub Date : 2016-11-01 DOI: 10.1016/j.cali.2016.01.008

A.I. Villímar Rodríguez , A.B. Gangoso Fermoso , C. Calvo Pita , G. Ariza Cardiel

Objective

To investigate the opinion of Primary Care physicians regarding electronic prescribing.

Methods

Descriptive study by means of a questionnaire sent to 527 primary care physicians. Period: June 2014. The questionnaire included closed questions about interest shown, satisfaction, benefits, weaknesses, and barriers, and one open question about difficulties, all of them referred to electronic prescribing. Satisfaction was measured using 1-10 scale, and benefits, weaknesses, and barriers were evaluated by a 5-ítems Likert scale. Interest was measured using both methods. The questionnaire was sent by e-mail for on line response through Google Drive® tool. A descriptive statistical analysis was performed.

Results

The response rate was 47% (248/527). Interest shown was 8.7 (95% CI; 8.5-8.9) and satisfaction was 7.9 (95% CI; 7.8-8). The great majority 87.9% (95% CI; 83.8-92%) of respondents used electronic prescribing where possible. Most reported benefits were: 73.4% (95% CI; 67.8-78.9%) of respondents considered that electronic prescribing facilitated medication review, and 59.3% (95% CI; 53.1-65.4) of them felt that it reduced bureaucratic burden. Among the observed weaknesses, they highlighted the following: 87.9% (95% CI; 83.8-92%) of respondents believed specialist care physicians should also be able to use electronic prescribing. Concerning to barriers: 30.2% (95% CI; 24.5-36%) of respondents think that entering a patient into the electronic prescribing system takes too much time, and 4% (95% CI; 1.6-6.5%) of them perceived the application as difficult to use.

Conclusions

Physicians showed a notable interest in using electronic prescribing and high satisfaction with the application performance.

目的了解基层医师对电子处方的看法。方法采用描述性研究方法，对527名初级保健医师进行问卷调查。期间:2014年6月。问卷包括关于兴趣表现、满意度、益处、弱点和障碍的封闭式问题，以及一个关于困难的开放式问题，所有问题都涉及电子处方。满意度采用1-10量表进行测量，益处、劣势和障碍采用5-ítems李克特量表进行评估。用两种方法测量兴趣。问卷通过电子邮件发送，通过Google Drive®工具在线回答。进行描述性统计分析。结果总有效率为47%(248/527)。显示的兴趣为8.7 (95% CI;8.5-8.9)，满意度为7.9 (95% CI;7.8 8)。绝大多数87.9% (95% CI;83.8% -92%)的受访者在可能的情况下使用电子处方。大多数报告的获益为:73.4% (95% CI;67.8-78.9%)的受访者认为电子处方促进了药物审查，59.3% (95% CI;53.1-65.4)的人认为减少了官僚负担。在观察到的弱点中，他们强调了以下几点:87.9% (95% CI;83.8% -92%)的受访者认为专科医生也应该能够使用电子处方。关于障碍:30.2% (95% CI;24.5-36%)的受访者认为将患者输入电子处方系统需要太多时间，4% (95% CI;1.6-6.5%)的受访者认为该应用程序难以使用。结论医师对电子处方的使用兴趣明显，对电子处方的应用效果满意。

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