K. Vrotsou , M. Orive-Calzada , N. González , I. Vergara , N. Pascual-Fernández , C. Guerra-López , R. García-Montes , J. Ortiz-Ribes , M.J. Onaindia-Ecenarro , J. Regalado-de los Cobos , M. Millet-Sampedro
{"title":"Factores relacionados con la carga de trabajo en hospitalización a domicilio: estudio de consenso Delphi","authors":"K. Vrotsou , M. Orive-Calzada , N. González , I. Vergara , N. Pascual-Fernández , C. Guerra-López , R. García-Montes , J. Ortiz-Ribes , M.J. Onaindia-Ecenarro , J. Regalado-de los Cobos , M. Millet-Sampedro","doi":"10.1016/j.jhqr.2022.09.001","DOIUrl":"https://doi.org/10.1016/j.jhqr.2022.09.001","url":null,"abstract":"<div><h3>Objectives</h3><p>To identify and prioritize a list of factors that contribute to the workload of the hospital at home (HaH) professionals.</p></div><div><h3>Material and methods</h3><p>A qualitative methodology study performed between January and December 2019 in the 10 HAH units of the Basque Country. The data were obtained in 4<!--> <!-->phases: 1. Systematic literature search and review; 2. Expert group meeting; 3. Consensus method: Delphi technique (2 survey rounds) and nominal group meeting; 4. Meeting of the research team.</p></div><div><h3>Results</h3><p>In the systematic literature search and review 85 factors were initially identified. These were reduced to 38 after the 8-person expert group meeting, in which 10 new factors were added. After the 2 Delphi rounds (106 and 57 professionals, respectively), 17 factors were maintained and 12 remained in doubt. The latter were evaluated at the nominal group meeting, consisting of 13 professionals who decided to eliminate 5 factors, include 3, and keep 3 as doubt. After the 8-person research team meeting, 14 potential factors were finally selected. They are related to the place of residence, the health state and social situation of the patients, as well as the health care provided at home.</p></div><div><h3>Conclusions</h3><p>The identified factors could serve for improving the organization and optimize the daily word of the HaH professionals.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49888099","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}
E. Gambó Ruberte , M.C. Chabbar Boudet , C. Albarrán Martín , C. Untoria Agustín , E. Murlanch Dosset , B. Peiró Aventín , F. Garza Benito
{"title":"Impacto pronóstico de la realización de un programa de rehabilitación cardiaca tras un síndrome coronario agudo","authors":"E. Gambó Ruberte , M.C. Chabbar Boudet , C. Albarrán Martín , C. Untoria Agustín , E. Murlanch Dosset , B. Peiró Aventín , F. Garza Benito","doi":"10.1016/j.jhqr.2023.01.001","DOIUrl":"https://doi.org/10.1016/j.jhqr.2023.01.001","url":null,"abstract":"<div><h3>Aim</h3><p>Reduction of major adverse cardiovascular events (MACE) at 5 years in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention who completed a cardiac rehabilitation program.</p></div><div><h3>Methods</h3><p>We included 230 consecutive men with a diagnosis of ACS and percutaneous coronary intervention in the first half of 2015 according to the inclusion criteria. Two cohorts of 115 patients each were compared, one of them (rehabilitated group) with patients who completed the cardiac rehabilitation program and the other (control group) who received conventional outpatient care. Base-line characteristics and MACE at 5-years follow-up were compared and analyzed. MACE included re-infarction, heart failure, cerebrovascular accident and all-cause mortality.</p></div><div><h3>Results</h3><p>At 5 years of follow-up, a statistically significant reduction in MACE (27.19% vs 7.83%; OR 0.23 [IC 0.10-0.50]; <em>P</em> <!-->=<!--> <!-->.0001), all-cause mortality (OR 0.12 [IC 0.01-0.94]; <em>P</em> <!-->=<!--> <!-->0.01), re-infarction rate (OR 0.29 [IC 0.11-0.77]; <em>P</em> <!-->=<!--> <!-->.007) and cerebrovascular accident (<em>P</em> <!-->=<!--> <!-->.014) was found in the rehabilitated group (RG). MACE-free survival was significantly longer in the RG, regardless of risk (HR 0.25 [IC 0.12-0.53]; <em>P</em> <!-->=<!--> <!-->.000).</p></div><div><h3>Conclusion</h3><p>In our sample, cardiac rehabilitation programs showed a prognostic benefit in patients with ACS and percutaneous coronary intervention, with a statistically significant reduction in MACE, re-infarction rate and CVA at five-year follow-up.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49888515","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}
C. Fajardo-Luna , S. Espil-Sanchez , R. Quico-Berrio , Y. Muñoz-Cure , C.R. Salazar , J. Moya-Salazar
{"title":"Comentarios sobre la seguridad del paciente y eventos adversos a propósito del estudio de Riera-Vázquez et al., (2022)","authors":"C. Fajardo-Luna , S. Espil-Sanchez , R. Quico-Berrio , Y. Muñoz-Cure , C.R. Salazar , J. Moya-Salazar","doi":"10.1016/j.jhqr.2022.09.007","DOIUrl":"https://doi.org/10.1016/j.jhqr.2022.09.007","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49888516","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}
{"title":"Applying machine learning methods to predict the hospital re-admission within 30 days of total hip arthroplasty and hemiarthroplasty","authors":"J.-M. Wu , B.-W. Cheng , C.-Y. Ou , J.-E. Chiu , S.-S. Tsou","doi":"10.1016/j.jhqr.2022.11.009","DOIUrl":"10.1016/j.jhqr.2022.11.009","url":null,"abstract":"<div><h3>Background</h3><p>Total hip arthroplasty (THA) and hemiarthroplasty are common treatments for severe hip joint disease. To predict the probability of re-admission after discharge when patients are hospitalized will support providing appropriate health education and guidance.</p></div><div><h3>Methods</h3><p>The research aims to use logistic regression (LR), decision trees (DT), random forests (RF), and artificial neural networks (ANN) to establish predictive models and compare their performances on re-admissions within 30 days after THA or hemiarthroplasty. The data of this study includes patient demographics, physiological measurements, disease history, and clinical laboratory test results.</p></div><div><h3>Results</h3><p>There were 508 and 309 patients in the THA and hemiarthroplasty studies respectively from September 2016 to December 2018. The accuracies of the four models LR, DT, RF, and ANN in the THA experiment are 94.3%, 93.2%, 97.3%, and 93.9%, respectively. In the hemiarthroplasty experiment, the accuracies of the four models are 92.4%, 86.1%, 94.2%, and 94.8%, respectively. Among these, we found that the RF model has the best sensitivity and ANN model has the best area under the receiver operating characteristic (AUROC) score in both experiments.</p></div><div><h3>Conclusions</h3><p>The THA experiment confirmed that the performance of the RF model is better than the other models. The key factors affecting the prognosis after THA surgery are creatinine, sodium, anesthesia duration, and dialysis. In the hemiarthroplasty experiment, the ANN model showed more accurate results. Poor kidney function increases the risk of hospital re-admission. This research highlights that RF and ANN model perform well on the hip replacement surgery outcome prediction.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9777136","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}
{"title":"El caballo de Troya como una metodología de gestión del cambio en una organización sanitaria: la experiencia y perspectiva de GiPSS, Tarragona","authors":"R. Qanneta","doi":"10.1016/j.jhqr.2022.11.004","DOIUrl":"https://doi.org/10.1016/j.jhqr.2022.11.004","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49888100","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}
N. Robles-Rodríguez , A. Llaneza-Folgueras , A. Lana
{"title":"Factors from healthcare delivery affecting breast cancer survival in a health area of Northern of Spain","authors":"N. Robles-Rodríguez , A. Llaneza-Folgueras , A. Lana","doi":"10.1016/j.jhqr.2023.04.001","DOIUrl":"10.1016/j.jhqr.2023.04.001","url":null,"abstract":"<div><h3>Objective</h3><p>Clinical breast cancer decision-making significantly affects life expectancy and management of hospital resources. The aims of the present study were to estimate the time of survival for breast cancer patients and to identify independent factors from healthcare delivery associated with survival rates in a specific health area of Northern of Spain.</p></div><div><h3>Methods</h3><p>Survival analysis was conducted among a cohort of 2545 patients diagnosed with breast cancer between 2006 and 2012 from the population breast cancer registry of Asturias-Spain and followed up till 2019. Adjusted Cox proportional hazard models were used to identify the independent prognostic factors of all-cause from death.</p></div><div><h3>Results</h3><p>The 5-year survival rate was 80%. Advanced age (>80 years) (hazard ratio, HR: 4.35; 95% confidence interval, CI: 3.41–5.54), hospitalization in small hospitals (HR: 1.46; 95% CI: 1.09–1.97), treatment in oncology wards (HR: 3.57; 95% CI: 2.41–5.27), and length of stay >30 days (HR: 2.24; 95% CI: 1.32–3.79) were the main predictors of death. By contrast, breast cancer suspected via screening was associated with a lower risk of death (HR: 0.55; 95% CI: 0.35–0.87).</p></div><div><h3>Conclusion</h3><p>There is room for improvement in survival rates after breast cancer in the health area of Asturias (Northern of Spain). Some healthcare delivery factors, and other clinical characteristics of the tumor influence the survival of breast cancer patients. Strengthening population screening programs could be relevant to increasing survival rates.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9783732","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}
A. Diaz , F. Astochado , J. Moya-Salazar , V. Rojas-Zumaran , M.C. Ruiz , A.N. Vasquez , C. Alcarraz
{"title":"Algunas reflexiones sobre el estado mental de las segundas víctimas de COVID-19 de las áreas de cuidados críticos","authors":"A. Diaz , F. Astochado , J. Moya-Salazar , V. Rojas-Zumaran , M.C. Ruiz , A.N. Vasquez , C. Alcarraz","doi":"10.1016/j.jhqr.2022.08.003","DOIUrl":"https://doi.org/10.1016/j.jhqr.2022.08.003","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49888101","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}
{"title":"Adherencia a las guías de práctica clínica, de la teoría a la acción en un hospital de Colombia","authors":"A. de la Torre , A. Franco","doi":"10.1016/j.jhqr.2022.11.001","DOIUrl":"https://doi.org/10.1016/j.jhqr.2022.11.001","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50175795","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}
A. González-Castro , E. Cuenca Fito , A. Fernandez , Y. Peñasco , V. Modesto i Alport , A. Medina Villanueva , A. Fajardo , P. Escude-Acha
{"title":"Coste-efectividad de la oxigenoterapia de alto flujo en el tratamiento de la neumonía por SARS-CoV-2","authors":"A. González-Castro , E. Cuenca Fito , A. Fernandez , Y. Peñasco , V. Modesto i Alport , A. Medina Villanueva , A. Fajardo , P. Escude-Acha","doi":"10.1016/j.jhqr.2022.10.004","DOIUrl":"https://doi.org/10.1016/j.jhqr.2022.10.004","url":null,"abstract":"<div><h3>Introduction</h3><p>high-oxygen nasal cannulas in patients with respiratory failure secondary to SARS-CoV-2 pneumonia have not been studied from a cost-effectiveness point of view.</p></div><div><h3>Methods</h3><p>Retrospective analysis of patients who had entered the COVID-area of an intensive medicine service in a third reference hospital, between March-December 2020. An effectiveness cost analysis was carried out comparing 2<!--> <!-->therapeutic decisions: the experimental strategy was defined as a mixed strategy consisting of the initial application of high flow nasal oxygen (HFNO) and application of VMI only to HFNO failures. The optimal rational decision was defined as maximizing expected profit, and economic efficiency was assessed by calculating the Incremental Cost-Effectiveness Ratio (ICER) for years of life gained.</p></div><div><h3>Results</h3><p>Of the 185 patients tested, 101 (55%) received invasive mechanical ventilation immediately and 84 (45%) were treated with HFNO at the outset. In the cost-effectiveness analysis, comparing both therapeutic strategies, the probability that the experimental strategy would be more effective was 0.974, reaching statistical significance: Difference in average proportions -0.113; 95% CI:-0.018 to -0.208. This corresponds to an NNT of 9 patients. The optimal decision was HFNO's strategy followed by VMI in HFNO failures. This option had an RCEI of 5582 euros per year of life gained.</p></div><div><h3>Conclusions</h3><p>It is important to establish in the future reliable markers in the use of HFNO so that this therapy improves its cost-effective benefits.</p></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50175793","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}