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Ruiz de Assín Valverde A, Alfaro Martínez JJ, López García MC, Jara Vidal M, Gallach Martínez M, Roig-Marin N, Quílez Toboso RP, Gonzalvo Díaz C, García Blasco L, Pinés Corrales PJ, Lamas Oliveira C, Aznar Rodríguez S, Parreño Caparrós E, López Jiménez LM. Evolution of interconsultal activity to endocrinology and nutrition in hospitalization floor in a third level hospital. ENDOCRINOL DIAB NUTR 2024; 71:163-170. [PMID: 38714475 DOI: 10.1016/j.endien.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/07/2024] [Indexed: 05/10/2024]
Abstract
INTRODUCTION Endocrinology and Nutrition (EyN) is an outpatient and hospital medical specialty. This study aims to understand the evolution of the activity of interdepartmental consultation (IC) carried out by EyN in hospitalization floor of a third level hospital, comparing its evolution with other medical specialties, and comparing endocrine IC with nutritional IC. MATERIAL AND METHODS Longitudinal and retrospective study which analyzes IC notes of EyN and other medical specialties between 01-01-2013 and 31-12-2022. RESULTS A total of 76093 IC notes (12623 patients) were performed by the EyN service (average age 65.4 years; 59% male) with an average of 4.8 notes per patient. Average annual growth was 7% in notes and 4% in patients (versus 6% and 3% of all other medical services, differences statistically significant). Of all patients hospitalized for 4 or more days, EyN went from attending 7.9% (2013) to 12.3% (2022). 66% of the IC performed by EyN was for nutritional cause and 34% for other pathologies. CONCLUSIONS The EyN service is the one that most patients attend in hospital IC activity, with growth over the last few years greater than other medical specialties. Nutritional pathology is the main reason for IC.
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Affiliation(s)
| | | | | | | | | | - Noel Roig-Marin
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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Santamaria J, Bretón I, Fernández A, Hanzu F, Luque R, Pinés P, Tejera C, Zugasti A, Del Prado N, Elola J, Escalada J. RECALSEEN 2021. Resources and quality in the Endocrinology and Nutrition units of the National Health System of Spain. ENDOCRINOL DIAB NUTR 2023; 70:459-467. [PMID: 37516609 DOI: 10.1016/j.endien.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/19/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES RECALSEEN project aims to analyze the structure, activity, and outcomes of the departments of endocrinology and nutrition (S-U_EyN) of the Spanish National Health System (SNHS). Based on the results obtained, the challenges for the specialty are analyzed and proposals for improvement policies are made. In this paper 2021 survey data and activity data from the 2007-2019 from the Minimum Basic Data Set (MBDS) are presented. MATERIAL AND METHODS Cross-sectional descriptive study of the S-U_EyN of acute general hospitals of the NHS in 2020. Data were obtained through: 1. an "ad hoc" survey answered by the S-U_EyN' consultants; and 2. analysing the acute general hospital discharges from S-U_EyN and discharges with endocrine-metabolic comorbidities registered in the minimum basis data set (MBDS) of the SNHS. RESULTS 112 responses from S-U_EyN were obtained from a total of 154 general acute hospitals of the NHS (73%). The 2021 S-U_EyN sample includes 24 more centers than in 2017. 54% of the S-U_EyN were endocrinology departments. The median number of endocrinologists per S-U_EyN was 7. The estimated rate of endocrinologists was 2.5 per 100,000 inhabitants. S-U_EyN showed a high level of collaboration with primary care teams and other hospital units. Use of telemedicine by S-U_EyN experienced a high increase in 2020. Notable differences in resources and activity have been found between hospitals and Autonomous Communities. There was a wide margin for improvement in quality management. CONCLUSIONS RECALSEEN is a useful project for the analysis of S-U_EyN. The remarkable variability found in the indicators of structure, activity and management probably indicates a wide margin for improvement.
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Affiliation(s)
- Javier Santamaria
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Hospital Universitario de Cruces, Barakaldo, Bizcaia, Spain
| | - Irene Bretón
- Presidenta de la Fundación de la Sociedad Española de Endocrinología y Nutrición, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Fernández
- Secretario de la Sociedad Española de Endocrinología y Nutrición, Hospital Universitario de Móstoles, Madrid, Spain
| | - Felicia Hanzu
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Raúl Luque
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Universidad de Córdoba/Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Pedro Pinés
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Cristina Tejera
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol, El Ferrol, Spain
| | - Ana Zugasti
- Vocal de la Sociedad Española de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain.
| | - Javier Escalada
- Presidente de la Sociedad Española de Endocrinología y Nutrición, Clínica Universidad de Navarra, Pamplona, Spain
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Cancer Minchot E, Elola Somoza FJ, Fernández Pérez C, Bernal Sobrino JL, Bretón Lesmes I, Botella Romero F. RECALSEEN. Subgroup: Patient care in the clinical nutrition units of the Spanish National Health System. ENDOCRINOL DIAB NUTR 2021; 68:354-362. [PMID: 34556266 DOI: 10.1016/j.endien.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Artificial nutrition (AI) is one of the most representative examples of coordinated therapeutic programs, and therefore requires adequate development and organization. The first clinical nutrition units (CNUs) emerged in the public hospitals of the Spanish National Health System (NHS) in the 80s and have gradually been incorporated into the departments of endocrinology and nutrition (DENs). The purpose of our article is to report on the results found in the RECALSEEN study as regards the professional and organizational aspects relating to CNUs and their structure and operation. MATERIALS AND METHODS Data were collected from the RECALSEEN study, a cross-sectional, descriptive study of the DENs in the Spanish NHS in 2016. The survey was compiled from March to September 2017. Qualitative variables were reported as frequency distributions (number of cases and percentages), and quantitative variables as the mean, median, and standard deviation (SD). RESULTS A total of 88 (70%) DENs, out of a total of 125 general acute hospitals of the NHS with 200 or more installed beds, completed the survey. CNUs were available in 83% of DENs (98% in hospitals with 500 or more beds). As a median, DENs had one nurse dedicated to nutrition (35% did not have this resource). Fifty-three percent of DENs with nutrition units had dieticians integrated into the unit (median: 1). DENs located in hospitals with 500 or more beds are more complex and have a wide portfolio of monographic unit services (morbid obesity, 78.3%; artificial home nutrition, 87%; chronic diseases, 65.2%) and specific techniques (impedanciometry, 78%). However, only 14% of the centers perform universal screening tests for malnutrition, and a secondary diagnosis of malnutrition only appears in 12.3 reports per 1000 hospital discharges. DISCUSSION After the 1997 and 2003 studies, the results of 2017 show a marked growth and consolidation of CNUs within the DENs in most hospitals. Today, the growth of this specialty is largely due to the care demand created by hospital clinical nutrition. CNUs still have an insufficient nursing staff and dietitians/nutritionists, and in the latter case, atypical contracts or grants funded by research projects or the pharmaceutical industry are common. Units for specific nutritional diseases and participation in multidisciplinary groups, quite heterogeneous, are concentrated in hospitals with 500 or more beds and represent an excellent opportunity for CNU development. CONCLUSIONS Many DENs of Spanish hospitals include CNUs where care is provided by endocrinologists, who devote most of their time to clinical nutrition in more than half of the hospitals. This is most common in large centers with a high workload in relation to staffing. There is considerable heterogeneity between hospitals in terms of both the number and type of activity of the CNUs.
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Affiliation(s)
| | | | - Cristina Fernández Pérez
- Fundación Instituto para la mejora de la asistencia sanitaria, Hospital Clínico San Carlos, Madrid, Spain
| | - José Luis Bernal Sobrino
- Fundación Instituto para la mejora de la asistencia sanitaria, Hospital Universitario 12 de Octubre, Madrid, Spain
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Alfaro Martínez JJ, Peña-Cortés VM, Gómez-García IR, Platero-Rodrigo E, Moreno-Fernandez J, Calderón-Vicente DM, Martínez-García A, Barrera-Martín A, Sanz-Velasco A, Miralles-Moragrega R, Palma-Moya M, Gonzalvo-Díaz C. Health care activity at the endocrinology and nutrition outpatient clinics of Castilla-La Mancha (the AACENCAM study). ENDOCRINOL DIAB NUTR 2021; 68:251-259. [PMID: 34266637 DOI: 10.1016/j.endien.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/24/2019] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study was promoted by Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes to ascertain the characteristics of patients seen at the outpatient clinics of endocrinology and nutrition of the Castilla-La Mancha Health Authority and the case mix of diagnoses. PATIENTS AND METHODS This was a retrospective, cross-sectional study of the activity of the endocrinology and nutrition outpatient clinics of public hospitals of Castile-La Mancha during 2018. All visits made on 10% of the working days were analyzed. Data collected comprised patient age and sex, whether a first or subsequent had been made, and whether this was face-to-face or not, and up to five diagnoses per visit. RESULTS A total of 10,709 visits with a subsequent/first visit ratio of 3.4 were analyzed. Patient age was 52.1?±?18.2 years, and 67.1% were women. Type 2 diabetes mellitus, primary hypothyroidism, thyroid nodular disease, and obesity/overweight were the most common conditions recorded as first diagnosis, accounting for more than half of the total number of visits. Type 1 diabetes mellitus and thyroid cancer were the diagnoses in which the subsequent/first visit ratio was greater. Type 2 diabetes mellitus, obesity, and primary hypothyroidism accounted for almost half of the first visits. CONCLUSIONS A wide variety of conditions were seen, some of which are among the most prevalent in the general population, while others are not so prevalent, but are complex and difficult to manage by other specialties. Improved knowledge and analysis of the data should allow for the identification of opportunities for improvement and for the implementation of specific actions.
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Affiliation(s)
| | | | - Inés-Rosa Gómez-García
- Servicio de Endocrinología y Nutrición, Hospital La Mancha-Centro, Alcázar de San Juan y Hospital de Tomelloso, Spain
| | | | - Jesús Moreno-Fernandez
- Servicio de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Spain
| | | | - Ana Martínez-García
- Servicio de Endocrinología y Nutrición, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain
| | - Ana Barrera-Martín
- Unidad de Endocrinología y Nutrición, Hospital Santa Bárbara, Puertollano, Spain
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Alfaro Martínez JJ, Peña-Cortés VM, Gómez-García IR, Platero-Rodrigo E, Moreno-Fernández J, Calderón-Vicente DM, Martínez-García A, Barrera-Martín A, Sanz-Velasco A, Miralles-Moragrega R, Palma-Moya M, Gonzalvo-Díaz C. Actividad asistencial en las consultas de Endocrinología y Nutrición de Castilla-La Mancha (estudio AACENCAM). ENDOCRINOL DIAB NUTR 2021; 68:251-259. [DOI: 10.1016/j.endinu.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 10/24/2022]
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[Pillars for excellence in nutrition support units. Training]. NUTR HOSP 2021; 38:1-7. [PMID: 33525885 DOI: 10.20960/nh.03554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Few areas of current medicine have undergone change and evolution in recent years such as those of clinical nutrition. Currently, 98 % of endocrinology and nutrition departments in hospitals with 500 or more beds incorporate a clinical nutrition and dietetics Unit. The training of the professionals that integrate these units has been and will be a key point in their ongoing development towards excellence. In medicine degree studies, despite its relevance, nutrition training is currently scarce and heterogeneous, and needs improvement, which may come hand in hand with the recently published ESPEN proposals. In the case of doctors specializing in endocrinology and nutrition, the adaptations in the teaching program established by the National Commission for this specialty, and the training efforts led by the SEEN have allowed significant improvement. In hospital pharmacy studies there is a nutrition training curriculum that could be updated. University training in nutrition within the nursing degree is also heterogeneous. The most related studies such as the Degree of Human Nutrition and Dietetics, Technician in Dietetics, Food Science and Technology or Bromatology fundamentally address issues related to dietetics. There is a lack of coordinated effort to define the role of the members of these multidisciplinary UNCyDs, also in regard to their training.
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[Pillars for excellence in nutrition support units. Regulation]. NUTR HOSP 2021; 38:8-14. [PMID: 33525887 DOI: 10.20960/nh.03555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Nutritional assessment and treatment, necessary for the prevention and treatment of disease-related malnutrition, should be carried out by a multidisciplinary team where each member has well-defined skills and functions, and mechanisms are established to allow adequate coordination, both in the inpatient and outpatient settings. In Spain, the development and implementation of these teams or units dedicated to clinical nutrition has been very important: today they are present in most hospitals. This paper reviews the characteristics of clinical nutrition units, the functions of their team members, and the regulatory framework in our country.
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Debate: healthcare professionals in nutrition support teams. NUTR HOSP 2021; 38:41-45. [PMID: 33525886 DOI: 10.20960/nh.03560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction The debate from the course preceding the SENPE (Spanish Society of Clinical Nutrition and Metabolism) 2020 Conference gathered together well-known professionals who form part of nutritional support teams (NSTs), as well as other specialists from departments whose patients benefit from the services offered by these NSTs. In this article, relevant points from the round table, including strengths and weaknesses detected in the implementation of nutrition support teams, are summarized.
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Desarrollo de un índice de complejidad en consultas externas de Endocrinología y Nutrición. ENDOCRINOL DIAB NUTR 2020; 67:500-508. [DOI: 10.1016/j.endinu.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/21/2022]
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10
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Cancer Minchot E, Elola Somoza FJ, Fernández Pérez C, Bernal Sobrino JL, Bretón Lesmes I, Botella Romero F. RECALSEEN. Subgroup: Patient care in the clinical nutrition units of the Spanish National Health System. ACTA ACUST UNITED AC 2020; 68:354-362. [PMID: 32792301 DOI: 10.1016/j.endinu.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Artificial nutrition (AI) is one of the most representative examples of coordinated therapeutic programs, and therefore requires adequate development and organization. The first clinical nutrition units (CNUs) emerged in the public hospitals of the Spanish National Health System (NHS) in the 80s and have gradually been incorporated into the departments of endocrinology and nutrition (DENs). The purpose of our article is to report on the results found in the RECALSEEN study as regards the professional and organizational aspects relating to CNUs and their structure and operation. MATERIALS AND METHODS Data were collected from the RECALSEEN study, a cross-sectional, descriptive study of the DENs in the Spanish NHS in 2016. The survey was compiled from March to September 2017. Qualitative variables were reported as frequency distributions (number of cases and percentages), and quantitative variables as the mean, median, and standard deviation (SD). RESULTS A total of 88 (70%) DENs, out of a total of 125 general acute hospitals of the NHS with 200 or more installed beds, completed the survey. CNUs were available in 83% of DENs (98% in hospitals with 500 or more beds). As a median, DENs had one nurse dedicated to nutrition (35% did not have this resource). Fifty-three percent of DENs with nutrition units had dieticians integrated into the unit (median: 1). DENs located in hospitals with 500 or more beds are more complex and have a wide portfolio of monographic unit services (morbid obesity, 78.3%; artificial home nutrition, 87%; chronic diseases, 65.2%) and specific techniques (impedanciometry, 78%). However, only 14% of the centers perform universal screening tests for malnutrition, and a secondary diagnosis of malnutrition only appears in 12.3 reports per 1000 hospital discharges. DISCUSSION After the 1997 and 2003 studies, the results of 2017 show a marked growth and consolidation of CNUs within the DENs in most hospitals. Today, the growth of this specialty is largely due to the care demand created by hospital clinical nutrition. CNUs still have an insufficient nursing staff and dietitians/nutritionists, and in the latter case, atypical contracts or grants funded by research projects or the pharmaceutical industry are common. Units for specific nutritional diseases and participation in multidisciplinary groups, quite heterogeneous, are concentrated in hospitals with 500 or more beds and represent an excellent opportunity for CNU development. CONCLUSIONS Many DENs of Spanish hospitals include CNUs where care is provided by endocrinologists, who devote most of their time to clinical nutrition in more than half of the hospitals. This is most common in large centers with a high workload in relation to staffing. There is considerable heterogeneity between hospitals in terms of both the number and type of activity of the CNUs.
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Affiliation(s)
| | | | - Cristina Fernández Pérez
- Fundación Instituto para la mejora de la asistencia sanitaria, Hospital Clínico San Carlos, Madrid, España
| | - José Luis Bernal Sobrino
- Fundación Instituto para la mejora de la asistencia sanitaria, Hospital Universitario 12 de Octubre, Madrid, España
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Alfaro-Martínez JJ, Peña-Cortés VM, Moreno-Fernández J, Platero-Rodrigo E, Calderón-Vicente DM, Gómez-García IR, Martínez-García A, Sanz-Velasco A, Gonzalvo-Díaz C, Miralles-Moragrega R. Healthcare on the Endocrinology and Nutrition ward in Castille-La Mancha (the AAPENCAM study). ACTA ACUST UNITED AC 2020; 67:665-671. [PMID: 32499203 DOI: 10.1016/j.endinu.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The activity of an Endocrinology and Nutrition (E&N) department consists of inpatient care both by those attached to the department and through consultations with specialists from other departments. The inpatient care activity of all the E&N departments of a public health system has not been studied in Spain. MATERIAL AND METHODS This was a retrospective study of hospital ward activity during 2018 of the E&N departments of the Castilla-La Mancha Public Health Service. It was undertaken in order to ascertain the characteristics of the patients attended to, both by those in charge of the E&N departments and through interconsultation with other departments, as well as the case-mix of the pathology of these patients. All patients admitted to E&N and a 10% sample of those treated through interconsultation were analysed. RESULTS 261 admissions were recorded for Castilla-La Mancha Public Health Service E&N departments. 82.8% were urgent and 53.7% were due to type 1 diabetes mellitus. A total of 5955 patients were seen on an interconsultation basis, 591 of whom were analysed. The most frequent reason for interconsultation was diabetes mellitus/hyperglucemia (28.8%), requiring 6.1±6.7 days per patient. However, interconsultations for artificial nutrition required more days of attendance per patient and accounted for a higher percentage of the total number of days of interconsultation (60.4%). CONCLUSIONS The inpatient care activity of the E&N departments of Castilla-La Mancha Public Health Service mainly consists of attending to patients with chronic pathologies of high hospital prevalence such as diabetes mellitus/hyperglucemia and, especially, clinical nutrition.
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Affiliation(s)
| | | | - Jesús Moreno-Fernández
- Servicio de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Eduardo Platero-Rodrigo
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Guadalajara, Guadalajara, España
| | | | - Inés-Rosa Gómez-García
- Servicio de Endocrinología y Nutrición, Hospital La Mancha-Centro, Alcázar de San Juan, España
| | - Ana Martínez-García
- Servicio de Endocrinología y Nutrición, Hospital Nuestra Señora del Prado, Talavera de la Reina, España
| | - Alberto Sanz-Velasco
- Unidad de Endocrinología y Nutrición, Hospital General de Villarrobledo, Villarrobledo, España
| | - César Gonzalvo-Díaz
- Unidad de Endocrinología y Nutrición, Hospital General de Hellín, Hellín, España
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Reyes García R, Bernal Sobrino JL, Fernandez Pérez C, Morillas Ariño C, Azriel Mira S, Elola Somoza FJ, Breton Lesmes I, Botella Romero F. Trends on Diabetes Mellitus's healthcare management in Spain 2007-2015. Diabetes Res Clin Pract 2019; 156:107824. [PMID: 31446112 DOI: 10.1016/j.diabres.2019.107824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/01/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
Abstract
AIMS To analyze the trends on diabetes mellitus (DM) healthcare management in Spain. METHODS Retrospective observational study between January 1st 2007 and 31th December 2015 with DM as the principal diagnosis. The main clinical outcome measures were all-cause, in-hospital mortality and 30-day readmissions. We also analyze three Prevention Quality Indicators (PQI) for DM. RESULTS The number of hospitalization episodes decreased significantly as well as the frequentation rate and average length of stay (Incidence Rate Ratio [IRR] = 0.963, p < 0.001; 0.91, p < 0.001 and 0.986, p < 0.001, respectively). Crude in-hospital mortality and readmissions rates and risk-standardized in-hospital mortality rates (RSMR), however, remained stable (IRR = 0.988, p = 0.073; IRR = 1.003, p = 0.334 and IRR = 0.997, p = 0.116, respectively). A relevant variability in RSMR, both at hospital (Median Odds Ratio 1.49) and regional level, was found. High volume hospitals (≥105 DM discharges at year) showed better outcomes. High variability was also found in PQI indicators al regional level. CONCLUSION The present analysis shows an improvement in hospitalizations related to DM in Spain in the period 2007-2015. There was also a decrease in the frequentation rate and in the average length of stay. These findings are probably explained by quality improvements in the healthcare management of the DM at the ambulatory level. However, there were important differences in the management of diabetic inpatients both at the hospital and the regional level.
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Affiliation(s)
- Rebeca Reyes García
- Unidad de Endocrinología y Nutrición, Hospital Universitario Torrecárdenas, Almería, Spain; Sociedad Española de Endocrinología y Nutricion (SEEN), Spain.
| | - Jose Luis Bernal Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Hospital 12 de Octubre, Madrid, Spain
| | - Cristina Fernandez Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Hospital 12 de Octubre, Madrid, Spain
| | - Carlos Morillas Ariño
- Sociedad Española de Endocrinología y Nutricion (SEEN), Spain; Sección de Endocrinología y Nutrición, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Sharona Azriel Mira
- Sociedad Española de Endocrinología y Nutricion (SEEN), Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Infanta Sofia, Madrid, Spain
| | | | - Irene Breton Lesmes
- Sociedad Española de Endocrinología y Nutricion (SEEN), Spain; Servicio de Endocrinologia y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco Botella Romero
- Sociedad Española de Endocrinología y Nutricion (SEEN), Spain; Gerencia de Atención Integrada de Albacete, Albacete, Spain
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Botella Romero F. Present and future of postgraduate training in Clinical Nutrition. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2019; 66:343-345. [PMID: 31109824 DOI: 10.1016/j.endinu.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Francisco Botella Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España.
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