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Wale A, Okolie C, Everitt J, Hookway A, Shaw H, Little K, Lewis R, Cooper A, Edwards A. The Effectiveness and Cost-Effectiveness of Community Diagnostic Centres: A Rapid Review. Int J Public Health 2024; 69:1606243. [PMID: 38322307 PMCID: PMC10844947 DOI: 10.3389/ijph.2024.1606243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Objectives: To examine the effectiveness of community diagnostic centres as a potential solution to increasing capacity and reducing pressure on secondary care in the UK. Methods: A comprehensive search for relevant primary studies was conducted in a range of electronic sources in August 2022. Screening and critical appraisal were undertaken by two independent reviewers. There were no geographical restrictions or limits to year of publication. A narrative synthesis approach was used to analyse data and present findings. Results: Twenty primary studies evaluating twelve individual diagnostic centres were included. Most studies were specific to cancer diagnosis and evaluated diagnostic centres located within hospitals. The evidence of effectiveness appeared mixed. There is evidence to suggest diagnostic centres can reduce various waiting times and reduce pressure on secondary care. However, cost-effectiveness may depend on whether the diagnostic centre is running at full capacity. Most included studies used weak methodologies that may be inadequate to infer effectiveness. Conclusion: Further well-designed, quality research is needed to better understand the effectiveness and cost-effectiveness of community diagnostic centres.
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Affiliation(s)
- Alesha Wale
- Public Health Wales NHS Trust, Cardiff, United Kingdom
| | | | | | - Amy Hookway
- Public Health Wales NHS Trust, Cardiff, United Kingdom
| | - Hannah Shaw
- Public Health Wales NHS Trust, Cardiff, United Kingdom
| | - Kirsty Little
- Public Health Wales NHS Trust, Cardiff, United Kingdom
| | - Ruth Lewis
- North Wales Medical School, Health and Care Research Wales Evidence Centre, PRIME Centre, Wales, Bangor University, Bangor, United Kingdom
| | - Alison Cooper
- Division of Population Medicine, Health and Care Research Wales Evidence Centre, PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Adrian Edwards
- Division of Population Medicine, Health and Care Research Wales Evidence Centre, PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review. HEALTH SCOPE 2021. [DOI: 10.5812/ealthscope.112833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (mRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.
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Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review. HEALTH SCOPE 2021. [DOI: 10.5812/jhealthscope.112833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (MRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.
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Bosch X, Capdevila A, Grafia I, Ladino A, Moreno PJ, López-Soto A. The impact of Covid-19 on patients with suspected cancer: An analysis of ED presentation and referrals to a quick diagnosis unit. Am J Emerg Med 2021; 48:1-11. [PMID: 33836386 PMCID: PMC8016540 DOI: 10.1016/j.ajem.2021.03.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 01/21/2023] Open
Abstract
Purpose Patients evaluated in the emergency department (ED) who have concerning symptoms suggestive of a cancer diagnosis are mostly referred to the quick diagnosis unit of our tertiary hospital. This study analyzed the impact of the Covid-19 pandemic on the volume, disease patterns, and accessibility to essential investigations of patients with suspected cancer referred by the ED to this unit. Methods Trends in referrals were analyzed from January 1 to July 8, 2020 and the corresponding dates of 2019. Only non-Covid-19 conditions were evaluated. Three time-based cohorts were defined: prepandemic (January 1–February 19), pandemic (February 19–April 22), and postpandemic (April 22–July 8). Along with descriptive statistics, linear regression was used to test for time trends with weekly referrals as the dependent variable. Results There were 384, 193, and 450 patients referred during the prepandemic, pandemic, and postpandemic periods, respectively. Following an increasing rate, referrals decreased to unprecedented levels in the pandemic period (average weekly slope: −2.1 cases), then increasing again until near normalization. Waiting times to most diagnostic procedures including radiology, endoscopic, nuclear medicine, and biopsy/cytology during the pandemic period were significantly delayed and time-to-diagnosis was considerably longer (19.72 ± 10.37 days vs. 8.33 ± 3.94 days in prepandemic and 13.49 ± 6.45 days in postpandemic period; P < 0.001 in both). Compared to other cohorts, pandemic cohort patients were more likely to have unintentional weight loss and fever of unknown origin as referral indications while anemia and lymphadenopathy were less common. Patients from the pandemic cohort had a significantly lower rate of malignancies and higher of benign gastrointestinal disorders (40.93% vs. 19.53% and 20.89% in prepandemic and postpandemic periods, respectively; P < 0.001 in both), most notably irritable bowel disease, and of mental and behavioral disorders (15.54% vs. 3.39% and 6.00% in prepandemic and postpandemic periods, respectively; P < 0.001 in both). Conclusions As our hospital switched its traditional care to one focused on Covid-19 patients, recognized indicators of healthcare quality of quick diagnosis units were severely disrupted. The clinical patterns of presentation and diagnosis of the pandemic period suggested that mass media-generated mental and behavioral responses with distressing symptoms played a significant role in most of these patients.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Aina Capdevila
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Ignacio Grafia
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Andrea Ladino
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Pedro J Moreno
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Alfonso López-Soto
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
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Bosch X, Montori E, Merino-Peñas MJ, Compta Y, Ladino A, Ramon J, López-Soto A. A comparative cost analysis between two quick diagnosis units of different levels of complexity. J Comp Eff Res 2021; 10:381-392. [PMID: 33709770 DOI: 10.2217/cer-2020-0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare by micro-costing the costs incurred by quick diagnosis units of tertiary and second-level hospitals. Patients & methods: We included 407 patients from a tertiary and secondary hospital unit. A bottom-up approach was applied. Results: Cost per patient was €577.5 ± 219.6 in the tertiary versus €394.7 ± 92.58 in the secondary unit (p = 0.0559). Mean number of visits and ratio of successive/first visits were significantly higher in the former (3.098 and 2.07 vs 2.123 and 1.12, respectively). Personnel and indirect costs including their percent contribution to overall costs accounted for the main differences. Conclusion: A greater volume of appointments, number of staff and staff time and a greater complexity of patients from the tertiary hospital unit justified the differences in cost outcomes.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Hospital Clínic, Barcelona 08036, Spain
| | - Elisabet Montori
- Unit of Internal Medicine, University of Barcelona, Hospital Plató, Barcelona 08006, Spain
| | - Maria J Merino-Peñas
- Economic & Administrative Unit, Clinical Institute of Medicine & Dermatology (ICMiD), Hospital Clínic, Barcelona 08036, Spain
| | - Yaroslau Compta
- Department of Neurology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Hospital Clínic, Barcelona 08036, Spain
| | - Andrea Ladino
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Hospital Clínic, Barcelona 08036, Spain
| | - Jordi Ramon
- Unit of Internal Medicine, University of Barcelona, Hospital Plató, Barcelona 08006, Spain
| | - Alfonso López-Soto
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Hospital Clínic, Barcelona 08036, Spain
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Nicolás D, Camós-Carreras A, Spencer F, Arenas A, Butori E, Maymó P, Anmella G, Torrallardona-Murphy O, Alves E, García L, Pereta I, Castells E, Seijas N, Ibáñez B, Grané C, Bodro M, Cardozo C, Barroso S, Olive V, Tortajada M, Hernández C, Cucchiari D, Coloma E, Pericàs JM. A Prospective Cohort of SARS-CoV-2-Infected Health Care Workers: Clinical Characteristics, Outcomes, and Follow-up Strategy. Open Forum Infect Dis 2021; 8:ofaa592. [PMID: 33537362 PMCID: PMC7798565 DOI: 10.1093/ofid/ofaa592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/07/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) outbreaks, health care workers (HCWs) are at a high risk of infection. Strategies to reduce in-hospital transmission between HCWs and to safely manage infected HCWs are lacking. Our aim was to describe an active strategy for the management of COVID-19 in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected HCWs and investigate its outcomes. METHODS A prospective cohort study of SARS-CoV-2-infected health care workers in a tertiary teaching hospital in Barcelona, Spain, was performed. An active strategy of weekly polymerase chain reaction screening of HCWs for SARS-CoV-2 was established by the Occupational Health department. Every positive HCW was admitted to the Hospital at Home Unit with daily assessment online and in-person discretionary visits. Clinical and epidemiological data were recorded. RESULTS Of the 590 HCWs included in the cohort, 134 (22%) were asymptomatic at diagnosis, and 15% (89 patients) remained asymptomatic during follow-up. A third of positive cases were detected during routine screening. The most frequent symptoms were cough (68%), hyposmia/anosmia (49%), and fever (41%). Ten percent of the patients required specific treatment at home, while only 4% of the patients developed pneumonia. Seventeen patients required a visit to the outpatient clinic for further evaluation, and 6 of these (1%) required hospital admission. None of the HCWs included in this cohort required intensive care unit admission or died. CONCLUSIONS Active screening for SARS-CoV-2 among HCWs for early diagnosis and stopping in-hospital transmission chains proved efficacious in our institution, particularly due to the high percentage of asymptomatic HCWs. Follow-up of HCWs in Hospital at Home units is safe and effective, with low rates of severe infection and readmission.
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Affiliation(s)
- David Nicolás
- Internal Medicine Service, Hospital Clinic Barcelona, Barcelona, Spain
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | | | - Felipe Spencer
- Ophthalmology Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Andrea Arenas
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eugenia Butori
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Pol Maymó
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Gerard Anmella
- Psychiatry Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Orla Torrallardona-Murphy
- Internal Medicine Service, Hospital Clinic Barcelona, Barcelona, Spain
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eduarda Alves
- Internal Medicine Service, Hospital Clinic Barcelona, Barcelona, Spain
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Laura García
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Irene Pereta
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eva Castells
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Nuria Seijas
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Begoña Ibáñez
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Carme Grané
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
| | - Marta Bodro
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- Infectious Disease Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- Infectious Disease Service, Hospital Clínic Barcelona, Barcelona, Spain
| | - Sonia Barroso
- Human Resources Department, Workplace Health and Safety Service, Hospital Clinic Barcelona, Barcelona, Spain
| | - Victoria Olive
- Human Resources Department, Workplace Health and Safety Service, Hospital Clinic Barcelona, Barcelona, Spain
| | - Marta Tortajada
- Human Resources Department, Workplace Health and Safety Service, Hospital Clinic Barcelona, Barcelona, Spain
| | - Carme Hernández
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Cucchiari
- Renal Transplant Unit, Nephrology Service, Hospital Clinic Barcelona, Barcelona, Spain
| | - Emmanuel Coloma
- Internal Medicine Service, Hospital Clinic Barcelona, Barcelona, Spain
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Juan M Pericàs
- Internal Medicine Service, Hospital Clinic Barcelona, Barcelona, Spain
- Hospital at Home Unit, Medical and Nurse Direction, Hospital Clinic Barcelona, Barcelona, Spain
- Vall d’Hebron Institute for Research (VHIR), Barcelona, Spain
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Amorim P, Santos BS, Dias P, Silva S, Martins H. Serious Games for Stroke Telerehabilitation of Upper Limb - A Review for Future Research. Int J Telerehabil 2020; 12:65-76. [PMID: 33520096 PMCID: PMC7757643 DOI: 10.5195/ijt.2020.6326] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Maintaining appropriate home rehabilitation programs after stroke, with proper adherence and remote monitoring is a challenging task. Virtual reality (VR) - based serious games could be a strategy used in telerehabilitation (TR) to engage patients in an enjoyable and therapeutic approach. The aim of this review was to analyze the background and quality of clinical research on this matter to guide future research. The review was based on research material obtained from PubMed and Cochrane up to April 2020 using the PRISMA approach. The use of VR serious games has shown evidence of efficacy on upper limb TR after stroke, but the evidence strength is still low due to a limited number of randomized controlled trials (RCT), a small number of participants involved, and heterogeneous samples. Although this is a promising strategy to complement conventional rehabilitation, further investigation is needed to strengthen the evidence of effectiveness and support the dissemination of the developed solutions.
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Affiliation(s)
- Paula Amorim
- Faculty of Health Sciences, University of Beira Interior, Portugal
| | - Beatriz Sousa Santos
- Institute of Electronics and Informatics Engineering of Aveiro.,Department of Electronics Telecommunications and Informatics, University of Aveiro, Portugal
| | - Paulo Dias
- Institute of Electronics and Informatics Engineering of Aveiro.,Department of Electronics Telecommunications and Informatics, University of Aveiro, Portugal
| | - Samuel Silva
- Institute of Electronics and Informatics Engineering of Aveiro
| | - Henrique Martins
- Faculty of Health Sciences, University of Beira Interior, Portugal
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Delforge J, Sovaila S, Alix L, Didon A, Steichen O, Ranque B, Froissart A, Amadou K, Hanslik T, Cador B, Bergmann JF, Mekininan A, Goujard C, Gayet S, Cathebras P, Fantin B, Raigniac D, Weber JC, Rosenthal E, Hery L, Andres E, Benhamou Y, Bourgarit A. [Characteristics of patients admitted from emergency units in 18 internal medicine departments and organisation of these departments: A cross sectional study from SNFMI (SiFMI study group) in 2015]. Rev Med Interne 2020; 42:79-85. [PMID: 33160706 DOI: 10.1016/j.revmed.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/04/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients admitted from emergency units represent a large portion of the population in internal medicine departments. The aim of this study is to identify characteristics of patients and organization of these departments. METHODS Between June 29th and July 26th 2015, voluntary internal medicine departments from the SiFMI group prospectively filled anonymized internet forms to collect data of each patients admitted in their ward from emergency units, during seven consecutive days. RESULTS Three hundred and sixty-five patients from emergency departments were admitted in 18 internal medicine inpatients departments, totalling 1100 beds and 33,530 annual stays, 56% of them for emergency units inpatients. Mean age was 68 years, 54% were women, mean Charlson score was 2.6 and 44% of the patients took at least three drugs. Main causes of hospitalization were infectious (29%) and neurological (17%) diseases. Mean length of stay was 9.2 days. The medical team was composed by a median value of 4,5 [2,75-6,25] senior full-time equivalents, 86% were internists. Each department except one received residents, two third of them were from general medicine. CONCLUSION This study highlights a high organizational variability among internal medicine departments and patients, and sets internal medicine as a specialty with a great capacity to achieve an integrative/comprehensive management of patients and to offer a comprehensive basis for physicians in training.
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Affiliation(s)
- J Delforge
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - S Sovaila
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - L Alix
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - A Didon
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - O Steichen
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - B Ranque
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Froissart
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - K Amadou
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - T Hanslik
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - B Cador
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - J F Bergmann
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Mekininan
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - C Goujard
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - S Gayet
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - P Cathebras
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - B Fantin
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - D Raigniac
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - J C Weber
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - E Rosenthal
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - L Hery
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - E Andres
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Y Benhamou
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Bourgarit
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
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- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
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Trends in Hospitalization of Patients with Potentially Serious Diseases Evaluated at a Quick Diagnosis Clinic. Diagnostics (Basel) 2020; 10:diagnostics10080585. [PMID: 32823623 PMCID: PMC7460236 DOI: 10.3390/diagnostics10080585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/01/2020] [Accepted: 08/10/2020] [Indexed: 02/01/2023] Open
Abstract
Although quick diagnosis units (QDU) have become a cost-effective alternative to inpatient admission for diagnosis of potentially serious diseases, the rate of return hospitalizations among evaluated patients is unknown. This study examined the temporal trends in admissions of QDU patients through 15 years. Adult patients referred to QDU from 2004 to 2019 who were hospitalized between the first and last visit in the unit were eligible. Decisions about admissions were mainly based on the Appropriateness Evaluation Protocol and required independent validation by experienced clinicians using a customized tool. The final analysis included 825 patients. Patient characteristics and major reasons for admission were compared each year and linear trends were analyzed. Admission rates decreased from 7.2% in 2004–2005 to 4.3% in 2018–2019 (p < 0.0001). While a significant increasing trend was observed in the rate of admissions due to cancer-related complications (from 39.5% in 2004–2005 to 61.7% in 2018–2019; p < 0.0001), those due to anemia-related complications and scheduled invasive procedures experienced a significant downward trend. A likely explanation for these declining trends was the relocation of the unit to a new daycare center in 2013–2014 with recovery rooms and armchairs for IV treatments. The facts of this study could help in the provision of anticipatory guidance for the optimal management of patients at risk of clinical complications.
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10
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Montori-Palacín E, Ramon J, Compta Y, Insa M, Prieto-González S, Carrasco-Miserachs I, Vidal-Serra RX, Altes-Capella J, López-Soto A, Bosch X. Quick diagnosis units: predictors of time to diagnosis and costs. Medicine (Baltimore) 2020; 99:e21241. [PMID: 32791698 PMCID: PMC7386954 DOI: 10.1097/md.0000000000021241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Financial crisis has forced health systems to seek alternatives to hospitalization-based healthcare. Quick diagnosis units (QDUs) are cost-effective compared to hospitalization, but the determinants of QDU costs have not been studied.We aimed at assessing the predictors of costs of a district hospital QDU (Hospital Plató, Barcelona) between 2009 and 2016.This study was a retrospective longitudinal single center study of 404 consecutive outpatients referred to the QDU of Hospital Plató. The referral reason was dichotomized into suggestive of malignancy vs other. The final diagnosis was dichotomized into organic vs nonorganic and malignancy vs nonmalignancy. All individual resource costs were obtained from the finance department to conduct a micro-costing analysis of the study period.Mean age was 62 ± 20 years (women = 56%), and median time-to-diagnosis, 12 days. Total and partial costs were greater in cases with final diagnosis of organic vs nonorganic disorder, as it was in those with symptoms suggestive or a final diagnosis of cancer vs noncancer. Of all subcosts, imaging showed the stronger correlation with total cost. Time-to-diagnosis and imaging costs were significant predictors of total cost above the median in binary logistic regression, with imaging costs also being a significant predictor in multiple linear regression (with total cost as quantitative outcome).Predictors of QDU costs are partly nonmodifiable (i.e., cancer suspicion, actually one of the goals of QDUs). Yet, improved primary-care-to-hospital referral circuits reducing time to diagnosis as well as optimized imaging protocols might further increase the QDU cost-effectiveness process. Prospective studies (ideally with direct comparison to conventional hospitalization costs) are needed to explore this possibility.
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Affiliation(s)
| | | | - Yaroslau Compta
- Neurology Service, Hospital Clínic de Barcelona/Department of Medicine
| | | | - Sergio Prieto-González
- Department of Internal Medicine, Hospital Clínic de Barcelona, University of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | | | - Alfons López-Soto
- Department of Internal Medicine, Hospital Clínic de Barcelona, University of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Bosch
- Department of Internal Medicine, Hospital Clínic de Barcelona, University of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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11
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Arias-de la Torre J, Zioga EAM, Macorigh L, Muñoz L, Estrada O, Mias M, Estrada MD, Puigdomenech E, Valderas JM, Martín V, Molina AJ, Espallargues M. Differences in Results and Related Factors Between Hospital-at-Home Modalities in Catalonia: A Cross-Sectional Study. J Clin Med 2020; 9:jcm9051461. [PMID: 32414161 PMCID: PMC7361969 DOI: 10.3390/jcm9051461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/02/2022] Open
Abstract
Hospital-at-home (HaH) is a healthcare modality that provides active treatment by healthcare staff in the patient’s home for a condition that would otherwise require hospitalization. The aims were to describe the characteristics of different types of hospital-at-home (HaH), assess their results, and examine which factors could be related to these results. A cross-sectional study based on data from all 2014 HaH contacts from Catalonia was designed. The following HaH modalities were considered—admission avoidance (n = 7214; 75.1%) and early assisted discharge (n = 2387; 24.9%). The main outcome indicators were readmission, mortality, and length of stay (days). Multivariable models were fitted to assess the association between explanatory factors and outcomes. Hospital admission avoidance is a scheme in which, instead of being admitted to acute care hospitals, patients are directly treated in their own homes. Early assisted discharge is a scheme in which hospital in-care patients continue their treatment at home. In the hospital avoidance modality, there were 8.3% readmissions, 0.9% mortality, and a mean length of stay (SD) of 9.6 (10.6) days. In the early assisted discharge modality, these figures were 7.9%, 0.5%, and 9.8 (11.1), respectively. In both modalities, readmission and mean length of stay were related to comorbidity and type of hospital, and mortality with age. The results of HaH in Catalonia are similar to those observed in other contexts. The factors related to these results identified might help to improve the effectiveness and efficiency of the different HaH modalities.
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Affiliation(s)
- Jorge Arias-de la Torre
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Instituto de Biomedicina (IBIOMED). Universidad de León, 24004 León, Spain;
- Correspondence:
| | | | - Lizza Macorigh
- Departamento de Medicina Interna, Hospital de Granollers, 08402 Barcelona, Spain;
| | - Laura Muñoz
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28029 Madrid, Spain
| | - Oriol Estrada
- Dirección de Procesos Asistenciales y Alianzas. Gerencia Territorial Metropolitana Nord, Institut Català de la Salut, 08007 Barcelona, Spain;
| | - Montse Mias
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
| | - Maria-Dolors Estrada
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Elisa Puigdomenech
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28029 Madrid, Spain
| | - Jose M. Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter EX2 4TE, UK;
| | - Vicente Martín
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Instituto de Biomedicina (IBIOMED). Universidad de León, 24004 León, Spain;
| | - Antonio J. Molina
- Instituto de Biomedicina (IBIOMED). Universidad de León, 24004 León, Spain;
| | - Mireia Espallargues
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), 08005 Barcelona, Spain; (L.M.); (M.M.); (M.-D.E.); (E.P.); (M.E.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28029 Madrid, Spain
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12
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Cremades M, Ferret G, Parés D, Navinés J, Espin F, Pardo F, Caballero A, Viciano M, Julian JF. Telemedicine to follow patients in a general surgery department. A randomized controlled trial. Am J Surg 2020; 219:882-887. [PMID: 32252983 DOI: 10.1016/j.amjsurg.2020.03.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Telemedicine is becoming more popular in many medical specialties but few studies have been conducted in General Surgery. This study aims to evaluate the feasibility of its introduction in this specialty. METHODS A prospective randomized clinical trial (RCT) was conducted in 200 patients to compare conventional vs telemedicine follow-up in the outpatient clinics. The primary outcome was the feasibility of telemedicine follow-up and the secondary outcomes were its clinical impact and patient satisfaction. RESULTS Patients were enrolled between March 2017 and April 2018 and there were no statistically significant differences between the groups' characteristics. The primary outcome was achieved in 90% of the conventional follow-up group and in 74% of the telemedicine group (P = 0.003). No differences were found in clinical outcomes (P = 0.832) or patient satisfaction (P = 0.099). CONCLUSION Telemedicine is a good complementary service to facilitate follow-up management in selected patients from a General Surgery department.
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Affiliation(s)
- Manel Cremades
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain.
| | - Georgina Ferret
- General Surgery, Hospital Universitari Doctor Josep Trueta, Spain
| | - David Parés
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Jordi Navinés
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Franc Espin
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Fernando Pardo
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Albert Caballero
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Marta Viciano
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
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13
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Pericà S JM, Llopis J, González-Ramallo V, Goenaga MÁ, Muñoz P, García-Leoni ME, Fariñas MC, Pajarón M, Ambrosioni J, Luque R, Goikoetxea J, Oteo JA, Carrizo E, Bodro M, Reguera-Iglesias JM, Navas E, Hidalgo-Tenorio C, Miró JM. Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis: A Prospective Cohort Study From the GAMES Cohort. Clin Infect Dis 2019; 69:1690-1700. [PMID: 30649282 DOI: 10.1093/cid/ciz030] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). METHODS Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed. RESULTS A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09-.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22-.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. CONCLUSIONS OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.
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Affiliation(s)
- Juan M Pericà S
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | - Jaume Llopis
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | - Víctor González-Ramallo
- Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria, Gregorio Marañón. Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES, CB06/06/0058), Department of Medicine, Universidad Complutense de Madrid, Santander
| | | | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria, Gregorio Marañón. Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES, CB06/06/0058), Department of Medicine, Universidad Complutense de Madrid, Santander
| | - M Eugenia García-Leoni
- Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria, Gregorio Marañón. Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES, CB06/06/0058), Department of Medicine, Universidad Complutense de Madrid, Santander
| | - M Carmen Fariñas
- Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Marcos Pajarón
- Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Juan Ambrosioni
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | - Rafael Luque
- Hospital Universitario Virgen del Rocío, Sevilla
| | | | | | - Enara Carrizo
- Hospital Universitario de Araba-Txagorritxu, Gasteiz
| | - Marta Bodro
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
| | | | | | | | - José M Miró
- Hospital Clínic de Barcelona, Institut de Recerca Augusti Pi i Sunyer, Universitat de Barcelona, Santander
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14
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Vaartio-Rajalin H, Fagerström L. Professional care at home: Patient-centredness, interprofessionality and effectivity? A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e270-e288. [PMID: 30843316 DOI: 10.1111/hsc.12731] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/07/2019] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
The aim of this scoping review was to describe the state of knowledge on professional care at home with regard to different perspectives on patient-centredness, content of care, interprofessional collaboration, competence framework and effectivity. A scoping review, n = 35 papers, from four databases (EBSCO, CINAHL, Medline, Swemed) were reviewed between May and August 2018 using the terms: hospital-at-home, hospital-in-the-home, advanced home healthcare, hospital-based home care or patient-centered medical home. Criteria for inclusion in this review included full text papers, published between 2001 and 2018, in English, Swedish or Finnish. A descriptive content analysis was conducted. Patient-centredness appears to be one aim of professional care at home, but clarity is lacking regarding patient recruitment and the planning and evaluation of care. Content depends, to a certain degree, on the type of care at home and how it is organised: the more non-acute care needs, the more nurse-coordinated care and family involvement and the less interprofessionality. The competence framework presupposed for care at home was extensive yet not explicit, varying from maturity, clinical experience, collaboration skills, ongoing clinical assessment education to Master's studies or degree. The effectivity of care at home services was discussed in terms of experiential, clinical and economic aspects. Patients and their family caregivers were satisfied with care at home, but there was no consensus on clinical or economic outcomes compared with inpatient care. In the context of professional care at home, there is still a lot to do regarding patient-centredness, patient recruitment, patient and care staff education, the organisation of interprofessional collaboration and the analysis of effectivity.
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Affiliation(s)
- Heli Vaartio-Rajalin
- Department of Caring Science, Åbo Akademi University, Vasa, Finland
- Nursing Program, Novia University of Applied Sciences, Åbo, Finland
| | - Lisbeth Fagerström
- Department of Caring Science, Åbo Akademi University, Vasa, Finland
- University of South-Eastern Norway, Kongsberg, Norway
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15
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Lopez-de-Andres A, de Miguel-Diez J, Hernandez-Barrera V, Jiménez-Trujillo I, Martinez-Huedo MA, Del Barrio JL, Jimenez-Garcia R. Effect of the economic crisis on the use of health and home care services among elderly Spanish diabetes patients. Diabetes Res Clin Pract 2018; 140:27-35. [PMID: 29601915 DOI: 10.1016/j.diabres.2018.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/03/2018] [Accepted: 03/20/2018] [Indexed: 11/22/2022]
Abstract
AIMS To describe the utilization of health and home care services among older people (≥65 years) with diabetes during the economic crisis; to identify the factors associated with changes in the utilization of these services; and to study the time trends (2009-2014). METHODS We used the European Health Interview Surveys for Spain (EEHSS) for 2009/10 and 2014. The dependent variables included self-reported hospitalizations; general practitioner (GP) visits; 'other healthcare services' (OHS) used; and home care services (HCS) used. RESULTS We identified 6026 and 6020 diabetic patients (EEHSS2009 and EEHSS2014, respectively). A significant decrease in the number of GP visits (OR 0.94; 95% CI 0.91-0.98) and the use of HCS (OR 0.95; 95% CI 0.91-0.99) was found; however, we found an increase in the use of OHS (OR 1.06; 95% CI 1.02-1.10). Multivariate models showed that factors associated with an increased use included chronic conditions, worse self-rated health, pain and mental disorders. Physical activity was a strong predictor of lower hospitalizations and HCS use. Female gender was associated with significantly lower hospitalizations and a higher use of OHC and HCS. CONCLUSION We found a decrease in the number of GP visits and the use of HCS among elderly diabetic adults; however, we also observed an increase in the use of OHS, which may partly explain this decrease in the figures. Significant differences in the use of health services were found according to gender. The effect of the economic crisis, if any, seems to have had a small magnitude.
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Affiliation(s)
- Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain.
| | - Javier de Miguel-Diez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Comunidad de Madrid, Spain
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Maria-Angeles Martinez-Huedo
- Preventive Medicine and Public Health, Unidad de Docencia, Hospital Universitario La Paz, Madrid, Comunidad de Madrid, Spain
| | - José Luis Del Barrio
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
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Bosch X, Sanclemente-Ansó C, Escoda O, Monclús E, Franco-Vanegas J, Moreno P, Guerra-García M, Guasch N, López-Soto A. Time to diagnosis and associated costs of an outpatient vs inpatient setting in the diagnosis of lymphoma: a retrospective study of a large cohort of major lymphoma subtypes in Spain. BMC Cancer 2018; 18:276. [PMID: 29530002 PMCID: PMC5848556 DOI: 10.1186/s12885-018-4187-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mainly because of the diversity of clinical presentations, diagnostic delays in lymphoma can be excessive. The time spent in primary care before referral to the specialist may be relatively short compared with the interval between hospital appointment and diagnosis. Although studies have examined the diagnostic intervals and referral patterns of patients with lymphoma, the time to diagnosis of outpatient compared to inpatient settings and the costs incurred are unknown. METHODS We performed a retrospective study at two academic hospitals to evaluate the time to diagnosis and associated costs of hospital-based outpatient diagnostic clinics or conventional hospitalization in four representative lymphoma subtypes. The frequency, clinical and prognostic features of each lymphoma subtype and the activities of the two settings were analyzed. The costs incurred during the evaluation were compared by microcosting analysis. RESULTS A total of 1779 patients diagnosed between 2006 and 2016 with classical Hodgkin, large B-cell, follicular, and mature nodal peripheral T-cell lymphomas were identified. Clinically aggressive subtypes including large B-cell and peripheral T-cell lymphomas were more commonly diagnosed in inpatients than in outpatients (39.1 vs 31.2% and 18.9 vs 13.5%, respectively). For each lymphoma subtype, inpatients were older and more likely than outpatients to have systemic symptoms, worse performance status, more advanced Ann Arbor stages, and high-risk prognostic scores. The admission time for diagnosis (i.e. from admission to excisional biopsy) of inpatients was significantly shorter than the time to diagnosis of outpatients (12.3 [3.3] vs 16.2 [2.7] days; P < .001). Microcosting revealed a mean cost of €4039.56 (513.02) per inpatient and of €1408.48 (197.32) per outpatient, or a difference of €2631.08 per patient. CONCLUSIONS Although diagnosis of lymphoma was quicker with hospitalization, the outpatient approach seems to be cost-effective and not detrimental. Despite the considerable savings with the latter approach, there may be hospitalization-associated factors which may not be properly managed in an outpatient unit (e.g. aggressive lymphomas with severe symptoms) and the cost analysis did not account for this potentially added value. While outcomes were not analyzed in this study, the impact on patient outcome of an outpatient vs inpatient diagnostic setting may represent a challenging future research.
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Affiliation(s)
- Xavier Bosch
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Quick Diagnosis Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Carmen Sanclemente-Ansó
- Quick Diagnosis Unit, Department of Internal Medicine, Hospital of Bellvitge, University of Barcelona, Barcelona, Spain
| | - Ona Escoda
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esther Monclús
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Jonathan Franco-Vanegas
- Quick Diagnosis Unit, Department of Internal Medicine, Hospital of Bellvitge, University of Barcelona, Barcelona, Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Mar Guerra-García
- Adult Day Care Center, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Neus Guasch
- Adult Day Care Center, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Alfons López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
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17
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Pajarón-Guerrero M, Fernández-Miera MF, Dueñas-Puebla JC, Cagigas-Fernández C, Allende-Mancisidor I, Cristóbal-Poch L, Gómez-Fleitas M, Manzano-Peral MA, Gonzalez-Fernandez CR, Aguilera-Zubizarreta A, Sanroma-Mendizábal P. Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery. Eur Surg Res 2017; 58:263-273. [PMID: 28793287 DOI: 10.1159/000479004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/26/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND To audit the safety of the early hospital discharge care model offered by a Hospital-at-home (HAH) unit during early postoperative follow-up of these patients, and to determine whether this care model is more efficient compared to the traditional care model. METHODS A prospective study of 50 patients included consecutively for 1 year in an early discharge programme after laparoscopic colorectal surgery was performed. As of day 3 after surgery, if the patient met the relevant inclusion criteria they were transferred to the HAH unit. The domiciliary protocol consists of daily clinical follow-up and a series of analytical controls with the purpose of early detection of postoperative complications. If the clinical course was favourable on day 7 after the postoperative period the patient was discharged. RESULTS A total of 66% were males, and the mean age was 60.6 years. The surgical procedure most commonly performed was sigmoidectomy. The mean stay was 5.5 days. There were no deaths during follow-up. The average estimated cost per day of stay in a HAH system was EUR 174.29 whilst the same average cost on a surgery ward stood at EUR 1,032.42. CONCLUSIONS For patients undergoing major colorectal surgery with minimally invasive surgical technique, an early hospital discharge care programme by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.
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Affiliation(s)
- Marcos Pajarón-Guerrero
- Domiciliary Hospitalisation Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Carmen Cagigas-Fernández
- Department of General and Gastrointestinal Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Lidia Cristóbal-Poch
- Department of General and Gastrointestinal Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuel Gómez-Fleitas
- Department of General and Gastrointestinal Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Ana Aguilera-Zubizarreta
- Domiciliary Hospitalisation Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Pedro Sanroma-Mendizábal
- Domiciliary Hospitalisation Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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18
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Saini V, Garcia-Armesto S, Klemperer D, Paris V, Elshaug AG, Brownlee S, Ioannidis JPA, Fisher ES. Drivers of poor medical care. Lancet 2017; 390:178-190. [PMID: 28077235 DOI: 10.1016/s0140-6736(16)30947-3] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The global ubiquity of overuse and underuse of health-care resources and the gravity of resulting harms necessitate an investigation of drivers to inform potential solutions. We describe the network of influences that contribute to poor care and suggest that it is driven by factors that fall into three domains: money and finance; knowledge, bias, and uncertainty; and power and human relationships. In each domain the drivers operate at the global, national, regional, and individual level, and are modulated by the specific contexts within which they act. We discuss in detail drivers of poor care in each domain.
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Affiliation(s)
| | - Sandra Garcia-Armesto
- Aragon Agency for Research and Development, Zaragoza, Spain; Aragon Health Sciences Institute, Aragon, Spain
| | - David Klemperer
- Ostbayerische Technische Hochschule Regensburg, Fakultät Angewandte Sozial-und Gesundheitswissenschaften, Regensburg, Germany
| | - Valerie Paris
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Adam G Elshaug
- Lown Institute, Brookline, MA, USA; Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia
| | - Shannon Brownlee
- Lown Institute, Brookline, MA, USA; Department of Health Policy, Havard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford University, Stanford, CA, USA; Department of Statistics, Stanford University School of Humanities and Sciences and Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA
| | - Elliott S Fisher
- The Dartmouth Institute for Health Policy and Clinical Practice, Stanford University, Stanford, CA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Montori-Palacín E, Prieto-González S, Carrasco-Miserachs I, Altes-Capella J, Compta Y, López-Soto A, Bosch X. Quick outpatient diagnosis in small district or general tertiary hospitals: A comparative observational study. Medicine (Baltimore) 2017; 96:e6886. [PMID: 28562538 PMCID: PMC5459703 DOI: 10.1097/md.0000000000006886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
While quick diagnosis units (QDUs) have expanded as an innovative cost-effective alternative to admission for workup, studies investigating how QDUs compare are lacking. This study aimed to comparatively describe the diagnostic performance of the QDU of an urban district hospital and the QDU of its reference general hospital.This was an observational descriptive study of 336 consecutive outpatients aged ≥18 years referred to the QDU of a urban district hospital in Barcelona (QDU1) during 2009 to 2016 for evaluation of suspected severe conditions whose physical performance allowed them to travel from home to hospital and back for visits and examinations. For comparison purposes, 530 randomly selected outpatients aged ≥18 years referred to the QDU of the reference tertiary hospital (QDU2), also in Barcelona, were included. Clinical and QDU variables were analyzed and compared.Mean age and sex were similar (61.97 (19.93) years and 55% of females in QDU1 vs 60.0 (18.81) years and 52% of females in QDU2; P values = .14 and .10, respectively). Primary care was the main referral source in QDU1 (69%) and the emergency department in QDU2 (59%). Predominant referral reasons in QDU1 and 2 were unintentional weight loss (UWL) (21 and 16%), anemia (14 and 21%), adenopathies and/or palpable masses (10 and 11%), and gastrointestinal symptoms (10 and 19%). Time-to-diagnosis was longer in QDU1 than 2 (12 [1-28] vs 8 [4-14] days; P < .001). Malignancy was more common in QDU2 than 1 (19 vs 13%; P = .001). Patients from both groups with malignancy, aged ≥65 years and requiring >2 visits to be diagnosed were in general more likely to be males, to have UWL and adenopathies and/or palpable masses but less likely anemia, to undergo more examinations except endoscopy, and to be referred onward to specialist outpatient clinics.Despite some differences, results showed that, for diagnostic purposes, the overall performance and effectiveness of QDUs of urban district and reference general hospitals in evaluating patients with potentially serious conditions were similar. This study, the first to compare the performance of 2 hospital-based QDUs, adds evidence to the opportunity of producing standardized guidelines to optimize QDUs infrastructure, functioning, and efficiency.
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Affiliation(s)
| | - Sergio Prieto-González
- Department of Systemic Autoimmune Diseases, Hospital Clínic, University of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS)
| | | | | | - Yaroslau Compta
- Neurology Service, Hospital Clínic/Department of Biomedicine, University of Barcelona
| | - Alfons López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, López-Soto A. Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients. PLoS One 2017; 12:e0175125. [PMID: 28388637 PMCID: PMC5384681 DOI: 10.1371/journal.pone.0175125] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/21/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Whereas there are numerous studies on unintentional weight loss (UWL), these have been limited by small sample sizes, short or variable follow-up, and focus on older patients. Although some case series have revealed that malignancies escaping early detection and uncovered subsequently are exceptional, reported follow-ups have been too short or unspecified and necropsies seldom made. Our objective was to examine the etiologies, characteristics, and long-term outcome of UWL in a large cohort of outpatients. METHODS We prospectively enrolled patients referred to an outpatient diagnosis unit for evaluation of UWL as a dominant or isolated feature of disease. Eligible patients underwent a standard baseline evaluation with laboratory tests and chest X-ray. Patients without identifiable causes 6 months after presentation underwent a systematic follow-up lasting for 60 further months. Subjects aged ≥65 years without initially recognizable causes underwent an oral cavity examination, a videofluoroscopy or swallowing study, and a depression and cognitive assessment. RESULTS Overall, 2677 patients (mean age, 64.4 [14.7] years; 51% males) were included. Predominant etiologies were digestive organic disorders (nonmalignant in 17% and malignant in 16%). Psychosocial disorders explained 16% of cases. Oral disorders were second to nonhematologic malignancies as cause of UWL in patients aged ≥65 years. Although 375 (14%) patients were initially diagnosed with unexplained UWL, malignancies were detected in only 19 (5%) within the first 28 months after referral. Diagnosis was established at autopsy in 14 cases. CONCLUSION This investigation provides new information on the relevance of follow-up in the long-term clinical outcome of patients with unexplained UWL and on the role of age on this entity. Although unexplained UWL seldom constitutes a short-term medical alert, malignancies may be undetectable until death. Therefore, these patients should be followed up regularly (eg yearly visits) for longer than reported periods, and autopsies pursued when facing unsolved deaths.
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Affiliation(s)
- Xavier Bosch
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Esther Monclús
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ona Escoda
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Mar Guerra-García
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Neus Guasch
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alfons López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Bosch X, Montori E, Guerra-García M, Costa-Rodríguez J, Quintanilla MH, Tolosa-Chapasian PE, Moreno P, Guasch N, López-Soto A. A comprehensive evaluation of the gastrointestinal tract in iron-deficiency anemia with predefined hemoglobin below 9mg/dL: A prospective cohort study. Dig Liver Dis 2017; 49:417-426. [PMID: 28065528 DOI: 10.1016/j.dld.2016.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anemia is defined as hemoglobin below the cutoff of normal in studies examining the gastrointestinal (GI) tract in iron-deficiency anemia (IDA). Although the risk of GI cancer (GIC) increases as hemoglobin decreases, guidelines do not usually recommend hemoglobin thresholds for IDA investigation. METHODS To elucidate whether underlying GI disorders explain the different hemoglobin values and clinical outcomes observed initially in IDA patients referred for GI workup, we prospectively investigated the diagnostic yield of a thorough GI examination in consecutive IDA adults with predefined hemoglobin <9g/dL and no extraintestinal bleeding. RESULTS 4552 patients were enrolled over 10 years. 96% of 4038 GI lesions were consistent with occult bleeding disorders and 4% with non-bleeding disorders. Predominant bleeding disorders included upper GI ulcerative/erosive lesions (51%), GIC (15%), and angiodysplasias (12%). Diffuse angiodysplasias (45% of angiodysplasias) and GIC showed the lowest hemoglobin values (6.3 [1.5] and 6.4 [1.3]g/dL, respectively). While the spread (diffuse vs. localized) and number (<3 vs. ≥3) of angiodysplasias correlated with the degree of anemia, hemoglobin values were lower in GIC with vs. without ulcerated/friable lesions (6.0 [1.1] vs. 7.0 [1.2]g/dL, P<0.001). CONCLUSION Not only GIC but also diffuse angiodysplasias caused the most severe anemia in IDA with predefined hemoglobin values <9g/dL.
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Affiliation(s)
- Xavier Bosch
- Quick Diagnosis Unit, Adult Day Care Center, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Department of Internal Medicine, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - Elisabet Montori
- Quick Diagnosis Unit, Department of Internal Medicine, Hospital Plató, Barcelona, Spain
| | - Mar Guerra-García
- Quick Diagnosis Unit, Adult Day Care Center, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | | | | | - Pedro Moreno
- Department of Internal Medicine, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Neus Guasch
- Quick Diagnosis Unit, Adult Day Care Center, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Alfons López-Soto
- Department of Internal Medicine, Clinical Institute of Medicine and Dermatology (ICMiD), Hospital Clínic, Institutd'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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A fast-track anaemia clinic in the Emergency Department: cost-analysis of intravenous iron administration for treating iron-deficiency anaemia. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:438-446. [PMID: 28151394 DOI: 10.2450/2017.0282-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND A fast-track anaemia clinic (FTAC) for the management of moderate-to-severe iron-deficiency anaemia (IDA) was established in our Emergency Department in 2010. In this FTAC, the replacement of packed red cell transfusion by ferric carboxymaltose administration was proven to be safe and effective. The aim of this study was a cost-analysis of IDA management in the FTAC, comparing this management with the previous standard care pathway consisting of packed red cell transfusion, if needed, and referral to outpatient specialised care. MATERIALS AND METHODS A cost study was performed for patients with IDA who were at risk of requiring transfusion (haemoglobin <9 g/dL) but did not require hospitalisation. Total IDA treatment costs in the FTAC were compared to those theoretically incurred if these patients had been managed using the standard care pathway. In addition, a sensitivity analysis considering variations of up to ±30% in ferric carboxymaltose and packed red cell acquisition costs was performed (49 possible scenarios). RESULTS Between 2012 and 2015, 238 IDA patients were treated in the FTAC. The average treatment cost was € 594±337/patient in the FTAC group and € 672±301/patient in the standard care pathway group, with a saving of € 78±28/patient (95% CI, 22-133; p<0.001). The sensitivity analysis showed that IDA treatment costs in the FTAC (€ 480-722/patient), compared with those of the standard care pathway (€ 550-794/patient), resulted in significant cost-savings for all studied scenarios (€ 51-104/patient; p<0.005). DISCUSSION The administration of ferric carboxymaltose for IDA management in a FTAC may be cost-saving compared with the standard care pathway.
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Sanclemente-Ansó C, Bosch X, Salazar A, Moreno R, Capdevila C, Rosón B, Corbella X. Cost-minimization analysis favors outpatient quick diagnosis unit over hospitalization for the diagnosis of potentially serious diseases. Eur J Intern Med 2016; 30:11-17. [PMID: 26944565 DOI: 10.1016/j.ejim.2015.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Quick diagnosis units (QDUs) are a promising alternative to conventional hospitalization for the diagnosis of suspected serious diseases, most commonly cancer and severe anemia. Although QDUs are as effective as hospitalization in reaching a timely diagnosis, a full economic evaluation comparing both approaches has not been reported. AIMS To evaluate the costs of QDU vs. conventional hospitalization for the diagnosis of cancer and anemia using a cost-minimization analysis on the proven assumption that health outcomes of both approaches were equivalent. METHODS Patients referred to the QDU of Bellvitge University Hospital of Barcelona over 51 months with a final diagnosis of severe anemia (unrelated to malignancy), lymphoma, and lung cancer were compared with patients hospitalized for workup with the same diagnoses. The total cost per patient until diagnosis was analyzed. Direct and non-direct costs of QDU and hospitalization were compared. RESULTS Time to diagnosis in QDU patients (n=195) and length-of-stay in hospitalized patients (n=237) were equivalent. There were considerable costs savings from hospitalization. Highest savings for the three groups were related to fixed direct costs of hospital stays (66% of total savings). Savings related to fixed non-direct costs of structural and general functioning were 33% of total savings. Savings related to variable direct costs of investigations were 1% of total savings. Overall savings from hospitalization of all patients were €867,719.31. CONCLUSION QDUs appear to be a cost-effective resource for avoiding unnecessary hospitalization in patients with anemia and cancer. Internists, hospital executives, and healthcare authorities should consider establishing this model elsewhere.
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Affiliation(s)
- Carmen Sanclemente-Ansó
- Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
| | - Xavier Bosch
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques Auguts Pi i Sunyer, Barcelona, Catalonia, Spain
| | - Albert Salazar
- Emergency Department, Bellvitge University Hospital, Department of Medicine, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Ramón Moreno
- Department of Economic Development, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Cristina Capdevila
- Emergency Department, Bellvitge University Hospital, Department of Medicine, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Beatriz Rosón
- Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Albert J. Jovell Institute of Public Health and Patients, Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Catalonia, Spain
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Bosch X, Monclús E, Inciarte A, Moreno P, Jordán A, López-Soto A. Factors Associated with Hospitalization among Emergency Department Patients Referred for Quick Investigation of Iron-Deficiency Anemia. J Emerg Med 2016; 50:394-402.e1. [DOI: 10.1016/j.jemermed.2015.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/13/2015] [Accepted: 08/13/2015] [Indexed: 10/22/2022]
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Nolla JM, Martínez C, García-Vicuña R, Seoane-Mato D, Rosario Lozano MP, Alonso A, Alperi M, Barbazán C, Calvo J, Delgado C, Fernández-Nebro A, Mateo L, Pérez Sandoval T, Pérez Venegas J, Rodríguez Lozano C, Rosas J. Quality standards for rheumatology outpatient clinic. The EXTRELLA project. ACTA ACUST UNITED AC 2016; 12:248-55. [PMID: 26775226 DOI: 10.1016/j.reuma.2015.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/02/2015] [Accepted: 11/06/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In recent years, outpatient clinics have undergone extensive development. At present, patients with rheumatic diseases are mainly assisted in this area. However, the quality standards of care are poorly documented. OBJECTIVE To develop specific quality criteria and standards for an outpatient rheumatology clinic. METHOD The project was based on the two-round Delphi method. The following groups of participants took part: scientific committee (13 rheumatologists), five nominal groups (45 rheumatologists and 12 nurses) and a group of discussion formed by 9 patients. Different drafts were consecutively generated until a final document was obtained that included the standards that received a punctuation equal or over 7 in at least 70% of the participants. RESULTS 148 standards were developed, grouped into the following 9 dimensions: a) structure (22), b) clinical activity and relationship with the patients (34), c) planning (7), d) levels of priority (5), e) relations with primary care physicians, with Emergency Department and with other clinical departments, f) process (26), g) nursing (13), h) teaching and research (13) and i) activity measures (8). CONCLUSION This study established specific quality standards for rheumatology outpatient clinic. It can be a useful tool for organising this area in the Rheumatology Department and as a reference when proposing improvement measures to health administrators.
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Affiliation(s)
- Joan M Nolla
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - Carmen Martínez
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | - Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España
| | - Daniel Seoane-Mato
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | | | - Alberto Alonso
- Servicio de Reumatología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - Mercedes Alperi
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España
| | - Ceferino Barbazán
- Servicio de Reumatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - Jaime Calvo
- Servicio de Reumatología, Hospital Sierrallana, Torrelavega, Cantabria, España
| | - Concepción Delgado
- Servicio de Reumatología, Hospital Clínco Universitario Lozano Blesa, Zaragoza, España
| | | | - Lourdes Mateo
- Servicio de Reumatología, Hospital Universitari Germans Trías i Pujol, Badalona, Barcelona, España
| | | | - José Pérez Venegas
- Servicio de Reumatología, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, España
| | - Carlos Rodríguez Lozano
- Servicio de Reumatología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, España
| | - José Rosas
- Servicio de Reumatología, Hospital de la Marina Baixa, Villajoyosa, Alicante, España
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Sanclemente-Ansó C, Salazar A, Bosch X, Capdevila C, Giménez-Requena A, Rosón-Hernández B, Corbella X. Perception of quality of care of patients with potentially severe diseases evaluated at a distinct quick diagnostic delivery model: a cross-sectional study. BMC Health Serv Res 2015; 15:434. [PMID: 26420244 PMCID: PMC4589195 DOI: 10.1186/s12913-015-1070-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 09/17/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although hospital-based outpatient quick diagnosis units (QDU) are an increasingly recognized cost-effective alternative to hospitalization for the diagnosis of potentially serious diseases, patient perception of their quality of care has not been evaluated well enough. This cross-sectional study analyzed the perceived quality of care of a QDU of a public third-level university hospital in Barcelona. METHODS One hundred sixty-two consecutive patients aged ≥ 18 years attending the QDU over a 9-month period were invited to participate. A validated questionnaire distributed by the QDU attending physician and completed at the end of the first and last QDU visit evaluated perceived quality of care using six subscales. RESULTS Response rate was 98 %. Perceived care in all subscales was high. Waiting times were rated as 'short'/'very short' or 'better'/'much better' than expected by 69-89 % of respondents and physical environment as 'better'/'much better' than expected by 94-96 %. As to accessibility, only 3 % reported not finding the Unit easily and 7 % said that frequent travels to hospital for visits and investigations were uncomfortable. Perception of patient-physician encounter was high, with 90-94 % choosing the positive extreme ends of the clinical information and personal interaction subscales items. Mean score of willingness to recommend the Unit using an analogue scale where 0 was 'never' and 10 'without a doubt' was 9.5 (0.70). On multivariate linear regression, age >65 years was an independent predictor of clinical information, personal interaction, and recommendation, while age 18-44 years was associated with lower scores in these subscales. No schooling predicted higher clinical information and recommendation scores, while university education had remarkable negative influence on them. Having ≥4 QDU visits was associated with lower time to diagnosis and recommendation scores and malignancy was a negative predictor of time to diagnosis, clinical information, and recommendation. DISCUSSION It is worthy of note that the questionnaire evaluated patient perception and opinions of healthcare quality including recommendation rather than simply satisfaction. It has been argued that perception of quality of care is a more valuable approach than satisfaction. In addition to embracing an affective dimension, satisfaction appears more dependent on patient expectations than is perception of quality. CONCLUSIONS While appreciating that completing the questionnaire immediately after the visit and its distribution by the QDU physician may have affected the results, scores of perceived quality of care including recommendation were high. There were, however, significant differences in several subscales associated with age, education, number of QDU visits, and diagnosis of malignant vs. benign condition.
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Affiliation(s)
- Carmen Sanclemente-Ansó
- Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Biomedical Research Institute (IDIBELL), Consultas Externas, Area de Gestión Administrativa, c/Feixa Llarga s/n, 08907-L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Albert Salazar
- Emergency Department, Bellvitge University Hospital, Department of Medicine, University of Barcelona, Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Xavier Bosch
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c/Villarroel 170, 08036, Barcelona, Spain.
| | - Cristina Capdevila
- Emergency Department, Bellvitge University Hospital, Department of Medicine, University of Barcelona, Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Amparo Giménez-Requena
- Department of Quality, Bellvitge University Hospital, University of Barcelona, Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Beatriz Rosón-Hernández
- Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Biomedical Research Institute (IDIBELL), Consultas Externas, Area de Gestión Administrativa, c/Feixa Llarga s/n, 08907-L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Biomedical Research Institute (IDIBELL), Consultas Externas, Area de Gestión Administrativa, c/Feixa Llarga s/n, 08907-L'Hospitalet de Llobregat, Barcelona, Spain. .,Global Institute of Public Health and Health Policy, School of Medicine, International University of Catalonia, Barcelona, Spain.
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Bosch X. Reforming Spanish health care: a matter of survival. Health Policy 2014; 119:107-10. [PMID: 25467281 DOI: 10.1016/j.healthpol.2014.10.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 10/10/2014] [Accepted: 10/29/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Bosch X, Coloma E, Donate C, Colomo L, Doti P, Jordán A, López-Soto A. Evaluation of unexplained peripheral lymphadenopathy and suspected malignancy using a distinct quick diagnostic delivery model: prospective study of 372 patients. Medicine (Baltimore) 2014; 93:e95. [PMID: 25310744 PMCID: PMC4616296 DOI: 10.1097/md.0000000000000095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/24/2014] [Accepted: 08/03/2014] [Indexed: 12/22/2022] Open
Abstract
Although rapid diagnostic testing is essential in suspicious peripheral lymphadenopathy, delays in accessing them can be considerable. We investigated the usefulness of an internist-led outpatient quick diagnosis unit (QDU) in assessing patients with unexplained peripheral lymphadenopathy, focusing on the characteristics, diagnostic, and treatment waiting times of those with malignancy. Patients aged ≥ 18 years, consecutively referred from 12 primary health care centers (PHCs) or the emergency department (ED) for unexplained peripheral lymphadenopathy, were prospectively evaluated during 7 years. Diagnostic investigations were done using a predefined study protocol. Three experienced cytopathologists performed a fine-needle aspiration cytology (FNAC) systematic approach of clinically suspicious lymphadenopathy with cytomorphology and immunophenotyping analyses. We evaluated 372 patients with a mean age (SD) of 45.3 (13.8) years; 56% were women. Malignancy was diagnosed in 120 (32%) patients, including 81 lymphomas and 39 metastatic tumors. Metastatic lymphadenopathy was diagnosed by FNAC in all 39 patients and the primary tumor site was identified in 82% of them when cytomorphology and immunocytochemistry were combined. A correct diagnosis of lymphoma was reached by FNAC in 73% of patients. When accepting "suspicious of" as correct diagnosis, the FNAC diagnosis rate of lymphoma increased to 94%. Among patients with malignancy, FNAC yielded 1.3% of false negatives and no false positives. All patients with an FNAC report of correct or suspicious lymphoma underwent a surgical biopsy, as it is a mandatory requirement of the hematology department. Mean times from first QDU visit to FNAC diagnosis of malignancy were 5.4 days in metastatic lymphadenopathy and 7.5 days in lymphoma. Mean times from receiving the initial referral report to first treatment were 29.2 days in metastatic lymphadenopathy and 40 days in lymphoma. In conclusion, a distinct internal medicine QDU allows an expeditious, agile, and prearranged system to diagnose malignant peripheral lymphadenopathy. Because of the close collaboration with the cytopathology unit and the FNAC methodical approach, diagnostic and treatment waiting times of patients with malignancy fulfilled national and international time frame standards. This particular diagnostic delivery unit could help overcome the difficulties facing PHC, ED, and other physicians when trying to provide rapid access to investigations to patients with troublesome lymphadenopathy.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine (XB, EC, CD, PD, AJ, AL-S); and Department of Pathology (Cytopathology Section) (LC), Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Trovato GM. Sustainable medical research by effective and comprehensive medical skills: overcoming the frontiers by predictive, preventive and personalized medicine. EPMA J 2014; 5:14. [PMID: 25250099 PMCID: PMC4171719 DOI: 10.1186/1878-5085-5-14] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/09/2014] [Indexed: 01/01/2023]
Abstract
Background Clinical research and practice require affordable objectives, sustainable tools, rewarding training strategies and meaningful collaboration. Method Our unit delivers courses on project design and management promoting ideas, useful skills, teaching and exploring implementation of networks and existing collaborations. We investigated the effectiveness of a sustainable approach of comprehensive diagnosis and care and its usefulness within concrete models of research project teaching methodology. Results The model of predictive, preventive and personalized medicine (PPPM) of adolescent hypertension, developed since 1976 and still active, was displayed. This is a paradigm of comprehensive PPPM aimed at the management of a recognized, but actually neglected, societal and clinical problem. The second model was addressed to the analysis of performance of an outpatient diagnostic and therapy unit and its relationship with the emergency department. Part of the patients, 4,057 cancer patients presenting at the emergency care, were addressed to the outpatient diagnostic and therapy unit for further assessment, treatment and follow-up. The stay in DH was 6.3 ± 2.1 non-consecutive days, with shortage of costs, vs. in-hospital stays. Research planning courses, based on these models, ensued in an increase of competitive project submission and successful funding. Discussion Active promotion of interdisciplinary knowledge and skills is warranted. Misleading messages and information are detrimental not only to healthy and sick people but, equally, to all health professionals: efforts for basing on evidence by research any statement are needed. The actual pre-requisite of personalized medicine is the coherent and articulated promotion of the professional quality of staff. Health professionals should and can be skilled in sustainable non-invasive diagnostic procedures, in non-pharmacological intervention, in translational research (from epidemiology to personalized therapy) and in timely dissemination of the information. Conclusion Recommendations are provided according to PPPM: proposed models are based on financial sustainability and patient's satisfaction criteria and are addressed to research projects and dissemination also by e-learning. The guidelines of the EU calls in personalized medicine are able to provide a critical added value by accurate planning, transparency of assessment and unbiased reports, dissemination and exploitation.
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Affiliation(s)
- Guglielmo M Trovato
- Dipartimento di Scienze Mediche e Pediatriche, Unità di Terapia e Diagnostica Medica non Invasiva AOU Policlinico-VE, University of Catania, 95124 Catania, Italy
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Brito-Zerón P, Nicolás-Ocejo D, Jordán A, Retamozo S, López-Soto A, Bosch X. Diagnosing unexplained fever: can quick diagnosis units replace inpatient hospitalization? Eur J Clin Invest 2014; 44:707-18. [PMID: 24920307 DOI: 10.1111/eci.12287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/06/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Outpatient quick diagnosis units (QDUs) have become an increasingly recognized alternative to hospitalization for the diagnosis of a number of potentially serious diseases. No study has prospectively evaluated the usefulness of QDU for the diagnosis of unexplained fever. MATERIALS AND METHODS We prospectively assessed patients referred to QDU due to fever of uncertain nature (FUN), defined as a temperature > 38 °C during at least 1 week and no diagnosis after a previous evaluation. We also evaluated consecutive patients with FUN who were hospitalized during the same period. QDU and hospital costs were analysed by micro-costing techniques. RESULTS We evaluated 176 QDU patients and 168 controls. QDU patients were younger and required fewer investigations than controls. QDU patients had higher prevalence of viral infections (36% vs. 8%, P < 0·001) and lower prevalence of bacterial infections (6% vs. 46%, P < 0·001) and malignancies (2% vs. 14%, P < 0·001). While time-to-diagnosis of QDU patients was longer than length-of-stay of controls (25·82 vs.12·89 days, P < 0·001), 56% of QDU patients only required up to two visits. Cost per QDU patient was €644·59, while it was €4404·64 per hospitalized patient. CONCLUSIONS QDU patients with FUN were younger and had less serious diseases than controls including more viral and less bacterial infections and fewer malignancies. Mainly owing to untimely diagnostic reports, time-to-diagnosis was longer in QDU patients. Cost-savings in QDU were substantial. Using objective tools to evaluate the condition severity and general health status of FUN patients could help decide the most appropriate setting for their diagnostic study.
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Affiliation(s)
- Pilar Brito-Zerón
- Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Bosch X, Escoda O, Nicolás D, Coloma E, Fernández S, Coca A, López-Soto A. Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study. BMC FAMILY PRACTICE 2014; 15:75. [PMID: 24775097 PMCID: PMC4021313 DOI: 10.1186/1471-2296-15-75] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 04/22/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Spain, primary healthcare (PHC) referrals for diagnostic procedures are subject to long waiting-times, and physicians and patients often use the emergency department (ED) as a shortcut. We aimed to determine whether patients evaluated at a hospital outpatient quick diagnosis unit (QDU) who were referred to ED from 12 PHC centers could have been directly referred to QDU, thus avoiding ED visits. As a secondary objective, we determined the proportion of QDU patients who might have been evaluated in a less rapid, non-QDU setting. METHODS We carried out a cross-sectional retrospective cohort study of patients with potentially serious conditions attended by the QDU from December 2007 to December 2012. We established 2 groups of patients: 1) patients referred from PHC to QDU (PHC-QDU group) and 2) patients referred from PHC to ED, then to QDU (PHC-ED-QDU group). Two observers assessed the appropriateness/inappropriateness of each referral using a scoring system. The interobserver agreement was assessed by calculating the kappa index. Multivariate logistic regression analysis was performed to identify the factors associated with the dependent variable 'ED referral'. RESULTS We evaluated 1186 PHC-QDU and 1004 PHC-ED-QDU patients and estimated that 93.1% of PHC-ED-QDU patients might have been directly referred to QDU. In contrast, 96% of PHC-QDU patients were found to be appropriately referred to QDU first. The agreement for PHC-QDU referrals (PHC-QDU group) was rated as excellent (ϰ=0.81), while it was rated as good for PHC-ED referrals (PHC-ED-QDU group) (ϰ=0.75). The mean waiting-time for the first QDU visit was longer in PHC-QDU (4.8 days) than in PHC-ED-QDU (2.6 days) patients (P=.001). On multivariate analysis, anemia (OR 2.87, 95% CI 1.49-4.55, P<.001), rectorrhagia (OR 2.18, 95% CI 1.10-3.77, P=.01) and febrile syndrome (OR 2.53, 95% CI 1.33-4.12, P=.002) were independent factors associated with ED referral. Nearly one-fifth of all QDU patients were found who might have been evaluated in a less rapid, non-QDU setting. CONCLUSIONS Most PHC-ED-QDU patients might have been directly referred to QDU from PHC, avoiding the inconvenience of the ED visit. A stricter definition of QDU evaluation criteria may be needed to improve and hasten PHC referrals.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Spain.
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Trovato GM. Suggestions for a sustainable medical quality-centered approach within a predictive, preventive and personalized medicine: the promotion of alternatives to conventional hospitalization in an era of financial constraint. EPMA J 2014. [PMCID: PMC4125881 DOI: 10.1186/1878-5085-5-s1-a156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bosch X, Moreno P, López-Soto A. The Painful Effects of the Financial Crisis on Spanish Health Care. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2014; 44:25-51. [DOI: 10.2190/hs.44.1.c] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Spain has an advanced, integrated health care system that has achieved remarkable results, including substantially improved health outcomes, over a relatively short time. Measures introduced by central and regional governments to combat the financial crisis may be severely affecting the health sector, with proposed changes potentially threatening the principles of equity and social cohesion underlying the welfare state. This article examines recent developments in Spanish health care, focusing on the austerity measures introduced since 2010. In Spain, as in other countries, evaluation of health care changes is difficult due to the paucity of data and because the effects of measures often lag well behind their introduction, meaning the full effects of changes on access to care or health outcomes only become apparent years later. However, some effects are already clear. With exceptions, Spain has not used the crisis as an opportunity to increase efficiency and quality, rationalize and reorganize health services, increase productivity, and regain public trust. We argue that immediate health care cuts may not be the best long-term answer and suggest evidence-driven interventions that involve the portfolio of free services and the private sector, while ensuring that the most vulnerable are protected.
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Quaglio G, Karapiperis T, Van Woensel L, Arnold E, McDaid D. Austerity and health in Europe. Health Policy 2013; 113:13-9. [DOI: 10.1016/j.healthpol.2013.09.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/09/2013] [Accepted: 09/16/2013] [Indexed: 11/25/2022]
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