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Waibel S, Vargas I, Aller M, Vázquez ML, Coderch J, Cots F, Abizanda M, Calero S, Colomés L, Llopart JR, Farré J. Relational continuity in primary and secondary care in the Catalan national health system. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Waibel
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - I Vargas
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - M Aller
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - ML Vázquez
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - J Coderch
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Palamós, Spain
| | - F Cots
- Parc de Salut Mar, Medical Research Institute (IMIM), Barcelona, Spain
| | - M Abizanda
- Institut de Prestacions d’Assistència Mèdica al Personal Municipal, Barcelona, Spain
| | - S Calero
- Catalan Health Institute, Barcelona, Spain
| | - Ll Colomés
- Health Policy and Health Services Research Group; Strategic Planning Division. Sagessa Group, Reus, Spain
| | - JR Llopart
- Badalona Healthcare Services, Badalona, Spain
| | - J Farré
- Centre Integral de Salut Cotxeres, Barcelona, Spain
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Aller MB, Waibel S, Vargas I, Vázquez ML, Coderch J, Cots F, Abizanda M, Calero S, Colomés L, Llopart JR, Farré J. How do doctors and patients perceive coordination and continuity across care levels in Catalonia? Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- MB Aller
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - S Waibel
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - I Vargas
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - ML Vázquez
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - J Coderch
- Grup de Recerca en Serveis Sanitaris I Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Palamós, Spain
| | - F Cots
- Parc de Salut Mar, Medical Research Institute (IMIM), Barcelona, Spain
| | - M Abizanda
- Institut de Prestacions d’Assistència Mèdica al Personal Municipal, Barcelona, Spain
| | - S Calero
- Catalan Health Institute, Barcelona, Spain
| | - Ll Colomés
- Health Policy and Health Services Research Group; Strategic Planning Division. SAGESSA Group, Reus, Spain
| | - JR Llopart
- Badalona Healthcare Services, Badalona, Spain
| | - J Farré
- Centre Integral de Salut Cotxeres, Barcelona, Spain
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Porthé V, Vargas I, Malmusi D, Sanz B, Otero L, Bosch L, Ronda E, Heras-Mosteriro J, Plaza I, Ballesta M, Llopart JR, Colomes L, Vázquez ML. Economic crisis, cutbacks and migrants’ access to healthcare in Spain: health workers’ perspective. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Porthé
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - I Vargas
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - D Malmusi
- Health Information Systems, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - B Sanz
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - L Otero
- CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
- Sección Departamental de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - L Bosch
- Unitat de Atenció al Ciutadà i Comunicació. Serveis de Salut Integrats del Baix Empordà Palamós, Girona, Spain
| | - E Ronda
- Public Health Department, University of Alicante, Alicante, Spain
| | - J Heras-Mosteriro
- Public Health and Preventive Medicine Service, Universitary Hospital Ramón y Cajal, Madrid, Spain
| | - I Plaza
- Evaluation, Information network and Quality Unit, Catalonian Health Institute, Barcelona, Spain
| | - M Ballesta
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
| | - JR Llopart
- General Surgery Department, Badalona Serveis Assistencials, Badalona, Spain
| | - L Colomes
- Health Policy and Health Services Research Group; Strategic Planning Division. SAGESSA Group, Reus, Spain
| | - ML Vázquez
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
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Aller MB, Waibel S, Vargas I, Vázquez ML, Coderch J, Cots F, Abizanda M, Calero S, Colomés L, Llopart JR, Farré J. Factors influencing coordination and continuity across care levels in the Catalan Health Care System. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- MB Aller
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - S Waibel
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - I Vargas
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - ML Vázquez
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - J Coderch
- Grup de Recerca en Serveis Sanitaris I Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Palamós, Spain
| | - F Cots
- Parc de Salut Mar, Medical Research Institute (IMIM), Barcelona, Spain
| | - M Abizanda
- Institut de Prestacions d’Assistència Mèdica al Personal Municipal, Barcelona, Spain
| | - S Calero
- Catalan Health Institute, Barcelona, Spain
| | - Ll Colomés
- Health Policy and Health Services Research Group; Strategic Planning Division. SAGESSA Group, Reus, Spain
| | - JR Llopart
- Badalona Healthcare Services, Badalona, Spain
| | - J Farré
- Centre Integral de Salut Cotxeres, Barcelona, Spain
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Aller MB, Vargas I, Coderch J, Calero S, Cots F, Abizanda M, Farré J, Llopart JR, Colomés L, Vázquez ML. Development and testing of indicators to measure coordination of clinical information and management across levels of care. BMC Health Serv Res 2015; 15:323. [PMID: 26268694 PMCID: PMC4535786 DOI: 10.1186/s12913-015-0968-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 07/24/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Coordination across levels of care is becoming increasingly important due to rapid advances in technology, high specialisation and changes in the organization of healthcare services; to date, however, the development of indicators to evaluate coordination has been limited. The aim of this study is to develop and test a set of indicators to comprehensively evaluate clinical coordination across levels of care. METHODS A systematic review of literature was conducted to identify indicators of clinical coordination across levels of care. These indicators were analysed to identify attributes of coordination and classified accordingly. They were then discussed within an expert team and adapted or newly developed, and their relevance, scientific soundness and feasibility were examined. The indicators were tested in three healthcare areas of the Catalan health system. RESULTS 52 indicators were identified addressing 11 attributes of clinical coordination across levels of care. The final set consisted of 21 output indicators. Clinical information transfer is evaluated based on information flow (4) and the adequacy of shared information (3). Clinical management coordination indicators evaluate care coherence through diagnostic testing (2) and medication (1), provision of care at the most appropriate level (2), completion of diagnostic process (1), follow-up after hospital discharge (4) and accessibility across levels of care (4). The application of indicators showed differences in the degree of clinical coordination depending on the attribute and area. CONCLUSION A set of rigorous and scientifically sound measures of clinical coordination across levels of care were developed based on a literature review and discussion with experts. This set of indicators comprehensively address the different attributes of clinical coordination in main transitions across levels of care. It could be employed to identify areas in which health services can be improved, as well as to measure the effect of efforts to improve clinical coordination in healthcare organizations.
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Affiliation(s)
- Marta-Beatriz Aller
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, 08022, Barcelona, Spain.
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, 08022, Barcelona, Spain.
| | - Jordi Coderch
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Carrer Hospital, 17-19 Edif. Fleming, 17230, Palamós, Spain.
| | - Sebastià Calero
- Catalan Health Institute, Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain.
| | - Francesc Cots
- IMIM - Hospital del Mar Medical Research Institute, Carrer Dr. Aiguader, 88, 08003, Barcelona, Spain.
| | - Mercè Abizanda
- Institut de Prestacions d'Assistència Mèdica al Personal Municipal, Carrer Viladomat, 127, 08015, Barcelona, Spain.
| | - Joan Farré
- Centre Integral de Salut Cotxers, Avinguda de Borbó, 18 - 30, 08016, Barcelona, Spain.
| | - Josep Ramon Llopart
- Health Policy and Health Services Research Group; Division of Management, Planning and Organizational Development, Badalona Healthcare Services, Via Augusta, 9-13, 08911, Badalona, Spain.
| | - Lluís Colomés
- Health Policy and Health Services Research Group; Strategic Planning Division, SAGESSA Group, Avinguda del Dr. Josep Laporte, 2, 43204, Reus, Spain.
| | - María Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, 08022, Barcelona, Spain.
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Aller MB, Vargas I, Coderch J, Calero S, Cots F, Abizanda M, Farré J, Llopart JR, Colomés L, Vázquez ML. Care coordination across care levels in Catalonia: the healthcare professionals’ perspective. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Waibel S, Aller M, Vargas I, Coderch-Lassaletta J, Farré J, Llopart JR, Colomés L, Calero S, Luisa Vázquez M. How do healthcare users experience continuity of care across care levels in different settings in the Catalan healthcare system? Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Aller MB, Vargas I, Waibel S, Coderch J, Sánchez-Pérez I, Colomés L, Llopart JR, Ferran M, Vázquez ML. A comprehensive analysis of patients' perceptions of continuity of care and their associated factors. Int J Qual Health Care 2013; 25:291-9. [PMID: 23425531 DOI: 10.1093/intqhc/mzt010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine the patients' perceived degree of continuity of care between primary and secondary care and to identify contextual and individual factors that influence patients' perceptions of continuity of care. DESIGN Cross-sectional study by means of a survey of patients attended to in primary and secondary care. SETTING Three health-care areas of the Catalonian public health-care system. PARTICIPANTS A random sample of 1500 patients. MAIN OUTCOME MEASURES Relational, informational and managerial continuity of care measured by means of Likert scales, using the CCAENA questionnaire. RESULTS Overall, 93.8 and 83.8% of patients perceived an ongoing relationship with primary and secondary care physicians, respectively (relational continuity), 71.2% perceived high levels of information transfer (informational continuity) and 90.7% perceived high levels of consistency of care (managerial continuity). Patients from health-care areas where primary and secondary care were managed by a single organization and the elderly tended to perceive higher levels of all three types of continuity. Foreign-born patients were less likely to perceive relational continuity with primary care physicians; those with higher educational levels were less likely to perceive high levels of informational continuity and patients with worse health status were less likely to report high levels of managerial and relational continuity with secondary care physicians. CONCLUSIONS Study results suggest high levels of perceived continuity of care, especially for relational and managerial continuity. The adopted comprehensive approach proves to be useful to properly understand the phenomenon because perceptions and associated factors vary according to the type of continuity.
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Affiliation(s)
- Marta-Beatriz Aller
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
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Aller MB, Vargas I, Waibel S, Coderch-Lassaletta J, Sánchez-Pérez I, Llopart JR, Colomés L, Ferran M, Garcia-Subirats I, Vázquez Navarrete ML. Factors associated to experienced continuity of care between primary and outpatient secondary care in the Catalan public healthcare system. Gac Sanit 2012; 27:207-13. [PMID: 22981418 DOI: 10.1016/j.gaceta.2012.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/15/2012] [Accepted: 06/26/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze patient's reported elements of relational, informational and managerial (dis)continuity between primary and outpatient secondary care and to identify associated factors. METHODS Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care for the same condition. The study settings consisted of three health areas of the Catalan health system. Data were collected in 2010 using the CCAENA questionnaire, which identifies patients' experiences of continuity of care. Descriptive analyses and multivariable logistic regression models were carried out. RESULTS Elements of continuity of care were experienced by most patients. However, elements of discontinuity were also identified: 20% and 15% were seen by more than one primary or secondary care physician, respectively. Their secondary care physician or both professionals were identified as responsible for their care by 40% and 45% of users, respectively. Approximately 20% reported a lack of information transfer. Finally, 72% of secondary care consultations were due to primary care referral, whilst only 36% reported a referral back to primary care. Associated factors were healthcare setting, age, sex, perceived health status and disease duration. CONCLUSION Users generally reported continuity of care, although elements of discontinuity were also identified, which can be partially explained by the healthcare setting and some individual factors. Elements of discontinuity should be addressed to better adapt care to patients' needs.
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Affiliation(s)
- Marta-Beatriz Aller
- Grupo de Investigación en Políticas de Salud y Servicios Sanitarios, Servicio de Estudios y Prospectivas en Políticas de Salud, Consorcio de Salud y Social de Cataluña, Barcelona, Spain.
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Martínez-Ródenas F, Pié J, Gómez M, Moreno I, Dedéu JM, Moreno JE, Alcaide A, Torres G, Pou E, Vila JM, Llopart JR. Extra-gastrointestinal stromal tumour--semiology and clinical therapy peculiarities. Rev Esp Enferm Dig 2002; 94:625-32. [PMID: 12647412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The gastrointestinal stromal tumor with extragastrointestinal location are very infrequent. We often diagnose them when they show a big size. Their bening or malignant nature is difficult to fix. The best histological parameters to evaluate their prognosis are a high cellularity, the tumor-like necrosis presence and having more than two mitosis per fifty high-power fields. We introduce an asyntomatic patient's case by a routine echographical control for chronic hepatitis by C virus, that has been diagnosed of a mesentery tumor. The patient has been treated surgically. The inmunohistological study of the tumor had confirmed a stromal gastrointestinal tumor. The showed case's analysis and the considered bibliography suggest some clinical discoveries characteristic of this entity. The histogenesis of these neoplasias are examined and made up to date and the usefulness of the new medication to control check the tumor-like progress is emphasized.
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Affiliation(s)
- F Martínez-Ródenas
- General Surgery Service, Hospital Municipal de Badalona, Barcelona, Spain
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Abstract
We present two cases of a rare entity: pharyngeal perforation caused by blunt external neck trauma. In both cases the patients were asymptomatic for the first 24 h and the results of laryngoscopic study were negative, and it was only possible to demonstrate rupture through the radiologic findings. Early diagnosis is essential as delay in treatment increases morbidity and mortality.
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Affiliation(s)
- J Català
- Department of Radiology, Consorci Hospitalari del Parc Taulí, Parc Taulí s/n, E-08 208 Sabadell, Barcelona, Spain
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Llopart JR, Alvarez H, Hernández G, García Correa F, Suárez J, Febles G, Moneva E, Soriano A. [Intraperitoneal desmoid tumors and polyposis coli (presentation of 2 cases)]. Rev Esp Enferm Dig 1990; 78:377-9. [PMID: 1965412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Two patients with polyposis coli, developed intraperitoneal desmoid tumours after colectomy. The tumours in both cases, were inoperable. Death occurred in one patient and the other required ileostomy.
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Affiliation(s)
- J R Llopart
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Nuestra Señora de la Candelaria Santa Cruz de Tenerife
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