[Frequency of attendance at primary care clinics. A new conceptual framework].
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Health Services Misuse↗
Biomedical subjects
A Sarría Santamera
Publications and source records attributed to A Sarría Santamera.
[Hospitalization rates in infants aged less than 1 year in Madrid and their relationship with socioeconomic indicators and infant mortality].
BACKGROUND: Hospital utilization represents a significant part of all the health services offered to the population. Previous studies have demonstrated considerable variability in hospital utilization among the pediatric population. OBJECTIVE: To describe hospitalization rates in infants aged less than 1 year in the municipal districts of the city of Madrid and to analyze their association with socioeconomic indicators and infant mortality. METHODS: Ecological study with the health district of the city of Madrid as the unit of analysis. The following variables were included: overall hospital discharge rates, ambulatory care sensitive condition (ACSC) discharge rates and infant mortality rates, as well as the percentages of university graduates, without primary education, unemployed, without telephone and without tap water. Correlation and multiple regression analysis were performed. RESULTS: The mean overall and ACSC discharge rates were 280.10 94.09 and 52.65 29.29. Their coefficient of variation was 32.47 and 55.63. Discharge rates showed significant correlation with the percentage of unemployed (0.71), university graduates (-0.66) and those without primary education (0.88). ACSC rates were correlated with the percentage of unemployed (0.51) and of university graduates (-0.48). The variables included in the multiple lineal regression models were the percentage without primary education for discharge rates (R2 0.78; p < 0.0000) and the percentage of unemployed for ACSC rates (R2 0.26; p < 0.032). CONCLUSIONS: Overall and ACSC discharge rates in infants showed significant variation across the health district of the city of Madrid. These rates were significantly associated with socioeconomic indicators, but not with infant mortality.
Catchment Area, Health↗
[Why are children hospitalized in Spain?].
OBJECTIVE: Hospital services represent a significant amount of the overall health care devoted to the pediatric population. This work describes regional differences in Spanish pediatric hospital admissions. PATIENTS AND METHODS: National, regional, age-specific and diagnostic-specific discharge rates were obtained from the 1987 Hospital Morbidity Survey. To assess regional variations, weighted coefficient of variations (WCV) were obtained. RESULTS: The overall national discharge rate was 60.45 discharges per 1000 children less than 15 years of age. The weighted coefficient of variation obtained for the sex and age adjusted discharge rates of the 10 more frequent diagnoses was highest for phimosis (56.13) and lowest for appendicitis (19.44). CONCLUSIONS: Differences in supply and professional practice style have been recognized as causes for the variations in hospital utilization. Hospitalization of patients represents costs and risks. They are justified when scientific evidence shows that their suggested benefits overcome their inconveniences. The existence of this difference leads to suspect that non-clinical factors could be decisive in medical decisions.
Adolescent↗
[Regional differences in hospital utilization].
Many recent studies have demonstrated that hospital utilization rates vary widely among similar areas and regions. The objective of this study is to find out the variation among the hospitalization rates in Spain across the 17 Autonomic Communities in 1988. From the Hospital Morbidity Survey we calculate the general discharge rate and the rate for 14 diagnostics. To evaluate the degree of variation we calculate the coefficient of variation, the ratio of variation and the systematic component of variation, which ranges from 0.96 (hernia) to 8.45 (varicose veins). This substantial variations are consistent with studies performed in countries with different health systems. Although new information systems which allow to perform population based studies are due to establish, these variations are too large to ignore and have to be taken account in policy making.
Data Collection↗
[Evolution of cesarean section rates in Spain: 1984-1988].
The objective of this work is to describe the evolution of cesarean section rates in Spain from 1984 through 1988. National rates increased from 9.92% to 19.99%. Trend is significantly rising nationwide and in all Communities. Overall differences have decreased (CSV from 1.73 to 11.72) because there are two groups of regions: one with high rates, the other one with low rates. Rates are significantly higher in private hospitals (14.53%). These differences could show the controversy and uncertainty in the indications and the influence of organizational factors. Although new sources of information to obtain population rates and outcomes studies adjusted by women clinic and sociodemographic characteristics are due to be developed, these differences lead to suspect that there is a gap between the theoretic quality medical science could provide and the actual quality medical practice is providing, explained just by reasons out from clinical factors.
Adult↗
[Differences in hospital utilization between the autonomous communities of Madrid and Catalonia].
Regional differences in hospital utilization have been long recognized. The objective of this study is to find out differences in hospital utilization and structure between Madrid and Catalonia. We calculate the crude and adjusted discharge and bed days rates and average length of stay from 1987 through 1989 for all diagnoses, and for 30 selected diagnoses by province of residence in 1987. We obtained the located and allocated beds, and the distribution of discharges by payers and of beds by providers for both regions, Catalonia shows consistently higher discharge rates (40% of public beds and 3.70 used beds) and Madrid has longer hospital stays (70% of public beds and 3.98 used beds). This work allows to formulate two questions about how health services operate: 1) organizational aspects could affect medical behavior. 2) hospital bed days could depend more on discharge rates than on length of stay.
Hospitals↗