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Biomedical subjects

S Peiró

Publications and source records attributed to S Peiró.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Inappropriate use of pediatric hospitalization].

OBJECTIVE: Our aim was to identify the inappropriate utilization of pediatric hospitalization, its reasons and associated factors. PATIENTS AND METHODS: Three hundred twenty-three medical records were randomly selected among the patients aged 6 months to 14 years and hospitalized in 1995 in a public hospital of the Community of Valencia. The validated Spanish version of the "Pediatric Appropriateness Evaluation Protocol" was retrospectively applied. The proportions of inappropriate admissions and stays and their reasons were estimated and their association with certain factors analyzed. RESULTS: Of the admissions 17.7% (95% CI: 13.5-21.8) and 15.5% of the stays (95% CI: 11.5-19.4) were considered inappropriate. The most frequent reason for inappropriate admission was that diagnostic and therapeutic needs might have been solved by ambulatory care. Inappropriate stays were in mot cases (70%) due to that doctors did not pay attention to keeping the patient in the hospital although acute care was no longer needed. Female patients, non-elective admissions, admissions by general pediatricians or traumatology and weekend stays had significantly higher proportions of inappropriate utilization. CONCLUSIONS: A considerable proportion of inappropriate admissions and stays was observed, although it is in the lower range of those observed in other studies in pediatric patients. The most frequent reasons were attributed to an excessively conservative medical practice.

Adolescent↗
PubMed1998

[Effect of the presentation of results from clinical trials on the intention to prescribing: relativity of the relative risk].

OBJECTIVE: To determine if the methods of reporting results of clinical trials affects the physician views on prescribing. DESIGN: Analysis of responses, from a convenience sample of primary care physicians, of one teaching exercise on prescribing intention which showed 5 different methods of reporting results: relative risk reduction (RRR), absolute risk reduction, the percent of event free patients, the number needed to treat (NNT) and RRR and mortality. SETTING: Curses of clinical management in Valencia and Barcelona. RESULTS: The willingness to prescribe was significantly influenced by the way in which data were presented, being major when they were showed as RRR and minor when mortality was added. CONCLUSIONS: The method of reporting trial results has an important influence on the prescribing intention. The reporting of clinical trial results, and their abstracts or citations, should be include the NNT and negative results, for avoiding a subjective bias of treatment effect magnification.

Clinical Trials as Topic↗
PubMed1998

Variations in diagnostic and therapeutic intensity between home and conventional hospitalization.

OBJECTIVE: To analyse the variations in diagnostic and therapeutic intensity in patients with similar clinical conditions depending on whether they had hospitalization at home (HH) or remained in conventional hospitalization (CH). DESIGN: Observational study of two patient cohorts (HH and CH) selected prospectively. SETTING: University Hospital in the Valencia Health Service network, and the Hospital at Home Unit that it administers. STUDY PARTICIPANTS: One hundred and forty-eight consecutive patients admitted to a Hospital at Home Unit, and 148 patients (matched by age, sex, disease group and hospital department) who remained in hospital in spite of fulfilling clinical criteria for HH as assessed by the nurses who normally evaluate suitability of admission to HH. MAIN OUTCOME MEASURES: Number and cost of diagnostic tests, and cost of drugs and nursing materials per hospitalization in HH and CH. RESULTS: The average number of tests for admission was significantly lower at home than in hospital (HH, 0.89; CH, 3.53); this translated into significant differences in the average diagnostic cost per hospitalization (HH, Pesetas 131; CH, Pesetas 3.316; US$1 approximately 130 Pesetas in 1994). Expenditures on drugs per episode (HH, Pesetas 7028; CH, Pesetas 16684) was also lower at home, but the differences were not significant for this or for expenditure for nursing materials (HH, Pesetas 3329; CH, Pesetas 2556). CONCLUSIONS: Although some limitations of the study do not make it possible to establish unequivocal conclusions, the results point to the existence of different diagnostic and therapeutic patterns in HH and CH, which translate into significant differences in hospitalization costs.

Adolescent↗
PubMed1997

[Hospital at home and conventional hospitalization. An economic evaluation].

BACKGROUND: To carry out an economic evaluation of hospital at home (HH) vs. conventional hospitalization (CH) from the hospital cost perspective. METHODS: A minimization cost analysis were performed in 2 groups of patients (HH: 148 patients, 1,776 days of care; CH: 148 patients, 1,113 days) with similar characteristics. We used cost per hospital episode (only for the comparable period in HH and HC) and cost per day as outcome measures. The costs of health care professionals, pharmacy, sanitary material, diagnostic and therapeutic tests and transport were directly estimated for each patient. Other costs were indirectly assigned from the hospital accountability information system. RESULTS: The average episode cost at home was 172,043 ptas. (about $1,300) less compared to the conventional hospitalization. Cost per diem for HH was 25,565 ptas. less than CH. Marginal costs were 14,987 and 2,913 ptas. minor in HH than CH, per episode and day respectively. When we consider HH staff as a differential cost (i.e. to establish a new hospital at home unit with new staff) marginal cost per episode was 2,276 pesetas higher than CH. CONCLUSIONS: HH is a cost-effective option when decisions take into account the average cost (establishment of a new unit vs. a new ward) or when the HH unit is created as a substitute service through the conversion of pre-existent resources. However, HH is a disadvantaged cost option when it is created as an additional resource.

Adolescent↗
PubMed1996

[Structural analysis of the new model of primary care in the community of Valencia].

OBJECTIVES: To analyse the structure of the new model of primary care (NMPC) in the Community of Valencia, and to identify the strategic importance of its characteristic variables and the possibilities of intervention to affect these variables. DESIGN: A qualitative study through a method of structural analysis (crossed impact method-multiplication applied to a classification) of the relationships between 37 variables characterising the NMPC which were identified by prior qualitative research, with interpretation of the results using the Téniere-Buchot Model. SETTING: Community of Valencia. RESULTS: The structural variables identified were those relating to the political-legal framework and to the allocation of primary care resources; and the resultant variables, those relating to efficiency and primary care quality. Between these two categories, the intervention variables covered management, NMPC professionals, health needs and the community's use of services. CONCLUSIONS: The structural analysis gives the legal-political and economical framework a determining role in NMPC, which can hardly be influenced from within the system. Management and organisation are identified as key variables from which an intervention can be made in the short or medium term to achieve the aims of the system.

Models, Organizational↗
PubMed1996

[Validity of the protocol for evaluating the inappropriate use of hospitalization].

BACKGROUND: The study was carried out in order to assess the inter-observer reliability and validity in respect of clinical appraisal given by the Appropriateness Evaluation Protocol (AEP), in the context of the Spanish Public Hospital System. MATERIAL AND METHOD: In order to assess the reliability a total of 614 hospital stays chosen at random from 56 hospital admissions were independently analysed by three reviewers (two doctors and one nurse). In order to assess the validity, the findings obtained by the nurse were compared with the majority opinion given by the 7 hospital specialists in respect of each of hospital stays under evaluation. As part of the analytical procedure, indices for observed agreement, and specific agreement were calculated, as well as the Kappa statistic, all forming of various random samples of 614 hospital stays. In order to assess the predictive validity of the AEP, its sensitivity, specificity and predictive values were all measured against the majority clinical judgement. RESULTS: The study exhibited a high degree of inter-observer reliability (specific agreement > 64%, kappa > 0.75) and a reasonable validity in comparison with the consensus of opinions formed by a least 4 or 5 of its 7 clinical reviewers (specific agreement > 61%, kappa > 0.64), these values decreasing notably when the consensus of 6 or 7 of the reviewers was required. The AEP revealed a high degree of sensitivity and a low degree of specificity in comparison with the majority clinical assessment, thus minimising the occurrence of false results when the stay was regarded as appropriate, and producing false negatives (appropriate hospital stays regarded as inappropriate) varying in degree from moderate to very high. CONCLUSIONS: The results showing high reliability and moderate validity regarding clinical assessment shows the AEP to be a useful instrument in the sifting-out of inappropriate use of hospitalisation, although they do not allow a definitive judgement to be made concerning the efficiency of hospital services nor judgements regarding individual cases.

Evaluation Studies as Topic↗
PubMed1996

[Factors associated with emergency hospital readmission in digestive and hepatobiliary diseases].

OBJECTIVE: To describe the epidemiological characteristics of emergency readmissions due to digestive and hepatobiliary diseases within the hospitals of the Valencian Health Service (VHS), Spain, and to examine their relationship with defined variables related to patients or to previous periods of hospitalization. PATIENTS AND METHODS: Out of the 212,947 episodes of patient hospitalization included in the Uniform Hospital Discharge Data Set of the VHS, excluding those persons under 16 years of age, those who had died in hospital or were discharged due to being transferred to another hospital and also excluding the two hospitals whose record were of poor quality, 18,075 patients were chosen whose principal diagnosis on first admission was one of a digestive or hepatobiliary disease. After a descriptive analysis the relationship was explored between risk of readmission and the variables of age, gender, hospital funding, whether the environment is a rural or urban one, the hospital itself, the diagnostic group, comorbidity, type of admission, length of stay, presence of surgical procedure, discharge criteria and service using an independent Cox Proportional Hazards analysis for each variable and a second Cox analysis adjusted for selected variables. RESULTS: 16.9% of those patients discharged for digestive disorders are re-admitted within a year. The risk of readmission is associated with age, comorbidity, male sex and chronic diseases and, with respect to the previous episode of hospitalization, it is associated with emergency admission, longer period of hospitalization, non-surgical discharge and admission to certain hospitals. CONCLUSION: The risk of emergency readmission is associated with defined variables relating to patient or previous episodes of hospitalization connected with a more serious condition. The risk adjustment carried out could be used in order to identify high-risk cases which could then be paid special attention in order to delay or prevent readmission and as an indirect indicator for use in monitoring the quality of hospital care.

Adolescent↗
PubMed1994

[What does the average stay say about the diagnosis-related groups?].

BACKGROUND: The systems for classifying patients into homogeneous groups of resource consumption such as diagnosis related groups (DRG) use mean stay (MS) as the principal predictive variable of this consumer entity. The standard of MS for each DRG is usually defined as the MS of this DRG in one group of hospitals. This method omits the existence of unnecessary days of hospitalization which are added to the standard and may be identified by review of hospitalary use. METHODS: A retrospective review of the clinical need for 933 days of hospitalization (190 days of admission plus 743 successive stays for the same) in 190 cases of 167 DRG (appendicectomy without complications or comorbidity in those under the age of 70 years) in 8 public hospitals in Valencia (Spain) was performed by the Appropriateness Use Evaluation Protocol. RESULTS: Four days of admission (2.1%) and 284 successive stays (38.2%) were considered unnecessary from a clinical point of view. Necessary MS was estimated as 3.4 days for GRD vs the 5.1 days of MS observed. CONCLUSIONS: The common construction of standards of mean stay per disease demonstrates an important proportion of unnecessary use of hospitalization, the correction of which would allow a reduction in the mean costs of the process without a reduction in the quality of care.

Adolescent↗
PubMedDate not supplied

[Patient classification systems in intermediate and long-term stay institutions: evolution and future perspectives].

The importance of long term care sector is increasingly growing. Actually, the use of patient classification systems is a useful tool for the planning and management of health services for chronic and geriatric patients. Despite being much less known, patient classification systems have had a richer and earlier development in the long term care sector than in the acute care sector. Thus, one could could see the evolution from classifications based on the assessment of functional dependency to classifications progressively including variables corresponding to clinical complexity, and finally to complex systems such as RUG-III. Patient classification systems were first utilised as tools for the financing of long term centres, based on the patients' characteristics. Later, their applications have spread out to objectives related to the management of centres, assessment of quality of care, staff allocation level, control of access and national policies. In Spain, the only experience in the use of a patient classification system is the one used by the Catalan Health Care Administration which uses a classification for the financing of their centres.

Activities of Daily Living↗
PubMedDate not supplied

[Declaring conflict of interest in scientific publications. Time for the spotlights and stenographers in the backroom of research financed by the industry?].

The term conflict of interests is applied to those situations in which the research validity and integrity may be influenced by a secondary interest, typically an economic benefit, but also an ideological, personal or professional interest. In this work we describe some ways of conflict of interests--particularly those related with the publication of clinical and epidemiological research supported by the industry--and the regulation of this problem from medical journals, including references to the situation in Spain. The conflict of interest is not synonymous of scientific fraud neither malpraxis in research, but in the medical literature there exists enough evidence to consider it as an important source of biases. The usual form of facing the conflict of interests is to make it public, so that readers can judge its importance. The editorial policies of the Spanish journals are, in general, far from giving importance to this problem, an aspect which could favor an attitude of the investigators, to maintain funding or to obtain new contracts, unnecessarily subordinated to the interests of the companies.

Conflict of Interest↗
PubMedDate not supplied

[Evolution of childhood hospitalization in Spain. Variation among autonomous communities].

BACKGROUND: To describe trends in children hospitalization in Spain during 1985-1994 and its variability among regions. METHODS: Description between 1985 and 1994, by autonomous regions, of the evolution in the rates of available beds, discharges, stays and visits and average length of stay, from data provided by the health care centres with inpatient statistics. RESULTS: The average length of stay decreased 23.9%, but there was a 4.5% increase in bed availability, a 39.5% increase in the discharges rate and 36.8% in the visits rate. Regions showed large differences in all indicators, that trends to converge in beds availability and discharges, but not in length of stay and visits rate. CONCLUSIONS: There has been an increase in hospital performance with strong variation among regions. Differences tends to reduce in some indicators but not in others.

Adolescent↗
PubMedDate not supplied

[Drug expenditure in primary care: associated variables and allocation of drug budgets according to health district].

OBJECTIVES: Identify factors explaining variability in prescribing costs after reviewing ecological data related to costs and socio-demographic characteristics of the health care zones in the autonomous region of Valencia, and explore the usefulness of using the model to set prescribing budgets in basic healthcare zones. MATERIALS AND METHODS: An ecological analysis of the value socio-demographic characteristics and use of healthcare services to explain prescribing costs in 1997. Development of a prediction model based on multiple linear regression in data for prescribing costs in 1997 and validation in data for 1998. RESULTS: Factors that correlated positively with prescribing costs were the percentage of inhabitants over the age of 80, the death rate, the percentage of inhabitants with only primary education or less, the percentage of inhabitants between the ages of 65 and 79 and the distance from the capital city. A multivariate model including the death rate, the percentage of inhabitants 80 years of age and older, the number of cars per 100 inhabitants and number of visits per inhabitant accounted for 44.5% of the variations in prescribing costs in 1997 and 32% in 1998. CONCLUSIONS: Socio-demographic factors and certain variables associated with health care utilization can be applied, within certain limitations, to set prescribing budgets in basic healthcare zones.

Budgets↗
PubMedDate not supplied

[Management of research in healthcare centers. An exploration through nominal group dynamics].

OBJECTIVES: To determine the opinions of hospital and other research organizations managers concerning three questions: 1) the desirability of healthcare centers' managing biomedical research as a specific product; 2) the characteristics that define a "research management" culture as opposed to the current "administration of research" culture and 3) the management instruments needed to implement a "research management" culture. MATERIALS AND METHODS: A meeting was held with 14 experts from healthcare centers or research organizations from Barcelona, Madrid and Valencia to discuss the three questions and evaluate the relative importance of items comprising the last two with a score system from 1 (little relevance) to 9 (extremely relevant). RESULTS: The group was in favor of healthcare centers' managing research as a specific and differentiated product. Keys to achieving a management culture (items scoring higher than 7 with the above system) included the development of a culture to evaluate work and external auditing, transversal support and sharing infrastructures and intellectual capital, specific accounting, unified management, prioritization of research lines and capacity for cooperation, and strategic alliances between centers. Management instruments deemed essential (items scoring 7 or higher with the above system) were: support to research foundations or other organizational formulae to ensure autonomy, specific budgetary control, development of support structures and contractual formulae to support autonomy, creativity and researchers' accountability. CONCLUSIONS: Research conducted in healthcare centers should be managed just as any other product derived from the center's activities. Key points to success are prioritization, evaluation and clear assignation of responsibilities, which requires organizational structures with greater flexibility and specific information systems.

Attitude of Health Personnel↗