Gestión clínica: aplicación práctica en una unidad hospitalaria (II)

[Accreditation of processes in hepatology]

The Spanish Association for the Study of the Liver decided in 2006 to develop a project to assess the quality of the professionals, processes and medical units dealing with the management of patients with liver diseases in Spain. The current article reports the criteria proposed to assess the quality and the accreditation of the processes in hepatology. The processes considered include most patients with liver diseases and the accreditation system designed is highly specific. This document, together with a previous one published in gastroenterología y hepatología concerning the accreditation of the professionals and a third document dealing with the accreditation of liver units that will be published soon, form the basis of the quality assessment of hepatology in our country.

Servicios hospitalarios de Medicina Interna. Una descripción de la actividad en el Sistema Público de Andalucía en 2002

BACKGROUND

Description of the patients admitted in the general Internal Medicine (IM) departments of the Public Health System in Andalusia (Spain) (PHSA) during 2002.

PATIENTS AND METHODS

It is an analysis of the Minimum Basic Set of Data (MBSD) and its management by the Diagnostic Related Groups (DRG) of admission episodes in Andalusian public hospitals. We divided the hospitals into group 1: more than 600 beds; group 2: between 200 and 600 beds, and group 3: less than 200 beds.

RESULTS

IM services discharged 80,514 patients (total in PHSA, 558,114); 25.9%, 29.6% and 44.5% from groups 1, 2 y 3, respectively; 87.4% were admitted from the emergency room. Gross mortality rate was 10.23%. Average age was 72 years, 8 years more than in the other medical departments. Mean diagnosis per episode was 5.4. The most frequent pathologies (33%) were chronic obstructive pulmonary disease, congestive heart failure, brain stroke and coronary heart disease. Adjusted length of stay was 9.35 days, this being somewhat longer in big hospitals. Mean weight of the episodes (DRG weight) of IM services was 20% higher than the mean of the rest and it accumulates 18.02% of the total weight. Real hours of outpatient clinics was 5.45% of the total.

CONCLUSIONS

The activity of the general IM services is very high in relative and absolute terms. Higher age and the multiple pathologies are typical characteristics of IM patients in Andalusia. Author claim it is very important to be careful with the clinical and administrative records. Interventions on prevalent diseases in IM services may produce positive and valuable results due to their high volume.