1
|
San Jose-Saras D, Vicente-Guijarro J, Sousa P, Moreno-Nunez P, Aranaz-Andres JM. Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study. BMC Med 2023; 21:312. [PMID: 37592294 PMCID: PMC10433586 DOI: 10.1186/s12916-023-03024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND All health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were the following: (1) to analyze the association between IHA and the development of subsequent AEs; (2) to explore the distinct clinical and economic implications of AEs subsequent IHA compared to appropriate admissions. METHODS An observational cross-sectional study was conducted on hospitalized patients in May 2019 in a high-complexity hospital in Madrid, Spain. The Appropriateness Evaluation Protocol was used to measure IHA, and the methodologies of the Harvard Medical Practice Study and the European Point Prevalence Survey of Healthcare-associated Infections were used to detect and characterize AEs. The association between IHA and the subsequent. RESULTS A total of 558 patients in the hospital ward were studied. IHA increased the risk of subsequent occurrence of AEs (OR [95% CI]: 3.54 [1.87 to 6.69], versus appropriate) and doubled the mean AEs per patient (coefficient [95% CI]: 0.19 [0.08 to 0.30] increase, versus appropriate) after adjusting for confounders. IHA was a predictive variable of subsequent AEs and the number of AEs per patient. AEs developed after IHA were associated with scheduled admissions (78.9% of AEs, versus 27.9% after appropriate admissions; p < 0.001). Compared with AEs developed after appropriate admissions, AEs after IHA added 2.4 additional days of stay in the intensive care unit and incurred an extra cost of €166,324.9 for the studied sample. CONCLUSIONS Patients with IHA have a higher risk of subsequent occurrence of AE. Due to the multifactorial nature of AEs, IHA is a possible contributing factor. AEs developed after IHA are associated with scheduled admissions, prolonged ICU stays, and resulted in significant cost overruns.
Collapse
Affiliation(s)
- Diego San Jose-Saras
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal, IRYCIS, 28034, Madrid, Spain
- Universidad de Alcalá, School of Medicine and Health Sciences, Department of Medicine and Medical Specialities, Alcalá de Henares, Spain
| | - Jorge Vicente-Guijarro
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal. IRYCIS. CIBER of Epidemiology and Public Health (CIBERESP), 28034, Madrid, Spain.
- Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain.
| | - Paulo Sousa
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Paloma Moreno-Nunez
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal, IRYCIS, 28034, Madrid, Spain
- Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain
| | - Jesús María Aranaz-Andres
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal. IRYCIS. CIBER of Epidemiology and Public Health (CIBERESP), 28034, Madrid, Spain
- Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain
| |
Collapse
|
2
|
Avoidable Adverse Events Related to Ignoring the Do-Not-Do Recommendations: A Retrospective Cohort Study Conducted in the Spanish Primary Care Setting: Erratum. J Patient Saf 2023; 19:220. [PMID: 36972318 DOI: 10.1097/PTS.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
|
3
|
Baré M, Lleal M, Sevilla-Sánchez D, Ortonobes S, Herranz S, Ferrandez O, Corral-Vázquez C, Molist N, Nazco GJ, Martín-González C, Márquez MÁ. Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study. Int J Environ Res Public Health 2023; 20:3639. [PMID: 36834333 PMCID: PMC9964600 DOI: 10.3390/ijerph20043639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
There is no published evidence on the possible differences in multimorbidity, inappropriate prescribing, and adverse outcomes of care, simultaneously, from a sex perspective in older patients. We aimed to identify those possible differences in patients hospitalized because of a chronic disease exacerbation. A multicenter, prospective cohort study of 740 older hospitalized patients (≥65 years) was designed, registering sociodemographic variables, frailty, Barthel index, chronic conditions (CCs), geriatric syndromes (GSs), polypharmacy, potentially inappropriate prescribing (PIP) according to STOPP/START criteria, and adverse drug reactions (ADRs). Outcomes were length of stay (LOS), discharge to nursing home, in-hospital mortality, cause of mortality, and existence of any ADR and its worst consequence. Bivariate analyses between sex and all variables were performed, and a network graph was created for each sex using CC and GS. A total of 740 patients were included (53.2% females, 53.5% ≥85 years old). Women presented higher prevalence of frailty, and more were living in a nursing home or alone, and had a higher percentage of PIP related to anxiolytics or pain management drugs. Moreover, they presented significant pairwise associations between CC, such as asthma, vertigo, thyroid diseases, osteoarticular diseases, and sleep disorders, and with GS, such as chronic pain, constipation, and anxiety/depression. No significant differences in immediate adverse outcomes of care were observed between men and women in the exacerbation episode.
Collapse
Affiliation(s)
- Marisa Baré
- Institutional Committee for the Improvement of Clinical Practice Adequacy, Clinical Epidemiology and Cancer Screening Department, CRiSP Research Group, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain
- Research Network on Health Services in Chronic Patients (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Marina Lleal
- Institutional Committee for the Improvement of Clinical Practice Adequacy, Clinical Epidemiology and Cancer Screening Department, CRiSP Research Group, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine and Public Health, Autonomous University of Barcelona, Bellaterra, 08193 Barcelona, Spain
| | | | - Sara Ortonobes
- Pharmacy Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Susana Herranz
- Research Network on Health Services in Chronic Patients (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Acute Care Geriatric Unit, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Olivia Ferrandez
- Pharmacy Department, Consorci Parc de Salut MAR, 08003 Barcelona, Spain
| | - Celia Corral-Vázquez
- Research Network on Health Services in Chronic Patients (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Núria Molist
- Geriatrics Department-C3RG Research Ggoup, Consorci Hospitalari de Vic, 08500 Vic, Spain
| | - Gloria Julia Nazco
- Pharmacy Department, Hospital Universitario de Canarias, 38320 La Laguna, Spain
| | | | | | | |
Collapse
|
4
|
Kroon D, van Dulmen SA, Westert GP, Jeurissen PPT, Kool RB. Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study. BMJ Open 2022; 12:e062902. [PMID: 36343997 PMCID: PMC9644331 DOI: 10.1136/bmjopen-2022-062902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE We aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework. DESIGN AND METHODS This study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determinants of the scaling of healthcare innovations and interventions. PubMed and EMBASE were searched for relevant studies from 1995 to December 2020. We systematically extracted the determinants of the scaling of interventions and developed a literature-based framework. Subsequently, this framework was discussed in four focus groups with national and international de-implementation experts. The literature-based framework was complemented by the findings of the focus group meetings and adapted for the scaling of de-implementation strategies. RESULTS The literature search resulted in 42 articles that discussed the determinants of the scaling of innovations and interventions. No articles described determinants specifically for de-implementation strategies. During the focus groups, all participants agreed on the relevance of the extracted determinants for the scaling of de-implementation strategies. The experts emphasised that while the determinants are relevant for various countries, the implications differ due to different contexts, cultures and histories. The analyses of the focus groups resulted in additional topics and determinants, namely, medical training, professional networks, interests of stakeholders, clinical guidelines and patients' perspectives. The results of the focus group meetings were combined with the literature framework, which together formed the supporting the scaling of de-implementation strategies (SPREAD) framework. The SPREAD framework includes determinants from four domains: (1) scaling plan, (2) external context, (3) de-implementation strategy and (4) adopters. CONCLUSIONS The SPREAD framework describes the determinants of the scaling of de-implementation strategies. These determinants are potential targets for various parties to facilitate the scaling of de-implementation strategies. Future research should validate these determinants of the scaling of de-implementation strategies.
Collapse
Affiliation(s)
| | | | | | | | - Rudolf B Kool
- IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
5
|
Piñeiro-Pérez R, Ochoa-Sangrador C, López-Martín D, Martínez-Campos L, Calvo-Rey C, Nievas-Soriano BJ. Adherence of Spanish pediatricians to "do not do" guidelines to avoid low-value care in pediatrics. Eur J Pediatr 2022; 181:3965-3975. [PMID: 36102996 DOI: 10.1007/s00431-022-04613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022]
Abstract
UNLABELLED The main objective of this study was to analyze the degree of knowledge and compliance of Spanish pediatricians with the "do not do" recommendations of the Spanish Association of Pediatrics. A nationwide cross-sectional, descriptive study was carried out using a 25-item questionnaire among Spanish pediatricians. Univariate, bivariate, and multivariate analyses were performed. A total of 1137 pediatricians participated in the study. Most of them were women (75.1%), older than 55 (28.3%), worked in specialized care (56.9%), with public financing (91.2%), and had been working for more than 20 years (44.9%). The median of inappropriate answers per question was 9.1%. The bivariate and multivariate analyses showed that the factors that influenced higher adequacy to the "do not do" recommendations were younger than 45 years, working in specialized care, and working in the public health system. CONCLUSION This research is the first nationwide study in Spain to analyze the adequacy of "do not do" pediatric clinical recommendations. The study showed a high level of compliance by Spanish pediatricians with these recommendations. However, there is a lack of knowledge in less frequent infectious pathologies such as HIV or fungal infections, in not prolonging antibiotic treatment unnecessarily and directing it appropriately according to the antibiogram results. These aspects may be improved by designing measures to enhance pediatricians' knowledge in these specific aspects. Some demographical factors are related to higher adequacy. Performing this research in other countries may allow assessing the current clinical practice of pediatricians. WHAT IS KNOWN • Low-value care is defined as care that delivers little or no benefit, may cause patients harm, or outcomes marginal benefits at a disproportionately increased cost. • Few nationwide studies have assessed adherence to "do not do" guidelines, especially in pediatric settings. WHAT IS NEW • Albeit there is a high level of compliance by Spanish pediatricians with the «do not do» recommendations, there is a lack of knowledge in different aspects that may be improved. • Some demographical factors are related to higher adequacy. Performing this research in other countries may allow assessing the current clinical practice of pediatricians.
Collapse
Affiliation(s)
- Roi Piñeiro-Pérez
- Pediatrics Service, Villalba General University Hospital, Collado-Villalba, Madrid, Spain
| | | | | | | | | | - Bruno José Nievas-Soriano
- Nursing, Physiotherapy, and Medicine Department, University of Almería, Ctra de Sacramento, s/n, 1410 La Cañada, Almería, Spain.
| |
Collapse
|
6
|
Aranaz-ostáriz V, Gea-velázquez De Castro MT, López-rodríguez-arias F, San José-saras D, Vicente-guijarro J, Pardo-hernández A, Aranaz-andrés JM; on behalf of the ESHMAD Director Group and External Advisers. Surgery Is in Itself a Risk Factor for the Patient. IJERPH 2022; 19:4761. [PMID: 35457626 PMCID: PMC9026870 DOI: 10.3390/ijerph19084761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: Adverse events (AE) affect about 1 in 10 hospitalised patients, and almost half are related to surgical care. The aim of this study is to determine the prevalence of AE in operated and non-operated patients in surgical departments in order to determine whether surgical treatment is a risk factor for AE. (2) Methods: A cross-sectional design that included 3123 patients of 34 public hospitals in the Community of Madrid determining the prevalence of AEs in operated and non-operated patients in surgical departments. (3) Results: The prevalence of AE in non-operated patients was 8.7% and in those operated was 15.8%. The frequency of AE was higher in emergency surgery (20.6% vs. 12.4%). The 48.3% of AEs led to an increase in hospital stay, and surgery was involved in 92.4% of cases. The most frequent AEs were related to hospital-acquired infection (42.63%), followed by those related to a procedure (37.72%). In the multivariate analysis, being operated on represented 2.3 times the risk of developing an AE. (4) Conclusions: Surgical sites are particularly vulnerable to AE. Surgical intervention alone is a risk factor for AE, and we must continue to work to improve the safety of both patient care and the working environment of surgical professionals.
Collapse
|
7
|
Cheikh-Moussa K, Caro Mendivelso J, Carrillo I, Astier-Peña MP, Olivera G, Silvestre C, Nuín M, Mira JJ. Frequency and estimated costs of ten low-value practices in the Spanish Primary Care: a retrospective study. Expert Opin Drug Saf 2022; 21:995-1003. [PMID: 35020555 DOI: 10.1080/14740338.2022.2026924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/04/2022]
Abstract
BACKGROUND The frequency of low-value practices (LVPs) in the healthcare system is a worldwide challenge. Far less is known about the related extra cost. This study aimed to evaluate the LVPs trend in Spanish primary care (PC), its frequency in both sexes, and estimate its related extra cost. METHODS A multicentric, retrospective, and national research project was conducted. Ten LVPs highly frequent and potentially harmful for patients were analyzed. Algorithms were applied to collect the data from 28,872,851 episodes registered into national databases (2015-2017). Cost estimation was made. RESULTS LVPs registered a total of 7,160,952 (26.5%) episodes plus a total of 259,326 avoidable PSA screening tests. In adults, a high frequency was found for prescription of 1g paracetamol >3 days, antibiotics for acute bronchitis (unconfirmed comorbidity), and benzodiazepines in patients >65 years with insomnia. Women received more jeopardizing practices (p≤0.001). Pediatrics presented a downward of antibiotic and paracetamol-ibuprofen prescription combination. The estimated extra cost was close to €292 million (2.8% of the total cost in PC). CONCLUSION LVPs reduction during the analyzed period was moderate compared to studies following 'Choosing Wisely list' of LVPs and must improve to reduce patient risk and the extra related costs.
Collapse
Affiliation(s)
- Kamila Cheikh-Moussa
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Sant Joan d'Alacant, Spain
| | - Johanna Caro Mendivelso
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Irene Carrillo
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - María Pilar Astier-Peña
- Family and Community Medicine, Universitas Health Centre, Zaragoza I Sector, Aragonese Health Service (SALUD), Zaragoza, Spain.,University of Zaragoza, Aragon Health Research Institute (IISA), Zaragoza, Spain
| | | | - Carmen Silvestre
- Healthcare Effectiveness and Safety Service, Navarre Health Service-Osasunbidea, Pamplona, Spain
| | - Marian Nuín
- Healthcare Effectiveness and Safety Service, Navarre Health Service-Osasunbidea, Pamplona, Spain
| | - José Joaquín Mira
- Department of Health Psychology, Miguel Hernández University, Elche, Spain.,Health District Alicante-Sant Joan, Alicante, Spain.,REDISSEC, Spain
| |
Collapse
|
8
|
Mira Solves JJ. [The time for high value practices]. Med Clin (Barc) 2021; 157:480-482. [PMID: 34598793 DOI: 10.1016/j.medcli.2021.09.003] [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] [Received: 07/03/2021] [Revised: 08/29/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022]
|