Design and validation of a decision support checklist for efficient resource allocation in research projects during proposal preparation

PURPOSE

This article presents the design and validation of evaluation criteria checklist aimed at facilitating decision-making processes regarding participation in research projects and allocation of resources before the preparation of research proposals.

MATERIALS AND METHODS

A multidisciplinary team developed a comprehensive evaluation focusing on the proposal preparation phase of research projects. A Delphi survey method was used to establish a connection between the relevance of the project and the possible success of research proposals. Assessment criteria were agreed upon, each assigned specific weights. The results of the survey were applied to a database of 62 proposals for which our research group sought funding during 2020-2021. The method was validated using the funding body's outcomes (approval or rejection) of the submitted proposals as the ground truth per project type (national, European and regional).

RESULTS

The results of the survey generated a checklist of 8 criteria (excellence, impact, and efficiency aspects) that effectively assess the possibility of success of research proposals during the preparatory phase. For national projects, the tool validation demonstrated a sensitivity of 100% and a specificity of 76.19%; European projects exhibited a sensitivity of 100% and a specificity of 53.84%; and regional projects showed a sensitivity of 80% and a specificity of 30%.

CONCLUSIONS

By establishing an agreed set of evaluation criteria, the developed comprehensive index enables a more precise decision support tool for the participation in research proposals and the allocation of necessary resources. This control system saves valuable time and effort for research groups while enhancing the overall efficiency of available resources.

Medical imaging clinical trials unit: A professional need

PURPOSE

To design and describe a management and control tool and the human resources needed to efficiently manage the imaging process within clinical trials for a better quality of care for the patient.

METHODS

A unit was created to efficiently organise the participation of our Medical Imaging Department in clinical trials. This entity was defined and monitored using a customized, flexible and modular software package that provides the necessary information to execute and monitor requests (appointments, protocols, reports, complaints, billing). Various indicators of activity and professional satisfaction were parameterised.

RESULTS

From 2016 to 2020, 367 trials were participated and monitored, 50% of all the hospital clinical trials. The budget of the Medical Imaging Department grew by 47% in this period. The coordination with other departments and principal investigators improved, as shown by surveys (62% fluid and 38% very fluid), with a high perception of collaboration (86%).

CONCLUSIONS

The implementation of a Medical Imaging Clinical Trials Unit involve identifying the tasks, personnel, organisational needs, workflow, monitoring and invoicing. The creation of this Unit has improved the control and traceability of clinical trials within the Department.

[Impact of cardiovascular risk factors on the consumption of resources in Primary Care according to Clinical Risk Groups]

Objetivo

Analizar en el contexto de una Zona Básica de Salud (ZBS) la prevalencia de los factores de riesgo cardiovascular (FRCV) y el impacto que generan en la morbilidad y el consumo de recursos sanitarios en la población estratificada según el sistema Clinical Risk Groups (CRG) en Atención Primaria (AP), con la finalidad de identificar la población con multimorbilidad para aplicar medidas preventivas, así como aquella que genera más carga asistencial y necesidades sociales.

Diseño

Estudio observacional, de corte transversal y ámbito poblacional para una ZBS durante el año 2013.

Emplazamiento

Departamento de salud de Castellón, Comunidad Valenciana (CV). Incluye asistencia ambulatoria en AP y especializada.

Participantes

Todos los ciudadanos dados de alta en el Sistema de Información Poblacional (SIP), N = 32.667.

Mediciones

Del sistema informatizado Abucasis obtuvimos las variables demográficas, clínicas y de consumo de recursos sanitarios. Consideramos la prevalencia de los FRCV a partir de la presencia o ausencia de los códigos diagnósticos CIE.9.MC. Se analizó la relación de los FRCV con los 9 estados de salud CRG, y se realizó un análisis predictivo con el modelo de regresión logística para evaluar la capacidad explicativa de cada variable. Además se obtuvo mediante regresión multivariante un modelo explicativo del gasto farmaceútico ambulatorio.

Resultados

La población del estado de salud CRG 4 en adelante tenía multimorbilidad. Los estados de salud CRG 7 y CRG 6 tienen mayor prevalencia de FRCV. Fue predictivo que a mayor morbilidad, mayor consumo de recursos, mediante OR superiores a la media, p < 0,05 e intervalos de confianza del 95%. Se observó que un 59,8% del gasto farmacéutico ambulatorio quedaba explicado por el sistema CRG y todos los FRCV (p < 0,05 y R² corregido = 0,598). En cuanto al efecto de los FRCV sobre los estados de salud CRG, hubo asociación significativa (p < 0,05) para la alteración de la glucemia, dislipidemia e HTA en todos los estados CRG.

Conclusiones

El estudio de los FRCV en una población estratificada mediante el sistema CRG identifica y predice dónde se genera mayor impacto en la morbilidad y consumo de recursos sanitarios. Nos permite conocer los grupos de pacientes en quienes desarrollar estrategias de prevención y cronicidad. A nivel de la práctica clínica se aporta un nuevo concepto de multimorbilidad, definido a partir del estado de salud CRG 4 en adelante.

[Impact of Morbidity on Health Care Costs of a Department of Health through Clinical Risk Groups. Valencian Community, Spain]

BACKGROUND

Risk adjustment systems based on diagnosis stratify the population according to the observed morbidity. The aim of this study was to analyze the total health expenditure in a health area, relating to age, gender and morbidity observed in the population.

METHODS

Observational cross-sectional study of population and area of health care costs in the Health District of Denia-Marina Salud (Alicante) in 2013. Population (N=156,811) were stratified by Clinical Risk Groups into 9 states of health, state 1 being healthy, and state 9 the highest disease burden. Each inhabitant was charged with the hospital costs, primary care and outpatient pharmacy to obtain the total costs. Health status and severity by age and gender, as well as the costs of each group were analysed. The statistical tests, student t and χ2 were applied to verify the existence of significant differences between and intra groups.

RESULTS

The average cost per inhabitant was 983 euros which increased from 240 euros to 42,881 at the state 9 and severity level 6. Patients of health states 5 and 6 caused the largest expenditure by concentration of the population, but health states 8 and 9 had the highest average expenditure, with 80% of hospitalised cost.

CONCLUSIONS

A different composition of health expenditure per individual morbidity was corroborated, with an exponential growth in hospital spending.

[Immigrant women care in a health intercultural mediation program]

BACKGROUND

Intercultural Mediation is a strategy for quality health care aimed at reducing inequalities in immigrant population. The aim is to analyse main reasons consultation with the mediation service, women care profile and characteristics of intervention.

METHODS

Cross-sectional study of 339 episodes of care by two intercultural mediators (MI) from February 2008 to October 2011 in Valencia. Variables were analysed individual records of the consultations of the MI: reasons for referral to MI and professionals who refer, motives and problems identified by MI, kind of intervention, kind of derivation of MI and socio-economic variables. To evaluate the differences between countries, X2 test was used for qualitative variables and one-way ANOVA test for quantitative variables.

RESULTS

123 women (36,3%), were referred to the MI by the Sexual and Reproductive Health Centre and 98 (28,9%) by the midwife. 272 women (80,24%) were referred for information and demand for contraception. The MI conducted health education and detected social problems in 67 women (19,7%) and gender violence in 38 (11,21%).

CONCLUSIONS

The women attending were Latin American immigrants (those of Bolivia showed more vulnerability) and were referred for contraception. The MI provided information, education and facilitated access to reproductive health services. Bolivian women showed more vulnerability factors: irregular situation, precarious work and low residence time.

[Incidence and variability of temporary disability due to anxiety disorders during 2009 in the Valencia Community, Spain]

BACKGROUND

Anxiety, dissociative and somatoform disorders (WHO-e 300) are the second cause of Temporary Disability (TD) in Spain. This is the main reason that justifies the analysis of the variability among primary health care centers (PHC) of the Valencian Community in the prescription processes of Temporary Disability for these disorders.

METHODS

Epidemiological cross-sectional descriptive study of variability of TD processes initiated in 2009 corresponding to diagnosis e 300 in 739 PHC from 23 health districts in the Valencian Community, where 25,859 TD processes for the diagnosis e 300 were prescribed. Traditional indicators of variation developed for the analysis of small areas were used to determine variability in the incidence rate of TD processes. The analysis of variance was used to determine the percentage of explanation of the factors studied.

RESULTS

The average incidence rate obtained was of 1.08 for 100 individuals. The variation range was between 0.01 and 1.97 for percentiles P(5) to P(95). In the variance components analysis, the factor of health district explains the highest percentage of variability (22.12), followed by the factor province (20.21%), coastal areas (4.65%), teaching accreditation (2.44%) and the size of population assigned to each PHC (2.40%).

CONCLUSIONS

Significant differences were observed in the incidence rate of TD processes for the diagnosis e 300. The PHCs with greater population pressure and those that are accredited had the highest rates of incidence.

[The cost-effectiveness of Haemophilus influenzae type b vaccine for children under 2 years of age in Colombia]

OBJECTIVE

Conjugate vaccines are the best public health tools available for preventing most invasive diseases caused by Haemophilus influenzae type b (Hib), but the high cost of the vaccines has so far kept them from being introduced worldwide. The objective of this study was to estimate the cost-effectiveness of introducing Hib conjugate vaccines for the prevention of meningitis and pneumonia among children under 2 years of age in Colombia.

METHODS

We estimated the direct and indirect costs of managing in-hospital pneumonia and meningitis cases. In addition, following the recommendations of the World Health Organization, we assessed the cost-effectiveness of Hib vaccination programs. We also estimated the costs for preventing Hib cases, and the cost per year of life saved in two hypothetical situations: (1) with vaccination against Hib (with 90% coverage) and (2) without vaccination.

RESULTS

The average in-hospital treatment costs were 611.50 US$ (95% confidence interval (95% CI) = 532.2 to 690.8 US$) per case of pneumonia and 848.9 US$ (95% CI = 716.8 to 981.0 US$) per case of meningitis. The average cost per Hib case prevented was 316.7 US$ (95% CI = 294.2 to 339.2 US$). In terms of cost-effectiveness, the cost would be 2.38 US$ per year of life saved for vaccination, versus 3.81 US$ per year of life saved without vaccination.

CONCLUSION

Having an adequate Hib vaccination program in Colombia could prevent around 25,000 cases of invasive disease per year, representing a cost savings of at least 15 million US$ annually. Furthermore, the program could prevent some 700 deaths per year and save 44,054 years of life per year.