Hospital admissions/mortality ratio: a composite health indicator for monitoring NCD

Background

Our aim was to test the usefulness of a new tool to monitor NCD. We evaluated a composite indicator, the ratio of hospitalizations vs mortality rates (HMR), by assessing its capacity of identifying additional variability among regions. In this communication, we present the analysis corresponding to ischemic heart disease as an example.

Methods

We used the Hospital Morbidity Survey and the Death Statistics for Spain in 2016, both provided by the National Institute of Statistics, to calculate age-adjusted hospitalisation and mortality rates for ischemic heart disease for men and women in all 52 provinces of Spain. Subsequently, we computed HMR, the ratio of the age-adjusted of hospital morbidity and mortality rates. The correlation and linear adjustment between provincial mortality and morbidity rates, as well as mortality and HMR, were also estimated by sex.

Results

The rate of hospital admissions for ischemic heart disease in Spain was 407 per 100,000 in men and 129.4 in women. The mortality rate was 93.1 per 100,000 in men and 40.3 in women. In both sexes, the highest morbidity and mortality rates were observed in the south of Spain. Pearson correlation between morbidity and mortality rates were 0.53 (p < 0.01) in men and 0.75 (p < 0.05) in women. HMR showed a different spatial pattern with important variability. In men the average ratio was 4.3, with a range of 2.8 (Tenerife) to 7.1 (Melilla); in women the average was 3.2 with a range between1.7 (Zamora and Tenerife) and 4.7 (Barcelona), and in both sexes very high ratios were found in Catalonia's provinces. Association between mortality rate and HMR showed a negative correlation in both men (-0.39; p < 0.01) and women (-0.24; p < 0.05).

Conclusions

HMR is a composite indicator that provides complementary information regarding the individual analysis of hospital morbidity and mortality rates. HMR of ischemic heart disease shows an important geographical variability and an inverse association with mortality.

Towards an EU sustainable health information infrastructure. Integrating technical and political views and interest

Background

Health information systems (HIS) play a key role in providing information for decision-making. Europe lacks of an integrated HIS on non-communicable diseases (NCD) and Health Systems Performance (HSP) able to compare health problems across countries. NCDs are the main contributor to the EU-burden of disease, including the highest mortality rates. There is a general agreement among public health policy makers and researchers on the need of an integrated EU health information (HI) infrastructure to monitor risk factors, NCD and HSP. Such infrastructure would provide common inputs for public health and research to prioritize health policies. However, there is no EU-EEA consensus on how to go forward with this initiative.

Methods

The Information for Action (InfAct) project is aimed at establishing a sustainable HI infrastructure on HIS and HSP by cataloging resources, experience, research capacities and expertise into a 'one-stop shop'. Significant political will is needed to support and systematically feed a functional and permanent governance structure. InfAct provides a ground for Member States to discuss and generate consensus through two main boards: 1) Technical Dialogues (TD), composed by national experts, to discuss scientific aspects, feasibility and added value; and 2) Assembly of Members (AoM) where political representatives from Ministries of Health and Research provide the framework of political acceptance and guarantee of implementation and future development.

Results

Both boards reveal different interests and concerns. The AoM rather focused on resources and necessary political decisions based on expected returns. The TD focused on feasibility aspects and new adaptations required from current systems. The feedback provided by both boards is key to develop a sustainable EU-HIS infrastructure.

Conclusions

The TD and the AoM are key forums to provide feedback, guidance and advocacy to build a sustainable EU-HIS infrastructure

Use of non-health EU databases for health surveillance. En-risk application

Background

To combine health information and environmental health determinants is key, for epidemiological monitoring and health risk studies but its integration represents a challenge that requires specific expertise. An example of a potentially useful source of significant environmental data relevant for health is the European Pollutant Release and Transfer Register (E-PRTR), which allows estimating exposure to industrial pollution. Our aim was to develop an easy-to-use tool that allows to perform a screening suggesting the presence/absence of excess risk of a disease linked to residential proximity to industrial pollution.

Methods

En-risk: java interactive tool was developed to merge E-PRTR information and municipal mortality/morbidity data, to perform an exploratory spatial analysis of association between them by type of industrial facility using distance as proxy of exposure. The application needs cartography of the country and a database of the annual observed deaths (mortality) or cases (morbidity) and population broken down by age groups and sex per municipality. With this it calculates the expected number of deaths, the distance from the municipal centroids to the industrial location (classifying municipalities as exposed or not exposed), and perform the statistical analyses. Municipal lung cancer deaths (2005-2009) in Spain provided by the National Institute of Statistics were analyzed with this application as an example.

Results

En-risk gives a table of Relative Risk of mortality/morbidity due to exposure to industrial pollution by industrial sector and sex. The analysis in lung cancer deaths showed an excess of mortality associated to proximity to several industrial sectors.

Conclusions

En-risk facilitates the study of the relationship between industrial pollution and health around Europe. It can be used by public health services to identify health problems.

[Work setting, satisfaction and burnout of the nurses in critical care units and hospitalization units. RN4CAST-Spain project]

OBJECTIVE

To know if there are differences between the critical care units and the medical-surgical care units regarding the perception of the nurses working in National Health System hospitals about their work environment, burnout level and job satisfaction.

METHOD

A cross-sectional study was conducted with 6,417 nurses from the medical-surgical care units and with 1,122 nurses from critical care units of 59 Spanish hospitals with more than 150 beds. Socio-demographic, job satisfaction, perception of work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI questionnaire]) and burnout measured with the Maslach Burnout Inventory (MBI) data were collected.

RESULTS

The PES-NWI showed differences in 4 out of its 5 factors. It showed better values in medical-surgical units in all the factors, except for Staffing and resource adequacy (P<.001), where critical care units showed a mean level of agreement of 2.41 versus 2.19 for the medical-surgical units. Regarding burnout, this was higher in the medical-surgical care units (P=.039) where 23% (952) of the nurses had high levels. Job satisfaction was lower in the critical care units (P=.044) with 70% (578) of nurses being very or strongly satisfied.

CONCLUSIONS

The opinion of the nurses, working in critical care units about their hospital is unfavorable. They showed lower levels of burnout than those working in medical-surgical units.