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Navarro-Perez J.,Institute Investigacion Sanitaria INCLIVA | Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Lopez-Alcina E.,Consorcio Hospital General Universitario Of Valencia | Real-Romaguera A.,Consorcio Hospital General Universitario Of Valencia
Atencion Primaria | Year: 2014

Objective To assess quality of care indicators for benign prostatic hyperplasia (BPH), and to evaluate their strengths and weaknesses for incorporation into health information systems. Design Structured expert meeting, using procedures adapted from the nominal group techniques and the Rand consensus method. Setting Valencian School of Health Studies. Participants and/or contexts Forty panellists (74% doctors, 70% from primary care settings) with experience in the management of BPH from 15 departments of the Valencia Health Agency. Method Three workshops were held simultaneously (examination and diagnosis, drug therapy, and appropriateness and results), and the 15 quality indicators selected by the coordination group were assessed. Results Eleven of the 15 indicators scored in the range of high relevance. The 5 best rated were: the use of alpha-blockers + 5-alpha reductase inhibitor from certain severity level, digital rectal examination in the initial assessment, follow-up with the International Prostate Symptoms Score (IPSS), the rate of urgent catheterization in Hospital Accident & Emergency Units, initial assessment with the IPSS and the use of alpha-blockers prior to catheter removal for acute retention of urine. Conclusions Some of the assessed indicators can be useful for incorporation into health information systems. © 2013 Elsevier España, S.L. All rights reserved.


PubMed | Centro Superior Of Investigacion En Salud Publica Csisp Fisabio, Consorcio Hospital General Universitario Of Valencia and Institute Investigacion Sanitaria INCLIVA
Type: Journal Article | Journal: Atencion primaria | Year: 2014

To assess quality of care indicators for benign prostatic hyperplasia (BPH), and to evaluate their strengths and weaknesses for incorporation into health information systems.Structured expert meeting, using procedures adapted from the nominal group techniques and the Rand consensus method.Valencian School of Health Studies.Forty panellists (74% doctors, 70% from primary care settings) with experience in the management of BPH from 15 departments of the Valencia Health Agency.Three workshops were held simultaneously (examination and diagnosis, drug therapy, and appropriateness and results), and the 15 quality indicators selected by the coordination group were assessed.Eleven of the 15 indicators scored in the range of high relevance. The 5 best rated were: the use of alpha-blockers + 5-alpha reductase inhibitor from certain severity level, digital rectal examination in the initial assessment, follow-up with the International Prostate Symptoms Score (IPSS), the rate of urgent catheterization in Hospital Accident & Emergency Units, initial assessment with the IPSS and the use of alpha-blockers prior to catheter removal for acute retention of urine.Some of the assessed indicators can be useful for incorporation into health information systems.


Pla A.B.,Fundacion Of Investigacion Del Hospital Clinico Universitario Institute Investigacion Sanitaria | Soler V.G.,Fundacion Of Investigacion Del Hospital Clinico Universitario Institute Investigacion Sanitaria | Ridao-Lopez M.,Instituto Aragones Of Ciencia Of La Salud Institute Investigacion Sanitaria Aragon | Ridao-Lopez M.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | And 3 more authors.
Revista Espanola de Salud Publica | Year: 2013

Background: To Estimate, in the context of a Health Department of the Valencia HealthAgency, the budgetary impact ofthe widespread use of dabigatran at doses of 110 and 150 mg in patients with non-valvular atrial fibrillation (AF), regarding the current scenario with acenocoumarol the-rapy. Methods: Budget impact analysis of three scenarios of oral anticoa-gulation use inAF: a) current treatment with acenocoumarol, b) widespre-ad replacement of acenocoumarol for Dabigatran 110 mg and, c) idem at doses of 150 mg. The analysis was conducted from the perspective of the Valencia HealthAgency with a time horizon of one year (2009). The effec-tiveness and adverse effects were extrapolated from the RE-LY study, whi-le prevalence and cost data correspond tothe Health Department estimates in 2009. Results: We included 5889 patients (2.4% of the population > 18 years) diagnosed with AF, of which 3726 (63.2%) were treated with ace-nocoumarol. The total costs of each scenario were € 1,119,412 (€ 300 patient/year) for acenocoumarol, € 4,985,095 (€ 1,337 patient/year) for dabigatran 110 and € 4,981,226 (€ 1,336 patient/year) for dabigatran 150, with a budget impact of 1,037 euros/year per patient shifted from aceno-cumarol to dabigatran-150 . Conclusions: The high budgetary impact of moving to a scenario of widespread substitution of warfarin for Dabigatran supports the restriction of this therapeutic strategy to subgroups of patients at high risk or difficult control.


Mari-Dell'Olmo M.,CIBER ISCIII | Mari-Dell'Olmo M.,Biomedical Research Institute Sant Pau | Martinez-Beneito M.A.,CIBER ISCIII | Martinez-Beneito M.A.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | And 4 more authors.
Stochastic Environmental Research and Risk Assessment | Year: 2014

Smoothed analysis of variance (SANOVA) has recently been proposed for carrying out disease mapping. The main advantage of this approach is its conceptual simplicity and ease of interpretation. Moreover, it allows us to fix the combination of diseases of particular interest in advance and to make specific inferences about them. In this paper we propose a reformulation of SANOVA in the context of ecological regression studies. This proposal considers the introduction in a non-parametric way of one (or several) covariate(s) into the model, explaining some pre-specified combinations of the outcome variables. In addition, random effects are also incorporated in order to model geographical variation in the combinations of outcome variables not explained by the covariate. Lastly, the model permits the decomposition of the variance in the set of outcome variables into different orthogonal components, quantifying the contribution of every one of them. The proposed model is applied to the geographical analysis of mortality due to malignant stomach neoplasm among women resident in the city of Barcelona (Spain). The available outcome variables are deaths grouped into two time periods, and a socioeconomic deprivation index is included as a covariate. The model has been implemented through INLA, a novel inference tool for Bayesian statistics. © 2013 Springer-Verlag Berlin Heidelberg.


Artells J.J.,Fundacion Salud | Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Meneu R.,Fundacion Institute Investigacion En Servicios Of Salud
Revista Espanola de Salud Publica | Year: 2014

Background: To identify difficulties, obstacles and limitations to establish an organizational structure devoted to the evaluation of healthcare technologies for incorporation, maintenance or removal from the services portfolio of the Spanish National Health System (sNHS). Methods: Panel of 14 experts, structured according to processes adapted from brainstorming, nominal group, and Rand consensus method techniques. Results: The panel proposed 77 items as potential obstacles to the establishment of an official and independent "agency" able to inform on sNHS healthcare benefits funding or selective disinvestment. These items were focused on: 1) lack of political motivation to introduce the cost-effectiveness analysis from the state and regional governments and lack of independence and transparency of the evaluation processes, 2) the tension between a decentralized health system and evaluation activities with significant scale economies, 3) technical difficulties of the evaluation processes, including their ability to influence decision making and 4) social and professional refusal to the exclusion of healthcare benefits when it is perceived as indiscriminate. Conclusion: Although there is a different number and type of obstacles for developing the capacity of the sNHS to include or exclude healthcare benefits based on the evaluation of their effectiveness and efficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field.


Cano-Blanquer D.,Sociedad Valenciana de Farmaceuticos de Atencion Primaria | Cervera-Casino P.,Sociedad Valenciana de Farmaceuticos de Atencion Primaria | Peiro-Moreno S.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Mateu-Garcia M.,Sociedad Valenciana de Farmaceuticos de Atencion Primaria | Barreda-Aznar A.,Sociedad Valenciana de Farmaceuticos de Atencion Primaria
Revista Espanola de Salud Publica | Year: 2013

Background: Self-monitoring of blood glucose (SMBG) in noninsulintreated type 2 diabetes patients (T2DM) is a controversial topic. We aimed to describe the SMBG prevalence in noninsulin-treated (NIT) T2DM patients in the Valencia Community (VC) and to analyze factors associated with their use. Method: Cross-sectional studywith 573 NIT-T2DM patients from 83 primary care surgeries. Electronic medical records and patient interview were used. We examine associations among patient, doctors and organizational characteristics, and the SMBG indication. Results: 289 (50.4%) of the 573 NIT-T2DM patients used SMBG. In the multivariable analysis SMBG use was associated with age (OR:2.3 for 65-84 and 6.0 for <65 years vs 85+ years old)) the length from diagnosis (OR:2.2 for 10-15 years vs 0-5 years), the number of OAAs prescribed (OR:2.5, 4.1 and 5.7 for 1, 2 or 3+ OAAs vs no treatment with OAAs) and type (with more SMBG prescribed in patients with sulfonylureas and glitazones), glycated haemoglobin figures (OR: 1.9 y 1.6 for 7-8 and >8, vs <7), sedentary behaviour (OR:1.6), obesity (OR:1.5), and housewife status, and chronic respiratory disease antecedents (OR:0.5). After controlling these factors, SMBG use was also associated with the length of doctor's professional practice and some healthcare departments. Conclusions: In the Valencia Community the SMBG use in noninsulintreated T2DM patients is strongly associated with clinic patient' characteristics, but some non-clinical factors explain part of the variance in their utilization.


PubMed | Red de Investigacion en Servicios de Salud en Enfermedades Cronicas REDISSEC and Centro Superior Of Investigacion En Salud Publica Csisp Fisabio
Type: Journal Article | Journal: BMC health services research | Year: 2016

Potentially Preventable Hospitalizations (PPH) are hospital admissions for conditions which are preventable with timely and appropriate outpatient care being Chronic Obstructive Pulmonary Disease (COPD) admissions one of the most relevant PPH. We estimate the population age-sex standardized relative risk of admission for COPD-PPH by year and area of residence in the Spanish National Health System (sNHS) during the period 2002-2013.The study was conducted in the 203 Hospital Service Areas of the sNHS, using the 2002 to 2013 hospital admissions for a COPD-PPH condition of patients aged 20 and over. We use conventional small area variation statistics and a Bayesian hierarchical approach to model the different risk structures of dependence in both space and time.COPD-PPH admissions declined from 24.5 to 15.5 per 10,000 persons-year (Men: from 40.6 to 25.1; Women: from 9.1 to 6.4). The relative risk declined from 1.19 (19% above 2002-2013 average) in 2002 to 0.77 (30% below average) in 2013. Both the starting point and the slope were different for the different regions. Variation among admission rates between extreme areas dropped from 6.7 times higher in 2002 to 4.6 times higher in 2013.COPD-PPH conditions in Spain have undergone a strong decline and a reduction in geographical variation in the last 12years, suggesting a general improvement in health policies and health care over time. Variability among areas still remains, with a substantial room for improvement.


Librero J.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Belda A.,Servicio de Analisis de Sistemas de Informacion Sanitaria | Calabuig J.,Servicio de Analisis de Sistemas de Informacion Sanitaria
Revista Espanola de Salud Publica | Year: 2014

Background: the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries. Methods: retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: minimum basic dataset).Alow-risk subpopulation consisting of women under-35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks. Results:atotal of117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks inthe population of low risk did not alter the hospital effect on the c-section rate. Conclusion: the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System.


Ibanez-Beroiz B.,NavarraBiomed Fundacion Miguel Servet | Librero J.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Bernal-Delgado E.,Instituto Aragones Of Ciencias Of La Salud Iis Aragon | Garcia-Armesto S.,Instituto Aragones Of Ciencias Of La Salud Iis Aragon | And 2 more authors.
BMC Medical Research Methodology | Year: 2014

Background: Rates of Potentially Preventable Hospitalizations (PPH) are used to evaluate access of territorially delimited populations to high quality ambulatory care. A common geographic pattern of several PPH would reflect the performance of healthcare providers. This study is aimed at modeling jointly the geographical variation in six chronic PPH conditions in one Spanish Autonomous Community for describing common and discrepant patterns, and to assess the relative weight of the common pattern on each condition. Methods. Data on the 39,970 PPH hospital admissions for diabetes short term complications, chronic obstructive pulmonary disease (COPD), congestive heart failure, dehydration, angina admission and adult asthma, between 2007 and 2009 were extracted from the Hospital Discharge Administrative Databases and assigned to one of the 240 Basic Health Zones. Rates and Standardized Hospitalization Ratios per geographic unit were estimated. The spatial analysis was carried out jointly for PPH conditions using Shared Component Models (SCM). Results: The component shared by the six PPH conditions explained about the 36% of the variability of each PPH condition, ranging from the 25.9 for dehydration to 58.7 for COPD. The geographical pattern found in the latent common component identifies territorial clusters with particularly high risk. The specific risk pattern that each isolated PPH does not share with the common pattern for all six conditions show many non-significant areas for most PPH, but with some exceptions. Conclusions: The geographical distribution of the risk of the PPH conditions is captured in a 36% by a unique latent pattern. The SCM modeling may be useful to evaluate healthcare system performance. © 2014 Ibañez-Beroiz et al.; licensee BioMed Central Ltd.


Catala-Lopez F.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Sanfelix-Gimeno G.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Ridao M.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Ridao M.,Instituto Aragones Of Ciencias Of La Salud Ics | Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio
PLoS ONE | Year: 2013

Background:We examined sponsorship of published cost-effectiveness analyses of statin use for cardiovascular (CV) prevention, and determined whether the funding source is associated with study conclusions.Methods and Findings:We searched PubMed/MEDLINE (up to June 2011) to identify cost-effectiveness analyses of statin use for CV prevention reporting outcomes as incremental costs per quality-adjusted life years (QALY) and/or life years gained (LYG). We examined relationships between the funding source and the study conclusions by means of tests of differences between proportions. Seventy-five studies were included. Forty-eight studies (64.0%) were industry-sponsored. Fifty-two (69.3%) articles compared statins versus non-active alternatives. Secondary CV prevention represented 42.7% of articles, followed by primary CV prevention (38.7%) and both (18.7%). Overall, industry-sponsored studies were much less likely to report unfavourable or neutral conclusions (0% versus 37.1%; p<0.001). For primary CV prevention, the proportion with unfavourable or neutral conclusions was 0% for industry-sponsored studies versus 57.9% for non-sponsored studies (p<0.001). Conversely, no statistically significant differences were identified for studies evaluating secondary CV prevention (0% versus 12.5%; p=0.222). Incremental costs per QALY/LYG estimates reported in industry-sponsored studies were generally more likely to fall below a hypothetical willingness-to-pay threshold of US $50,000.Conclusions:Our systematic analysis suggests that pharmaceutical industry sponsored economic evaluations of statins have generally favored the cost-effectiveness profile of their products particularly in primary CV prevention. © 2013 Catalá-López et al.

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