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Bartolome Benito E.,Direccion Tecnica de Procesos y Calidad | Miquel Gomez A.,Gerencia Adjunta de Planificacion y Calidad de la Gerencia de Atencion Primaria | Sanchez Perruca L.,Direccion Tecnica de Sistemas de Informacion | Jimenez Carraminana J.,Proyecto eWa | And 2 more authors.
Revista de Calidad Asistencial | Year: 2011

Objective: To identify and define a minimum and standard set of safety objectives in the Centre Agreement Program (CAP) of the Community of Madrid, the introduction of which has led to improved follow-up and an improvement in quality of care and patient safety in Primary Care. Material and Methods: The key element is the Centre Agreement Program developed with the EFQM model as a reference. Methodologically, this project has followed the steps set out in the PDCA cycle., Standardised safety objectives were included in the CAP during the planning phase. Indicators have been monitored by the e-SOAP application. Results: We have identified 12 safety goals and 21 indicators. All the criteria of the model included some safety objectives. We highlight the following results: in the criteria relating to processes, the program cover of patients who were on several medications was 59.22%, a bio-alcohol solution was used in 93% of health facilities, 89% of Health Centres had performed a control and maintenance of vital emergency equipment. As regards communication, 1096 medication errors were notified throughout the Community of Madrid. There were 239 adverse reactions to medication and 1945 safety incidents were reported. In criterion 6, 66.22% of INR determinations were within range. There were 19.46 defined daily doses (DDD) for women of 45-65 years, and 16.9 DDD of neuroleptics in the elderly population. The indicator related to minimising drugs considered inappropriate in the elderly (Beers) was 11.9%. An average of 1.19 safety measures were adopted per Centre. For Criterion 7, 14.44% of professionals had been trained in quality and patient safety. By implementing e-SOAP, Health Centres can know their results in order to implement improvements. In addition, improvements have been set up in the 2010 CAP. Conclusions: With the development of the CAP using the EFQM model as a benchmark, safety indicators have been implemented and monitored systematically in the Health Centres of the Community of Madrid. Best practices that ensure patient safety have been extended and we have begun to evaluate the impact of the health care provided in Primary Care with the measurement of indicators that the scientific evidence reveals affect patient safety. © 2011 SECA. Published by Elsevier España, S.L. All rights reserved. Source


Lopez-de-Andres A.,Rey Juan Carlos University | Jimenez-Trujillo I.,Rey Juan Carlos University | Jimenez-Garcia R.,Rey Juan Carlos University | Hernandez-Barrera V.,Rey Juan Carlos University | And 5 more authors.
Cardiovascular Diabetology | Year: 2015

Background: This study aims to describe trends in the rate of abdominal aortic aneurysm (AAA) and use of open surgery repair (OSR) and endovascular aneurysm repair (EVAR) in elderly patients with and without type 2 diabetes in Spain, 2003-2012. Methods: We select all patients with a discharge of AAA using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. In both groups OSR and EVAR were identified. The incidence of discharges attributed to AAA were calculated overall and stratified by diabetes status and year. We calculated length of stay (LOHS) and in-hospital mortality (IHM). Use of OSR and EVAR were calculated stratified by diabetes status. Multivariate analysis was adjusted by age, sex, year, smoking habit and comorbidity. Results: From 2003 to 2012, 115,020 discharges with AAA were identified. The mean age was 74.91 years and 16.7% suffered type 2 diabetes. Rates of discharges due to AAA increased significantly in diabetic patients (50.09 in 2003 to 78.23 cases per 100,000 in 2012) and non diabetic subjects (69.24 to 78.66). The incidences were higher among those without than those with diabetes in all the years studied. Conclusions: Incidence rates were higher in non-diabetic patients. For diabetic and non diabetic patients the use of EVAR has increased and open repair seems to be decreasing. IHM and LOHS have improved from 2003 to 2012. Patients with diabetes had significantly lower mortality. © 2015 Lopez-de-Andrés et al.; licensee BioMed Central. Source


Jimenez-Trujillo I.,Rey Juan Carlos University | Gonzalez-Pascual M.,Rey Juan Carlos University | Jimenez-Garca R.,Rey Juan Carlos University | Hernandez-Barrera V.,Rey Juan Carlos University | And 7 more authors.
Medicine (United States) | Year: 2016

To describe trends in the rates of discharge due to thoracic aortic aneurysm and dissection (TAAD) among patients with and without type 2 diabetes in Spain (2001-2012). We used national hospital discharge data to select all of the patients who were discharged from the hospital after TAAD. We focused our analysis on patients with TAAD in the primary diagnosis field. Discharges were grouped by diabetes status (diabetic or nondiabetic). Incidence was calculated overall and stratified by diabetes status. We divided the study period into 4 periods of 3 years each. We analyzed diagnostic and surgical procedures, length of stay, and in-hospital mortality. We identified 48,746 patients who were discharged with TAAD. The rates of discharge due to TAAD increased significantly in both diabetic patients (12.65 cases per 100,000 in 2001/2003 to 23.92 cases per 100,000 in 2010/2012) and nondiabetic patients (17.39 to 21.75, respectively). The incidence was higher among nondiabetic patients than diabetic patients in 3 of the 4 time periods. The percentage of patients who underwent thoracic endovascular aortic repair increased in both groups, whereas the percentage of patients who underwent open repair decreased. The frequency of hospitalization increased at a higher rate among diabetic patients (incidence rate ratio 1.14, 95% confidence interval [CI] 1.07-1.20) than among nondiabetic patients (incidence rate ratio 1.08, 95% CI 1.07-1.11). The in-hospital mortality was lower in diabetic patients than in nondiabetic patients (odds ratio 0.83, 95% CI 0.69-0.99). The incidence rates were higher in nondiabetic patients. Hospitalizations seemed to increase at a higher rate among diabetic patients. Diabetic patients had a significantly lower mortality, possibly because of earlier diagnoses, and improved and more readily available treatments. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source


Lopez-de-Andres A.,Rey Juan Carlos University | Jimenez-Garcia R.,Rey Juan Carlos University | Jimenez-Trujillo I.,Rey Juan Carlos University | Hernandez-Barrera V.,Rey Juan Carlos University | And 6 more authors.
Osteoporosis International | Year: 2016

Summary: Hip fracture is a serious public health problem. We used Spanish hospital discharge data to examine trends in 2004–2013 in the incidence of hip fracture among elderly patients. We found that hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. Introduction: This study aimed to describe trends in the incidence of hip fracture hospitalizations, use of surgical procedures, and hospital outcomes among elderly patients with and without type 2 diabetes mellitus (T2DM) in Spain, 2004–2013. Methods: We selected all patients with a discharge primary diagnosis of hip fracture using the Spanish national hospital discharge database. Discharges were grouped by diabetes status: Incidences were calculated overall and stratified by diabetes status and year. We analyzed surgical procedures, length of hospital stay (LOHS), and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year, comorbidity, and in-hospital complications (IHC). Results: From 2004 to 2013, 432,760 discharges with hip fracture were identified (21.3 % suffered T2DM). Incidence among diabetic men and women increased until year 2010 and then remained stable. Diabetic women have three times higher incidence than diabetic men. Incidences and IHC were higher among patients with diabetes beside sex. The proportion of patients that underwent internal fixation increased for all groups of patients and the arthroplasty repair decreased. After multivariate analysis, IHM has improved over the study period for all patients. Suffering diabetes was associated to higher IHM in women (odds ratio (OR) 1.12; 95 % confidence interval (CI) 1.07–1.17). Conclusions: Hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. In diabetic patients, incidence rates increased initially but have leveled from 2010 onwards. For all groups, the use of internal fixation has increased overtime and IHM and LOHS have decreased from 2004 to 2013. © 2015, International Osteoporosis Foundation and National Osteoporosis Foundation. Source


Lopez-de-Andres A.,Rey Juan Carlos University | Jimenez-Trujillo M.I.,Rey Juan Carlos University | Hernandez-Barrera V.,Rey Juan Carlos University | De Miguel-Yanes J.M.,Hospital Universitario del Sureste | And 7 more authors.
PLoS ONE | Year: 2015

Background: This study aims to describe trends in the prevalence of depression among hospitalized patients with type 2 diabetes in Spain, 2001-2011. Methods: We selected patients with a discharge diagnosis of type 2 diabetes using national hospital discharge data. Discharges were grouped by depression status. Prevalence of depression globally and according to primary diagnoses based on the Charlson comorbidity index (CCI) were analyzed.We calculated length of stay (LOHS) and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year and comorbidity. Results: From 2001 to 2011, 4,723,338 discharges with type 2 diabetes were identified (4.93% with depression). Prevalence of depression in diabetic patients increased from 3.54% in 2001 to 5.80% in 2011 (p<0.05). The prevalence of depression was significantly higher in women than in men in each year studied and increased from 5.22% in 2001 to 9.24% in 2011 (p<0.01). The highest prevalence was observed in the youngest age group (35-59 years). The median LOHS decreased significantly over this period. Men with diabetes and depression had higher IHM than women in all the years studied (p<0.05). Older age and greater comorbidity were significantly associated with a higher risk of dying, among diabetic patients with concomitant depression. Conclusions: Prevalence of depression increased significantly among hospitalized diabetic patients from 2001 to 2011 even if the health profile and LOHS have improved over this period. Programs targeted at preventing depression among persons with diabetes should be reinforced in Spain. © 2015 Lopez-de-Andrés et al. Source

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