Showing papers by "Joan Escarrabill published in 2016"

Integrated Health Care Barcelona Esquerra (Ais-Be): A Global View of Organisational Development, Re-Engineering of Processes and Improvement of the Information Systems. The Role of the Tertiary University Hospital in the Transformation

Abstract: The Integrated Health Area “Barcelona Esquerra” ( Area Integral de Salud de Barcelona Esquerra – AIS-BE), which covers a population of 524,000 residents in Barcelona city, is running a project to improve healthcare quality and efficiency based on co-ordination between the different suppliers in its area through the participation of their professionals. Endowed with an Organisational Model that seeks decision-taking that starts out from clinical knowledge and from Information Systems tools that facilitate this co-ordination (an interoperability platform and a website) it presents important results in its structured programmes that have been implemented such as the Reorganisation of Emergency Care, Screening for Colorectal Cancer, the Onset of type 2 Diabetes Mellitus, Teledermatology and the Development of Cross-sectional Healthcare Policies for Care in Chronicity.

Assessment of Chronic Health Care through an Internet Consensus Tool

Abstract: “Health Consensus for the Assessment of Chronic Care Programs” (HC-ACP) is an internet based application created to promote and facilitate the participation of health professionals in the definition of a set of indicators for the assessment of chronic care and management of areas of improvement in this field. The first prototype of the application has been applied twice, first in the region of Catalonia, and in a second project in the context of the whole Spanish Health System. HC-ACP has collected contributions from more than 800 health professionals from around Spain including profiles in the fields of management, health care professional, health planning and quality assessment, allowing sharing and aggregate knowledge and clinical experience from a wide range of points of view. After a process of literature review and panel meetings with professionals who proposed a wide list of indicators, the HCACP application was used to select a minimum set of indicators following a participative process based on Health Consensus, an online Real Time Delphi method. The first part of this chapter is devoted to expose paradigms that define the interdisciplinary research field of the method, the second part of the chapter presents the Health Consensus method, and finally the third part exposes a detailed description of the HC-ACP application and the followed process. Besides the relevance and utility of the Health Assessment of Chronic Health Care through an Internet Consensus Tool

Aproximación a la experiencia del paciente y sus cuidadores en la oxigenoterapia domiciliaria

Abstract: Resumen Introduccion Las terapias respiratorias a domicilio suponen un gran impacto en la vida del paciente y de sus familiares. El objetivo de este estudio reside en conocer las opiniones, percepciones y actitudes de los pacientes y sus cuidadores sobre la oxigenoterapia domiciliaria. Metodo Estudio cualitativo-fenomenologico de una muestra de 57 personas: 18 familiares y 39 pacientes que reciben oxigenoterapia domiciliaria en nucleos urbanos relevantes. Se realizaron 5 grupos focales entre marzo y julio de 2014 en centros hospitalarios de Barcelona, Madrid y Alicante. El material de analisis consto de las grabaciones en audio de las entrevistas en los grupos focales, la trascripcion de las mismas y las notas de campo registradas. El analisis de los datos se realizo a partir del metodo de las comparaciones constantes. Resultados Los datos se analizaron en 2 niveles. En un primer nivel de analisis se obtuvieron 21 categorias que, posteriormente, en un segundo nivel de analisis, se integraron en 6 metacategorias: atencion facilitada por los profesionales sanitarios, impacto psicologico, atencion facilitada por las casas comerciales, impacto en la vida cotidiana, inconvenientes y satisfaccion. Conclusiones La oxigenoterapia domiciliaria tiene un gran impacto psicologico y en la vida diaria tanto de los pacientes como de sus familiares. Por otro lado, seria conveniente mejorar la coordinacion entre los diferentes niveles asistenciales y las empresas suministradoras de oxigenoterapia para facilitar informacion coherente y estrategias utiles para los pacientes y familiares.

Protocol for regional implementation of collaborative lung function testing.

Abstract: The potential of forced spirometry (FS) testing for diagnosis, monitoring and management of chronic respiratory patients is well established1-3 such that FS is a pivotal test in both respiratory medicine and primary care. Moreover, it also shows potential in the informal care scenario: that is, in pharmacy offices for case-finding purposes4,5 and for self-management in selected patients.6,7 We acknowledge that well-designed studies8 have failed to show practical benefits of FS for asthma and COPD diagnosis and management in primary care. However, it has been demonstrated that historical limitations for extensive use of FS in primary care, because of suboptimal quality of testing, can be overcome by offline remote support by specialised professionals.9,10 Large-scale deployment of this type of setting has generated evidence of cost-effectiveness..

Defining Patient and Caregivers’ Experience of Home Oxygen Therapy

Abstract: Introduction Home oxygen therapy has a great impact on the lives of patients and their families. The aim of this study is to define the opinions, perceptions and attitudes of patients and their caregivers regarding home oxygen. Method Qualitative, phenomenological study of a sample of 57 subjects, consisting of 18 family members and/or caregivers and 39 patients receiving home oxygen in urban centers. Five focus groups were formed between March and July 2014 in hospitals in Barcelona, Madrid and Alicante. Prior informed consent was obtained from patients and families. The study material consisted of audio recordings of all focus group interviews, transcription of selected materials and field notes. Data analysis was performed using constant comparison method, establishing 2 levels of analysis. Results Data from the focus groups were analyzed on 2 levels. A first level of analysis gave 21 categories. In a second level of analysis, these were integrated into 6 meta-categories: care provided by health professionals, psychological impact, care provided by commercial companies, impact on daily life, problems and satisfaction. Conclusions Home oxygen has a major psychological impact on the daily lives of both patients and their families, and can cause social isolation. Although the results show that healthcare professionals are highly appreciated, better coordination is needed between different levels of care and companies supplying oxygen in order to provide patients and families with consistent information and useful strategies.

Desarrollo de un marco conceptual para la evaluación de la atención a la cronicidad en el sistema nacional de salud

Abstract: RESUMEN El objetivo del trabajo fue desarrollar un marco conceptual para la evaluacion de nuevos programas de gestion clinica y asistencial de caracter integrado en el Sistema Nacional de Salud para la atencion a las personas con enfermedades cronicas. Se realizo una revision exhaustiva de la literatura entre 2002-2013 incluyendo revisiones sistematicas, metaanalisis e informes con modelos de evaluacion y/o evaluaciones de programas. Se estudiaron y describieron programas locales de atencion a la cronicidad implementados en Cataluna y se realizaron entrevistas semiestructuradas con expertos clave en el ambito catalan. El alcance y el marco conceptual se definieron mediante la tecnica del brainstorming. De 910 resumenes identificados, se incluyeron 116 documentos que se referian a marcos conceptuales e indicadores de evaluacion a nivel espanol e internacional. Se identificaron 24 programas de atencion a la cronicidad (9 de caracter integrado). El marco conceptual propuesto contemplo: 1) la poblacion diana segun niveles de complejidad; 2) un enfoque de evaluacion de la estructura, procesos y resultados teniendo en cuenta el estado de salud conseguido, el proceso de recuperacion y mantenimiento de la salud; y 3) las dimensiones o atributos que se deben evaluar. El marco conceptual propuesto permitira desarrollar indicadores e implementarlos con un enfoque comunitario, orientados a los resultados y tener una vision territorial o poblacional, que sera imprescindible para saber cual es la estrategia mas efectiva, cuales son los elementos que determinan un mayor exito y cuales son los grupos de pacientes que mas se pueden beneficiar.

Integrated care in a metropolitan area: blurring the boundaries between high-tech hospital and the community

Abstract: The integration of health service provision is a conceptual framework that is easy to share from a theoretical point of view but raises problems when it comes to specifying actions and comparing the models and the results obtained. In general, the models for integration of services are hybrids and have been built up starting from an iterative process that receives the impact both of the general conditions (funding systems, health policies and social provisions) and of the local conditions (demography, types of supplier or available human resources). Until relatively recently high-tech hospitals were not aware of his dual function: A function of high-tech services to a very large part of the population but also a function of general hospital for the local community. Obviously, the strategy to address the problems of high technology can not be the same as to address the health problems of the community. Health professionals and organizations must adapt to provide the right services, avoiding the "one size fits all". In the workshop we will discuss the strengths and weaknesses of integrated care models in which it is involved high-tech hospital. It is therefore important to know the causes that drive transformation, levers for change and how to establish priorities.