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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">In the absence of a clear health care model for the management of patients with chronic obstructive pulmonary disease and chronic respiratory insufficiency&#44; we evaluated the effectiveness and efficiency of a specialized outpatient unit for these patients managed by the hospital&#39;s respiratory medicine department&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">This was a 1-year prospective study of a group of patients for whom historical control data were available&#46; The mean &#40;SD&#41; descriptive data for the 124 patients &#40;105 men&#41; were as follows&#58; age&#44; 69 &#40;7&#41; years&#59; forced vital capacity&#44; 64&#46;6&#37; &#40;16&#46;1&#37;&#41;&#59; forced expiratory volume in the first second &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; 35&#46;6&#37; &#40;12&#46;8&#37;&#41;&#59; PaO<span class="elsevierStyleInf">2</span>&#44; 56&#46;6 &#40;8&#46;3&#41; mm Hg&#59; PaCO<span class="elsevierStyleInf">2</span>&#44; 49&#46;8 &#40;6&#46;7&#41; mm Hg&#46; Forced spirometry and arterial blood gas analysis were performed at 3-monthly visits&#46; Participants completed a quality-of-life questionnaire &#40;Guyatt&#39;s Chronic Respiratory Disease Questionnaire&#41; at the beginning and end of the study&#46; The following variables were analyzed&#58; forced spirometry&#44; arterial blood gases&#44; quality of life&#44; number of emergency visits and hospital admissions&#44; mean length of stay in hospital&#44; reduction in the number of inpatient bed-days&#44; mean cost of emergency visits&#44; mean cost of hospital stays for both the Catalan Health Service &#40;CHS&#41; and the hospital&#44; mean total cost per patient for the CHS and the hospital&#44; and aggregate cost for the CHS and the hospital&#46; The results were compared with data for the preceding year taken from the hospital records&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Significant improvement was found in forced vital capacity and PaO<span class="elsevierStyleInf">2</span> &#40;which went from 56&#46;6 &#91;8&#46;2&#93; mm Hg to 59&#46;1 &#91;8&#46;9&#93; mm Hg during the prospective part of the study&#41;&#59; FEV<span class="elsevierStyleInf">1</span> also tended to improve &#40;875 &#91;282&#93; mL as against 912 &#91;321&#93; mL&#41;&#44; but this change was not significant &#40;P&#61;&#46;17&#41;&#46; A significant reduction was observed in the following variables&#58; PaCO<span class="elsevierStyleInf">2</span>&#59; hospital admissions&#44; 1&#46;16 &#40;1&#46;15&#41; in the historical control period compared to 0&#46;67 &#40;1&#46;17&#41; during the prospective study&#59; emergency visits&#44; 2&#46;06 &#40;1&#46;9&#41; as against 1&#46;5 &#40;2&#46;1&#41;&#59; mean length of stay in hospital&#44; 14&#46;2 &#40;19&#41; compared to 8&#46;1 &#40;16&#41; days&#59; total number of inpatient bed-days &#40;756 inpatient bed-days were saved in the study period&#41;&#59; mean cost of emergency visits and hospital stays for both the hospital &#40;&#8364;2246 &#91;&#8364;3007&#93; in the historical period as against &#8364;1297 &#91;&#8364;2639&#93; with the new management system&#41; and for the CHS&#59; and the aggregate cost both for the hospital &#40;&#8364;40&#8200;011 in the historical control period as against &#8364;6048 with the new model&#41; and the CHS &#40;&#8364;238&#8200;513 as against &#8364;152&#8200;312&#41;&#46; The quality-of-life score improved&#44; but the change was not significant&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The change in the health care model used to manage these patients led to an improvement in care &#40;effectiveness&#41; as well as a marked reduction in costs &#40;greater efficiency&#41; for both the funding entity &#40;CHS&#41; and for the care provider &#40;the hospital&#41;&#46; No change was observed in the quality of life as reported by the patients&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Puesto que no existe un modelo asistencial cla-ro para la atenci&#243;n a los pacientes con enfermedad pulmo-nar obstructiva cr&#243;nica e insuficiencia respiratoria cr&#243;nica&#44; se ha evaluado la efectividad y eficiencia de una consulta ex-terna hospitalaria monogr&#225;fica controlada por el Servicio de Neumolog&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Patientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio pros-pectivo de un a&#241;o de seguimiento con control hist&#243;rico&#46; La poblaci&#243;n estaba constituida por 124 pacientes &#40;105 varones&#59; edad media &#177; desviaci&#243;n est&#225;ndar de 69 &#177; 7 a&#241;os&#59; capa-cidad vital forzada&#58; 64&#44;6 &#177; 16&#44;1 &#37;&#59; volumen espiratorio for-zado en el primer segundo&#58; 35&#44;6 &#177; 12&#44;8&#37;&#59; presi&#243;n arterial de ox&#237;geno&#58; 56&#44;6 &#177; 8&#44;3 mmHg&#59; presi&#243;n arterial de anh&#237;drido carb&#243;nico&#58; 49&#44;8 &#177; 6&#44;7 mmHg&#41;&#46; En cada visita trimestral se practicaron una espirometr&#237;a forzada y una gasometr&#237;a arterial&#44; y al inicio y al final del estudio se pas&#243; un cuestionario de calidad de vida &#40;Chronic Respiratory Disease Questionnaire&#44; elaborado por Guyatt&#41;&#46; Se estudiaron las siguientes variables&#58; espirometr&#237;a forzada&#44; gasometr&#237;a arterial&#44; calidad de vida&#44; n&#250;mero de ingresos en urgencias y planta&#44; duraci&#243;n media de la hospitalizaci&#243;n&#44; ahorro de d&#237;as de hospitaliza-ci&#243;n&#44; coste medio de las visitas en urgencia&#44; coste medio de las hospitalizaciones para el Servei Catal&#224; de la Salut &#40;SCS&#41; y el hospital&#44; coste medio total por paciente para el SCS y el hospital&#44; y coste agregado para el SCS y el hospital&#46; Los re-sultados se compararon con los datos de los pacientes regis-trados en la Corporaci&#243; Parc Taul&#237; durante el a&#241;o previo&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se observ&#243; una mejor&#237;a estad&#237;sticamente significativa de la capacidad vital forzada y presi&#243;n arterial de ox&#237;geno &#40;56&#44;6 &#177; 8&#44;2 frente a 59&#44;1 &#177; 8&#44;9 mmHg&#41;&#59; el volu-men espiratorio forzado en el primer segundo mejor&#243; &#40;875 &#177; 282 frente a 912 &#177; 321 ml&#41;&#44; pero sin significaci&#243;n &#40;p &#61; 0&#44;17&#41;&#44; as&#237; como un descenso significativo de la presi&#243;n arterial de anh&#237;drido carb&#243;nico&#44; n&#250;mero de ingresos en planta &#40;1&#44;16 &#177; 1&#44;15 frente a 0&#44;67 &#177; 1&#44;17&#41; y urgencias &#40;2&#44;06 &#177; 1&#44;9 frente a 1&#44;5 &#177; 2&#44;1&#41;&#44; duraci&#243;n media de la hospitalizaci&#243;n &#40;14&#44;2 &#177; 19 frente a 8&#44;1 &#177; 16 d&#237;as&#41; y d&#237;as total de hospitalizaci&#243;n &#40;se ahorraron 756 d&#237;as de hospitalizaci&#243;n&#41;&#44; coste medio de visitas en urgencias y hospitalizaci&#243;n para el hospital &#40;2&#46;246 &#177; 3&#46;007 frente a 1&#46;297 &#177; 2&#46;639 &#8364;&#41; y el SCS&#44; y costes agregados tanto para el hospital &#40;-40&#46;011 frente a -6&#46;048 &#8364;&#41; como para el SCS &#40;238&#46;513 frente a 152&#46;312 &#8364;&#41;&#46; El &#237;ndice de calidad de vida mejor&#243;&#44; pero no significativamente&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">El cambio de la atenci&#243;n sanitaria de estos pacientes ha generado una mejor&#237;a asistencial &#40;efectividad&#41; reduciendo notablemente los costes econ&#243;micos &#40;eficiencia&#41; tanto para el financiador &#40;SCS&#41; como para el proveedor de servicios sanitarios &#40;hospital&#41;&#44; sin que se hayan observado cambios en la calidad de vida de los pacientes&#46;</p>"
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Vol. 42. Issue 3.
Pages 104-112 (March 2006)
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Vol. 42. Issue 3.
Pages 104-112 (March 2006)
Original Articles
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Effectiveness and Efficiency of a Specialized Unit in the Care of Patients With Chronic Obstructive Pulmonary Disease and Respiratory Insufficiency
Visits
5252
Ch. Domingoa,
Corresponding author
cdomingo@cspt.es

Correspondence: Dr. Ch. Domingo. Servicio de Neumología. Corporació Parc Taulí. Parc Taulí, s/n. 08208 Sabadell. Barcelona. España
, J. Sans-Torresa, J. Solàb, H. Espuelasa, A. Marína
a Servicio de Neumología, Corporació Parc Taulí, Sabadell, Barcelona, Spain
b Servicio de Epidemiología, Institut Català d'Oncologia (ICO), Corporació Parc Taulí-UAB, Sabadell, Barcelona, Spain
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Objective

In the absence of a clear health care model for the management of patients with chronic obstructive pulmonary disease and chronic respiratory insufficiency, we evaluated the effectiveness and efficiency of a specialized outpatient unit for these patients managed by the hospital's respiratory medicine department.

Patients and methods

This was a 1-year prospective study of a group of patients for whom historical control data were available. The mean (SD) descriptive data for the 124 patients (105 men) were as follows: age, 69 (7) years; forced vital capacity, 64.6% (16.1%); forced expiratory volume in the first second (FEV1), 35.6% (12.8%); PaO2, 56.6 (8.3) mm Hg; PaCO2, 49.8 (6.7) mm Hg. Forced spirometry and arterial blood gas analysis were performed at 3-monthly visits. Participants completed a quality-of-life questionnaire (Guyatt's Chronic Respiratory Disease Questionnaire) at the beginning and end of the study. The following variables were analyzed: forced spirometry, arterial blood gases, quality of life, number of emergency visits and hospital admissions, mean length of stay in hospital, reduction in the number of inpatient bed-days, mean cost of emergency visits, mean cost of hospital stays for both the Catalan Health Service (CHS) and the hospital, mean total cost per patient for the CHS and the hospital, and aggregate cost for the CHS and the hospital. The results were compared with data for the preceding year taken from the hospital records.

Results

Significant improvement was found in forced vital capacity and PaO2 (which went from 56.6 [8.2] mm Hg to 59.1 [8.9] mm Hg during the prospective part of the study); FEV1 also tended to improve (875 [282] mL as against 912 [321] mL), but this change was not significant (P=.17). A significant reduction was observed in the following variables: PaCO2; hospital admissions, 1.16 (1.15) in the historical control period compared to 0.67 (1.17) during the prospective study; emergency visits, 2.06 (1.9) as against 1.5 (2.1); mean length of stay in hospital, 14.2 (19) compared to 8.1 (16) days; total number of inpatient bed-days (756 inpatient bed-days were saved in the study period); mean cost of emergency visits and hospital stays for both the hospital (€2246 [€3007] in the historical period as against €1297 [€2639] with the new management system) and for the CHS; and the aggregate cost both for the hospital (€40 011 in the historical control period as against €6048 with the new model) and the CHS (€238 513 as against €152 312). The quality-of-life score improved, but the change was not significant.

Conclusions

The change in the health care model used to manage these patients led to an improvement in care (effectiveness) as well as a marked reduction in costs (greater efficiency) for both the funding entity (CHS) and for the care provider (the hospital). No change was observed in the quality of life as reported by the patients.

Key words:
COPD
Specialized unit
Cost minimization
Effectiveness
Efficiency
Objetivo

Puesto que no existe un modelo asistencial cla-ro para la atención a los pacientes con enfermedad pulmo-nar obstructiva crónica e insuficiencia respiratoria crónica, se ha evaluado la efectividad y eficiencia de una consulta ex-terna hospitalaria monográfica controlada por el Servicio de Neumología.

Patientes y métodos

Se ha realizado un estudio pros-pectivo de un año de seguimiento con control histórico. La población estaba constituida por 124 pacientes (105 varones; edad media ± desviación estándar de 69 ± 7 años; capa-cidad vital forzada: 64,6 ± 16,1 %; volumen espiratorio for-zado en el primer segundo: 35,6 ± 12,8%; presión arterial de oxígeno: 56,6 ± 8,3 mmHg; presión arterial de anhídrido carbónico: 49,8 ± 6,7 mmHg). En cada visita trimestral se practicaron una espirometría forzada y una gasometría arterial, y al inicio y al final del estudio se pasó un cuestionario de calidad de vida (Chronic Respiratory Disease Questionnaire, elaborado por Guyatt). Se estudiaron las siguientes variables: espirometría forzada, gasometría arterial, calidad de vida, número de ingresos en urgencias y planta, duración media de la hospitalización, ahorro de días de hospitaliza-ción, coste medio de las visitas en urgencia, coste medio de las hospitalizaciones para el Servei Català de la Salut (SCS) y el hospital, coste medio total por paciente para el SCS y el hospital, y coste agregado para el SCS y el hospital. Los re-sultados se compararon con los datos de los pacientes regis-trados en la Corporació Parc Taulí durante el año previo.

Resultados

Se observó una mejoría estadísticamente significativa de la capacidad vital forzada y presión arterial de oxígeno (56,6 ± 8,2 frente a 59,1 ± 8,9 mmHg); el volu-men espiratorio forzado en el primer segundo mejoró (875 ± 282 frente a 912 ± 321 ml), pero sin significación (p = 0,17), así como un descenso significativo de la presión arterial de anhídrido carbónico, número de ingresos en planta (1,16 ± 1,15 frente a 0,67 ± 1,17) y urgencias (2,06 ± 1,9 frente a 1,5 ± 2,1), duración media de la hospitalización (14,2 ± 19 frente a 8,1 ± 16 días) y días total de hospitalización (se ahorraron 756 días de hospitalización), coste medio de visitas en urgencias y hospitalización para el hospital (2.246 ± 3.007 frente a 1.297 ± 2.639 €) y el SCS, y costes agregados tanto para el hospital (-40.011 frente a -6.048 €) como para el SCS (238.513 frente a 152.312 €). El índice de calidad de vida mejoró, pero no significativamente.

Conclusiones

El cambio de la atención sanitaria de estos pacientes ha generado una mejoría asistencial (efectividad) reduciendo notablemente los costes económicos (eficiencia) tanto para el financiador (SCS) como para el proveedor de servicios sanitarios (hospital), sin que se hayan observado cambios en la calidad de vida de los pacientes.

Palabras clave:
EPOC
Consulta monográfica
Minimización de costes
Efectividad
Eficiencia
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Copyright © 2006. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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