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Effectiveness and Efficiency of a Specialized Unit in the Care of Patients With Chronic Obstructive Pulmonary Disease and Respiratory Insufficiency
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Romero, B. Rodríguez, S. Martínez, R. Cañizares, D. Sepúlveda, F. Manresa" "autores" => array:6 [ 0 => array:3 [ "preGrado" => "Dr." "nombre" => "P.V." "apellidos" => "Romero" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Rodríguez" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Martínez" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Cañizares" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Sepúlveda" ] 5 => array:2 [ "nombre" => "F." 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Molinos" "autores" => array:1 [ 0 => array:3 [ "preGrado" => "Dr." "nombre" => "L." "apellidos" => "Molinos" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906601262?idApp=UINPBA00003Z" "url" => "/15792129/0000004200000003/v1_201305150239/S1579212906601262/v1_201305150239/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Articles</span>" "titulo" => "Effectiveness and Efficiency of a Specialized Unit in the Care of Patients With Chronic Obstructive Pulmonary Disease and Respiratory Insufficiency" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "104" "paginaFinal" => "112" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ch. Domingo, J. Sans-Torres, J. Solà, H. Espuelas, A. Marín" "autores" => array:5 [ 0 => array:5 [ "preGrado" => "Dr." "nombre" => "Ch." "apellidos" => "Domingo" "email" => array:1 [ 0 => "cdomingo@cspt.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Sans-Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Solà" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 3 => array:3 [ "nombre" => "H." "apellidos" => "Espuelas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "Marín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Corporació Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Epidemiología, Institut Català d'Oncologia (ICO), Corporació Parc Taulí-UAB, Sabadell, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. Ch. Domingo. Servicio de Neumología. Corporació Parc Taulí. Parc Taulí, s/n. 08208 Sabadell. Barcelona. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-03-03" "fechaAceptado" => "2005-05-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154254" "palabras" => array:5 [ 0 => "COPD" 1 => "Specialized unit" 2 => "Cost minimization" 3 => "Effectiveness" 4 => "Efficiency" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154255" "palabras" => array:5 [ 0 => "EPOC" 1 => "Consulta monográfica" 2 => "Minimización de costes" 3 => "Efectividad" 4 => "Eficiencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "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, we evaluated the effectiveness and efficiency of a specialized outpatient unit for these patients managed by the hospital's respiratory medicine department.</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. 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 (FEV<span class="elsevierStyleInf">1</span>), 35.6% (12.8%); PaO<span class="elsevierStyleInf">2</span>, 56.6 (8.3) mm Hg; PaCO<span class="elsevierStyleInf">2</span>, 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.</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> (which went from 56.6 [8.2] mm Hg to 59.1 [8.9] mm Hg during the prospective part of the study); FEV<span class="elsevierStyleInf">1</span> 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: PaCO<span class="elsevierStyleInf">2</span>; 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.</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 (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.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Patientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de bronquitis crónica, asma y obstrucción al flujo aéreo en una zona urbano-industrial de Cataluña" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 33 | 23 | 56 |
| 2024 September | 29 | 12 | 41 |
| 2024 August | 62 | 51 | 113 |
| 2024 July | 26 | 22 | 48 |
| 2024 June | 39 | 18 | 57 |
| 2024 May | 41 | 28 | 69 |
| 2024 April | 20 | 25 | 45 |
| 2024 March | 30 | 16 | 46 |
| 2024 February | 24 | 24 | 48 |
| 2023 March | 3 | 2 | 5 |
| 2023 February | 17 | 19 | 36 |
| 2023 January | 19 | 27 | 46 |
| 2022 December | 18 | 25 | 43 |
| 2022 November | 32 | 25 | 57 |
| 2022 October | 37 | 25 | 62 |
| 2022 September | 14 | 21 | 35 |
| 2022 August | 22 | 42 | 64 |
| 2022 July | 28 | 46 | 74 |
| 2022 June | 28 | 33 | 61 |
| 2022 May | 22 | 31 | 53 |
| 2022 April | 27 | 31 | 58 |
| 2022 March | 23 | 38 | 61 |
| 2022 February | 24 | 36 | 60 |
| 2022 January | 14 | 30 | 44 |
| 2021 December | 17 | 44 | 61 |
| 2021 November | 18 | 38 | 56 |
| 2021 October | 18 | 52 | 70 |
| 2021 September | 18 | 37 | 55 |
| 2021 August | 11 | 34 | 45 |
| 2021 July | 13 | 24 | 37 |
| 2021 June | 9 | 29 | 38 |
| 2021 May | 19 | 34 | 53 |
| 2021 April | 24 | 60 | 84 |
| 2021 March | 13 | 14 | 27 |
| 2021 February | 5 | 14 | 19 |
| 2021 January | 5 | 7 | 12 |
| 2020 December | 9 | 6 | 15 |
| 2020 November | 3 | 9 | 12 |
| 2020 October | 12 | 6 | 18 |
| 2020 September | 4 | 6 | 10 |
| 2020 August | 8 | 6 | 14 |
| 2020 July | 6 | 14 | 20 |
| 2020 June | 16 | 7 | 23 |
| 2020 May | 18 | 13 | 31 |
| 2020 April | 11 | 11 | 22 |
| 2020 March | 17 | 9 | 26 |
| 2020 February | 12 | 13 | 25 |
| 2020 January | 14 | 14 | 28 |
| 2019 December | 14 | 10 | 24 |
| 2019 November | 5 | 6 | 11 |
| 2019 October | 17 | 4 | 21 |
| 2019 September | 12 | 11 | 23 |
| 2019 August | 16 | 4 | 20 |
| 2019 July | 10 | 13 | 23 |
| 2019 June | 8 | 5 | 13 |
| 2019 May | 12 | 10 | 22 |
| 2019 April | 29 | 11 | 40 |
| 2019 March | 19 | 10 | 29 |
| 2019 February | 10 | 7 | 17 |
| 2019 January | 9 | 12 | 21 |
| 2018 December | 8 | 12 | 20 |
| 2018 November | 15 | 12 | 27 |
| 2018 October | 29 | 13 | 42 |
| 2018 September | 8 | 14 | 22 |
| 2018 May | 8 | 0 | 8 |
| 2018 April | 3 | 5 | 8 |
| 2018 March | 3 | 3 | 6 |
| 2018 February | 7 | 11 | 18 |
| 2018 January | 2 | 6 | 8 |
| 2017 December | 6 | 5 | 11 |
| 2017 November | 5 | 2 | 7 |
| 2017 October | 6 | 6 | 12 |
| 2017 September | 6 | 3 | 9 |
| 2017 August | 8 | 10 | 18 |
| 2017 July | 6 | 3 | 9 |
| 2017 June | 6 | 13 | 19 |
| 2017 May | 9 | 12 | 21 |
| 2017 April | 1 | 2 | 3 |
| 2017 March | 4 | 5 | 9 |
| 2017 February | 1 | 1 | 2 |
| 2017 January | 1 | 2 | 3 |
| 2016 December | 12 | 7 | 19 |
| 2016 November | 18 | 7 | 25 |
| 2016 October | 24 | 10 | 34 |
| 2016 September | 5 | 2 | 7 |
| 2016 August | 6 | 3 | 9 |
| 2016 July | 6 | 0 | 6 |
| 2016 March | 3 | 0 | 3 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 25 | 5 | 30 |
| 2015 September | 72 | 3 | 75 |
| 2015 August | 169 | 10 | 179 |
| 2015 July | 100 | 4 | 104 |
| 2015 June | 29 | 4 | 33 |
| 2015 May | 48 | 7 | 55 |
| 2015 April | 50 | 7 | 57 |
| 2015 March | 64 | 9 | 73 |
| 2015 February | 24 | 9 | 33 |
| 2015 January | 24 | 10 | 34 |
| 2014 December | 26 | 4 | 30 |
| 2014 November | 23 | 5 | 28 |
| 2014 October | 162 | 9 | 171 |
| 2014 September | 224 | 7 | 231 |
| 2014 August | 303 | 10 | 313 |
| 2014 July | 205 | 6 | 211 |
| 2014 June | 130 | 10 | 140 |
| 2014 May | 70 | 12 | 82 |
| 2014 April | 41 | 5 | 46 |
| 2014 March | 46 | 8 | 54 |
| 2014 February | 49 | 8 | 57 |
| 2014 January | 77 | 9 | 86 |
| 2013 December | 79 | 7 | 86 |
| 2013 November | 36 | 5 | 41 |
| 2013 October | 31 | 11 | 42 |
| 2013 September | 28 | 10 | 38 |
| 2013 August | 31 | 7 | 38 |
| 2013 July | 43 | 13 | 56 |
| 2013 June | 24 | 3 | 27 |
| 2013 May | 28 | 5 | 33 |
| 2013 April | 15 | 6 | 21 |
| 2013 March | 6 | 2 | 8 |
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