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Evaluation of Clinical Practice in Patients Admitted With Community-Acquired Pneumonia Over a 4-Year Period
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España, José M. Quintana, Inmaculada Gorordo, Celia Sañudo, Amaia Bilbao" "autores" => array:6 [ 0 => array:5 [ "preGrado" => "Dr." "nombre" => "Alberto" "apellidos" => "Capelastegui" "email" => array:1 [ 0 => "acapelas@hgda.osakidetza.net" ] "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" => "Pedro P." "apellidos" => "España" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "José M." "apellidos" => "Quintana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 3 => array:3 [ "nombre" => "Inmaculada" "apellidos" => "Gorordo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "Celia" "apellidos" => "Sañudo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 5 => array:3 [ "nombre" => "Amaia" "apellidos" => "Bilbao" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital de Galdakao, Galdakao, Vizcaya, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Unidad de Investigación, Hospital de Galdakao, Galdakao, Vizcaya, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital de Galdakao, Galdakao, Vizcaya, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Fundación Vasca de Innovación e Investigación Sanitarias (BIOEF), Vizcaya, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. A. Capelastegui. Servicio de Neumología. Hospital de Galdakao. Barrio Labeaga, s/n. 48960 Galdakao. Vizcaya. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-07-13" "fechaAceptado" => "2005-11-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154399" "palabras" => array:3 [ 0 => "Community-acquired pneumonia" 1 => "Clinical guidelines" 2 => "Quality indicators" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154400" "palabras" => array:3 [ 0 => "Neumonía adquirida en la comunidad" 1 => "Guías clínicas" 2 => "Indicadores de calidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Since March 2000 we have been using a clinical practice guideline in the management of patients diagnosed with community-acquired pneumonia (CAP). The objective of this study was to analyze the evolution of quality of care received by these patients.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">This was a prospective observational study comparing the process of care and outcomes of 4 consecutive 1-year periods (March 1, 2000 through February 29,2004) in all patients admitted for CAP.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Over the 4 years studied, the following statistically significant trends were observed: reductions in hospital admissions (<span class="elsevierStyleItalic">P</span><.001), length of hospital stay (<span class="elsevierStyleItalic">P</span>«.05), and total duration of antibiotic treatment (<span class="elsevierStyleItalic">P</span>«.05); and increases in the coverage of atypical pathogens (<span class="elsevierStyleItalic">P</span>«.001) and administration of antibiotics within 8 hours of hospital arrival (<span class="elsevierStyleItalic">P</span>«.001). No significant differences were found in readmissions within 30 days, or in-hospital and 30-day mortality. Two other areas of improvement were also identified: a low percentage of admissions to the intensive care unit (4.4%) and of unnecessary hospitalization of low-risk patients (36.8%).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Systematic monitoring of the indicators of our clinical guidelines provided us with information about our clinical practice and facilitated an evaluation of the same. Many of these indicators were found to have evolved favorably and areas of improvement were identified.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">En nuestro hospital utilizamos desde marzo de 2000 una guía clínica para el tratamiento de los pacientes diagnosticados de neumonía adquirida en la comunidad (NAC). El objetivo de este estudio ha sido analizar la evolución de la calidad del tratamiento facilitado a los pacientes ingresados por NAC.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio observacional prospectivo. Se compararon, en 4 períodos consecutivos de 1 año (1 de marzo de 2000 a 29 de febrero de 2004), el tratamiento y los resultados de todos los pacientes ingresados por NAC.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">A lo largo de los 4 años se demostraron tendencias estadísticamente significativas en los siguientes indicadores: reducción de los ingresos hospitalarios (p < 0,001), de la duración de la estancia hospitalaria (p < 0,05) y de la duración total del tratamiento antibiótico (p < 0,05); aumento de la cobertura de gérmenes atípicos (p < 0,001) y de la administración del antibiótico en las primeras 8 h (p < 0,001). No se observaron diferencias significativas en la mortalidad intrahospitalaria, en la mortalidad en 30 días y en los reingresos en 30 días. También se identificaron 2 áreas de mejora: el bajo porcentaje de ingresos en la unidad de cuidados intensivos (4,4%) y los ingresos injustificados entre los pacientes de riesgo bajo (36,8%).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">El control sistemático de los indicadores de nuestra guía clínica nos permitió conocer y evaluar nuestra práctica clínica. Se comprobó una evolución favorable de muchos de estos indicadores y se identificaron áreas de mejora.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of community-acquired pneumonia in adults: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J Almirall" 1 => "I Bolíbar" 2 => "J Vidal" 3 => "G Sauca" 4 => "P Coll" 5 => "B Niklasson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2000" "volumen" => "15" "paginaInicial" => "757" "paginaFinal" => "763" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10780770" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired pneumonia: the annual cost to the National Health Service in the UK" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "JF Guest" 1 => "A Morris" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "1997" "volumen" => "10" "paginaInicial" => "1530" "paginaFinal" => "1534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9230242" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment and outcomes of community-acquired pneumonia at Canadian hospitals" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "BG Feagan" 1 => "TJ Marrie" 2 => "CY Lau" 3 => "SL Wheeler" 4 => "CJ Wong" 5 => "MK Vandervoort" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Can Med Assoc J" "fecha" => "2000" "volumen" => "162" "paginaInicial" => "1415" "paginaFinal" => "1420" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variation in length of hospital stay in patients with community-acquired pneumonia: are shorter stays associated with worse medical outcomes?" 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España" 2 => "JM Quintana" 3 => "I Gorordo" 4 => "M Ortega" 5 => "I Idoiaga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/423960" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2004" "volumen" => "39" "paginaInicial" => "955" "paginaFinal" => "963" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15472846" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prediction rule to identify low-risk patients with community-acquired pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "MJ Fine" 1 => "TE Auble" 2 => "DM Yealy" 3 => "BH Hanusa" 4 => "LA Weissfeld" 5 => "DE Singer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199701233360402" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1997" 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| Year/Month | Html | Total | |
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| 2021 January | 10 | 17 | 27 |
| 2020 December | 10 | 16 | 26 |
| 2020 November | 13 | 26 | 39 |
| 2020 October | 12 | 8 | 20 |
| 2020 September | 7 | 13 | 20 |
| 2020 August | 10 | 14 | 24 |
| 2020 July | 17 | 17 | 34 |
| 2020 June | 6 | 6 | 12 |
| 2020 May | 16 | 28 | 44 |
| 2020 April | 21 | 28 | 49 |
| 2020 March | 15 | 19 | 34 |
| 2020 February | 40 | 29 | 69 |
| 2020 January | 52 | 23 | 75 |
| 2019 December | 15 | 34 | 49 |
| 2019 November | 11 | 40 | 51 |
| 2019 October | 6 | 30 | 36 |
| 2019 September | 32 | 55 | 87 |
| 2019 August | 12 | 50 | 62 |
| 2019 July | 11 | 62 | 73 |
| 2019 June | 9 | 49 | 58 |
| 2019 May | 13 | 61 | 74 |
| 2019 April | 11 | 79 | 90 |
| 2019 March | 22 | 71 | 93 |
| 2019 February | 13 | 53 | 66 |
| 2019 January | 14 | 31 | 45 |
| 2018 December | 14 | 27 | 41 |
| 2018 November | 25 | 37 | 62 |
| 2018 October | 20 | 23 | 43 |
| 2018 September | 18 | 10 | 28 |
| 2018 May | 4 | 1 | 5 |
| 2018 April | 5 | 9 | 14 |
| 2018 March | 3 | 7 | 10 |
| 2018 February | 7 | 9 | 16 |
| 2018 January | 5 | 7 | 12 |
| 2017 December | 9 | 13 | 22 |
| 2017 November | 6 | 3 | 9 |
| 2017 October | 6 | 8 | 14 |
| 2017 September | 6 | 6 | 12 |
| 2017 August | 7 | 10 | 17 |
| 2017 July | 7 | 5 | 12 |
| 2017 June | 7 | 11 | 18 |
| 2017 May | 6 | 9 | 15 |
| 2017 April | 2 | 12 | 14 |
| 2017 March | 3 | 6 | 9 |
| 2017 February | 0 | 1 | 1 |
| 2017 January | 1 | 1 | 2 |
| 2016 December | 17 | 9 | 26 |
| 2016 November | 11 | 6 | 17 |
| 2016 October | 5 | 4 | 9 |
| 2016 September | 17 | 7 | 24 |
| 2016 August | 15 | 2 | 17 |
| 2016 July | 9 | 2 | 11 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 31 | 11 | 42 |
| 2015 September | 42 | 9 | 51 |
| 2015 August | 18 | 6 | 24 |
| 2015 July | 32 | 5 | 37 |
| 2015 June | 23 | 8 | 31 |
| 2015 May | 53 | 5 | 58 |
| 2015 April | 22 | 13 | 35 |
| 2015 March | 32 | 10 | 42 |
| 2015 February | 26 | 2 | 28 |
| 2015 January | 33 | 8 | 41 |
| 2014 December | 25 | 5 | 30 |
| 2014 November | 26 | 3 | 29 |
| 2014 October | 35 | 8 | 43 |
| 2014 September | 26 | 7 | 33 |
| 2014 August | 29 | 7 | 36 |
| 2014 July | 26 | 8 | 34 |
| 2014 June | 34 | 4 | 38 |
| 2014 May | 38 | 8 | 46 |
| 2014 April | 35 | 7 | 42 |
| 2014 March | 46 | 6 | 52 |
| 2014 February | 45 | 7 | 52 |
| 2014 January | 31 | 7 | 38 |
| 2013 December | 36 | 7 | 43 |
| 2013 November | 23 | 4 | 27 |
| 2013 October | 29 | 11 | 40 |
| 2013 September | 23 | 6 | 29 |
| 2013 August | 34 | 9 | 43 |
| 2013 July | 38 | 16 | 54 |
| 2013 June | 31 | 6 | 37 |
| 2013 May | 33 | 2 | 35 |
| 2013 April | 17 | 4 | 21 |
| 2013 March | 8 | 2 | 10 |
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