array:23 [
  "pii" => "S1579212915002918"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2015.08.006"
  "estado" => "S300"
  "fechaPublicacion" => "2015-10-01"
  "aid" => "1194"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2015"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Arch Bronconeumol. 2015;51:479-80"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2558
    "formatos" => array:3 [
      "EPUB" => 126
      "HTML" => 1810
      "PDF" => 622
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S030028961500188X"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2015.05.006"
      "estado" => "S300"
      "fechaPublicacion" => "2015-10-01"
      "aid" => "1194"
      "copyright" => "SEPAR"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Arch Bronconeumol. 2015;51:479-80"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 5497
        "formatos" => array:3 [
          "EPUB" => 116
          "HTML" => 4484
          "PDF" => 897
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "La auditor&#237;a cl&#237;nica y su circunstancia"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "479"
            "paginaFinal" => "480"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Clinical audit&#58; Why&#44; where and how&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Francisco Pozo-Rodr&#237;guez, Ady A&#46; Castro-Acosta, Carlos J&#46; &#193;lvarez-Mart&#237;nez"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Francisco"
                "apellidos" => "Pozo-Rodr&#237;guez"
              ]
              1 => array:2 [
                "nombre" => "Ady A&#46;"
                "apellidos" => "Castro-Acosta"
              ]
              2 => array:2 [
                "nombre" => "Carlos J&#46;"
                "apellidos" => "&#193;lvarez-Mart&#237;nez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1579212915002918"
          "doi" => "10.1016/j.arbr.2015.08.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002918?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961500188X?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005100000010/v1_201509302001/S030028961500188X/v1_201509302001/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S157921291500227X"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2015.01.002"
    "estado" => "S300"
    "fechaPublicacion" => "2015-10-01"
    "aid" => "1121"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2015;51:481-2"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 9262
      "formatos" => array:3 [
        "EPUB" => 161
        "HTML" => 8214
        "PDF" => 887
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Exercise-induced Oxygen Desaturation in Chronic Obstructive Pulmonary Disease Patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "481"
          "paginaFinal" => "482"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Desaturaci&#243;n de ox&#237;geno inducido por el ejercicio en pacientes con enfermedad pulmonar obstructiva cr&#243;nica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ignacio Garc&#237;a-Talavera, Patricia Jim&#233;nez Gonz&#225;lez, Rafael Dorta S&#225;nchez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Ignacio"
              "apellidos" => "Garc&#237;a-Talavera"
            ]
            1 => array:2 [
              "nombre" => "Patricia"
              "apellidos" => "Jim&#233;nez Gonz&#225;lez"
            ]
            2 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Dorta S&#225;nchez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289615000587"
        "doi" => "10.1016/j.arbres.2015.01.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615000587?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291500227X?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005100000010/v1_201509302252/S157921291500227X/v1_201509302252/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Clinical Audit&#58; Why&#44; Where and How&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "479"
        "paginaFinal" => "480"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Francisco Pozo-Rodr&#237;guez, Ady A&#46; Castro-Acosta, Carlos J&#46; &#193;lvarez-Mart&#237;nez"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "Francisco"
            "apellidos" => "Pozo-Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Ady A&#46;"
            "apellidos" => "Castro-Acosta"
            "email" => array:1 [
              0 => "ady&#64;h12o&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Carlos J&#46;"
            "apellidos" => "&#193;lvarez-Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Instituto de Investigaci&#243;n&#44; Hospital Universitario Doce de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Centro de Investigaci&#243;n Biom&#233;dica en Red de Enfermedades Respiratorias &#40;CIBERES&#47;CIBER-ISCIII&#41;&#44; Instituto de Investigaci&#243;n&#44; Hospital Universitario Doce de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Neumolog&#237;a&#44; Instituto de Investigaci&#243;n&#44; Hospital Universitario Doce de Octubre&#44; Centro de Investigaci&#243;n Biom&#233;dica en Red de Enfermedades Respiratorias &#40;CIBERES&#47;CIBER-ISCIII&#41;&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "La auditor&#237;a cl&#237;nica y su circunstancia"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Clinical audit &#40;CA&#41; is a &#8220;quality improvement process that seeks to improve patient care and outcomes through systematic review of care and the implementation of change&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This definition comprises 2 elements&#58; measuring performance and taking corrective action&#46; To measure performance&#44; &#40;i&#41; a systematic diagnosis of the clinical practice in terms of structure&#44; processes and outcomes must be made&#44; which &#40;ii&#41; must be measured against internal and external quality criteria&#44; and &#40;iii&#41; necessary changes must be identified&#46; Corrective action involves &#40;iv&#41; the implementation of the necessary changes&#44; and &#40;v&#41; evaluation of the outcomes of such changes&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the United Kingdom&#44; CAs come under National Health Service clinical governance&#44; but external organizations are also involved&#58; the National COPD Audit Program is a joint initiative involving the Royal College of Physicians&#44; the British Thoracic Society&#44; and the Primary Care Respiratory Society&#44; in collaboration with the British Lung Foundation&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In Spain&#44; CAs are not specifically included in the organization charts or mission statements of the Health Service or other scientific societies or professional colleges&#44; but some initiatives have been introduced in recent years&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">AUDIPOC Spain &#40;129 hospitals&#44; 5128 cases&#41; is an audit carried out in Spain on the standard of care in exacerbations of chronic obstructive pulmonary disease &#40;ECOPD&#41; between 2008 and 2009&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;5</span></a> The 2011 ERS COPD &#40;13 countries&#44; 432 hospitals&#44; 16&#44;081 cases&#41; is an ERS-sponsored European audit of the standard of care in ECOPD&#44; co-led by Spain&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> The MAG-1 study&#44; reported in this issue of <span class="elsevierStyleItalic">Archivos de Bronconeumonolog&#237;a</span>&#44; is a clinical audit of ECOPD performed in 30 hospitals and 910 cases in Catalonia at the beginning of 2011&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Catalonia also participated in the AUDIPOC &#40;10 hospitals&#44; 404 cases&#41; and the ERS Audit &#40;9 hospitals&#44; 475 cases&#41;&#46; These 3 studies&#44; being performed at the same time&#44; in the same geographical region&#44; and using similar methodologies&#44; are good candidates for a comparative assessment&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A common limitation of the MAG-1&#44; AUDIPOC and ERS COPD Audit studies is that the databases were constructed from clinical records&#44; and the frequency of missing or extremely improbable data is high&#46; All 3 audits identify weak points in the care process&#44; and report wide variability in terms of hospital and patient characteristics and outcomes&#46; MAG-1 manages variability by grouping hospitals by the number of COPD admissions per year&#44; while ERS COPD categorizes centers by number of beds&#46; Both identified significant differences between the various categories&#44; which could be often attributed to a logical clinical factor&#46; AUDIPOC deals with variations in mortality and readmission using a multilevel multivariate analysis adjusted for size&#44; number of cases enrolled and number of discharges&#46; This analysis revealed one or more underlying hospital-specific factors &#40;hospital-clustering effect&#41; that influence outcomes in a unique and independent manner and affect a significant proportion of inter-hospital variability&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Dissimilarities are also observed&#46; The results of MAG-1&#44; AUDIPOC and ERS in Catalonia reveal differences in the mean values of a number of clinical variables&#44; e&#46;g&#46;&#44; percentage of active smokers &#40;10&#37;&#44; 26&#37; and 25&#37;&#41;&#44; overall mortality &#40;12&#37;&#44; 7&#37; and 8&#37;&#41; or readmission &#40;49&#37;&#44; 37&#37; and 40&#37;&#41;&#46; These findings merit further study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">To identify outcome-associated variables&#44; MAG-1 used multivariate linear and logistic regression models&#58; a small number of variables were maintained&#44; mostly related with the personal characteristics or clinical status of the patients&#46; These outcomes were echoed in the AUDIPROC model&#58; after adjusting for the cluster effect&#44; some variables associated with patient age and clinical status were maintained&#46; The analyses of the ERS COPD Audit are complex and have yet to be published&#44; but they seem to point in the same direction&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the clinical audit setting&#44; the geographical region in which the audit is performed&#44; the emphasis on the intervention component&#44; the nature of data used&#44; and other aspects&#44; are all influencing factors&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The 3 audits studied were conducted in hospitals on a regional&#44; national and international level&#46; In our opinion&#44; the wider the net&#44; the more complicated the study&#44; with the ensuing problems of less stable databases&#44; more complex analyses&#44; and more difficulties in pinpointing specific weakness in hospital care provisions&#44; which is where the corrective action will finally need to be applied&#46; AUDIPOC alerted us to the hospital-clustering effect&#44; composed of both hospital-centered elements &#40;structural and organizational details or clinical practice styles not reflected in the variables under study&#44; and which are difficult to verify&#41;&#44; and non-hospital-centered elements &#40;socioeconomic makeup of the hospital&#39;s catchment area&#44; healthiness of the environment&#44; access to health services and the trickle-down effect on hospital admission&#44; to cite only a few&#41;&#46; The advantage of multi-hospital studies is that they measure performance in different settings and&#44; in theory&#44; identify the actions that need to be taken at various healthcare levels&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">All 3 audits place emphasis on the measurement of performance&#44; a situation diagnosis that is clearly necessary and probably essential&#46; However&#44; corrective actions are relegated to second place&#44; whereas these are in fact the ultimate reason for clinical audits&#44; and are most effective when applied directly in the hospital&#46; Moreover&#44; external agents will have a hard job overcoming obstacles to implement actions in the hospital&#44; despite the auditors&#8217; best efforts&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">All 3 audits use data retrieved from clinical records by different staff members&#46; The diversity of the clinical records that are collected in our health system&#44; irregular data completion&#44; and probable discrepancies in the thoroughness of the data extractors suggests that variability in the results due to clinical record artifacts should be taken into consideration&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">To sum up&#44; we believe that CAs are essential tools for improving healthcare quality&#44; and that stakeholders in the healthcare system must support their use&#46; CAs must be implemented to scrutinize the causes for variation&#44; and emphasis must be placed on the identification and implementation of corrective actions within the audited unit&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Pozo-Rodr&#237;guez F&#44; Castro-Acosta AA&#44; &#193;lvarez-Mart&#237;nez CJ&#46; La auditor&#237;a cl&#237;nica y su circunstancia&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;479&#8211;480&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New principles of best practice in clinical audit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Burguess"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2nd ed&#46;"
                        "fecha" => "2011"
                        "editorial" => "Radcliffe Publishing"
                        "editorialLocalizacion" => "London"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Audit &#38; quality improvement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "British Thoracic Society"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical audit of patients admitted to hospital in Spain due to exacerbation of COPD &#40;AUDIPOC Study&#41;&#58; method and organisation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Pozo-Rodr&#237;guez"
                            1 => "C&#46;J&#46; &#193;lvarez"
                            2 => "A&#46; Castro-Acosta"
                            3 => "C&#46; Melero Moreno"
                            4 => "A&#46; Capelastegui"
                            5 => "C&#46; Esteban"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2010.04.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2010"
                        "volumen" => "46"
                        "paginaInicial" => "349"
                        "paginaFinal" => "357"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20554103"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Auditor&#237;a Cl&#237;nica sobre las exacerbaciones de la Enfermedad Pulmonar Obstructiva Cr&#243;nica&#46; Madrid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Grupo AUDIPOC de Investigaci&#243;n&#46; AUDIPOC Espa&#241;a 2009"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2009"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical audit of COPD patients requiring hospital admissions in Spain&#58; AUDIPOC Study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "AUDIPOC Study Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Pozo-Rodr&#237;guez"
                            1 => "J&#46;L&#46; L&#243;pez-Campos"
                            2 => "C&#46;J&#46; &#193;lvarez-Mart&#237;nez"
                            3 => "A&#46; Castro-Acosta"
                            4 => "R&#46; Ag&#252;ero"
                            5 => "J&#46; Hueto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0042156"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "e42156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22911875"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European COPD Audit&#58; design&#44; organisation of work and methodology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; L&#243;pez-Campos"
                            1 => "S&#46; Hartl"
                            2 => "F&#46; Pozo-Rodr&#237;guez"
                            3 => "C&#46;M&#46; Roberts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00021812"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2013"
                        "volumen" => "41"
                        "paginaInicial" => "270"
                        "paginaFinal" => "276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22599361"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "An international comparison of COPD care in Europe&#46; Results of the first European COPD Audit"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2012"
                        "editorial" => "European Respiratory Society"
                        "editorialLocalizacion" => "Lausanne"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European COPD Audit Team&#46; Variability of hospital resources for acute care of COPD patients&#58; the European COPD Audit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; L&#243;pez-Campos"
                            1 => "S&#46; Hartl"
                            2 => "F&#46; Pozo-Rodr&#237;guez"
                            3 => "C&#46;M&#46; Roberts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00074413"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2014"
                        "volumen" => "43"
                        "paginaInicial" => "754"
                        "paginaFinal" => "762"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23988775"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "en nombre del equipo del Plan Director de las Enfermedades del Aparato Respiratorio &#40;PDMAR&#41; y del grupo colaborador del proyecto MAG-1Auditor&#237;a cl&#237;nica de los pacientes que ingresan en el hospital por agudizaci&#243;n de EPOC&#46; Estudio MAG-1"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Escarrabilla"
                            1 => "E&#46; Torrenteb"
                            2 => "C&#46; Esquinase"
                            3 => "C&#46; Hern&#225;ndez"
                            4 => "E&#46; Mons&#243;"
                            5 => "M&#46; Freixash"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The AUDIPOC Study Group&#46; Determinants of between-hospital variations in outcomes for patients admitted with COPD exacerbations&#58; findings from a nationwide clinical audit &#40;AUDIPOC&#41; in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Pozo-Rodr&#237;guez"
                            1 => "A&#46; Castro-Acosta"
                            2 => "C&#46;J&#46; &#193;lvarez"
                            3 => "J&#46;L&#46; L&#243;pez-Campos"
                            4 => "A&#46; Forte"
                            5 => "A&#46; L&#243;pez Quilez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijcp.12601"
                      "Revista" => array:2 [
                        "tituloSerie" => "Int J Clin Pract"
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005100000010/v1_201509302252/S1579212915002918/v1_201509302252/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14568"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000010/v1_201509302252/S1579212915002918/v1_201509302252/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002918?idApp=UINPBA00003Z"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial
Clinical Audit: Why, Where and How?
La auditoría clínica y su circunstancia
Francisco Pozo-Rodrígueza, Ady A. Castro-Acostab,
Corresponding author
ady@h12o.es

Corresponding author.
, Carlos J. Álvarez-Martínezc
a Instituto de Investigación, Hospital Universitario Doce de Octubre, Madrid, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES/CIBER-ISCIII), Instituto de Investigación, Hospital Universitario Doce de Octubre, Madrid, Spain
c Servicio de Neumología, Instituto de Investigación, Hospital Universitario Doce de Octubre, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES/CIBER-ISCIII), Madrid, Spain
Read
6421
Times
was read the article
2058
Total PDF
4363
Total HTML
Share statistics
 array:23 [
  "pii" => "S1579212915002918"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2015.08.006"
  "estado" => "S300"
  "fechaPublicacion" => "2015-10-01"
  "aid" => "1194"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2015"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Arch Bronconeumol. 2015;51:479-80"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2558
    "formatos" => array:3 [
      "EPUB" => 126
      "HTML" => 1810
      "PDF" => 622
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S030028961500188X"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2015.05.006"
      "estado" => "S300"
      "fechaPublicacion" => "2015-10-01"
      "aid" => "1194"
      "copyright" => "SEPAR"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Arch Bronconeumol. 2015;51:479-80"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 5497
        "formatos" => array:3 [
          "EPUB" => 116
          "HTML" => 4484
          "PDF" => 897
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "La auditor&#237;a cl&#237;nica y su circunstancia"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "479"
            "paginaFinal" => "480"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Clinical audit&#58; Why&#44; where and how&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Francisco Pozo-Rodr&#237;guez, Ady A&#46; Castro-Acosta, Carlos J&#46; &#193;lvarez-Mart&#237;nez"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Francisco"
                "apellidos" => "Pozo-Rodr&#237;guez"
              ]
              1 => array:2 [
                "nombre" => "Ady A&#46;"
                "apellidos" => "Castro-Acosta"
              ]
              2 => array:2 [
                "nombre" => "Carlos J&#46;"
                "apellidos" => "&#193;lvarez-Mart&#237;nez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1579212915002918"
          "doi" => "10.1016/j.arbr.2015.08.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002918?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961500188X?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005100000010/v1_201509302001/S030028961500188X/v1_201509302001/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S157921291500227X"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2015.01.002"
    "estado" => "S300"
    "fechaPublicacion" => "2015-10-01"
    "aid" => "1121"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2015;51:481-2"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 9262
      "formatos" => array:3 [
        "EPUB" => 161
        "HTML" => 8214
        "PDF" => 887
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Exercise-induced Oxygen Desaturation in Chronic Obstructive Pulmonary Disease Patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "481"
          "paginaFinal" => "482"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Desaturaci&#243;n de ox&#237;geno inducido por el ejercicio en pacientes con enfermedad pulmonar obstructiva cr&#243;nica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ignacio Garc&#237;a-Talavera, Patricia Jim&#233;nez Gonz&#225;lez, Rafael Dorta S&#225;nchez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Ignacio"
              "apellidos" => "Garc&#237;a-Talavera"
            ]
            1 => array:2 [
              "nombre" => "Patricia"
              "apellidos" => "Jim&#233;nez Gonz&#225;lez"
            ]
            2 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Dorta S&#225;nchez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289615000587"
        "doi" => "10.1016/j.arbres.2015.01.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615000587?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291500227X?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005100000010/v1_201509302252/S157921291500227X/v1_201509302252/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Clinical Audit&#58; Why&#44; Where and How&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "479"
        "paginaFinal" => "480"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Francisco Pozo-Rodr&#237;guez, Ady A&#46; Castro-Acosta, Carlos J&#46; &#193;lvarez-Mart&#237;nez"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "Francisco"
            "apellidos" => "Pozo-Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Ady A&#46;"
            "apellidos" => "Castro-Acosta"
            "email" => array:1 [
              0 => "ady&#64;h12o&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Carlos J&#46;"
            "apellidos" => "&#193;lvarez-Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Instituto de Investigaci&#243;n&#44; Hospital Universitario Doce de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Centro de Investigaci&#243;n Biom&#233;dica en Red de Enfermedades Respiratorias &#40;CIBERES&#47;CIBER-ISCIII&#41;&#44; Instituto de Investigaci&#243;n&#44; Hospital Universitario Doce de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Neumolog&#237;a&#44; Instituto de Investigaci&#243;n&#44; Hospital Universitario Doce de Octubre&#44; Centro de Investigaci&#243;n Biom&#233;dica en Red de Enfermedades Respiratorias &#40;CIBERES&#47;CIBER-ISCIII&#41;&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "La auditor&#237;a cl&#237;nica y su circunstancia"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Clinical audit &#40;CA&#41; is a &#8220;quality improvement process that seeks to improve patient care and outcomes through systematic review of care and the implementation of change&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This definition comprises 2 elements&#58; measuring performance and taking corrective action&#46; To measure performance&#44; &#40;i&#41; a systematic diagnosis of the clinical practice in terms of structure&#44; processes and outcomes must be made&#44; which &#40;ii&#41; must be measured against internal and external quality criteria&#44; and &#40;iii&#41; necessary changes must be identified&#46; Corrective action involves &#40;iv&#41; the implementation of the necessary changes&#44; and &#40;v&#41; evaluation of the outcomes of such changes&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the United Kingdom&#44; CAs come under National Health Service clinical governance&#44; but external organizations are also involved&#58; the National COPD Audit Program is a joint initiative involving the Royal College of Physicians&#44; the British Thoracic Society&#44; and the Primary Care Respiratory Society&#44; in collaboration with the British Lung Foundation&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In Spain&#44; CAs are not specifically included in the organization charts or mission statements of the Health Service or other scientific societies or professional colleges&#44; but some initiatives have been introduced in recent years&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">AUDIPOC Spain &#40;129 hospitals&#44; 5128 cases&#41; is an audit carried out in Spain on the standard of care in exacerbations of chronic obstructive pulmonary disease &#40;ECOPD&#41; between 2008 and 2009&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;5</span></a> The 2011 ERS COPD &#40;13 countries&#44; 432 hospitals&#44; 16&#44;081 cases&#41; is an ERS-sponsored European audit of the standard of care in ECOPD&#44; co-led by Spain&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> The MAG-1 study&#44; reported in this issue of <span class="elsevierStyleItalic">Archivos de Bronconeumonolog&#237;a</span>&#44; is a clinical audit of ECOPD performed in 30 hospitals and 910 cases in Catalonia at the beginning of 2011&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Catalonia also participated in the AUDIPOC &#40;10 hospitals&#44; 404 cases&#41; and the ERS Audit &#40;9 hospitals&#44; 475 cases&#41;&#46; These 3 studies&#44; being performed at the same time&#44; in the same geographical region&#44; and using similar methodologies&#44; are good candidates for a comparative assessment&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A common limitation of the MAG-1&#44; AUDIPOC and ERS COPD Audit studies is that the databases were constructed from clinical records&#44; and the frequency of missing or extremely improbable data is high&#46; All 3 audits identify weak points in the care process&#44; and report wide variability in terms of hospital and patient characteristics and outcomes&#46; MAG-1 manages variability by grouping hospitals by the number of COPD admissions per year&#44; while ERS COPD categorizes centers by number of beds&#46; Both identified significant differences between the various categories&#44; which could be often attributed to a logical clinical factor&#46; AUDIPOC deals with variations in mortality and readmission using a multilevel multivariate analysis adjusted for size&#44; number of cases enrolled and number of discharges&#46; This analysis revealed one or more underlying hospital-specific factors &#40;hospital-clustering effect&#41; that influence outcomes in a unique and independent manner and affect a significant proportion of inter-hospital variability&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Dissimilarities are also observed&#46; The results of MAG-1&#44; AUDIPOC and ERS in Catalonia reveal differences in the mean values of a number of clinical variables&#44; e&#46;g&#46;&#44; percentage of active smokers &#40;10&#37;&#44; 26&#37; and 25&#37;&#41;&#44; overall mortality &#40;12&#37;&#44; 7&#37; and 8&#37;&#41; or readmission &#40;49&#37;&#44; 37&#37; and 40&#37;&#41;&#46; These findings merit further study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">To identify outcome-associated variables&#44; MAG-1 used multivariate linear and logistic regression models&#58; a small number of variables were maintained&#44; mostly related with the personal characteristics or clinical status of the patients&#46; These outcomes were echoed in the AUDIPROC model&#58; after adjusting for the cluster effect&#44; some variables associated with patient age and clinical status were maintained&#46; The analyses of the ERS COPD Audit are complex and have yet to be published&#44; but they seem to point in the same direction&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the clinical audit setting&#44; the geographical region in which the audit is performed&#44; the emphasis on the intervention component&#44; the nature of data used&#44; and other aspects&#44; are all influencing factors&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The 3 audits studied were conducted in hospitals on a regional&#44; national and international level&#46; In our opinion&#44; the wider the net&#44; the more complicated the study&#44; with the ensuing problems of less stable databases&#44; more complex analyses&#44; and more difficulties in pinpointing specific weakness in hospital care provisions&#44; which is where the corrective action will finally need to be applied&#46; AUDIPOC alerted us to the hospital-clustering effect&#44; composed of both hospital-centered elements &#40;structural and organizational details or clinical practice styles not reflected in the variables under study&#44; and which are difficult to verify&#41;&#44; and non-hospital-centered elements &#40;socioeconomic makeup of the hospital&#39;s catchment area&#44; healthiness of the environment&#44; access to health services and the trickle-down effect on hospital admission&#44; to cite only a few&#41;&#46; The advantage of multi-hospital studies is that they measure performance in different settings and&#44; in theory&#44; identify the actions that need to be taken at various healthcare levels&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">All 3 audits place emphasis on the measurement of performance&#44; a situation diagnosis that is clearly necessary and probably essential&#46; However&#44; corrective actions are relegated to second place&#44; whereas these are in fact the ultimate reason for clinical audits&#44; and are most effective when applied directly in the hospital&#46; Moreover&#44; external agents will have a hard job overcoming obstacles to implement actions in the hospital&#44; despite the auditors&#8217; best efforts&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">All 3 audits use data retrieved from clinical records by different staff members&#46; The diversity of the clinical records that are collected in our health system&#44; irregular data completion&#44; and probable discrepancies in the thoroughness of the data extractors suggests that variability in the results due to clinical record artifacts should be taken into consideration&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">To sum up&#44; we believe that CAs are essential tools for improving healthcare quality&#44; and that stakeholders in the healthcare system must support their use&#46; CAs must be implemented to scrutinize the causes for variation&#44; and emphasis must be placed on the identification and implementation of corrective actions within the audited unit&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Pozo-Rodr&#237;guez F&#44; Castro-Acosta AA&#44; &#193;lvarez-Mart&#237;nez CJ&#46; La auditor&#237;a cl&#237;nica y su circunstancia&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;479&#8211;480&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New principles of best practice in clinical audit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Burguess"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2nd ed&#46;"
                        "fecha" => "2011"
                        "editorial" => "Radcliffe Publishing"
                        "editorialLocalizacion" => "London"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Audit &#38; quality improvement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "British Thoracic Society"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical audit of patients admitted to hospital in Spain due to exacerbation of COPD &#40;AUDIPOC Study&#41;&#58; method and organisation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Pozo-Rodr&#237;guez"
                            1 => "C&#46;J&#46; &#193;lvarez"
                            2 => "A&#46; Castro-Acosta"
                            3 => "C&#46; Melero Moreno"
                            4 => "A&#46; Capelastegui"
                            5 => "C&#46; Esteban"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2010.04.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2010"
                        "volumen" => "46"
                        "paginaInicial" => "349"
                        "paginaFinal" => "357"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20554103"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Auditor&#237;a Cl&#237;nica sobre las exacerbaciones de la Enfermedad Pulmonar Obstructiva Cr&#243;nica&#46; Madrid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Grupo AUDIPOC de Investigaci&#243;n&#46; AUDIPOC Espa&#241;a 2009"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2009"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical audit of COPD patients requiring hospital admissions in Spain&#58; AUDIPOC Study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "AUDIPOC Study Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Pozo-Rodr&#237;guez"
                            1 => "J&#46;L&#46; L&#243;pez-Campos"
                            2 => "C&#46;J&#46; &#193;lvarez-Mart&#237;nez"
                            3 => "A&#46; Castro-Acosta"
                            4 => "R&#46; Ag&#252;ero"
                            5 => "J&#46; Hueto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0042156"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "e42156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22911875"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European COPD Audit&#58; design&#44; organisation of work and methodology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; L&#243;pez-Campos"
                            1 => "S&#46; Hartl"
                            2 => "F&#46; Pozo-Rodr&#237;guez"
                            3 => "C&#46;M&#46; Roberts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00021812"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2013"
                        "volumen" => "41"
                        "paginaInicial" => "270"
                        "paginaFinal" => "276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22599361"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "An international comparison of COPD care in Europe&#46; Results of the first European COPD Audit"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2012"
                        "editorial" => "European Respiratory Society"
                        "editorialLocalizacion" => "Lausanne"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European COPD Audit Team&#46; Variability of hospital resources for acute care of COPD patients&#58; the European COPD Audit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; L&#243;pez-Campos"
                            1 => "S&#46; Hartl"
                            2 => "F&#46; Pozo-Rodr&#237;guez"
                            3 => "C&#46;M&#46; Roberts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00074413"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2014"
                        "volumen" => "43"
                        "paginaInicial" => "754"
                        "paginaFinal" => "762"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23988775"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "en nombre del equipo del Plan Director de las Enfermedades del Aparato Respiratorio &#40;PDMAR&#41; y del grupo colaborador del proyecto MAG-1Auditor&#237;a cl&#237;nica de los pacientes que ingresan en el hospital por agudizaci&#243;n de EPOC&#46; Estudio MAG-1"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Escarrabilla"
                            1 => "E&#46; Torrenteb"
                            2 => "C&#46; Esquinase"
                            3 => "C&#46; Hern&#225;ndez"
                            4 => "E&#46; Mons&#243;"
                            5 => "M&#46; Freixash"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The AUDIPOC Study Group&#46; Determinants of between-hospital variations in outcomes for patients admitted with COPD exacerbations&#58; findings from a nationwide clinical audit &#40;AUDIPOC&#41; in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Pozo-Rodr&#237;guez"
                            1 => "A&#46; Castro-Acosta"
                            2 => "C&#46;J&#46; &#193;lvarez"
                            3 => "J&#46;L&#46; L&#243;pez-Campos"
                            4 => "A&#46; Forte"
                            5 => "A&#46; L&#243;pez Quilez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijcp.12601"
                      "Revista" => array:2 [
                        "tituloSerie" => "Int J Clin Pract"
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005100000010/v1_201509302252/S1579212915002918/v1_201509302252/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14568"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000010/v1_201509302252/S1579212915002918/v1_201509302252/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002918?idApp=UINPBA00003Z"
]
Article information
ISSN: 15792129
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 5 2 7
2024 October 40 26 66
2024 September 57 13 70
2024 August 62 35 97
2024 July 53 17 70
2024 June 62 29 91
2024 May 64 28 92
2024 April 45 40 85
2024 March 52 27 79
2024 February 49 18 67
2023 October 1 3 4
2023 March 12 5 17
2023 February 44 22 66
2023 January 50 30 80
2022 December 58 31 89
2022 November 76 29 105
2022 October 45 43 88
2022 September 58 38 96
2022 August 40 32 72
2022 July 41 35 76
2022 June 48 40 88
2022 May 57 47 104
2022 April 54 34 88
2022 March 58 41 99
2022 February 71 39 110
2022 January 69 39 108
2021 December 62 45 107
2021 November 95 52 147
2021 October 73 54 127
2021 September 38 50 88
2021 August 43 29 72
2021 July 29 33 62
2021 June 46 45 91
2021 May 45 42 87
2021 April 123 74 197
2021 March 99 36 135
2021 February 93 26 119
2021 January 49 14 63
2020 December 52 19 71
2020 November 47 16 63
2020 October 55 23 78
2020 September 44 9 53
2020 August 45 23 68
2020 July 55 16 71
2020 June 38 20 58
2020 May 43 13 56
2020 April 46 23 69
2020 March 43 18 61
2020 February 37 28 65
2020 January 43 18 61
2019 December 43 16 59
2019 November 49 23 72
2019 October 33 8 41
2019 September 39 10 49
2019 August 41 14 55
2019 July 30 17 47
2019 June 42 19 61
2019 May 73 26 99
2019 April 76 38 114
2019 March 56 14 70
2019 February 44 16 60
2019 January 69 11 80
2018 December 62 20 82
2018 November 66 29 95
2018 October 112 31 143
2018 September 47 15 62
2018 May 8 1 9
2018 April 50 6 56
2018 March 28 8 36
2018 February 33 12 45
2018 January 100 10 110
2017 December 99 6 105
2017 November 43 7 50
2017 October 24 10 34
2017 September 24 21 45
2017 August 27 15 42
2017 July 25 13 38
2017 June 39 17 56
2017 May 38 15 53
2017 April 34 14 48
2017 March 23 14 37
2017 February 15 5 20
2017 January 16 10 26
2016 December 41 10 51
2016 November 32 7 39
2016 October 32 15 47
2016 September 38 14 52
2016 August 53 10 63
2016 July 36 10 46
2016 June 2 0 2
2016 May 0 17 17
2016 April 1 3 4
2016 March 5 0 5
2016 February 0 3 3
2016 January 1 7 8
2015 October 0 2 2
Show all

Follow this link to access the full text of the article

Archivos de Bronconeumología

Are you a health professional able to prescribe or dispense drugs?