Examinando por Autor "Marco, Javier"

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Admission of nursing home residents to a hospital internal medicine department. J Am Med Dir Assoc. 2012 Jan;13(1):82.e13-7
(Elsevier, 2012-01) Barba, Raquel; Zapatero, Antonio; Marco, Javier; Perez, Alejandro; Canora, Jesus; Plaza, Susana; Losa, Juan Emilio
Objective: Hospitalization of nursing home residents is costly and potentially exposes residents to iatrogenic disease and psychological harm. Design and setting: In this study, we analyzed the data from the Basic Minimum Data Set of patients hospitalized from the nursing home who were discharged from all the internal medicine departments at the National Health Service hospitals in Spain between 2005 and 2008, according to the data provided by the Ministry of Health and Consumer Affairs. Results: Between January 2005 and December 2008, 2,134,363 patients were admitted to internal medicine departments in Spain, of whom 45,757 (2.1%) were nursing home residents. Overall, 7898 (17.3%) patients died during hospitalization, 2442 (30.91%) of them in the first 48 hours. The following variables were the significant predictors of in-hospital mortality in multivariate analysis: age (odds ratio [OR] 1.02, 95% confidence intervals [CI] 1.02-1.03), female gender (OR 1.13, 95% CI 1.13-1.17), dementia (OR 1.09, 95% CI 1.03-1.16), previous feeding tube (OR 1.34, 95% CI 1.09-1.79), malignant disease (OR 2.03, 95% CI 1.86-2.23), acute infectious disease (OR 1.18, 95% CI 1.12-1.25), pressure sores (OR 1.88, 95% CI 1.62-1.95), acute respiratory failure (OR 2.00, 95% CI 1.90-2.10), and nosocomial pneumonia (OR 2.5, 95% CI 2.23-2.72). Conclusions: Two of every 100 patients admitted to internal medicine departments came from nursing homes. The rate of mortality is very high in these patients, with almost one third of patients dying in the first 48 hours, which suggests that many of these transfers were unnecessary. The cost of these admissions for 1 year was equivalent to the annual budget of a 300- to 400-bed public hospital in Spain. The mechanism of coordination between nursing homes and public hospitals must be reviewed with the aim of containing costs and facilitating the care of patients in the last days of life.
Advice from a medical expert through the Internet on queries about AIDS and hepatitis: analysis of a pilot experiment
(Public Library Science, 2006-07-04) Marco, Javier; Barba, Raquel; Losa, JE; de la Serna, CM; Sainz, M; de la Serna, JL
Background: Advice from a medical expert on concerns and queries expressed anonymously through the Internet by patients and later posted on the Web, offers a new type of patient-doctor relationship. The aim of the current study was to perform a descriptive analysis of questions about AIDS and hepatitis made to an infectious disease expert and sent through the Internet to a consumer-oriented Web site in the Spanish language. Methods and findings: Questions were e-mailed and the questions and answers were posted anonymously in the "expert-advice" section of a Web site focused on AIDS and hepatitis. We performed a descriptive study and a temporal analysis of the questions received in the first 12 months after the launch of the site. A total of 899 questions were received from December 2003 to November 2004, with a marked linear growth pattern. Questions originated in Spain in 68% of cases and 32% came from Latin America (the Caribbean, Central America, and South America). Eighty percent of the senders were male. Most of the questions concerned HIV infection (79%) with many fewer on hepatitis (17%). The highest numbers of questions were submitted just after the weekend (37% of questions were made on Mondays and Tuesdays). Risk factors for contracting HIV infection were the most frequent concern (69%), followed by the window period for detection (12.6%), laboratory results (5.9%), symptoms (4.7%), diagnosis (2.7%), and treatment (2.2%). Conclusions: Our results confirm a great demand for this type of "ask-the-expert" Internet service, at least for AIDS and hepatitis. Factors such as anonymity, free access, and immediate answers have been key factors in its success.
Anemia in chronic obstructive pulmonary disease: a readmission prognosis factor
(Taylor & Francis, 2012-03-28) Barba, Raquel; García de Casasola, Gonzalo; Marco, Javier; Losa, Juan Emilio; Plaza, Susana; Canora, Jesús; Zapatero, Antonio
Objective: The prevalence of comorbid anemia in patients with COPD ranges from 7.5% to 34%. The aim of this study is to determine if anemia is a risk factor for readmission in COPD patients. Methods: This study analyzed the hospital data of 289,077 adults with acute exacerbations of COPD admitted to the hospital at any public center in Spain, in 2006 and 2007. We calculated the prevalence of anemia and compared readmissions between COPD patients with and without anemia. Multiple regression analyses were carried out with the aim of determining the risk of readmission attributable to anemia, after the correction of possible confounding variables. Results: Of the patients with COPD, 9.8% (n = 26,899) had a diagnosis of anemia. Anemic patients were older, more likely to be female and had a greater comorbidity burden than non-anemic individuals. Multiple regression modeling revealed that multiple independent factors were associated with an increased risk of readmission in persons with COPD. Anemia was one of the greatest risks: anemic patients had a 25% higher risk of readmission than non-anemic patients (odds ratio [OR], 1.25; 95% confidence interval [CI] 1.21-1.29). Conclusion: Utilizing an administrative database the authors found that anemia correlates independently with readmission in COPD patients. Limitations: This is a retrospective cohort study and thus subject to multiple forms of bias. Although spirometric evidence of COPD was not available, our case identification methods have been previously validated and found to be accurate in recognizing COPD.
Predictive model of readmission to internal medicine wards.
(Elsevier, 2012-07) Zapatero, Antonio; Barba, Raquel; Marco, Javier; Hinojosa, Juan; Plaza, Susana; Losa, Juan Emilio; Canora, Jesús
-Objective: Prevention of readmission to hospital is considered an outstanding example of a cost-effective practice. Our aim was to derive and validate a clinically useful index to quantify the risk of readmission among patients discharged from Internal Medicine departments. Methods: We analysed hospital Basic Minimum Data Sets (BMDS) recorded between 2006 and 2008 to determine patterns of rehospitalization. Multivariate statistical analysis of routinely collected data was used to develop an algorithm ('SEMI INDEX') to identify patients predicted to have the highest risk of readmission in the 30 days following discharge. The algorithm was developed by using data from admissions in 2006-2007, for four age subgroups. Coefficients for the most powerful and statistically significant variables were applied against episodes recorded in 2008 to validate the findings of the algorithm developed from the first sample. Results: Of the 999,089 internal medicine admissions in Spain during 2006-2007, 12.4% were rehospitalized within 30 days. The key factors that predicted subsequent admission included male sex, length of stay, comorbidity of the patient, and some clinical conditions. There were small but relevant differences among the different age subgroups. Conclusions: Readmissions to Internal Medicine departments are prevalent (12.4%). The SEMI INDEX can be used to assess accurately the risk of readmission within 30 days after discharge.
Prolonged length of stay in hospitalized internal medicine patients
(Elsevier, 2015-12) Barba, Raquel; Marco, Javier; Canora, Jesús; Plaza, Susana; Nistal Juncos, Sara; Hinojosa, Juan; Mendez Bailon, Manuel; Zapatero, Antonio
Background: Targeting patients with prolonged hospitalizations may represent an effective strategy for reducing average hospital length of stay (LOS). Objective: We sought to characterize predictors of prolonged hospitalization among internal medicine patients in an effort to guide future improvement efforts. Design: We conducted a retrospective cohort study using administrative data of internal medicine patients from all hospitals of the Spanish Public Health Service between January 1st, 2005 and December 31st, 2013. Multivariable logistic regression was performed to assess the association between sociodemographic and clinical variables and prolonged LOS, defined as >30days. Key results: Of 5,275,139 discharges, 166,470 (3.2%) had a prolonged LOS. Prolonged hospitalizations accounted for 17.4% of total inpatient days and contributed 0.5days to an average LOS of 9.8days during the study period. Prolonged hospitalizations were associated with younger age (odds ratio [OR]: 0.97 per 10-year increase in age, 95% confidence interval [CI]: 0.96-0.98) and male gender (OR 0.88 IC95% 0.87-0.89). Compared to patients without prolonged LOS, prolonged LOS patients were more likely to require a palliative care consult (OR: 2.48, 95% CI: 2.39-2.58), surgery (OR: 6.9 95% CI: 6.8-7.0); and be discharged to a post-acute-care facility (OR: 2.91, 95% CI: 2.86-2.95). Conclusions: Prolonged hospitalizations in a small proportion of patients were an important contributor to overall LOS and particularly affected complex hospital stays who were not discharged home.
The impact of weekends on outcome for acute exacerbations of COPD
(European Respiratory Society, 2012-01) Barba, Raquel; Zapatero, Antonio; Losa, Juan Emilio; Marco, Javier; Plaza, Susana; Rosado, Cristina; Canora, Jesús
Differences in hospital staffing may influence outcomes for patients with acute conditions, including acute exacerbations of chronic obstructive pulmonary disease (COPD), depending on which day of the week the patients are admitted. This study was conducted to determine whether weekend admission increases the risk of dying in hospital. We analysed the clinical data of 289,077 adults with acute exacerbations of COPD admitted to the hospital at any public centre in Spain, during 2006 and 2007. We analysed the following factors for their association with death rate: day of admission, demographics, medical history and comorbidity. During the study period, there were 35,544 (12.4%) deaths during admission in COPD patients. Weekend admissions were associated with a significantly higher in-hospital mortality (12.9%) than weekday admissions (12.1%) among COPD patients (OR 1.07 (95% CI 1.04-1.10)). The differences in mortality persisted after adjustment for age, sex and coexisting disorders (OR 1.05 (95% CI 1.02-1.08)). Analyses of deaths within 2 days after admission showed larger relative differences in mortality between the weekend and weekday admissions (OR 1.17 (95% CI 1.11-1.23)). We conclude that patients with acute exacerbations of COPD are more likely to die in the hospital if they are admitted on a weekend compared with a weekday.