Auditoria clínica de los pacientes hospitalizados por exacerbación de EPOC en España (estudio AUDIPOC): método y organización del trabajo

Pozo-Rodrı́guez, Francisco; Álvarez, Carlos; Castro-Acosta, Ady; Moreno, Carlos Melero; Capelastegui, Alberto; Esteban, Cristóbal; Carcereny, Carmen Hernández; Lόpez-Campos, José Luís; Alonso, José L.; López‐Quílez, Antonio; Agustí, Àlvar

doi:10.1016/j.arbres.2010.04.004

Cited by 33 publications

(25 citation statements)

References 14 publications

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“…The AUDIPOC study methodology has been extensively described elsewhere 11. Briefly, the AUDIPOC comprised a clinical audit, with prospective case ascertainment and retrospective data acquisition of all consecutive AECOPD hospital admissions between 1 November and 31 December 2008.…”

Section: Methodsmentioning

confidence: 99%

“…Sampling was performed in two stages: first the hospitals and then the patients in the hospitals. As described in the methodological paper 11, the institutions included in the AUDIPOC study represented all of the main types of Spanish public hospitals in a fairly homogeneous manner. However, private centres were excluded 11.…”

Section: Methodsmentioning

confidence: 99%

“…As described in the methodological paper 11, the institutions included in the AUDIPOC study represented all of the main types of Spanish public hospitals in a fairly homogeneous manner. However, private centres were excluded 11. Hence, the AUDIPOC dataset has a hierarchical, multilevel structure with patients clustered within the hospitals.…”

Section: Methodsmentioning

confidence: 99%

“…Ultimately, 5178 patients (45% of the 11,564 patients who were initially considered to be potentially eligible for the study) were enroled as definite study cases. During the study period, over 750 variables were recorded, with information regarding the hospital resources, patient characteristics and processes of care for every participant centre and clinical case included 11.…”

Section: Methodsmentioning

confidence: 99%

“…However, previous studies have shown that there is significant variability in AECOPD processes of care and outcomes across hospitals 4, 5, 6, 7, 8, 9 and countries 10. The AUDIPOC study, a nationwide clinical audit on AECOPD conducted in Spain from 2008 to 2009 11, included 129 Spanish public general hospitals 12. The study confirmed that relevant variations in patient demographics and clinical characteristics, hospital resources and organisational variables, diagnostic and therapeutic interventions, and outcomes occurred among the participating hospitals 13.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of between‐hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit ( AUDIPOC ) in Spain

et al. 2015

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SummaryBackgroundPrevious studies have demonstrated significant variability in the processes of care and outcomes of chronic obstructive pulmonary disease (COPD) exacerbations. The AUDIPOC is a Spanish nationwide clinical audit that identified large between‐hospital variations in care and clinical outcomes. Here, we test the hypothesis that these variations can be attributed to either patient characteristics, hospital characteristics and/or the so‐called hospital‐clustering effect, which indicates that patients with similar characteristics may experience different processes of care and outcomes depending on the hospital to which they are admitted.MethodsA clinical audit of 5178 COPD patients consecutively admitted to 129 Spanish public hospitals was performed, with a 90‐day follow‐up. Multilevel regression analysis was conducted to model the probability of patients experiencing adverse outcomes. For each outcome, an empty model (with no independent variables) was fitted to assess the clustering effect, followed by a model adjusted for the patient‐ and hospital‐level covariables. The hospital‐clustering effect was estimated using the intracluster correlation coefficient (ICC); the cluster heterogeneity was estimated with the median odds ratio (MOR), and the coefficients of predictors were estimated with the odds ratio (OR).ResultsIn the empty models, the ICC (MOR) for inpatient mortality and the follow‐up mortality and readmission were 0.10 (1.80), 0.08 (1.65) and 0.01 (1.24), respectively. In the adjusted models, the variables that most represented the patients’ clinical conditions and interventions were identified as outcome predictors and further reduced the hospital variations. By contrast, the resource factors were primarily unrelated with outcomes.ConclusionsThis study demonstrates a noteworthy reduction in the observed crude between‐hospital variation in outcomes after accounting for the hospital‐cluster effect and the variables representing patient's clinical conditions. This emphasises the predictor importance of the patients’ clinical conditions and interventions, and understates the impacts of hospital resources and organisational factors.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Determinants of between‐hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit ( AUDIPOC ) in Spain

et al. 2015

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COPD patients with and without metabolic syndrome: clinical and functional differences

Díez-Manglano

Barquero-Romero²,

Almagro

et al. 2013

Intern Emerg Med

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Chronic obstructive pulmonary disease (COPD) and the metabolic syndrome (MetS) are considered public health challenges of the 21st century. The coexistence of MetS in COPD patients and any clinical differences between COPD patients with and without MetS have not been extensively studied. We aimed to describe the clinical characteristics of patients with MetS and COPD. An observational, multicenter study of 375 patients hospitalized for a COPD exacerbation with spirometric confirmation was performed. We measured the components of the MetS and collected comorbidity information using the Charlson index and other conditions. Dyspnea, use of steroids, exacerbations, and hospitalizations were also investigated. The overall prevalence of MetS in COPD patients was 42.9 %, was more frequent in women (59.5 %) than men (40.8 %), p = 0.02, but with no differences in age and smoking history. COPD patients with MetS had greater % predicted FEV1, more dyspnea, and more comorbidity and used more inhaled steroids (all p < 0.05). Diabetes, osteoporosis, coronary artery disease, and heart failure were more frequent in patients with MetS. They had been hospitalized more frequently for any cause but not for COPD. In multivariate analysis, the presence of MetS was independently associated with greater FEV1, inhaled steroids use, osteoporosis, diabetes, and heart failure. MetS is a frequent condition in COPD patients, and it is associated with greater FEV1, more dyspnea, and more comorbidities.

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Intervenciones en tabaquismo en pacientes con enfermedades cardiovasculares

Granda‐Orive¹,

Solano-Reina²,

Jiménez-Ruíz³

2013

Atención Primaria

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Smoking tobacco is the main cardiovascular risk factor and has a dose-dependent response. It has been shown that an aggressive policy, not only against consumption, achieves a significant decrease in cardiovascular deaths. Thus, we must provide and carry out activities to prevent or decrease the incidence of smoking (primary prevention), and to the early detection of the smoker and to reduce the prevalence (secondary prevention), and lastly to act on the effects of tobacco smoke, preventing complication and remissions (tertiary prevention). Thus, all health care levels must act in order that smokers do not develop cardiovascular disease when they quit smoking, both from Primary, as well as specialist care.

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Auditoria clínica de los pacientes hospitalizados por exacerbación de EPOC en España (estudio AUDIPOC): método y organización del trabajo

Cited by 33 publications

References 14 publications

Determinants of between‐hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit ( AUDIPOC ) in Spain

Determinants of between‐hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit ( AUDIPOC ) in Spain

COPD patients with and without metabolic syndrome: clinical and functional differences

Intervenciones en tabaquismo en pacientes con enfermedades cardiovasculares

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