Unidad de diagnóstico rápido en un hospital de tercer nivel. Estudio descriptivo del primer año y medio de funcionamiento

Rubio‐Rivas, Manuel; Vidaller, Antonio; Farriols, Ramon Pujol; Mast, Richard

doi:10.1016/s0014-2565(08)76034-x

Cited by 25 publications

(15 citation statements)

References 8 publications

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“…Second, our study was based on a single center. However, the population attended in our QDUs is fairly representative of patients attended in other Spanish QDUs according to Spanish language papers [6,8,9,40,41]. Third, although it could be considered better methodologically to study only patients with a clearly defined disorder (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Although a common diagnosis in Spanish QDUs (nearly 20% of patients) [6,7,8], no study has evaluated the utility of QDUs in cancer patients, even though the Strategy on Cancer of the Spanish National Health System 2010 states ‘[every] patient with a well-founded clinical suspicion of cancer must undergo a first confirmatory diagnostic test within 15 days’ [26] and that ‘[any] patient with a proven diagnosis of cancer must have an appointment in their hospital within a week of confirmation to propose a specific therapeutic plan’.…”

Section: Discussionmentioning

confidence: 99%

“…Due to shortcomings in outpatient services in Spain and other countries, acute beds are increasingly occupied by patients requiring diagnostic tests for non-acute but potentially severe diseases not requiring urgent treatment, thus reducing acute beds [6,8]. Although studies suggest that in Spain, as many as 20% of hospitalized patients in internal medicine departments could be studied on an outpatient basis, delays in outpatient diagnostic tests often render them impractical, especially when rapid tests for suspected cancer are required [9,10,11].…”

Section: Introductionmentioning

confidence: 99%

“…The search for alternatives includes quick diagnosis units (QDUs), i.e. outpatient diagnostic units for patients with suspected severe disease, mainly cancer [6,8,12]. …”

Section: Introductionmentioning

confidence: 99%

“…Most Spanish tertiary public hospitals and 30% or more of district hospitals now have QDUs, which are generally led by general internists and provide a prompt, effective diagnosis for patients with suspected severe disease, especially cancer [6,7,8]. …”

Section: Introductionmentioning

confidence: 99%

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Comparison of Quick Diagnosis Units and Conventional Hospitalization for the Diagnosis of Cancer in Spain: A Descriptive Cohort Study

Bosch

Moreno²,

Ríos³

et al. 2012

Oncology

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Objective: Quick diagnosis units (QDUs) in Spain provide patients with severe disease who would normally require hospitalization with the prompt and effective diagnosis they deserve. We compared the value and cost of a QDU and of conventional hospitalization in assessing patients with cancer. Methods: In a descriptive cohort study, 169 patients with a final diagnosis of cancer were prospectively evaluated between November 2008 and April 2010. We also analyzed a retrospective cohort of 53 randomly selected patients with neoplasia hospitalized during this period. In addition to the variables time to diagnosis and length of stay, we compared the costs of both models using microcosting techniques. Results: Colorectal cancer was the commonest cancer (26%). QDU patients were younger than hospitalized patients (68.3 vs. 74.7 years; p < 0.05), and there were also significant differences with respect to the source of referral (p < 0.00001) and destination (p < 0.00001), but not regarding diagnosis (p > 0.34), reason for consultation (p > 0.26) and time to diagnosis/length of stay (Wilcoxon rank sum test, p > 0.05). The mean costs for hospitalization were EUR 4,059.37 compared with EUR 601.84 in the QDU. Conclusion: For diagnostic purposes, cancer patients can be managed similarly in a QDU or in in-hospital settings, but the QDU model seems to incur fewer costs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The search for alternatives includes quick diagnosis units (QDUs), i.e. outpatient diagnostic units for patients with suspected severe disease, mainly cancer [6,8,12]. …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of Quick Diagnosis Units and Conventional Hospitalization for the Diagnosis of Cancer in Spain: A Descriptive Cohort Study

Bosch

Moreno²,

Ríos³

et al. 2012

Oncology

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Quick diagnosis units—an effective alternative to hospitalization for diagnostic workup: A systematic review

Gupta

Sukhal

Agarwal

et al. 2013

Journal of Hospital Medicine

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INTRODUCTION This era of healthcare reform emphasizes improving value of care. Inpatient admissions for diagnostic evaluation put economic pressure on an already strained healthcare system. We conducted a systematic review of effectiveness of quick diagnosis units (QDUs), an established outpatient model for early diagnostic workups in Europe. METHODS We searched MEDLINE and Embase for studies that focused on implementation of quick/rapid diagnosis units, with relevant Medical Subject Headings terms and keywords. Of 2047 studies, we selected 13 for full‐text screening and bibliography review. Of these, 5 studies included at least 2 primary outcomes of interest and were included in our review. These units functioned as outpatient clinics, staffed by internists, nurses, and clerical staff, with expedited scheduling of outpatient diagnostic tests. Our primary outcome measures were final diagnosis, the mean time to final diagnosis, inpatient bed‐days saved per patient, and costs saved per patient. We also studied discharge disposition, care preferences, and safety data. RESULTS About 18% to 30% of patients were diagnosed with malignancy, with an average time to diagnosis of 6 to 11 days. Inpatient bed‐days saved per patient ranged from 4.5 to 7. Savings from fixed costs of hospitalization ranged from $2336(€1764) to $3304(€2514) for each patient enrolled in the protocol. The QDU model was preferred by 88% of patients, and patient satisfaction rates were 95% to 97%. CONCLUSIONS QDUs seem an effective and cost‐saving alternative to inpatient hospitalization, and appear to be a safe approach for diagnostic workup of potentially severe diseases in select patient populations, although there are limited safety data available. Journal of Hospital Medicine 2014;9:54–59. © 2013 Society of Hospital Medicine

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Quick diagnosis units versus hospitalization for the diagnosis of potentially severe diseases in Spain

Bosch

Jordan

Coca

et al. 2011

Journal of Hospital Medicine

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OBJECTIVES: We describe the functioning of a quick diagnosis unit (QDU) in a Spanish public university hospital to ascertain the utility and cost of the model compared to conventional hospitalization. DESIGN: Observational study with a prospective and retrospective cohort. SETTING: Spanish tertiary public university hospital. PATIENTS: Two thousand consecutive patients evaluated between December 2007 and July 2010 with potentially severe diseases normally requiring hospitalization for diagnosis. For comparative purposes, we analyzed a randomized, retrospective cohort of 1454 hospitalized patients. MEASUREMENTS: Variables measured included source of referral, reason for consultation, time to diagnosis and length‐of‐stay, hospitalizations avoided, Charlson comorbidity index, costs, and patient satisfaction using a telephone survey. RESULTS: Suspected anemia, cachexia‐anorexia syndrome, febrile syndrome, adenopathies and/or palpable masses, abdominal pain, diarrhea, and lung abnormalities accounted for 88% of QDU patients. The most‐frequent diagnoses were cancer (26.3%) and iron‐deficiency anemia. QDU patients with anemia were significantly younger than hospitalized patients with the same diagnosis (P < 0.0001). Other parameters were similar between QDU and hospitalized patients. The mean cost of treatment was 3153.87 Euros for hospitalization and 702.33 Euros for the QDU. Patients expressed a high degree of satisfaction with QDU care. CONCLUSIONS: QDUs can manage the diagnosis of patients with potentially severe diseases equally as well as traditional hospitalization, and saves costs. QDU patients expressed a high degree of satisfaction, with most preferring this model to hospitalization. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine

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Unidad de diagnóstico rápido en un hospital de tercer nivel. Estudio descriptivo del primer año y medio de funcionamiento

Cited by 25 publications

References 8 publications

Comparison of Quick Diagnosis Units and Conventional Hospitalization for the Diagnosis of Cancer in Spain: A Descriptive Cohort Study

Comparison of Quick Diagnosis Units and Conventional Hospitalization for the Diagnosis of Cancer in Spain: A Descriptive Cohort Study

Quick diagnosis units—an effective alternative to hospitalization for diagnostic workup: A systematic review

Quick diagnosis units versus hospitalization for the diagnosis of potentially severe diseases in Spain

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