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Objetivo: Actualmente, los programas de mantenimiento con metadona (PMM) son la mejor alternativa de tratamiento para los adictos a opiáceos. Se pretende valorar el coste-efectividad de tres PMM que ofrecían diferentes servicios auxiliares utilizando como medida de efectividad el incremento de la calidad de vida. Métodos: Estudio de seguimiento a 12 meses de 586 pacientes que iniciaron tratamiento con metadona en los centros de atención y seguimiento municipales de Barcelona. Para medir la evolución de la calidad de vida se utilizó el Perfil de Salud de Nottingham (PSN). Se calcularon los costes unitarios estándar y el coste total por paciente a partir de los registros de actividad. Los datos sociodemográficos, de salud y toxicológicos se obtuvieron a través de una entrevista semiestructurada. El análisis coste-efectividad se realizó mediante dos modelos multivariados con idénticas variables de ajuste. Resultados: Cuanto mayor es la intensidad de programa, más elevado es el coste. Los modelos ajustados detectaron un aumento significativo de la calidad de vida (mejora de un 8% en el PSN) y de los costes (17%) entre el programa de intensidad baja y el de intensidad media. Conclusiones: El programa de media intensidad demostró la mejor relación coste-efectividad pero, dadas las limitaciones del estudio, es difícil ser taxativo en la generalización de sus resultados.

Objetivo: A pesar de que en los últimos 5 años la población inmigrante se ha triplicado en ciudades como Barcelona, hasta el momento no se ha evaluado de forma rigurosa el impacto de este colectivo en el sistema sanitario. El objetivo del presente estudio ha sido comparar el perfil de la hospitalización de la población inmigrante con la autóctona, desde el punto de vista de la casuística, gravedad, características demográficas y consumo de estancias. Material y métodos: Se han analizado las 15.057 altas del Hospital del Mar de Barcelona en el año 2000. Este hospital asiste el 60% de los ingresos hospitalarios del distrito de Ciutat Vella, distrito que presentaba en el año 2000 un porcentaje de inmigrantes residentes del 21%. Se han comparado las características sociodemográficas y de casuística de los pacientes en razón de ser o no inmigrantes. También se ha comparado el consumo de recursos hospitalarios teniendo en cuenta la edad, la casuística (grupos relacionados por el diagnóstico) y la gravedad (severidad, complicaciones y comorbilidades) de la patología atendida. Resultados: La población inmigrante ha presentado una casuística distinta de la autóctona por la marcada diferencia en la edad y por su mayor tasa de fecundidad. El 33% de los ingresos de inmigrantes han sido partos. El coste medio de las altas de inmigrantes de países de renta baja valorado en consumo de estancias hospitalarias, ha sido un 30% menor que el del resto de las altas. Una vez ajustadas la edad, la casuística y la severidad, el consumo de estancias hospitalarias en la población inmigrante ha sido significativamente menor. La diferencia se ha cifrado en un 5% cuando sólo se ha ajustado por patología y en un 10% cuando han sido considerados todos los factores. Conclusiones: Las diferencias en la casuística vienen marcadas por la edad y por las diferencias socioculturales. La pirámide de edad de la población hospitalaria inmigrante recompone la envejecida estructura de edad de los pacientes autóctonos y plantea la necesidad de recuperar el mayor peso de los servicios de ginecología-obstetricia y pediatría. El hecho de que exista menor consumo de recursos por alta hospitalaria en la población inmigrante de países de renta baja contradice la relación esperada de inmigrante-peor situación socioeconómica-mayor intensidad de consumo de recursos por alta hospitalaria. Deben proponerse nuevas hipótesis de trabajo y análisis que permitan explicar esta realidad.

Objective: To analyze the experience and perception of clinical coordination across care levels and doctor's organizational and interactional related factors, according to the type of management integration of the healthcare services of the area, in Catalonia., Method: Cross-sectional study based on an online survey by self-administration of the questionnaire COORDENA-CAT., Data Collection: October-December 2017., Study Population: primary and secondary care (acute and long-term care) doctors of the public Catalan health system., Sample: 3308 doctors., Outcome Variables: experience and perception of clinical coordination, knowledge and use of coordination mechanisms and organizational and interactional factors; explanatory variables: area according to type of management (integrated, semi-integrated, non-integrated), socio-demographic, employment characteristics and attitude toward work. Descriptive analysis by type of area and multivariate analysis by robust Poisson regression., Results: Better clinical coordination was observed in integrated areas compared to those semi-integrated, mainly in relation to information transfer, adequate follow-up and perception of coordination in the area. No differences were found between integrated and non-integrated areas in the clinical coordination experience, although there were differences in perception and some related factors. There are common problems across areas, such as accessibility to secondary care., Conclusions: Few differences were found between integrated and non-integrated areas, revealing that management integration may facilitate clinical coordination but is not enough. Differences with semi-integrated areas indicate the need to promote cooperation formulas between all the providers of the territory, with common objectives and coordination mechanisms, in order to avoid inequalities in quality of care., (Copyright © 2021 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To analyse doctors' opinions on clinical coordination between primary and secondary care in different healthcare networks and on the factors influencing it., Methods: A qualitative descriptive-interpretative study was conducted, based on semi-structured interviews. A two-stage theoretical sample was designed: 1) healthcare networks with different management models; 2) primary care and secondary care doctors in each network. Final sample size (n = 50) was reached by saturation. A thematic content analysis was conducted., Results: In all networks doctors perceived that primary and secondary care given to patients was coordinated in terms of information transfer, consistency and accessibility to SC following a referral. However, some problems emerged, related to difficulties in acceding non-urgent secondary care changes in prescriptions and the inadequacy of some referrals across care levels. Doctors identified the following factors: 1) organizational influencing factors: coordination is facilitated by mechanisms that facilitate information transfer, communication, rapid access and physical proximity that fosters positive attitudes towards collaboration; coordination is hindered by the insufficient time to use mechanisms, unshared incentives in prescription and, in two networks, the change in the organizational model; 2) professional factors: clinical skills and attitudes towards coordination., Conclusions: Although doctors perceive that primary and secondary care is coordinated, they also highlighted problems. Identified factors offer valuable insights on where to direct organizational efforts to improve coordination., (Copyright © 2017. Publicado por Elsevier España, S.L.U.)

Objective: To assess the hospital cost associated with colorectal cancer (CRC) treatment by stage at diagnosis, type of cost and disease phase in a public hospital., Methods: A retrospective analysis was conducted of the hospital costs associated with a cohort of 699 patients diagnosed with CRC and treated for this disease between 2000 and 2006 in a teaching hospital and who had a 5-year follow-up from the time of diagnosis. Data were collected from clinical-administrative databases. Mean costs per patient were analysed by stage at diagnosis, cost type and disease phase., Results: The mean cost per patient ranged from 6,573 Euros for patients with a diagnosis of CRC in situ to 36,894 € in those diagnosed in stage III. The main cost components were surgery-inpatient care (59.2%) and chemotherapy (19.4%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs and an increase in chemotherapy costs., Conclusions: This study provides the costs of CRC treatment based on clinical practice, with chemotherapy and surgery accounting for the major cost components. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain., (Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010., Methods: A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project., Results: This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure., Conclusions: Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System., (Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: To compare the initial costs of the three most established treatments for clinically localized prostate cancer according to risk, age and comorbidity groups, from the healthcare provider's perspective., Methods: We carried out a cost comparison study in a sample of patients consecutively recruited between 2003 and 2005 from a functional unit for prostate cancer treatment in Catalonia (Spain). The use of services up to 6 months after the treatment start date was obtained from hospital databases and direct costs were estimated by micro-cost calculation. Information on the clinical characteristics of patients and treatments was collected prospectively. Costs were compared by using nonparametric tests comparing medians (Kruskall-Wallis) and a semi-logarithmic multiple regression model., Results: Among the 398 patients included, the cost difference among treatments was statistically significant: medians were € 3,229.10, € 5,369.00 and € 6,265.60, respectively, for the groups of patients treated with external 3D conformal radiotherapy, brachytherapy and radical retropublic prostatectomy, (p<0.001). In the multivariate analysis (adjusted R(2)=0.8), the average costs of brachytherapy and external radiotherapy were significantly lower than that of prostatectomy (coefficient -0.212 and -0.729, respectively)., Conclusions: Radical prostatectomy proved to be the most expensive treatment option. Overall, the estimated costs in our study were lower than those published elsewhere. Most of the costs were explained by the therapeutic option and neither comorbidity nor risk groups showed an effect on total costs independent of treatment., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objectives: To evaluate the impact of a functional knee arthroplasty unit in Hospital de l'Esperança (Barcelona) on resource consumption, quality indicators and the direct costs of the healthcare process., Method: We performed a retrospective study based on two cross-sections: the first in 317 patients who underwent surgery in 2004 before the implementation of the functional knee arthroplasty unit and the second in 624 patients who underwent surgery in 2005. Data related to the process, complications and costs were collected., Results: The mean length of hospital stay decreased by 9 days (p<0.001). The number of patients requiring convalescence after the intervention increased by 9.5% (p<0.001). Overall, the total cost of the healthcare process decreased by 16%, from 9,031.34 to 7,591.54 euro (p<0.001). This cost reduction was due to decreases in the length of hospital stay (2,946.0 vs. 1,616.8 euro), surgery costs (2,156.7 vs. 1,776.7 euro) and prosthesis costs (2,730.5 vs. 2,678.1 euro)., Conclusions: The implementation of the functional knee arthroplasty unit reduced overall costs and length of hospital stay and substantially increased activity while maintaining a similar complication rate.

Concern about the viability of the hospital system has increased as demand has continued to grow and as the expected increase in public resources to meet this demand remains below requirements. The Central de Balances of CatSalut, which groups all the economic results of the Catalan Public Hospital Network (CPHN), has enabled determination of the relationship between activity and resources in the hospitals within the public sector from 1993 to 2000. We analyzed data from the Central de Balances to determine hospital functioning throughout the 1990s, paying special attention to the development of the hospital system's general productivity over this period. The annual accumulative growth in activity was 4.1%, that of expenses was 1.8% and that of revenues was 1.9%. Unitary cost in 2000 was 85.3% of the unitary cost in 1993.

Objective: Methadone maintenance programs (MMP) currently offer the best treatment for opioid-addicted patients. The aim of this study was to examine the cost-effectiveness of three MMPs that offered varying levels of supplementary services. Health-related quality of life was used as a measure of effectiveness., Methods: A 12-month follow-up study of 586 patients beginning methadone treatment in Drug Care Centers in Barcelona was performed. The Nottingham Health Profile was used to measure quality of life. Standard unit costs and total cost per patient were calculated from activity registries. Sociodemographic, health-related and toxicological data were collected through a semi-structured interview. A cost-effectiveness analysis was performed through two multiple linear regressions with the same adjusting variables., Results: The greater the number of supplementary services involved, the higher the costs. The adjusted models revealed a significant increase in health-related quality of life (an increase of 8% in the Nottingham Health Profile) and in costs (17%) between low- and medium-intensity programs., Conclusion: The medium-intensity program showed the best cost-effectiveness ratio. However, the study's limitations preclude categoric generalization of the data.

Objective: Although the immigrant population in cities such as Barcelona has tripled in the last five years, until now the impact of this group on the health system has not been rigorously evaluated. The aim of this study was to compare hospital resource utilization among the immigrant population with that among the native population through case mix, demographic characteristics and hospital day use. MATERIAL AMD METHODS: We analyzed 15,057 discharges from Hospital del Mar in Barcelona in 2000. This hospital attends 60% of admissions from the Ciutat Vella district. In 2000, 21% of the population of this district were immigrants. Socio-demographic patient characteristics and case mix were compared between the immigrant and the native population. Hospital resource use was compared according to age, case mix (diagnosis related groups) and seriousness (severity, complications and comorbidities) of the events requiring medical care., Results: The case mix of the immigrant population differed from that of the autochthonous population due to pronounced ge differences and a higher fertility rate. Thirty-three percent of immigrant admissions were for deliveries. The mean cost of discharge of immigrants from low-income countries was 30% lower than that for the remaining discharges. After adjusting for age, case mix and severity, length of stay among the immigrant population was significantly shorter. A 5% reduction was found after adjusting for case mix and a 10% reduction was found when all the factors were considered., Conclusions: Case mix differences are due to age and socio-cultural factors. Immigrants are rejuvenating the ageing native population and the role of gynecology-obstetrics and pediatrics needs to be increased. The finding that resource use per discharge is lower among immigrants from low-income countries contradicts the expectation that lower socioeconomic status leads to higher hospital resource use intensity. Therefore, new hypotheses and analyses that explain this situation should be put forward.

Since the mid-1990s, the introduction of new public hospital payment systems to improve the efficiency of Spanish hospitals within the context of managed competition has been debated. Blended systems, which recognize the importance of the activity performed, as well as the role of the hospital in the public health system, have emerged as the best-matched tools both in risk assignment and in efficiency-economic feasibility dialectic. In this article, the payment method used in Catalonia since 1997 is analyzed and contrasted with that introduced in Andalusia in 1998. The evaluation focuses on the instruments used to incorporate the mixed model in the two different settings. On the one hand, the capacity of diagnosis related groups (DRGs) to define hospital product cost is limited. Furthermore, DRGs require numerous adjustments before introduction into Spain. On the other hand, structural level can be defined through the Grade of Memberships in Catalonia and the Basic Centers in Andalusia. We also analyze the introduction of the different methods into Spain and their adaptation to the Catalan and Andalusian environments. The transition periods seem not to have led to a definitive solution and have served to highlight the fragility of the instruments used and of the use that has been made of them. We conclude that the introduction of new tools to improve hospital efficiency through payment systems was precipitate and, to a certain extent, naive. Public hospital payment systems can be considered to be effective when they manage to allocate resources over a period of time. Ensuring the efficiency of public hospitals implies daily work on the part of each hospital and the information systems generated by regional health systems and will not be achieved through external financial tools poorly adapted to the setting in which they are applied.