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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2015;145:385-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "PAPRICA-2 study: Role of precipitating factor of an acute heart failure episode on intermediate term prognosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "385" "paginaFinal" => "389" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio PAPRICA-2: papel del factor precipitante del episodio de insuficiencia cardiaca aguda en el pronóstico a medio plazo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2297 "Ancho" => 3557 "Tamanyo" => 590757 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Left: cumulative survival curves within 90 days for revisits to the emergency department (above) and mortality (below) depending on the presence of precipitating factors of acute episode of heart failure. Right: crude and adjusted hazard ratios for survival curves of revisits to the emergency room (above) and mortality (below) within 90 days for those precipitating factors of acute episode of heart failure statistically significant in the univariate analysis. Model A: epidemiological factors are included in adjustment (age and sex). Model B: epidemiological (age and sex) and baseline patient condition (NYHA functional class and Barthel index) factors are included in the adjustment. Model C: epidemiological (age and sex), baseline patient condition (functional NYHA class and Barthel index) and the current episode of acute heart failure (systolic blood pressure, blood saturation basal oxygen, creatinine and sodium) factors are included in the adjustment. Model D: epidemiological (age and sex), baseline patient condition (functional NYHA class and Barthel index), the current episode of acute heart failure (systolic blood pressure, baseline arterial oxygen saturation, creatinine and sodium) and final destination of the patient (hospital admission or discharge directly from the emergency department) factors are included in the adjustment.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Òscar Miró, Alfons Aguirre, Pablo Herrero, Javier Jacob, Francisco Javier Martín-Sánchez, Pere Llorens" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Òscar" "apellidos" => "Miró" ] 1 => array:2 [ "nombre" => "Alfons" "apellidos" => "Aguirre" ] 2 => array:2 [ "nombre" => "Pablo" "apellidos" => "Herrero" ] 3 => array:2 [ "nombre" => "Javier" "apellidos" => "Jacob" ] 4 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Martín-Sánchez" ] 5 => array:2 [ "nombre" => "Pere" "apellidos" => "Llorens" ] 6 => array:1 [ "colaborador" => "on behalf of the ICA-SEMES group" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315000731" "doi" => "10.1016/j.medcli.2015.01.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315000731?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616001789?idApp=UINPBA00004N" "url" => "/23870206/0000014500000009/v2_201605020201/S2387020616001789/v2_201605020201/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>" "titulo" => "Innovation in health" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "390" "paginaFinal" => "391" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Jose J. Navas Palacios" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Jose J." "apellidos" => "Navas Palacios" "email" => array:1 [ 0 => "jjnavas@gencat.cat" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Programa de Innovación Corporativa, Institut Catala de la Salut (ICS), Barcelona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La innovación en salud" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Innovation in the health sector is a value creation process for society, businesses and individuals. This value creation centers on the introduction of new products, services, production processes, business models and organizational models in the market and/or in the related organizations, in order to either obtain economic benefit or enhance the efficiency and competitiveness of organizations.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Innovative processes must aim to overcome the challenges and threats currently facing the health sector. These processes are not the exclusive task of creative individuals or entrepreneurs but must also involve all the actors in the health sector.</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is very useful to view this from the standpoint of the actors in the health care value chain envisaged by Lawton R. Burns.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,2</span></a> This author, a professor at Wharton Business School, identifies 5 major actors: (1) the regulators, planners and funding providers, represented by the health authority; (2) the purchasers of health care services, represented by the national and/or regional health service authorities and insurance companies; (3) the service providers, which are responsible for providing the health care services, represented by the corporations and the primary, secondary, tertiary, and social and mental health centers, and pharmacies; (4) the product and service distribution intermediaries, represented by the logistic platforms and provider cooperatives; and (5) the producers, represented by the companies that create pharmacological and non-pharmacological products.</p><p id="par0020" class="elsevierStylePara elsevierViewall">These actors make up the core of the health care sector. They all have their own skills, which are more or less exclusive, their interests, and their objectives, which are at times well-defined and, at others, contradictory.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, in order to innovate in the health sector, it is essential to encourage and prepare innovative processes involving all the actors in the industry. The health authorities must innovate in their remit with regard to regulation, planning and funding. They are, in short, responsible for maintaining, and innovating in, the health care model that to a large extent defines the playing field and rules of the game.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The purchasers of health care services must innovate in the design of the portfolios of services, payment systems, contracts-programs and results-based evaluation of centers.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The producers and the distribution intermediaries must innovate in generating new products and services, both pharmacological (medicines, serums and vaccines) and non-pharmacological (equipment, devices, diagnostic reagents, health materials, information technology, health communication, etc.).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The health care service providers (primary and specialist health care centers, social health and mental health care centers) perform a key role in the sector. This consists of, on the one hand, receipt of the economic resources from the actors providing funding and purchasing the services, and, on the other, the use of these resources to acquire the products and services from the producers and the distribution intermediaries. However, their key role is not confined to the flow of economic resources and the flow of products and support services. They are ultimately responsible for providing the health care services, which is the core purpose of any health care system. The health service providers must manage the service provision system according to the health plan guidelines, largely with reference to the users, and must ensure that the services provided are effective, safe and economical.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Consequently, the providers must manage all that they provide in the professional-user interface in an efficient manner. In the “clinical encounter” between the health care professionals and the patients and their relatives, the health care institutions provide a set of skills, structures, highly specialized human resources, professional expertise, technological resources and products; in short, an entire set of economic resources.</p><p id="par0050" class="elsevierStylePara elsevierViewall">This is the “core element” of the health care system, the basic health care service provided by the health care institutions. To a large extent, the providers are responsible for innovation in the skill area which is virtually exclusive to it, i.e. providing the service. However, there is no doubt either that they should take part in and influence the responsibilities of the regulators, planners, funders and purchasers since they will play a key role in determining the safety and cost-effectiveness of the services provided in the clinical encounter. Moreover, the providers must collaborate and set up alliances with the producers and distribution intermediaries to influence innovation in non-health products and services, which form a significant part of the package offered during the clinical encounter.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The providers occupy a key position in the health sector. Not only must they innovate in the processes relating to their particular responsibilities (business models, organization of the centers, purchasing processes, production processes, technological model, human resources policies, and staff training) but they must also contribute to the generation of knowledge and technological developments through research structures in collaboration with universities and corporations.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In all likelihood, we have witnessed decades in which the most important area, which received most attention and incentives, was product innovation. This was carried out by countries with more powerful national and corporate innovation systems. From the 1950s to the 1980s, the linear innovation model (science and technology push) was prevalent. However, starting in the 1980s and continuing in the 1990s, the interactive innovation models (market pull)<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> became gradually more important, with regard to both product and service innovation.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Based on the work by Clayton M. Christensen<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4–7</span></a> and Henry W. Chesbrough<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8,9</span></a> significant conceptual changes emerged in innovation (disruptive and open innovation). And from 2000 we have experienced an explosion of theories on innovation in services, and various countries and regions now include it in their strategic agendas. The same phenomenon occurred in the health sector.</p><p id="par0070" class="elsevierStylePara elsevierViewall">All actors are obliged to position themselves in this new situation. Firstly, those providing funding for R&D&I, the knowledge-generating centers, and the structures of the providers that focused more on product innovation, devoting little to encourage or stimulate service innovation. The importance of the tertiary economic sector in Western economies is such that certain pioneering countries, the OECD and the Europe Union<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">10,11</span></a> included innovation in services in the portfolio of projects for social transformation, taking into consideration at all times the end user, i.e. the patients and their families; to put it simply, society.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The health sector is obliged to change from basing everything on the effectiveness of its specialists and its product innovators to complementing these two main levers with a third, which is essential to service innovation and provision: patients and their relatives.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The convergence of these two paradigms, i.e. the biomedical paradigm (innovation in products and technologies) and the patient care and public health paradigm (innovation in health services)<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> requires an appropriate balance to be achieved.</p><p id="par0085" class="elsevierStylePara elsevierViewall">According to modern theory on services,<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13,14</span></a> health care services should not be a one-way process. The current situation is one of a “co-production” of the service that occurs during the “service encounter” (clinical encounter in the case of health care). This involves, first, the health care professionals and the institutions to which they belong, with all their skills and know-how and, second, the patients and their relatives, with their needs, autonomy, and economic, social and family background. This co-production of the clinical encounter should be driven by scientific evidence, bioethics and an evaluation of the results and the impact of the service provided.</p><p id="par0090" class="elsevierStylePara elsevierViewall">A this point, we should recognize that innovation in the provision of health services has lacked priority treatment, funding, programming and incentives; it is an area that has been relatively neglected. The bulk of the responsibility in innovation in health services lies with the providers on the one hand and the actors funding R&D&I on the other, since this area has not been given priority or incentives.</p><p id="par0095" class="elsevierStylePara elsevierViewall">A change in this trend is needed. The providers, without forgetting the importance of innovation in products, must develop clear-cut innovation policies, and they must back innovation programs and projects relating to services, with appropriate methodologies. The providers must encourage disruptive and/or incremental innovation processes using open innovation methods, to foster the participation and creativity of professionals and users alike.</p><p id="par0100" class="elsevierStylePara elsevierViewall">To this end, the most commonly used instrument is that relating to “innovation communities”,<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15–17</span></a> fostered by the WHO, OECD and the European Union in most of their innovation initiatives.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">18,19</span></a> This open innovation initiative should take advantage of the driving power of the main users, health care professionals and patients (lead users, according to the term used by Eric von Hippel).<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Innovation communities in the health care sector should be set up to include those involved in the clinical encounter (professionals and patients) with the providers, universities and corporations. The innovation community should host the generation of innovation ideas and processes in order to provide answers to what health care services should do, and how this should be done, in the future.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navas Palacios JJ. La innovación en salud. Med Clin (Barc). 2015;145:390–391.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The health care value chain: producers, purchasers, and providers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.R. 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