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"apellidos" => "Romero Garrido" ] 4 => array:2 [ "nombre" => "Laura Quintana" "apellidos" => "Tirado" ] 5 => array:2 [ "nombre" => "Inmaculada García" "apellidos" => "Montes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775314004631" "doi" => "10.1016/j.medcli.2014.05.036" "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/S0025775314004631?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615002697?idApp=UINPBA00004N" "url" => "/23870206/0000014400000010/v1_201601310051/S2387020615002697/v1_201601310051/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>" "titulo" => "Transparency and benchmarking for sustainability of the health system" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "449" "paginaFinal" => "451" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ángel Cequier, Anna García-Altés" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Ángel" "apellidos" => "Cequier" "email" => array:1 [ 0 => "acequier@bellvitgehospital.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Anna" "apellidos" => "García-Altés" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Agència de Qualitat i Avaluació Sanitàries (AQuAS), Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Transparencia y comparación de resultados para la sostenibilidad del sistema sanitario" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The current budget-constrained setting is making the health care system vulnerable. Aside from the cutbacks, more deep-seated changes are urgently required; changes with significant clinical repercussions that can help guarantee the sustainability of the system. The development of better clinical practice through transparency and comparisons between providers is a way of enhancing the health care system and directing resources towards those organisations and interventions that obtain the best results with the means available. Transparency and comparison promote competition in terms of effectiveness and efficiency and, as a whole, improve the quality of health care afforded to patients and the sustainability of the system.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Transparency in health care management</span> has an impact on the population's health through policies (in health and across other sectors), organisation management and clinical practice. Key factors include adequate public investment, highly qualified human resources, lower service provision costs and fostering competition through the comparison of results. Transparency should focus on analysing what is being done, how it is being done, what resources it requires and what results are obtained.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the public sector, access to government data ensures transparency, efficiency and equal opportunities. Transparency is guaranteed since data from official sources can be consulted and studied; efficiency is guaranteed since individuals and organisations can offer services that supplement those the administration itself can provide; and equal opportunities are guaranteed since access is the same for everyone, at the same time and in the same place. The European Commission also considers that government data should be made available because, in addition to transparency, free access constitutes a stimulus to further developing the information society that we live in, particularly in the digital content and services sector.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It has been shown that the <span class="elsevierStyleItalic">comparison of health care centres and transparent feedback on results</span> contribute directly to improving these and considerably optimise resources by enhancing the adequacy of procedures.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> The correction of disparities and redirection of efforts towards the health care needs of the population, with accessible, affordable services are also fundamental elements in all health care systems that seek to improve their performance.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">To obtain better results through benchmarking we must move beyond competing with comparison and transparency of results to implement these effectively to enhance health care quality. Health care professionals must be involved in making this improvement, learning about and sharing the best in daily clinical practice, identifying what is ineffective or inefficient, directing resources towards specific organisations and interventions that obtain better results, and implementing innovative management strategies.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The mission of the Catalonia Results Centre (<span class="elsevierStyleItalic">Central de Resultados de Cataluña</span>) is to measure, evaluate and disseminate results in the field of health care obtained by the health centres that make up the integrated public health care system of Catalonia (<span class="elsevierStyleItalic">Sistema Integral Sanitario de Cataluña</span>, SISCAT). The Results Centre presents reports at the request of the Catalan Health Service (<span class="elsevierStyleItalic">Servei Català de la Salut</span>) which, in its role as public guarantor, wants to see the different centres’ results.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The Results Centre aspires to become the instrument with which health care centres and government offer a transparent system measuring and assessing results so as to encourage comparisons between health care centres: i.e. benchmarking. It was officially established in 2003 and started publishing reports in 2010. These ranged from general reports to specific area-focused reports (in-patient treatment, primary care, medical and social care, mental health and addictions, and health care science research).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> Starting in 2012, each centre is identified along with results for each indicator. All data can be consulted by SISCAT professionals via an application and spreadsheets, open data and computer graphics are available to the public at <a id="intr0010" class="elsevierStyleInterRef" href="http://observatorisalut.gencat.cat/">http://observatorisalut.gencat.cat</a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This is a ground-breaking initiative in Spain, although records such as these have been published elsewhere in Europe for some time.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The Results Centre's main <span class="elsevierStyleItalic">source of information</span> on in-patient treatment are hospital discharge reports, although data from the programme for the vigilance of hospital acquired infections (VINCAT), the ictus code, the infarction code and the Arthroplasty Register (RACat), amongst others, are also included. The professionals responsible for hospital discharges are often unaware of the importance and implications of making accurate, detailed records of the processes, procedures performed, comorbidities, associated diseases, and main and secondary diagnoses. Not all professionals know the relevance of discharge reports for subsequent comparative analyses or how these reports can reflect variables that can be decisive in determining patient risk. Proper training, knowledge and standardisation in preparing discharge reports would facilitate the involvement of professionals, improve data quality, allow the identification of the least ideal scenarios and improve results.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The publication of Results Centre reports contributes to improving the quality of the data published. Providing the professionals who gather the data with feedback is essential if we are to ensure the quality of their information systems. Generally, data quality improves significantly if whoever provides it obtains immediate, direct benefits from their contribution. The use of these data and, above all, the transparent publication of the centres’ results help pinpoint deficiencies in the information and encourage centres to write thorough, quality reports, and put the information they gather to better use.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The analyses and comparisons of results must analyse centres with the same level of complexity, as the Results Centre reports suggest. Comparisons between tertiary care centres or reference centres and secondary care centres can lead to incorrect results and wrong interpretations. Likewise, some indicators are adjusted for risk to facilitate comparisons between centres that, in spite of being at the same level, attend patients with different levels of complexity.</p><p id="par0060" class="elsevierStylePara elsevierViewall">It is essential we create a culture in which comparisons and final results are not interpreted as some type of inquisition but, rather, as a vital tool to enable us to identify scenarios that can be improved. Results must be published with maximum objectivity, with unbiased interpretations, and for constructive purposes so that they encourage professionals to become involved, to analyse their own results, identify what can be improved, and act to seek potential solutions. Furthermore, time must be allowed for the corrective actions that are implemented to be reflected in the results of subsequent assessments.</p><p id="par0065" class="elsevierStylePara elsevierViewall">When <span class="elsevierStyleItalic">comparing</span> centres, <span class="elsevierStyleItalic">there is a marked variability</span> in procedure performance rates and the morbidity and mortality of patients with certain diseases. Part of this variability is justified, but part may be due to variations in the quality and safety of clinical practice. For instance, several studies conducted in other countries have shown significant differences between hospitals and regions in the treatment of patients with acute myocardial infarction.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7–11</span></a> The most recent study has shown that the care level of a hospital, receiving attention in the cardiology service, and a greater use of percutaneous coronary interventions associate with a higher intrahospital survival rate.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> The conclusions drawn from comparative assessments have highly significant implications for the care and management of services and health care facilities for junior and senior managers of health care centres, scientific societies and government bodies.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The identification of less than ideal scenarios should prompt <span class="elsevierStyleItalic">those in charge of health care facilities</span> to restructure the functioning of their centres so as to minimise any limitations discovered in the care processes. For instance, several studies<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9,10</span></a> have revealed lower adhesion to clinical practice guidelines when treating patients in hospitals at a lower level of complexity. The establishment of dynamic interchange between hospitals at different care levels can facilitate a rapid response for patients admitted to lower complexity hospitals who need tertiary procedures. We must encourage communication between professionals at hospitals of different levels of care and involve different managerial levels to promote collaborative work practices.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11,12</span></a> By establishing protocols agreed by services at different care levels, we can enhance the selection of those patients who need to be referred for complex procedures or other additional therapeutic treatments.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">senior managers of centres</span> play a decisive role in relation to these objectives. They must participate in the analysis and facilitate organisational and logistical changes and, if necessary, the redistribution of resources. In hospitals that perform complex procedures, it is essential we assess how many are performed and maintain the level of competence since there is a significant association between the experience of professionals who perform particular procedures and mortality rates.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> Concentrating tertiary activity in higher level hospitals seems reasonable as the number of procedures per centre and hospital mortality rates are associated in inverse proportion.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The knowledge derived from Results Centre data also poses a great challenge for <span class="elsevierStyleItalic">scientific societies.</span> As they are completely independent of government, it is their responsibility to discuss with government the introduction of measures needed to reverse or minimise any differences observed. Scientific societies can identify scenarios in which solutions are more feasible and accessible, with a higher impact on prognosis enhancement and lower need for resources. Furthermore, they can indicate the changes needed and the agents that should be involved, and can recommend the strategies needed to divide activity by sectors or concentrate activity. Likewise, they can suggest the best therapeutic alternatives based on the implementation of existing scientific evidence. Within the current budget-constrained setting, they must direct and recommend innovations in logistics, technology and treatment, and solutions that provide the best therapeutic options with the best usage criteria.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Finally, <span class="elsevierStyleItalic">health care administrations</span> have valuable information that can facilitate the implementation of structural or logistic changes through plans based on objective data. Moreover, since the criteria for the organisation, design, equipment and management of health care facilities are defined in multiple dimensions,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> the measures to be implemented can easily be based on efficiency and good results. The final decision to divide by sectors or regions, and concentrate activity in the reorganisation of specific care procedures will depend on government. At the same time, it is essential we implement tools for clinical management in health care facilities and centres and foster managerial structures for health care networks, regardless of whether each facility/integrated service maintains its own identity. In these structures, all units in the network must be represented, with defined equal access for patients from the given regional-geographical-population area.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In general, the information obtained by the Results Centre refers to well-established and widely practised health care processes. However, it is not unusual for the implementation of generally costly, new techniques or treatments, to be based on limited evidence obtained from controlled trials that cannot be applied to daily care activities. Keeping <span class="elsevierStyleItalic">specific, mandatory, audited records</span> is the best way to obtain information quickly to assess pharmacological or technological innovations. Scientific societies, together with government bodies, are responsible for promoting a culture of registries, implementing this, making the registries mandatory, and ensuring they are consistent and of a high quality. The analysis of records is crucial to enable us to monitor the methods, results and effectiveness of established measures, facilitating the introduction of changes in those scenarios in which the results obtained are not as expected. Governments are also responsible for these records since, together with scientific societies, they must define their objectives, foster them, provide the necessary resources, monitor their performance and audit the results. Their objectives must not be limited to assessing clinical results and quality of care but should embrace the analysis of effectiveness and sustainability too.</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: Cequier Á, García-Altés A. Transparencia y comparación de resultados para la sostenibilidad del sistema sanitario. Med Clin (Barc). 2015;144:449–451.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transparencia y buen gobierno en sanidad. También para salir de la crisis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Meneu" 1 => "V. 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Journal Information
Vol. 144. Issue 10.
Pages 449-451 (May 2015)
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Vol. 144. Issue 10.
Pages 449-451 (May 2015)
Editorial article
Transparency and benchmarking for sustainability of the health system
Transparencia y comparación de resultados para la sostenibilidad del sistema sanitario
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a Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
b Agència de Qualitat i Avaluació Sanitàries (AQuAS), Barcelona, Spain
c Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
d Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
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