Tomás Sola Martínez

Effect of a quality improvement strategy on several haemodialysis outcomes

BACKGROUND Intermediate outcomes are associated with the survival of long-term haemodialysis patients; however, outcome variability across centres may result in heterogeneous quality of care. The study aim was to evaluate a multifaceted quality improvement activity (QIA) targeting several haemodialysis clinical performance measures. METHODS A total (prevalent and incident) of 313 patients from four dialysis units were included. The QIA was based on a multifaceted strategy involving collection of haemodialysis clinical performance measures every 6-8 months, feedback about results, improvement plans and benchmarking, and it was tested in a 3-year prospective interventional study. Two timepoints of clinical performance measures were considered for evaluating the QIA: baseline (February 2003, pre-QIA) and final (February 2006, post-QIA). RESULTS Centres showed significant improvement in percentage of patients with haemoglobin <11 g/dl, mean haemoglobin; percentage of patients with Kt/v <1.2, mean Kt/v; percentage of patients with phosphorous >5.5 mg/dl, mean phosphorous; percentage of patients with calcium phosphate product >55, mean calcium phosphate product; and percentage of patients with ferritin <200 ng/ml, mean ferritin. No change was observed in percentage of patients with haemoglobin between 11 and 13 g/dl, erythropoietin consumed; percentage of patients with ferritin <100 ng/ml; percentage of patients with ferritin >800 ng/ml; percentage of patients with albumin <3.5 g/dl, mean albumin; or percentage of native arteriovenous fistula. The percentage of patients with haemoglobin >13 g/dl was increased. CONCLUSIONS Quality-improvement strategies can help improve haemodialysis performance for anaemia, dialysis dose and bone metabolism. The importance of assessing patients with high haemoglobin level should be stressed.

Determinantes de la capacidad funcional en personas mayores según el género

El proposito de este trabajo es identificar factores determinantes de caracter socio-demograficos, de salud y de actividad fisica que influyan en la aparicion de la discapacidad para las actividades basicas e instrumentales de la vida diaria en 380 individuos mayores de 64 anos que asisten a centros sociales de Zaragoza. Un modelo multivariante de regresion logistica analizo la capacidad funcional por sexo. Variables sociodemograficas, enfermedades cronicas y actividad fisica fueron variables explicativas. Conclusiones: las condiciones medicas son el principal marcador de la discapacidad, y la actividad fisica es una medida que se puede promover en la Atencion Primaria para reducir el riesgo de discapacidad.

Servicios sanitarios y sociales utilizados por las personas mayores del medio rural

OBJECTIVES To describe the use of health and social services, and to analyze the influence of functional capacity for Instrumental Activities of Daily Living (IADL) and other factors in their use. METHOD Cross-sectional study in a non-institutionalized population older than 64 years old in a basic rural health area of Zaragoza. DEPENDENT VARIABLES use of different health and social services. Main independent variable: functional capacity for IADL according to the Lawton-Brody. Confounding variables: sociodemographic, physical exercise, comorbidity, self-perceived health, walking aids, social resources and economic resources (OARS-MAFQ). The relationship between the use of services and functional capacity for IADL was assessed using crude OR (ORC) and adjusted (adjusted OR) with CI95% by means of multivariate logistic regression models. RESULTS The use of social and health services increased with age and worse functional capacity for IADL. The increased use of health services was related with bad stage of health, limited social and economic resources, physical inactivity and female. The increased use of home help services was related with limited social resources, low education level and male. Regular physical activity and using walking aids were associated with greater participation in recreational activities. CONCLUSIONS The probability of using social and health services increased in older people with impaired functional capacity for IADL. The specific use of them changed according to differences in health, demographic and contextual features.