Are you R. Pascual Palacín?

Claim your profile

Publications (8)11.81 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objetivo. Evaluar la relación coste-efectividad del tratamiento en procesos complejos predefinidos que precisan ventilación mecánica (VM). Diseño. Estudio de cohorte retrospectivo con análisis coste-efectividad y estimación del porcentaje de pacientes sometidos a cuidados potencialmente ineficientes (CPI). Ámbito. Unidad de Cuidados Intensivos (UCI) de un hospital general. Pacientes. Pacientes ingresados entre los años 1997 y 2001, asignados al alta hospitalaria a los GRD 475 (diagnósticos del sistema respiratorio con ventilación asistida) y 483 (traqueostomía excepto trastornos de la boca, laringe o faringe). Intervenciones. Ninguna. Variables de interés principales. Edad, sexo, gravedad (mediante APACHE II), estado crónico de salud, grupo patológico de base, estancia en UCI, estancia hospitalaria, duración de la VM, mortalidad hospitalaria predicha y observada. Estimación del coste-efectividad mediante cociente entre costes totales hospitalarios y años de vida ganados (avg). Porcentaje de pacientes sometidos a CPI, definido como pacientes con costes totales superiores al percentil 90 y destino exitus. Resultados. Se estudiaron 247 pacientes, 142 del GRD 475 y 105 del GRD 483. Los dos grupos poseían características similares, salvo mayor predominio de pacientes médicos, menor estancia y duración de VM en el GRD 475. El coste-efectividad fue favorable en todos los subgrupos estudiados, y mostró un incremento en ambos grupos de GRD según aumentaba la edad, la gravedad y la duración de la VM. La distribución del coste-efectividad por estado crónico de salud no mostró diferencias en el GRD 475, mientras que en el GRD 483 se producía un incremento del mismo según empeoraba el estado de salud. En el GRD 483 y grupo patológico de base cardiológico, se observaron los peores valores de coste-efectividad. El porcentaje de CPI fue del 7,0% en GRD 475 y del 5,4% en GRD 483. Conclusiones. El tratamiento de los pacientes críticos agrupables a los GRD 475 y 483, se ha mostrado coste-efectivo de forma global y en todos los subgrupos analizados. La estimación del coste-efectividad y del porcentaje de pacientes sometidos a CPI, en procesos con similar complejidad de la casuística, ofrece información médica y económica del funcionamiento de una UCI.
    Full-text · Article · Dec 2004 · Medicina Intensiva
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective. To evaluate cost-effectiveness of the treatment in predefined complex processes that require mechanical ventilation (MV). Design. Retrospective cohort study with cost-effectiveness analysis and estimation of the percentage of patients subject to potentially inefficient care (PIC). Area. Intensive care unit (ICU) of a general hospital. Patients. Patients hospitalized between 1997 and 2001, assigned after hospital discharge to DRGs 475 (diagnoses of the respiratory system with assisted ventilation) and 483 (tracheostomy, except for disorders of the mouth, larynx or pharynx). Interventions. None. Main outcomes. Age, sex, severity (through APACHE II), chronic health state, main pathological group, ICU stay, hospital stay, lenght of MV, predicted and observed hospital mortality. Cost-effectiveness estimation through ratio between hospital total costs and lifetime years saved (LTYS). Percentage of patients subject to PIC, defined as patients with total costs higher than percentile 90 and death as outcome. Results. 247 patient were studied, 142 with DRG 475 and 105 with DRG 483. Both groups had similar characteristics, except for higher predominance of non-surgical patients, and lower stay and MV lenght in DRG 475. Cost-effectiveness was favorable in all subgroups studied, and showed an increase in both DRG groups as increased the age, the severity, and MV lenght. The distribution of cost-effectiveness by chronic health state did not show differences in DRG 475, while in DRG 483 an increase occurred as the state of health worsened. In DRG 483 and in the cardiology main pathological group the lower values of cost-effectiveness were observed. The percentage of PIC was 7.0% in DRG 475 and 5.4% in DRG 483. Conclusions. The treatment of DRGs 475 and 483 critical patients has been cost-effective, globally and in all the subgroups analyzed. The estimate of cost-effectiveness and of percentage of patients subject to PIC in processes with similar complexity of the casuistics offers medical and economic information on the perfomance of an ICU.
    No preview · Article · Oct 2004 · Medicina Intensiva
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prostatic abscess is a rare disease that is usually associated with prostatitis. Diagnosis may be delayed, as the clinical manifestations are nonspecific. Severe systemic complications are even more infrequent. A high degree of suspicion and imaging studies are required to confirm the diagnosis. We report the case of a patient with septic shock complicating a prostatic abscess. A literature review revealed very few cases of severe systemic complications in this type of patient. Despite its low incidence, prostatic abscess should be considered in patients with nonspecific findings or with symptoms and signs compatible with urinary tract/prostate infection who show a poor response to antibiotic therapy.
    No preview · Article · Apr 2004 · Medicina Intensiva
  • [Show abstract] [Hide abstract]
    ABSTRACT: El absceso prostático es una enfermedad poco frecuente, asociada generalmente a prostatitis, y cuyo diagnóstico puede retrasarse por lo inespecífico de la clínica. Es aún más raro que aparezcan complicaciones graves sistémicas. Será preciso un alto nivel de sospecha y la realización de técnicas de imagen para llegar a un diagnóstico de certeza. Presentamos el caso de un paciente en situación de shock séptico secundario a un absceso de próstata. Tras revisar la bibliografía comprobamos que son escasos los casos documentados de complicaciones sistémicas graves de este tipo de pacientes.
    No preview · Article · Jan 2004 · Medicina Intensiva
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction The clinical-financial management of an intensive care unit (ICU) necessitates a method to approximate individual costs and establish a costs proxy. The aim of this study was to analyze actual costs and their estimation through severity and activity scores, as well as to evaluate whether at an individual level the nine equivalents of nursing manpower use score (NEMS) could be useful for their measurement. Method We performed a cohort study of patients admitted to an ICU in 2000. Stratified random sampling was used to select 106 patients with the 14 most common diagnosis-related groups (DRG). Direct variable costs for each patient were registered with allocation of direct and indirect fixed costs according to length of hospital stay. Length of hospital stay, physiological severity of illness indices (APACHE II, SAPS II, MPM 0, MPM 24) and therapeutic dependence scales (NEMS, TISS-28 and OMEGA) were measured. Statistical analysis was based on Spearman’s correlation coefficient between total costs and indexes. The actual and theoretical costs calculated on the basis of the NEMS were compared by the median difference between these costs (AMD, 5th and 95th percentile) and by the Bland and Altman analysis. The values are expressed as means (95% confidence interval). Results One hundred and six patients were selected from 861 patients in whom length of hospital stay was 1 day or more. The mean age was 68.2 years (65.4; 71.0); 74 were men; length of hospital stay: 7.3 (5.3; 9.3); mean APACHE II score: 17.6 (16.0; 19.2); NEMS: 219.7 (153.7; 285.8); DRG weight: 5.8 (4.6; 6.9); cost/patient 6767.34 euros (4919.95; 8614.74); costs per DRG/patient: 6282.29 euros (4992.82; 7571.76); cost/NEMS: 12.42 euros (11.09; 13.76); cost/length of hospital stay ratio: 921.28 euros (888.22; 954.34). The results of Spearman’s correlation coefficient were as follows, r (p): Length of hospital stay: 0.98 (0.000); APACHE II 0.36 (0.000); SAPS II 0.27 (0.007); MPM 0 0.20 (0.032); MPM 24 0.21 (0.029); NEMS 0.92 (0.000); TISS-28 0.91 (0.000); OMEGA 0.85 (0.000); DRG weight 0.55 (0.000). AMD: –154.71 (–3719.86/958.07). Conclusions Cost calculation through the method described was more approximate than allocation by DRG. The component with the greatest impact on total costs was length of hospital stay. NEMS may be useful for calculating actual costs. Even when there are individual differences between actual and estimated costs, the method used can be useful to calculate the financial resources of an ICU.
    No preview · Article · Dec 2003 · Medicina Intensiva
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. The clinical-financial management of an intensive care unit (ICU) necessitates a method to approximate individual costs and establish a costs proxy. The aim of this study was to analyze actual costs and their estimation through severity and activity scores, as well as to evaluate whether at an individual level the nine equivalents of nursing manpower use score (NEMS) could be useful for their measurement. Method. We performed a cohort study of patients admitted to an ICU in 2000. Stratified random sampling was used to select 106 patients with the 14 most common diagnosis-related groups (DRG). Direct variable costs for each patient were registered with allocation of direct and indirect fixed costs according to length of hospital stay. Length of hospital stay, physiological severity of illness indices (APACHE II, SAPS II, MPM0, MPM24) and therapeutic dependence scales (NEMS, TISS-28 and OMEGA) were measured. Statistical analysis was based on Spearman's correlation coefficient between total costs and indexes. The actual and theoretical costs calculated on the basis of the NEMS were compared by the median difference between these costs (AMD, 5th and 95th percentile) and by the Bland and Altman analysis. The values are expressed as means (95% confidence interval). Results. One hundred and six patients were selected from 861 patients in whom length of hospital stay was 1 day or more. The mean age was 68.2 years (65.4; 71.0); 74 were men; length of hospital stay: 7.3 (5.3; 9.3); mean APACHE II score: 17.6 (16.0; 19.2); NEMS: 219.7 (153.7; 285.8); DRG weight: 5.8 (4.6; 6.9); cost/patient 6767.34 euros (4919.95; 8614.74); costs per DRG/patient: 6282.29 euros (4992.82; 7571.76); cost/NEMS: 12.42 euros (11.09; 13.76); cost/length of hospital stay ratio: 921.28 euros (888.22; 954.34). The results of Spearman's correlation coefficient were as follows, r (p): Length of hospital stay: 0.98 (0.000); APACHE II 0.36 (0.000); SAPS II 0.27 (0.007); MPM0 0.20 (0.032); MPM24 0.21 (0.929); NEMS 0.92 (0.000); TISS-28 0.91 (0.000); OMEGA 0.85 (0.000); DRG weight 0.55 (0.000). AMD: -154.71 (-3719.86/958.07) Conclusions. Cost calculation through the method described was more approximate than allocation by DRG. The component with the greatest impact on total costs was length of hospital stay. NEMS may be useful for calculating actual costs. Even when there are individual differences between actual and estimated costs, the method used can be useful to calculate the financial resources of an ICU.
    No preview · Article · Aug 2003 · Medicina Intensiva
  • [Show abstract] [Hide abstract]
    ABSTRACT: Unidad Coronaria. Hospital Río Carrión. Avda. Donantes de Sangre, s/n. 34005 Palencia.
    No preview · Article · Dec 2001
  • [Show abstract] [Hide abstract]
    ABSTRACT: Scarce information is available about the use, clinical course and follow-up of patients with acute myocardial infarction treated with mechanical ventilation. Historical cohort study of patients with acute myocardial infarction, included in Spanish registry ARIAM. Differences in clinical characteristics and prognosis from patients treated with or without mechanical ventilation were compared. Three hundred and thirty-three of the 4143 patients (8.1%) with acute myocardial infarction were treated with mechanical ventilation. Treated patients were older, more frequently female, and had more frequently reinfarcts, anterior infarction, Killip III and IV, and higher creatine phosphokinase peak. Diabetes and high blood pressure were more frequent in those in which the technique was applied. They had a higher mortality at the coronary care unit (65.7 vs 5.1%; p < 0.001) than the non-ventilated patients. In multivariate analysis, creatine phosphokinase peak levels higher than 1.200 units/ml, Killip III and IV, and an infarction localization different to inferior were independent predictors of mechanical ventilation application. The 220 treated patients who died were older, more frequently female, had been more frequently admitted to the coronary unit, and had Killip IV whereas Killip III was more frequent among survivors. In multivariate analysis, restricted to patients treated with mechanical ventilation, Killip III was an independent predictor of survival with an odds ratio for mortality of 0.26 (CI 95%: 0.09-0.77). CONCUSIONS: Mechanical ventilation is a vital support technique employed in a significant number of complicated acute myocardial infarction patients. The high mortality of these patients was related to more extended myocardial infarction and a worse clinical state.
    No preview · Article · Aug 2001 · Revista Espa de Cardiologia