Anàlisi dels indicadors de seguretat i eficàcia per a l'avaluació del programa de tractament antibiòtic endovenós d'una unitat d'hospitalització a domicili.

Abstract

Hospital at Home (HAH) treats at home patients than, in other case, should be admitted at hospital. The portfolio of services includes parenteral antibiotic treatment at home (PATH). It covers a wide variety of infections. Their results depend on factors related to patient selection, drug administered, infusion devices and practitioners and nurses who administer it. No systematic studies exist in the state that assesses this activity. No indicators have been defined for the analysis PATH._x000D_ Objectives:_x000D_ The overall objective is to evaluate a PATH program, the description of the welfare activities of the program. Indicators will be identified to assess PATH safety, clinical outcomes and resource consumption._x000D_ Material and methods:_x000D_ Indicators of clinical safety, effectiveness and satisfaction of PATH are analyzed. This thesis studies the first two. The PATH is considered safe if it does not cause adverse effects or additional risks to patients. The effectiveness is analyzed by the clinical outcomes and resource consumption. The research work behind this thesis is an observational, prospective, under conditions of routine clinical practice study. Studied period: February 2001 to April 2007. Population: patients HAH receiving PATH in a high-tech hospital. The defined variables are recorded in a specific database._x000D_ The reading, manipulation, validation and statistical analysis of the database has been performed with the software: SAS v9.1, SAS Institute Inc., Cary, NC, USA. The value of statistical significance was 0.05._x000D_ Results:_x000D_ 380 patients received TAPAD in 434 episodes. Average age: 61 years +/- 17.13 (16-95). Gender distribution: 131 women and 249 men. 56.3% of the patients came from the medical department, 36.3% surgical department, emergency unit 10.3% and 2.1% other. 25.5% were respiratory infections, 21.8% abdominal infections, 15.8% urinary tract infections, 12,1% skin infections and soft tissue, 7.6% infections in immunocompromised patients, 5.3% sepsis, 4.8% for bone and joint infections and 7.1% other locations. Comorbidity associated of the patients was 2.23 +/- 2.18 (0-10). 4.54% of patients treated showed signs of severe sepsis on admission to HC. Microbiological examination was performed in 352 patients, tested positive in 253 (71.9%). 309 organisms were isolated and 52 showed antibiotic multiresistance profile._x000D_ Analysis of results:_x000D_ Statistical analysis shows different associations with predictive value of the adequacy and appropriateness of PATH._x000D_ PATH safety indicators: unexpected events, adverse effects associated with the treatment and complications related or not to infection._x000D_ PATH performance indicators: rate of complete treatments and clinical outcomes (target to discharge and readmission at 30 days)._x000D_ Indicators related to resource consumption: PATH duration, treatment modality and rates of HAH staff intervention._x000D_ Conclusions:_x000D_ The studied case series meets the defined criteria. Unexpected events (unexpected return, unplanned treatment change, unexpected phone calls), adverse effects related to treatment and complications (infection related or not) are predictive indicators of PATH safety._x000D_ The rate of complete treatments, discharge HAH destination, readmission at 30 days, average stay in the hospital and HAH are indicators of clinical outcome of treatment with predictive value regarding the adequacy of PATH._x000D_ Intervention rates, the number of blood test and treatment variables (duration of PATH, treatment modality, proportion PATH/total antibiotic treatment, combined treatment using infusion pumps) are indicators of resource consumption PATH.

Date of Award	20 Jul 2010
Original language	Catalan
Supervisor	Alfons Cuxart Melich (Director) & Vicente Fonollosa Pla (Director)