Originales
La calidad de la atención al hombro doloroso. Audit clínico
The quality of care in pain shoulder. A medical audit
Manuel Marín-Gómeza,b, María José Navarro-Colladob,c, Salvador Peiróa,b,
, Carlos Trenor-Gomisc, Alfonso Payá-Rubioc, Enrique Bernal-Delgadob,d, Antonio Hernández-Royoe
Autor para correspondencia
peiro_bor@gva.es
Correspondencia: Salvador Peiró. Escuela Valenciana de Estudios de la Salud. Juan de Garay, 21. 46017 Valencia. España.
Correspondencia: Salvador Peiró. Escuela Valenciana de Estudios de la Salud. Juan de Garay, 21. 46017 Valencia. España.
a Escuela Valenciana de Estudios de la Salud, Conselleria de Sanitat, Valencia, España
b Fundación Instituto de Investigación en Servicios de Salud, Hospital Universitario Dr. Peset, Valencia, España
c Servicio de Rehabilitación, Hospital Universitario Dr. Peset, Valencia, España
d Instituto Aragonés de Ciencias de la Salud, Zaragoza, España
e Servicio de Rehabilitación, Hospital Arnau de Vilanova, Valencia, España
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Escuela Valenciana de Estudios de la Salud. Juan de Garay, 21. 46017 Valencia. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The quality of care in pain shoulder. A medical audit" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-04-20" "fechaAceptado" => "2005-12-23" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec14047" "palabras" => array:5 [ 0 => "Hombro doloroso" 1 => "Audit médico" 2 => "Calidad asistencial" 3 => "Rehabilitación" 4 => "Atención ambulatoria" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec14048" "palabras" => array:5 [ 0 => "Shoulder Pain" 1 => "Medical Audit" 2 => "Quality of Health Care" 3 => "Rehabilitation" 4 => "Ambulatory Care" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p class="elsevierStyleSimplePara elsevierViewall">Valorar la calidad de la atención al hombro doloroso no quirúrgico en la consulta externa hospitalaria mediante la revisión de historias clínicas (HC) y su contraste con indicadores de calidad.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Revisión retrospectiva de 245 HC de pacientes no quirúrgicos atendidos por hombro doloroso entre 1999-2000 en dos hospitales públicos. Se establecieron indicadores de calidad de la anamnesis, exploración física, diagnóstico y tratamiento, basados en revisiones sistemáticas de ensayos clínicos, guías de práctica y revisión por expertos. La revisión de HC se realizó por dos médicos rehabilitadores y se analizó la cumplimentación de los criterios de calidad y las diferencias entre hospitales.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Un 76,3% de las HC no recogía<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>4 de los 10 criterios de calidad de la anamnesis, un 61,6% no incluía<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3 de los 10 criterios de calidad de la exploración física y un 7,7% no tenía el diagnóstico anotado. El 96,9% de los 98 pacientes con síndrome subacromial no cumplía el criterio de tratamiento antiinflamatorio o infiltración en los tiempos preestablecidos, y a un 15,3% no se le había propuesto fisioterapia o ejercicio programado en las 4 semanas tras el diagnóstico; al 95,8% de los 24 pacientes con rotura del manguito de rotadores no se le propuso evaluación temprana para posible cirugía, y el 86,7% de los 15 casos de capsulitis adhesiva no recibió instrucciones para realizar ejercicio programado en los tiempos propuestos.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Hay importantes insuficiencias en la calidad de la atención al hombro doloroso o en su registro en la HC.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p class="elsevierStyleSimplePara elsevierViewall">To evaluate the quality of hospital ambulatory care in non-surgical painful shoulder by auditing medical records using quality indicators.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We reviewed 245 medical records of non-surgical patients assisted for pain shoulder in 1999-2000 in two public hospitals. Quality of care indicators for antecedents, physic exploration, diagnosis and treatment were developed based in systematic reviews of clinical trials, guidelines and expert criteria. Medical records review was carried out by two rehabilitative doctors. Fulfilling of quality criteria and differences between hospitals was analyzed.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">76.3% of the medical records did not fulfill ≥ 4 of 10 quality criteria for antecedents, 61.6% did not fulfill ≥ 3 of 10 criteria for physical exploration, and 7.7% did not have any diagnosis registered. 96.9% of the 98 patients with impingement syndrome did not complete the criteria of anti-inflammatory treatment or infiltration in the pre-established time, and up to 15.3% had not been proposed physiotherapy or programmed exercise in the 4 weeks after the diagnosis; 95.8% of the 24 patients with rotators cuff tears were not proposed for early surgical evaluation, and 86.7% of the 15 cases of adhesive capsulitis did not receive instructions to carry out programmed exercise in the proposed times.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The audit revealed significant deficiencies in adherence to quality indicators in non-surgical pain shoulder. 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Información del artículo
ISSN: 02139111Idioma original: Español
DOI:10.1157/13087322
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