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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evaluar el impacto de la introducci&#243;n de una trayectoria cl&#237;nica sobre la atenci&#243;n a los pacientes con un ictus isqu&#233;mico&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se dise&#241;&#243; un estudio de intervenci&#243;n&#44; controlado&#44; sin asignaci&#243;n aleatoria&#44; de seguimiento de 2 cohortes de pacientes&#44; no coincidentes en el tiempo&#44; correspondiente a los per&#237;odos inmediatamente anterior &#40;grupo PRE o control&#41; y posterior &#40;grupo POST o intervenci&#243;n&#41; a la introducci&#243;n de la trayectoria cl&#237;nica&#46; Las principales medidas del resultado fueron&#58; <span class="elsevierStyleItalic">a&#41;</span> indicadores de calidad asistencial&#59; <span class="elsevierStyleItalic">b&#41;</span> mejora en la capacidad funcional &#40;&#237;ndice de Barthel&#41; y la funci&#243;n neurol&#243;gica &#40;escala Canadiense&#41;&#59; <span class="elsevierStyleItalic">c&#41;</span> complicaciones intrahospitalarias&#59; <span class="elsevierStyleItalic">d&#41;</span> satisfacci&#243;n&#44; y <span class="elsevierStyleItalic">e&#41;</span> estancia media&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se reclut&#243; a 139 pacientes&#44; 69 correspondientes al per&#237;odo PRE y 70 al per&#237;odo POST&#44; sin que se observaran diferencias significativas al ingreso entre ambos grupos&#46; Se constat&#243; una reducci&#243;n del 36&#44;5&#37; en el tiempo transcurrido desde el ingreso hasta el inicio de la movilizaci&#243;n&#44; aunque no se observaron diferencias significativas en los otros indicadores de calidad ni en el incremento de la funci&#243;n neurol&#243;gica o la capacidad funcional&#46; El porcentaje de individuos con alguna complicaci&#243;n durante el ingreso fue del 44&#44;6&#37; en el per&#237;odo PRE y del 28&#44;6&#37; en el per&#237;odo POST &#40;p &#61; 0&#44;039&#41;&#46; No se observaron diferencias significativas en la valoraci&#243;n global del cuestionario de satisfacci&#243;n&#44; pero los pacientes del per&#237;odo POST presentaron una mayor satisfacci&#243;n en las dimensiones &#171;informaci&#243;n recibida&#187; y &#171;profesionalidad y confianza &#187;&#46; La estancia media se redujo de 11 a 10 d&#237;as&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La introducci&#243;n de la trayectoria cl&#237;nica del ictus isqu&#233;mico puede contribuir a reducir el n&#250;mero de complicaciones y los d&#237;as de estancia&#44; as&#237; como mejorar la calidad de la atenci&#243;n y la satisfacci&#243;n de los pacientes&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">To assess the impact of the implementation of a clinical pathway for stroke patients&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">We performed a controlled intervention study without random allocation that compared two non-concomitant cohorts of stroke patients corresponding to the periods immediately before &#40;control group&#41; and after &#40;intervention group&#41; the implementation of a clinical pathway&#46; The main outcome measures were&#58; <span class="elsevierStyleItalic">a&#41;</span> quality of care indicators&#59; <span class="elsevierStyleItalic">b&#41;</span> improvements in functional capacity &#40;Barthel score&#41; and neurological function &#40;Canadian scale&#41;&#59; <span class="elsevierStyleItalic">c&#41;</span> nosocomial complications&#59; <span class="elsevierStyleItalic">d&#41;</span> satisfaction&#44; and <span class="elsevierStyleItalic">e&#41;</span> mean length of hospital stay&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">One hundred and thirty-nine patients were recruited&#46; Sixty-nine corresponded to the period before implementation of the pathway and 70 corresponded to the period after implementation&#46; There were no significant differences between the two groups on admission&#46; A 36&#46;5&#37; reduction in the time from admission to mobilization was observed&#46; No significant differences were observed between the groups for the other quality of care indicators&#44; or in improvements in functional and neurological capacity&#46; Nosocomial complications occurred in 44&#46;5&#37; of patients in the control group compared with 28&#46;6&#37; in the intervention group &#40;p &#61; &#46;039&#41;&#46; No significant differences were observed in the overall satisfaction assessment&#44; but patients in the intervention group showed greater satisfaction in the dimensions of &#171;information&#187; and &#171;trust and professionalism &#187;&#46; The mean length of hospital stay was reduced from 11 to 10 days&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The implementation of the stroke clinical pathway contributed to reducing the length of hospital stay and the number of inpatient complications&#44; as well as to improving some quality of care indicators&#46;</p>"
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Vol. 18. Núm. 3.
Páginas 197-204 (mayo - junio 2004)
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Vol. 18. Núm. 3.
Páginas 197-204 (mayo - junio 2004)
Open Access
Evaluación del impacto de una trayectoria clínica sobre el ictus isquémico
Impact of a clinical pathway for stroke patients
Visitas
7142
Margarita Estevea, Mateu Serra-Pratb,
Autor para correspondencia
mserra@csm.scs.es

Correspondencia: Unitat de Recerca. Hospital de Mataró. Ctra. de Cirera, s/n. 08304 Mataró (Barcelona). España.
, Carme Zaldívara, Albert Verdaguerc, Joan Berenguerd
a Dirección de Enfermería. Hospital de Mataró. Mataró. Barcelona
b Unidad de Investigación. Consorci Sanitari del Maresme. Mataró. Barcelona
c Dirección Médica. Hospital de Mataró. Mataró. Barcelona
d Gerencia. Hospital de Mataró. Mataró. Barcelona. España
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Bibliografía
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Resumen
Objetivo

Evaluar el impacto de la introducción de una trayectoria clínica sobre la atención a los pacientes con un ictus isquémico.

Métodos

Se diseñó un estudio de intervención, controlado, sin asignación aleatoria, de seguimiento de 2 cohortes de pacientes, no coincidentes en el tiempo, correspondiente a los períodos inmediatamente anterior (grupo PRE o control) y posterior (grupo POST o intervención) a la introducción de la trayectoria clínica. Las principales medidas del resultado fueron: a) indicadores de calidad asistencial; b) mejora en la capacidad funcional (índice de Barthel) y la función neurológica (escala Canadiense); c) complicaciones intrahospitalarias; d) satisfacción, y e) estancia media.

Resultados

Se reclutó a 139 pacientes, 69 correspondientes al período PRE y 70 al período POST, sin que se observaran diferencias significativas al ingreso entre ambos grupos. Se constató una reducción del 36,5% en el tiempo transcurrido desde el ingreso hasta el inicio de la movilización, aunque no se observaron diferencias significativas en los otros indicadores de calidad ni en el incremento de la función neurológica o la capacidad funcional. El porcentaje de individuos con alguna complicación durante el ingreso fue del 44,6% en el período PRE y del 28,6% en el período POST (p = 0,039). No se observaron diferencias significativas en la valoración global del cuestionario de satisfacción, pero los pacientes del período POST presentaron una mayor satisfacción en las dimensiones «información recibida» y «profesionalidad y confianza ». La estancia media se redujo de 11 a 10 días.

Conclusiones

La introducción de la trayectoria clínica del ictus isquémico puede contribuir a reducir el número de complicaciones y los días de estancia, así como mejorar la calidad de la atención y la satisfacción de los pacientes.

Palabras clave:
Trayectorias clínicas
Vías clínicas
Planes estandarizados de los cuidados enfermeros
Ictus
Calidad
Eficiencia
Abstract
Objective

To assess the impact of the implementation of a clinical pathway for stroke patients.

Methods

We performed a controlled intervention study without random allocation that compared two non-concomitant cohorts of stroke patients corresponding to the periods immediately before (control group) and after (intervention group) the implementation of a clinical pathway. The main outcome measures were: a) quality of care indicators; b) improvements in functional capacity (Barthel score) and neurological function (Canadian scale); c) nosocomial complications; d) satisfaction, and e) mean length of hospital stay.

Results

One hundred and thirty-nine patients were recruited. Sixty-nine corresponded to the period before implementation of the pathway and 70 corresponded to the period after implementation. There were no significant differences between the two groups on admission. A 36.5% reduction in the time from admission to mobilization was observed. No significant differences were observed between the groups for the other quality of care indicators, or in improvements in functional and neurological capacity. Nosocomial complications occurred in 44.5% of patients in the control group compared with 28.6% in the intervention group (p = .039). No significant differences were observed in the overall satisfaction assessment, but patients in the intervention group showed greater satisfaction in the dimensions of «information» and «trust and professionalism ». The mean length of hospital stay was reduced from 11 to 10 days.

Conclusions

The implementation of the stroke clinical pathway contributed to reducing the length of hospital stay and the number of inpatient complications, as well as to improving some quality of care indicators.

Key words:
Critical pathways
Clinical pathways
Care maps
Stroke
Quality
Efficiency
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Este proyecto ha sido financiado con fondos del Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo (ayuda de investigación, expediente 01/10047).

Copyright © 2004. Sociedad Española de Salud Pública y Administración Sanitaria
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