{"id":117021,"date":"2018-03-11T10:46:22","date_gmt":"2018-03-11T10:46:22","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/calidad-del-manejo-del-dolor-cronico-oncologico-perspectiva-global-revision-de-la-evidencia-diseno-y-validacion-de-indicadores\/"},"modified":"2018-03-11T10:46:22","modified_gmt":"2018-03-11T10:46:22","slug":"calidad-del-manejo-del-dolor-cronico-oncologico-perspectiva-global-revision-de-la-evidencia-diseno-y-validacion-de-indicadores","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/salud-publica\/calidad-del-manejo-del-dolor-cronico-oncologico-perspectiva-global-revision-de-la-evidencia-diseno-y-validacion-de-indicadores\/","title":{"rendered":"Calidad del manejo del dolor cr\u00f3nico oncol\u00f3gico: perspectiva global, revisi\u00f3n de la evidencia, dise\u00f1o y validaci\u00f3n de indicadores"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Ismael Mart\u00ednez Nicol\u00e1s <\/strong><\/h2>\n<p>Resumen objetivos: el objetivo de este proyecto fue el desarrollo y el pilotaje de factibilidad, fiabilidad y utilidad de un set de indicadores de calidad para el manejo del dolor oncol\u00f3gico basado en evidencia y centrado en el tratamiento dirigido a iniciativas internas de mejora de la calidad en servicios sanitarios. Adicionalmente, los resultados preliminares del cumplimiento y la valoraci\u00f3n por expertos externos de los indicadores pod\u00edan ser de inter\u00e9s como objetivos secundarios. m\u00e9todos: se cre\u00f3 un set integral basado en la evidencia siguiendo siete pasos secuenciales: (1) definici\u00f3n operativa de dolor oncol\u00f3gico; (2) definici\u00f3n de buenas pr\u00e1cticas en el dolor oncol\u00f3gico; (3) revisi\u00f3n de indicadores existentes sobre el manejo del dolor oncol\u00f3gico; (4) construcci\u00f3n de indicadores nuevos sobre el manejo del dolor oncol\u00f3gico; (5) dise\u00f1o del formato de recogida y almacenamiento de datos; (6) dise\u00f1o de pilotaje del set de indicadores propuestos; y (7) valoraci\u00f3n de los indicadores en base a la opini\u00f3n de expertos externos. los centros asistenciales objeto de estudio fueron el hospital cl\u00ednico universitario virgen de la arrixaca, el hospital general universitario morales meseguer y el centro de salud alcantarilla-sangonera. las unidades de estudio fueron seleccionadas a partir del conjunto m\u00ednimo b\u00e1sico de datos (cmbd) y de listados provistos por el servicio murciano de salud, utilizando c\u00f3digos cie-9 y ciap-2 relacionados con c\u00e1ncer para hospitales y centros de salud, respectivamente. Se utiliz\u00f3 el m\u00e9todo de muestro aleatorio sistem\u00e1tico. se defini\u00f3 la metodolog\u00eda para el pilotaje enfocada a comprobar lo siguiente: &quot;\tfactibilidad de medici\u00f3n, en los diversos \u00e1mbitos en los que los indicadores son aplicables (m\u00e9todo cualitativo basado en informe de incidencias).  &quot;\tfiabilidad de los indicadores. Comprobada emp\u00edricamente con el c\u00e1lculo del \u00edndice kappa de las evaluaciones realizadas por dos evaluadores independientes. &quot;\tcapacidad para identificar problemas de calidad. Utilizamos para ello la t\u00e9cnica de lqas (lot quality acceptance sampling), para dos situaciones diferentes: (i) est\u00e1ndar de cumplimiento de 75% (umbral de 40%); y (ii) est\u00e1ndar de cumplimiento de 95% (umbral de 70).  adicionalmente, se realiza una estimaci\u00f3n del cumplimiento de los indicadores y su intervalo de confianza del 95%. se realiz\u00f3 una encuesta de valoraci\u00f3n del inter\u00e9s potencial de los indicadores, entregada a profesionales responsables de programas sobre manejo del dolor o vinculados a la gesti\u00f3n de calidad en las diferentes ccaa. A dichos profesionales se les provey\u00f3 de un cuestionario que comprend\u00eda todos los indicadores para que pudiesen ser valorados con una puntuaci\u00f3n de 1 (sin inter\u00e9s) a 5 (totalmente de acuerdo con su inter\u00e9s). resultados: veintid\u00f3s indicadores fueron pilotados. Diecisiete resultaron factibles en los hospitales y 12 en todos los \u00e1mbitos asistenciales. Las barreras de factibilidad inclu\u00edan dificultades en la identificaci\u00f3n de las poblaciones diana, registros e historias cl\u00ednicas deficientes y baja preValencia de casos para algunos indicadores. La fiabilidad fue mayoritariamente de muy buena a excelente (k &gt; 0.8). cuatro indicadores, todos ellos relacionados con la medicaci\u00f3n y la prevenci\u00f3n de efectos secundarios, tuvieron un cumplimiento aceptable alcanzando el est\u00e1ndar lqas de 75%\/40%. Otros importantes indicadores relacionados con la medicaci\u00f3n (es decir, medicaci\u00f3n ajustada a la intensidad del dolor, prescripci\u00f3n para el dolor irruptivo y la evaluaci\u00f3n del dolor en escala validada), los indicadores de medidas no farmacol\u00f3gicas y los relacionados con la atenci\u00f3n centrada en el paciente (como por ejemplo, atenci\u00f3n al sufrimiento psicol\u00f3gico y las necesidades educativas del paciente) tuvieron un cumplimiento muy bajo, subrayando oportunidades de mejora espec\u00edficas. pr\u00e1cticamente todos los indicadores obtuvieron buenos resultados de puntuaci\u00f3n basada en la opini\u00f3n de expertos (?3 de media in una escala tipo likert de 1 a 5). Entre los 12 indicadores mejor valorados, 9 fueron factibles y podr\u00edan ser considerados como indicadores prioritarios para \u00e9stos u otros prop\u00f3sitos.  abstract objectives: the aim of this project was the development and feasibility, reliability and usefulness pilot-test of a therapy-focused, evidence-based set of quality indicators on cancer pain management for internal quality improvement initiatives in healthcare services. Additionally, preliminary results of compliance and external experts rating of indicators could be of interest as secondary objectives.  methods: we built a comprehensive set of evidence-based indicators following seven sequential steps: (1) operational definition of cancer pain; (2) definition of best practices in cancer pain management; (3) review and systematization of existing indicators on the management of cancer pain; (4) development of new indicators in order to complete a set of measures for the previously identified best practices; (5) design of collecting data tools and database for analysis; (6) design of pilot test for feasibility(in hospital and primary care settings), reliability (kappa), and usefulness for the identification of quality problems using the lot quality acceptance sampling (lqas) method and estimates of compliance; and (7) external experts opinion rating. two academic hospitals (hospital cl\u00ednico universitario virgen de la arrixaca, el hospital general universitario morales meseguer) and one primary care center (centro de salud alcantarilla-sangonera) were selected for these purposes. All healthcare units and clinicians that could have been involved in the management of pain of cancer patients were evaluated. study units were selected from minimum data-base set (mdbs) and servicio murciano de salud&apos;s administrative services using icd-9 (spanish version) and icpc-2 (spanish version) codes for hospitals and primary care, respectively. Systematic random sampling was used. pilot test methods were as follows: &quot;\tfeasibility of measurement, in the various settings in which the indicators are applicable (qualitative method based on incidences report).  &quot;\treliability of the indicators. Tested empirically by calculating the kappa index from evaluations performed by two independent raters. &quot;\tability to identify quality issues. For this purpose lqas (lot quality acceptance sampling) technique was used, for two different situations: (i) 75% compliance standard (40% threshold); and (ii) 95% compliance standard (70% threshold).  calculations were also performed of estimated compliance with indicators and its 95% confidence interval. in order to determine which indicators would be a high priority for incorporation into healthcare quality processes, a survey to assess their potential interest was designed, to be given to professionals responsible for pain management programmes or staff involved in quality management in the various regions of spain. These experts were provided with a questionnaire containing all the indicators to enable them to be rated with a score of 1 (of no interest) to 5 (extremely interesting).  results: twenty-two indicators were eventually pilot tested. Seventeen were feasible in hospitals and 12 in all settings. Feasibility barriers included difficulties in identifying target populations, deficient clinical records and low prevalence of cases for some indicators. Reliability was mostly very good or excellent (k &gt; 0.8). four indicators, all of them related to medication and prevention of side effects, had acceptable compliance at 75%\/40% lqas level. Other important medication-related indicators (i.E., Adjustment to pain intensity, prescription for breakthrough pain and pain assessment through validated scale), non-pharmacological measures and indicators concerning patient-centered care (e.G., Attention to psychological distress and educational needs) had very low compliance, highlighting specific quality gaps. virtually all the indicators obtained good results in expert opinion rating (?3 average in a likert scale from 1 to 5). Within the 12 best rated indicators, 9 were feasible and could be considered as priority indicators for these or other purposes.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Calidad del manejo del dolor cr\u00f3nico oncol\u00f3gico: perspectiva global, revisi\u00f3n de la evidencia, dise\u00f1o y validaci\u00f3n de indicadores<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Calidad del manejo del dolor cr\u00f3nico oncol\u00f3gico: perspectiva global, revisi\u00f3n de la evidencia, dise\u00f1o y validaci\u00f3n de indicadores <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Ismael Mart\u00ednez Nicol\u00e1s <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 16\/01\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Pedro J. Saturno Hern\u00e1ndez<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: victoriano Soria aledo <\/li>\n<li>adriana catarina De souza oliveira (vocal)<\/li>\n<li>pedro Parra hidalgo (vocal)<\/li>\n<li>julio Jos\u00e9 Lopez picazo ferrer (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Ismael Mart\u00ednez Nicol\u00e1s Resumen objetivos: el objetivo de este proyecto fue el desarrollo y el pilotaje de [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[8235,967,12380,36711,30277],"tags":[199204,230792,175430,8317,175412,8813],"class_list":["post-117021","post","type-post","status-publish","format-standard","hentry","category-murcia","category-salud-publica","category-sector-de-la-salud","category-servicios-sanitarios","category-sistemas-automatizados-de-control-de-calidad","tag-adriana-catarina-de-souza-oliveira","tag-ismael-Martinez-nicolas","tag-julio-jose-lopez-picazo-ferrer","tag-pedro-j-saturno-hernandez","tag-pedro-parra-hidalgo","tag-victoriano-soria-aledo"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117021","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=117021"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117021\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=117021"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=117021"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=117021"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}