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Despite the publication of great number of tools to aid decisions in COVID-19 patients, there is a lack of good instruments to predict clinical deterioration. COVID19-Osakidetza is a prospective cohort study recruiting COVID-19 patients. We collected information from baseline to discharge on: sociodemographic characteristics, comorbidities and associated medications, vital signs, treatment received and lab test results. Outcome was need for intensive ventilatory support (with at least standard high-flow oxygen face mask with a reservoir bag for at least 6 h and need for more intensive therapy afterwards or Optiflow high-flow nasal cannula or noninvasive or invasive mechanical ventilation) and/or admission to a critical care unit and/or death during hospitalization. We developed a Catboost model summarizing the findings using Shapley Additive Explanations. Performance of the model was assessed using area under the receiver operating characteristic and prediction recall curves (AUROC and AUPRC respectively) and calibrated using the Hosmer–Lemeshow test. Overall, 1568 patients were included in the derivation cohort and 956 in the (external) validation cohort. The percentages of patients who reached the composite endpoint were 23.3% vs 20% respectively. The strongest predictors of clinical deterioration were arterial blood oxygen pressure, followed by age, levels of several markers of inflammation (procalcitonin, LDH, CRP) and alterations in blood count and coagulation. Some medications, namely, ATC AO2 (antiacids) and N05 (neuroleptics) were also among the group of main predictors, together with C03 (diuretics). In the validation set, the CatBoost AUROC was 0.79, AUPRC 0.21 and Hosmer–Lemeshow test statistic 0.36. We present a machine learning-based prediction model with excellent performance properties to implement in EHRs. Our main goal was to predict progression to a score of 5 or higher on the WHO Clinical Progression Scale before patients required mechanical ventilation. Future steps are to externally validate the model in other settings and in a cohort from a different period and to apply the algorithm in clinical practice. Registration: ClinicalTrials.gov Identifier: NCT04463706.

The factors that predispose an individual to a higher risk of death from COVID-19 are poorly understood. The goal of the study was to identify factors associated with risk of death among patients with COVID-19. This is a retrospective cohort study of people with laboratory-confirmed SARS-CoV-2 infection from February to May 22, 2020. Data retrieved for this study included patient sociodemographic data, baseline comorbidities, baseline treatments, other background data on care provided in hospital or primary care settings, and vital status. Main outcome was deaths until June 29, 2020. In the multivariable model based on nursing home residents, predictors of mortality were being male, older than 80 years, admitted to a hospital for COVID-19, and having cardiovascular disease, kidney disease or dementia while taking anticoagulants or lipid-lowering drugs at baseline was protective. The AUC was 0.754 for the risk score based on this model and 0.717 in the validation subsample. Predictors of death among people from the general population were being male and/or older than 60 years, having been hospitalized in the month before admission for COVID-19, being admitted to a hospital for COVID-19, having cardiovascular disease, dementia, respiratory disease, liver disease, diabetes with organ damage, or cancer while being on anticoagulants was protective. The AUC was 0.941 for this model’s risk score and 0.938 in the validation subsample. Our risk scores could help physicians identify high-risk groups and establish preventive measures and better follow-up for patients at high risk of dying.ClinicalTrials.gov Identifier: NCT04463706

Objective. To describe the implementation of the European Foundation for Quality Management (EFQM) excellence model as a common framework for quality management in a regional health care service. Design. Prospective, descriptive observational study. Setting. Thirty-one organizations (hospitals, primary care organizations, mental health institutions, and emergency services) of the Basque Health Service (serving a population of 2200000 inhabitants) in Basque Country, Spain. Methods. Since 1995, the experiences with the EFQM excellence model were initiated by training, the design of quality tools and application guidelines, and actions related to criteria of the EFQM model. Results. Four assessment cycles in which most of the organizations have participated were completed. Scores for most of the criteria improved, particularly in ‘processes’. The overall patients’ satisfaction was higher than 89% in all settings, in most of the cases higher than 95%. Ten organizations (32%) exceeded 400 points in an external evaluation with the EFQM excellence model, and 2 (6%) 500 points. Eighty-three percent of hospitals have some ISO-certified areas of activity. In the primary care setting, 40% of people were attended in a certified center. Conclusions. Stimulating actions towards quality have resulted in progressive implementation of the EFQM model, this approach being possibly related to positive evolution of some outcomes. Key factors identified have been pursuing the objective of total quality management during several years and the assignment of the resources for training and implementation of quality systems.

Background To determine whether there is greater employee satisfaction in organisations that have made more progress in implementation of the European Foundation for Quality Management (EFQM) model. Methods A series of cross-sectional studies (one for each assessment cycle) comparing staff satisfaction survey results between groups of healthcare organisations by degree of implementation of the EFQM model (assessed in terms of external recognition of management quality in each organisation). Setting: 30 healthcare organisations including hospitals, primary care and mental health providers in Osakidetza, the Basque public health service. Participants: Employees of 30 Osakidetza organisations. Intervention: Progress in implementation of EFQM model. Main outcome measures: Scores in 9 dimensions of employee satisfaction from questionnaires administered in healthcare organisations in 4 assessment cycles between 2001 and 2010. Results Comparing satisfaction results in organisations granted Gold or Silver Q Awards and those without this type of external recognition, we found statistically significant differences in the dimensions of training and internal communication. Then, comparing recipients of Gold Q Awards with those with no Q Certification, differences in leadership style and in policy and strategy also emerged as significant. Conclusions Progress of healthcare organisations in the implementation of the EFQM Excellence Model is associated with increases in their employee satisfaction in dimensions that can be managed at the level of each organisation, while dimensions in which no statistically significant differences were found represent common organisational elements with little scope for self-management.

El constante envejecimiento poblacional y el incremento de la cronicidad (para 2040 se duplicará el nº de pacientes crónicos > de 65 años, en 2011 era un 19,8% según el Eustat), el aumento del gasto sanitario (un paciente crónico consume 47 veces más que un paciente no crónico) y con un modelo biomédico concebido en su origen para la atención de pacientes agudos y centrado en estructuras y no en las personas. Este es el contexto que permitió un replanteamiento estratégico y redefinición del SPSV, orientándolo a la búsqueda de una atención integrada, que garantizara una continuidad asistencial, situando a las personas en el centro del sistema y con una visión integral de “sanidad” a “salud”.  En la búsqueda de esa continuidad asistencial se ha avanzado hacia un nuevo modelo organizativo con: La unificación de estructuras asistenciales bajo el modelo de Organización Sanitaria Integral (OSI), finalizada en 2016 La estratificación de la población para adecuar el tipo de intervención a cada estrato de población. Un soporte de Sistemas de Información y Tecnologías integradas, como la historia digital clínica única, accesible desde cualquier punto (Osabide Global con el historial farmacológico del paciente), los canales de interacción entre profesionales (consultas no presenciales) y entre profesionales y pacientes (carpeta de salud) y canales no presenciales (Osarean). La colaboración con el ámbito comunitario y social, mediante la elaboración de Guías, redes locales de salud y creación de Equipos Sociosanitarios, así como actividades de prevención y promoción de estilos y hábitos de vida con visión multidisciplinar El avance hacia un sistema más proactivo y que da mayor protagonismo a la persona para la autogestión de su enfermedad. La adopción de herramientas para su evaluación, como son; el IEMAC o Instrumento de Evaluación de Modelos de Atención a la Cronicidad, el D`AMOUR para medir la colaboración entre profesionales, el nuevo Contrato Programa de financiación y de orientación al cambio y la incorporación reciente del IEXPAC o Instrumento de Evaluación de la Experiencia del PACiente. Y el reto de la integración clínica centrada en los procesos asistenciales con rutas asistenciales y/o planes individualizados de cuidados para pacientes Pluripatológicos, con EPOC, Insuficiencia Cardiaca, Paliativos, con dolor, entre otros. Todo esto ha supuesto un cambio estructural y cultural para la ciudadanía en general y para los profesionales que han tenido que asumir nuevos roles y afrontar nuevos retos.

The Basque Country Public Health Service has moved in the last years from considering quality as an attribute of patient care to thinking that all management can be subject to improvement. Consequently, its general management team has promoted and supported a self-assessment experience of all their centres by means of the European Quality Model. This strategy has been facilitated by the Basque Country Government, which has strongly encouraged total quality management in companies, and has created the Basque Foundation for Quality Promotion, a key institution in this whole process. A total of 26 centres of the Public Health Service concluded a self-assessment process. As the main result of this, different improvement areas were detected, and various necessary actions were implemented in the centres assessed. Advantages, troubles and future work lines to extend and improve the use of the EFQM model in the health sector are discussed.