Asistance Quality Standards in Rheumatology

Alonso Ruiz, Alberto; Vidal Fuentes, Javier; Tornero Molina, Jesús; Carbonell Abelló, Jordi; y de Mercado, Pablo Lázaro; Dolores Aguilar Conesa, M.

doi:10.1016/S2173-5743(07)70252-6

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Objective

To develop standards for quality of care and processing times in rheumatology.

Materials and methods

After a systematic review of the literature, a working group of 10 rheumatologists and 2 methodologists selected 164 indicators of quality of care and processing times. A panel of 65 experts rated the indicators following a Delphi methodology.

Results

Among the most important of the 164 standards obtained were: maximum number of inhabitants per rheumatologist (40 000-50 000); minimum number of rheumatologists in a Rheumatology Unit (3); duration of the first visit (30minutes) and successive visits (19minutes), ratio of successive/first visits (3.2); a rheumatologist should receive no more than 5 first visits/day and no more than 11 successive visits/day, and should spend no more than 5 hours on patients visits/day nor more than 4 days/week; the maximum waiting time for first visits should not exceed 4 weeks; the time needed to visit hospitalized patients (43minutes on admission, 17minutes for daily visit and 40minutes at discharge); and time to carry out some of the most frequent procedures in rheumatology (12minutes for arthrocentesis and infiltrations and 17minutes for synovial fluid analysis).

Conclusions

This study establishes basic standards for quality of care, organization and process times. It is a useful tool for organizing a rheumatology unit, which can facilitate dialogue with health administrators and help improve the quality of rheumatology care.

Key words:

Standards

Quality of care

Rheumatology

Objetivo

Elaborar estándares de calidad asistencial y de tiempos de los procesos reumatológicos.

Material y métodos

Tras una revisión sistemática de la literatura un grupo de trabajo, constituido por 10 reumatólogos y 2 metodólogos, ha seleccionado 164 indicadores de calidad y de tiempos de proceso. Un panel de 65 expertos los ha puntuado mediante metodología Delphi.

Resultados

Entre los 164 estándares obtenidos destacan: número máximo de habitantes por reumatólogo (40.000- 50.000); número mínimo de reumatólogos en una unidad de reumatología (3); tiempo de duración de la primera consulta (30min) y la sucesiva (19min), relación sucesiva/primera consulta (3,2); un reumatólogo no debe atender más de 5 primeras visitas/día y no más de 11 consultas sucesivas/día, no debe pasar consulta más de 5 h/día, ni más de 4 días/semana; el tiempo máximo de espera para la primera consulta no será superior a 4 semanas; el tiempo necesario para la visita de pacientes ingresados (43min al ingreso, 17min la visita diaria y 40min el alta); tiempo para la realización de las técnicas más frecuentes en reumatología (12min para artrocentesis e infiltraciones y 17min para análisis del líquido sinovial).

Conclusiones

Este estudio fija estándares básicos de calidad, organización y tiempo, y es un instrumento útil para la organización de una unidad de reumatología, ya que facilita el diálogo con los gestores sanitarios y contribuye a mejorar la calidad de la práctica reumatológica.

Palabras clave:

Estándares

Calidad asistencial

Reumatología

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