Análisis comparados de sistemas de información en el estudio del impacto de la gripe en la atención hospitalaria
OBJECTIVES: The main objective of the study is to determine the impact of the improvement of an epidemiological surveillance system on the clinical and organisational outcomes of patients hospitalised with influenza. Secondary objectives are: to identify the key elements of an influenza surveillance...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Universidad de Valladolid |
| Repositorio: | UVaDOC. Repositorio Documental de la Universidad de Valladolid |
| OAI Identifier: | oai:uvadoc.uva.es:10324/67893 |
| Acceso en línea: | https://doi.org/10.35376/10324/67893 https://uvadoc.uva.es/handle/10324/67893 |
| Access Level: | acceso abierto |
| Palabra clave: | Medicina preventiva Influenza Gripe Preventive medicine Medicina Preventiva Surveillance systems Sistemas de vigilancia 3210 Medicina Preventiva |
| Sumario: | OBJECTIVES: The main objective of the study is to determine the impact of the improvement of an epidemiological surveillance system on the clinical and organisational outcomes of patients hospitalised with influenza. Secondary objectives are: to identify the key elements of an influenza surveillance system that provides value to patients and professionals; to assess the magnitude of nosocomial transmission of influenza in a hospital, through a surveillance system with active search for new cases; to analyse the frequency of complications in patients hospitalised with influenza, including cardiovascular events in the surveillance; and to determine the validity and usefulness of the RAE-CMBD, compared to an epidemiological surveillance system, in the characterisation of patients hospitalised with influenza. METHODS: Three options for universal influenza surveillance in hospitals were compared: 1) Maintain a case register with passive surveillance; 2) Opt for a real-time epidemiological surveillance system; and 3) Explore the use of a secondary data source, such as the RAE-CMBD. The results of the implementation of each of the alternatives were evaluated through 3 differentiated and harmonic designs: observational, descriptive and cross-sectional studies; a quasi-experimental before-after study; and a concordance study. In total, 96,184 discharges from a tertiary hospital between 1 January 2017 and 31 December 2019 were analysed, focusing on the 1,196 adults hospitalised with confirmed influenza during three seasons (2016/2017, 2017/2018 and 2018/2019). RESULTS: After implementation of the real-time influenza surveillance system, the percentage of patients with early diagnosis and isolation was significantly increased (13.7% vs. 68.2%, p<0.001), nosocomial transmission of the virus decreased from 17% to 9.2% (p=0.001) and the average length of stay of all patients hospitalised with influenza was reduced by 2 days (10±13 vs. 8±6, p<0.001). A cardiac event was a complication in 2.5% of patients hospitalised with influenza and was associated with vaccination (OR 0.32; 95%CI 0.13-0.83; p=0.02), ICU admission (OR 6.9; 95%CI 1.64-29.1; p=0.008) and multi-organ failure (OR 4.84; 95%CI 1.73-13.53; p=0.003). A near 100% match (97.74%) was achieved between both data sources, the surveillance system and the RAE-CMBD. Inter-observer agreement for the identification of influenza episodes was high (k = 0.828) and the RAE-CMBD showed a sensitivity of 79.87%, specificity of 99.72%, positive predictive value of 86.71% and negative of 99.54%. The risk-adjusted mortality ratio (RMAR) of patients with influenza was lower than that of patients without influenza: 0.667 (0.53-0.82) vs. 1.008 (0.98-1.04) and the risk-adjusted length of stay ratio (REAR) higher: 1.15 (1.12-1.18) vs. 1.00 (0.996-1.001). CONCLUSIONS: Active surveillance of patients hospitalised with influenza increases the safety of patients and professionals by reducing nosocomial transmission of the virus; improves effectiveness, as it increases the capacity to detect new cases and the quality of data; increases efficiency, as it contributes to the reduction of hospital stay; and allows answering clinical and epidemiological research hypotheses. Influenza causes major complications in more than one third of hospitalised patients. Although most of these are respiratory, cardiac events also stand out, with a high mortality rate. The surveillance system established has shown the protective role of vaccination in the development of a cardiac event after influenza. The validity of the RAE-CMBD was proved with the data from the epidemiological surveillance system, which multiplies the information and broadens the knowledge of the disease. However, it does not replace active surveillance of cases, due to its retrospective approach and insufficient capacity to detect nosocomial transmission. |
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