The arthroplasty registry of Catalonia and the collaboration between clinicians and researchers

25 Oct
Jorge Arias

Establishing collaborations with different research projects driven from the arthroplasty registry of Catalonia (RACat) reveals the importance of the relationships and communication between professionals who manage and analyse data on the one hand and clinicians on the other.

A registry is a data base with a huge potential. The RACat, both in the number of cases registered and in the way data is used, is a very powerful research tool which needs the collaboration between clinicians and researchers. It concerns two visions, both equally necessary and complementary.

Today, we interview Jorge Arias, a researcher that works at the RACat who is involved in different research projects driven by the registry itself at the AQuAS.

Do clinicians and researchers speak the same language?

Yes and no. Even though we are usually in it together, we do not have the clinical experience to be able to fully interpret results and propose sufficiently precise studies which reflect the reality of clinical practice. Clinicians, on the other hand, are often not used to the different analyses used so that collaboration becomes a key element to obtain results of interest.

How do you solve this?

By speaking, of course.

Who decides what statistical analyses are done?

I would say that the researcher directs things but in practice it doesn’t happen quite like this. In some ways, the analysis is determined by the data itself and the objective that is established.

Let me explain. Depending on what one wants to investigate, to achieve the greatest possible precision the analysis needs to be “pre-defined”, in some way or another, so to speak. It is true that there is always scope for innovation and you almost always need to choose (from among several approaches to the problem) the most appropriate one. But in my opinion, in most cases the type of analysis is determined, as I mentioned before, by the aim of the research and the data available.

What are you working on at the moment?

At a Catalan level, we are starting a relatively new line of work in our environment in collaboration with the Hospital de Sant Rafael. It is related to the assessment of results according to the annual volume of procedures (arthroplasties in our case), and we are pleased with the interest which the project seems to be generating.

When you talk of interest, what are you referring to?

In this case, we are referring to the fact that we presented our results at the congress Sociedad Española de Cirugía Ortopédica (SECOT) (Spanish Society for Orthopaedic Surgery) and several

hospitals have since contacted us showing their interest in collaborating in this line. We feel this is very important.

Could you point out any other experience?

Yes. We are also involved in comparing results based on specific models of prosthesis, in comparing a “more general” type of implant, bone cements and in analysing the possible influence of comorbidity in surgical results.

In terms of patients, how do you incorporate their views or experiences?

Although the patient is at the centre of all the projects mentioned, in particular I would like to highlight the projects related to those known as “PROMS”, Patient Reported Outcome Measures. These results are particularly interesting because it is in fact the patient who rates the surgical results in terms of, for example, pain and improvement in life quality.

Focusing on the idea of collaboration, I would like to highlight what I think is a particularly relevant project. We began it with clinicians at the University of Exeter in the United Kingdom by “looking for” the questionnaires we could include in the registry, but seeing that the most used questionnaires in other registries were not available in our context we decided to take the initiative and adapt them ourselves.

In addition, in the following weeks, we hope to obtain a “direct” product from this project in collaboration with the University of León and the University of Oviedo, respectively, because I am in fact right now working with them to pilot one of these questionnaires on the quality of life, more specifically the HOOS, Hip disability and Osteoarthritis Outcome Score.

What do all these experiences have in common?

Without doubt, collaboration.

In your opinion, what influence can this collaboration have?

Collaboration in any field of science is basic and necessary in order to obtain results with real practical implications which in the end improve some important aspect.

We have spoken of collaboration at a clinical-researcher level but I guess we should talk of the need for this collaboration at all levels; that is, not only with clinicians but also with patients, managers and even the industry.

The subject is vast but focusing on the clinician-researcher collaboration, I would like to end by saying that from the RACat we encourage and are delighted to work with health professionals with foresight and clinical experience that want to collaborate with us. And, it goes without saying, us with them.

Results Centre. Hospital Setting. 2014 Data.

6 Aug

AGA2Anna García-Altés, Head of the Catalan Health System Observatory

This report presents the results of all public hospitals network (SISCAT) for 2014. The structure of this year’s report is slightly different from previous years. It deals with fewer topics but in a more concrete, in depth manner. A special effort has been made to include indicators of nursing care evaluations, an area little discussed up until now in the reports of the Results Centre, and other new indicators from records that so far have not been analyzed in the reports. Some examples of such indicators are: mortality in low mortality DRG’s, mortality in patients who have developed complications, bedsores, or indicators relating to donation and transplants registration and the A&E MBDSHowever, the tables with the values ​​of all indicators centre by centre -the distinguishing feature of the Results Centre- remain. As in previous years, all reports include innovative experiences that provide good care results, included in the Health Care Innovation Observatory in Catalonia (OIGS) as well as the experts’ opinion and specific results indicators of a monographic hospital, this year the Hospital Maternoinfantil de Vall d’Hebron.
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“The Poverty Hypothesis” versus “The Capacity Hypothesis”

16 Apr

Jordi VarelaJordi Varela, Editor of the blog “Advances in Clinical Management

The socioeconomic status influences the consumption of goods and services in each community in a very obvious way, a phenomenon which logically includes hospitalisation rates. But in what sense does poverty or wealth determine hospital utilisation? And what role does the accessibility to the number of installed beds in the community play in hospitalisation rates?

To try to answer these two questions I will examine two projects, an English one and an American one that emphasise two different hypothesis, the first one being based on the influence of poverty and the second one, on the installed capacity.

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