Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain).

The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011-12) and pancreatic cancer (2012-15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients' homes and their reference centers, clinical patient and treatment data, income category, and data from the patients' district hospitals.

Transanal Total Mesorectal Excision Versus Anterior Total Mesorectal Excision for Rectal Cancer: A Propensity Score Matched, Population-Based Study in Catalonia, Spain.

Background: The clinical value of transanal total mesorectal excision is debated.

Objective: This study aimed to compare short- and medium-term effects of transanal versus anterior total mesorectal excision for rectal cancer.

Design: This was a multicenter retrospective cohort study.

Postoperative mortality after surgery for inflammatory bowel disease in the era of biological agents: A population-based study in Southern Europe.

Background: Despite the efficacy of biological agents, surgery is still required for a large percentage of patients with inflammatory bowel disease (IBD).

Aims: To assess the postoperative mortality rates and associated risk factors in IBD patients in a population-based setting in the era of biological agents.

Methods: This is a population-based longitudinal study including all patients diagnosed with IBD in Catalonia who underwent intestinal resection or colectomy between 2007 and 2016, identified from the Catalan Health Surveillance System database.

[Clinical validation of 2 morbidity groups in the primary care setting].

Introduction: Adjusted Morbidity Groups (GMAs) and the Clinical Risk Groups (CRGs) are population morbidity based stratification tools which classify patients into mutually exclusive categories.

Objetive: To compare the stratification provided by the GMAs, CRGs and that carried out by the evaluators according to the levels of complexity.

Design: Random sample stratified by morbidity risk.

A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study.

Aim: The oncological risk/benefit trade-off for laparoscopy in rectal cancer is controversial. Our aim was to compare laparoscopic vs open surgery for resection of rectal cancer, using unselected data from the public healthcare system of Catalonia (Spain).

Methods: This was a multicentre retrospective cohort study of all patients who had surgery with curative intent for primary rectal cancer at Catalonian public hospitals from 2011 to 2012.

Influence of age on variation in patterns of care in patients with rectal cancer in Catalonia (Spain).

Background: Population ageing is a relevant concern in people diagnosed with rectal cancer. This study evaluates the adherence to clinical practice guidelines (CPGs) and patient outcomes in rectal cancer, with a particular focus on variation according to age.

Methods: This is a multicentre retrospective cohort study of all patients surgically treated for the first time for primary rectal cancer with curative intent in public hospitals in Catalonia during two study periods: first, with data from 2005 to 2007, and then with data from 2011 to 2012.

Improving survival and local control in rectal cancer in Catalonia (Spain) in the context of centralisation: A full cycle audit assessment.

Background: Rectal cancer surgery in Catalonia has been involved in a process of centralisation. We assessed the impact of this health policy strategy on quality of care and clinical results.

Methods: We compared patterns of care and clinical outcomes of all rectal cancer patients receiving radical surgery for the first time in public hospitals in two time periods, before (2005 and 2007) and after (2011-2012) centralisation, analysing indicators of care quality according to the regional clinical practice guidelines.

Improving clinical outcomes through centralization of rectal cancer surgery and clinical audit: a mixed-methods assessment.

Background: The aim of centralizing rectal cancer surgery in Catalonia (Spain) was to improve the quality of patient care. We evaluated the impact of this policy by assessing patterns of care, comparing the clinical audits carried out and analysing the implications of the healthcare reform from an organizational perspective.

Methods: A mixed methods approach based on a convergent parallel design was used.

[The transformation of the healthcare model in Catalonia to improve the quality of care].

The changes taking place in western countries require health systems to adapt to the public's evolving needs and expectations. The healthcare model in Catalonia is undergoing significant transformation in order to provide an adequate response to this new situation while ensuring the system's sustainability in the current climate of economic crisis. This transformation is based on converting the current disease-centred model which is fragmented into different levels, to a more patient-centred integrated and territorial care model that promotes the use of a shared network of the different specialities, the professionals, resources and levels of care, entering into territorial agreements and pacts which stipulate joint goals or objectives.

The extension of smoke-free areas and acute myocardial infarction mortality: before and after study.

Objectives: Recent studies suggest that comprehensive smoking regulations to decrease exposure to second-hand smoke reduce the rates of acute myocardial infarction (AMI). The objective of this paper is to analyse if deaths due to AMI in Spain declined after smoking prevention legislation came into force in January 2006.

Design: Information was collected on deaths registered by the Instituto Nacional de Estadística for 2004-2007.

[Performance assessment of health services in Catalonia (Spain): evaluation of initial results of the Catalan healthcare service project].

Performance assessment of healthcare services is receiving greater attention due to increasing health care expenditures, greater expectations among the population, and the need to obtain results from the invested resources. Taking advantage of the existing experience of the Agència de Salut Pública de Barcelona and the Consorci Sanitari de Barcelona, which compared the healthcare services of Barcelona and Montreal, a grant from the Agència d'Avaluació de Tecnologia i Recerca Mèdiques, and the health planning interest of the Departament de Salut, the performance assessment of the Catalan healthcare service project was started in Catalonia in 2005. This article aims to present the development of the project, to provide some examples that illustrate the kind of numerical and graphical information that could be obtained and the kind of analysis that could be performed, to provide possible explanations for the results shown, and to discuss some limitations and implications.

[Planning highly specialised services in Catalonia].

One of the principal challenges in healthcare systems is deciding which services have to be concentrated, taking into account, among other things, their low-frequency, complexity, risk, accumulated experience and costs., Concentration must make it possible to guarantee the quality of the service and the best results possible. This article describes, the conceptual elements, the benchmark criteria, the impact on the centres and the minimum conditions that the mechanisms must meet, which have been taken into account in the reorganisation of high-complexity services in Catalonia.

Measuring the performance of urban healthcare services: results of an international experience.

The objective of this paper is to apply a framework for country-level performance assessment to the cities of Montreal, Canada, and Barcelona, Spain, and to use this framework to explore and understand the differences in their health systems. The UK National Health Service Performance Assessment Framework was chosen. Its indicators went through a process of selection, adaptation and prioritisation.

[Reasons for attending emergency departments. People speak out].

Objective: To ascertain why people attend hospital emergency departments (ED) for low complexity health problems.

Method: A phenomenological, interactionist, qualitative study was performed. A theoretical sample that selected one urban and one rural area from Catalonia (Spain) was designed.

[Comparison of primary care teams in Barcelona according to management formulas].

Objective: The aim of the study is to compare, among socio-economically similar areas, the use of medical services, clinical practice and pharmacy costs depending on the how the primary healthcare teams, that provide these services, are organized according to different managemental formulas.

Design: Descriptive study of the evaluation of health care services.

Patients And Methods: The population units (basic health areas) attended by the reformed primary health care services in Barcelona were classified into three levels according to the population's socioeconomic status (high, medium or low).

[An evaluation of the impact of primary care reform on health].

Objective: Evaluation of the impact of the reform of primary health care services on the population health.

Design: Comparative analysis of mortality rates for the 1984-96 period in three zones of homogeneous socioeconomic level, assessing the effect of the differential development of the reform of public primary health care services.

Setting: The study is restricted to the 23 health areas with lower socioeconomic status in the city of Barcelona (443092 inhabitants).

[Reorganising specialist care in the Ciutat Vella Health Sector: analysis of an experience].

Objective: Analysis of the results obtained in terms of improvement in the continuity of care, its resolutive capacity and accessibility, in the framework of the organisational change brought about by the reorganisation of specialist care (RSC) in the Ciutat Vella Health Sector.

Design: A descriptive study of the reorganised model of specialist care introduced in 1995 and comparison between this and the previous model (1993) in terms of activity, further tests made, referral to hospital, filling in the clinical history and waiting-list. T SETTING: The experience involved 4 PCTs in the Ciutat Vella Health sector of Barcelona (covering 74,449 people).

[Correction of social inequalities in health: reform of primary health care as a strategy].

Objectives: To evaluate the impact of a policy to define priorities for the reform of primary health care services among small areas according to health and social indicators.

Design: Qualitative study of the changes in the provision of primary health care services after a priority setting exercise based in social and a health indicators.

Setting: The city of Barcelona (Catalonia, Spain).

[Vaccination against hepatitis B in health workers and other staff in Barcelona].

Objective: To analyse the results of a hepatitis B vaccination programme, in order to find the levels of acceptance of the programme and adherence to it, as well as the immunological response and the impact of age, gender and the index of corporal mass (ICM).

Design: This was a retrospective study.

Setting: Primary Care.

[Study of diffuse chronic hepatopathy in the outpatient context].

Objective: Description of the general characteristics of patients with Diffuse Chronic Hepatopathy (DCH) in an ABS.

Design: Empirical study of a prospective and retrospective type. Site.

[A tumor registry at a primary care center].

Aim: We analysed the data obtained from a tumor register kept in a Primary Care Centre (PCC) to find out the variables which contribute to the diagnostic and therapeutic evolution of our patients.

Design: Retrospective study on every Neoplasia registered in the Centre.

Patients: 293 malignant Neoplasias were recorded in the period between June 1984 and June 1990 (184 in males--62.