Healthcare Quality According to ICU Level of Care

Introduction: Little is known about the quality of healthcare in intensive care units (ICUs) in Poland. Data on patients hospitalized in ICUs in Warsaw and the results of their treatment are scarce. This information, crucial for improving the quality of ICU healthcare services, is not collected routinely. Quality indicators are essential in the concept of holistic quality management. Implementation of these indicators in ICUs is a complex and time-consuming process. Systematic increase in demand for quality assessment tools that can reflect real conditions of the practices of ICUs, prompts the search for effective solutions. Methods: The study included 12,155 patients hospitalized in 16 ICUs of Warsaw hospitals (8 ICUs, n = 3293 of the first level of care, and 8 ICUs, n = 8862 of the second level) between 1st January 2017 and 31st December 2018. ICUs in pediatric and oncological hospitals were excluded from the study. Characteristics and demography of patients as well as the structure, treatment and human resources of the ICUs in Warsaw were analyzed. Length of stay, unexpected extubations, nosocomial infections, ICU readmissions and standardized mortality ratios (SMR) were retrieved from National Health Fund, Ministry of Health, and other public databases. Results: In primary level ICUs patients’ age (66.42 vs. 64.43 years;p = 0.005) and comorbidity rate (30.56% vs. 22.78%, p = 0.037) were higher when compared to ICUs of the second level of care. The crude mortality rate in ICUs in Warsaw was significantly higher than in other EU countries and differed between ICUs of the first and the second level (34.77% vs. 24.53%, respectively;p = 0.004). SMRs were however very low: 0.71 and 0.64 (ns), respectively. ICU readmission rate, unexpected extubations, central catheter related infections, and length of stay were identical in both groups. More patients were admitted to ICU form emergency department and/or discharged home in Level 1 ICUs (18.9% vs 12.9%, p Conclusions: There are no major differences in quality of care provided by Level 1 and Level 2 ICUs in Poland, although more rigorous adhesion to admission and discharge policies is needed. Implementation of the instruments for assessing quality of ICUs including benchmarking, self-assessment of departments and evaluation of changes resulting from audits according to the Deming cycle is of utmost importance. Standardization of quality measures and markers, communication, and cooperation in reporting and creation of ICU medical registers is necessary to improve the quality of healthcare.

Burden of celiac disease in the Mediterranean area

AIM: To estimate the burden of undiagnosed celiac disease (CD) in the Mediterranean area in terms of morbidity, mortality and health cost. METHODS: For statistics regarding the population of each country in the Mediterranean area, we accessed authoritative international sources (World Bank, World Health Organization and United Nations). The prevalence of CD was obtained for most countries from published reports. An overall prevalence rate of 1% cases/total population was finally estimated to represent the frequency of the disease in the area, since none of the available conf idence intervals of the reported rates significantly excluded this rate. The distribution of symptoms and complications was obtained from reliable reports in the same cohort. A standardized mortality rate of 1.8 was obtained from recent reports. Crude health cost was estimated for the years between symptoms and diagnosis for adults and children, and was standardized for purchasing power parity to account for the different economic prof iles amongst Mediterranean countries. RESULTS: In the next 10 years, the Mediterranean area will have about half a billion inhabitants, of which 120 million will be children. The projected number of CD diagnoses in 2020 is 5 million cases (1 million celiac children), with a relative increase of 11% compared to 2010. Based on the 2010 rate, there will be about 550 000 symptomatic adults and about 240 000 sick children: 85% of the symptomatic patients will suffer from gastrointestinal complaints, 40% are likely to have anemia, 30% will likely have osteopenia, 20% of children will have short stature, and 10% will have abnormal liver enzymes. The estimated standardized medical costs for symptomatic celiac patients during the delay between symptom onset and diagnosis (mean 6 years for adults, 2 years for children) will be about €4 billion (€387 million for children) over the next 10 years. A delay in diagnosis is expected to increase mortality: about 600 000 celiac patients will die in the next 10 years, with an excess of 44.4% vs age-and sexmatched controls. CONCLUSION: In the near future, the burden of CD will increase tremendously. Few Mediterranean countries are able to face this expanding epidemic alone.