title: [Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure].
abstract: OBJECTIVE
  To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF).
  
  
  METHODS
  Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health.
  
  
  METHODS
  Health area of the region of Madrid (n=466.901).
  
  
  METHODS
  There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007.
  
  
  METHODS
  risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system.
  
  
  RESULTS
  227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49).
  
  
  CONCLUSIONS
  Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF.
authors.affiliation: Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España. Electronic address: vdelsaz8@gmail.com.
authors.forename: Vicente
authors.initials: V
authors.lastname: del Saz Moreno
authors.affiliation: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Unidad Docente Multiprofesional de Atención Familiar y Comunitaria, Dirección Asistencial Centro, Madrid, España.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Alberquilla Menéndez-Asenjo
authors.affiliation: Dirección General de Sistemas de Información, Unidad Sistemas de Información de Atención Primaria, Madrid, España.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Camacho Hernández
authors.affiliation: Unidad de Investigación Clínica (imas12-CIBERESP), Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: David
authors.initials: D
authors.lastname: Lora Pablos
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Enríquez de Salamanca Lorente
authors.affiliation: Centro de Salud Pavones, Madrid, España.
authors.forename: Purificación
authors.initials: P
authors.lastname: Magán Tapia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D016022:Case-Control Studies; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care; D011787:Quality of Health Care; D012306:Risk
keywords: Atención Primaria de Salud; Evaluación de proceso (Atención de Salud); Heart failure; Hospitalización; Hospitalization; Indicadores de calidad de la Atención de Salud; Insuficiencia cardiaca; Primary Health Care; Process Assessment (Health Care); Quality indicators