title: Variability in Rheumatology day care hospitals in Spain: VALORA study.
abstract: OBJECTIVE
  To describe the variability of the day care hospital units (DCHUs) of Rheumatology in Spain, in terms of structural resources and operating processes.
  
  
  METHODS
  Multicenter descriptive study with data from a self-completed questionnaire of DCHUs self-assessment based on DCHUs quality standards of the Spanish Society of Rheumatology. Structural resources and operating processes were analyzed and stratified by hospital complexity (regional, general, major and complex). Variability was determined using the coefficient of variation (CV) of the variable with clinical relevance that presented statistically significant differences when was compared by centers.
  
  
  RESULTS
  A total of 89 hospitals (16 autonomous regions and Melilla) were included in the analysis. 11.2% of hospitals are regional, 22,5% general, 27%, major and 39,3% complex. A total of 92% of DCHUs were polyvalent. The number of treatments applied, the coordination between DCHUs and hospital pharmacy and the post graduate training process were the variables that showed statistically significant differences depending on the complexity of hospital. The highest rate of rheumatologic treatments was found in complex hospitals (2.97 per 1,000 population), and the lowest in general hospitals (2.01 per 1,000 population). The CV was 0.88 in major hospitals; 0.86 in regional; 0.76 in general, and 0.72 in the complex.
  
  
  CONCLUSIONS
  there was variability in the number of treatments delivered in DCHUs, being greater in major hospitals and then in regional centers. Nonetheless, the variability in terms of structure and function does not seem due to differences in center complexity.
authors.affiliation: Servicio de Reumatología, Hospital Clínic de Barcelona-IDIBAPS, Barcelona, España.
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Hernández Miguel
authors.affiliation: Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España.
authors.forename: María Auxiliadora
authors.initials: MA
authors.lastname: Martín Martínez
authors.affiliation: Servicio de Reumatología, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España.
authors.forename: Héctor
authors.initials: H
authors.lastname: Corominas
authors.affiliation: Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sanchez-Piedra
authors.affiliation: Servicio de Reumatología, Hospital Clínic de Barcelona-IDIBAPS, Barcelona, España; Servicio de Reumatología, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España.
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmartí
authors.affiliation: Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernandez Martinez
authors.affiliation: Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España. Electronic address: vicuna111@gmail.com.
authors.forename: Rosario
authors.initials: R
authors.lastname: García-Vicuña
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D012219:Rheumatology / Q000458:organization & administration* / Q000706:statistics & numerical data; D013030:Spain
keywords: Clinical practice variability; Day care hospital; Estándares de calidad; Hospital de día; Reumatología; Rheumatology; Standard of care; Variabilidad