array:21 [
  "pii" => "X2013251414053818"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2013.Dec.12286"
  "estado" => "S300"
  "fechaPublicacion" => "2014-03-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2014;34:158-74"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 9617
    "formatos" => array:3 [
      "EPUB" => 343
      "HTML" => 8225
      "PDF" => 1049
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699514053810"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2013.Dec.12286"
      "estado" => "S300"
      "fechaPublicacion" => "2014-03-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2014;34:158-74"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 13780
        "formatos" => array:3 [
          "EPUB" => 331
          "HTML" => 12535
          "PDF" => 914
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Diseño de un método de evaluación y mejora de la calidad asistencial en Nefrología mediante técnica Delphi"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "158"
            "paginaFinal" => "174"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Designing a method to assess and improve the quality of healthcare in Nephrology by means of the Delphi technique"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Tab.  1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier España"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "12286_19904_52780_es_12286_t1.jpg"
                "Alto" => 345
                "Ancho" => 700
                "Tamanyo" => 230952
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Acuerdos sobre criterios/indicadores para la evaluación de la calidad asistencial."
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "José Miguel Arce, José M. Arce, Luis Hernando, Alberto Ortiz, Mónica Díaz, Milagros Polo, María Lombardo, Antonio Robles"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "José Miguel"
                "apellidos" => "Arce"
              ]
              1 => array:2 [
                "nombre" => "José M."
                "apellidos" => "Arce"
              ]
              2 => array:2 [
                "nombre" => "Luis"
                "apellidos" => "Hernando"
              ]
              3 => array:2 [
                "nombre" => "Alberto"
                "apellidos" => "Ortiz"
              ]
              4 => array:2 [
                "nombre" => "Mónica"
                "apellidos" => "Díaz"
              ]
              5 => array:2 [
                "nombre" => "Milagros"
                "apellidos" => "Polo"
              ]
              6 => array:2 [
                "nombre" => "María"
                "apellidos" => "Lombardo"
              ]
              7 => array:2 [
                "nombre" => "Antonio"
                "apellidos" => "Robles"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251414053818"
          "doi" => "10.3265/Nefrologia.pre2013.Dec.12286"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053818?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699514053810?idApp=UINPBA000064"
      "url" => "/02116995/0000003400000002/v0_201502091349/X0211699514053810/v0_201502091349/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X201325141405380X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2014.Jan.12280"
    "estado" => "S300"
    "fechaPublicacion" => "2014-03-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2014;34:175-88"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8074
      "formatos" => array:3 [
        "EPUB" => 331
        "HTML" => 6937
        "PDF" => 806
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Spanish nephrologists and the management of mineral and bone metabolism disorders in chronic kidney disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "175"
          "paginaFinal" => "188"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Los nefrólogos españoles y el manejo de las alteraciones del metabolismo óseo-mineral en la enfermedad renal crónica"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "12280_16025_56452_en_t15.12280_04.jpg"
              "Alto" => 9292
              "Ancho" => 2168
              "Tamanyo" => 4635887
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Statistical results for the 86 statements."
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jorge Cannata-Andía, J. Vicente Torregrosa"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Cannata-Andía"
            ]
            1 => array:2 [
              "nombre" => "J. Vicente"
              "apellidos" => "Torregrosa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699514053802"
        "doi" => "10.3265/Nefrologia.pre2014.Jan.12280"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699514053802?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141405380X?idApp=UINPBA000064"
    "url" => "/20132514/0000003400000002/v0_201502091616/X201325141405380X/v0_201502091616/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251414053826"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2014.Jan.12115"
    "estado" => "S300"
    "fechaPublicacion" => "2014-03-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2014;34:149-57"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 7130
      "formatos" => array:3 [
        "EPUB" => 315
        "HTML" => 6103
        "PDF" => 712
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Methodological approach to designing a telecare system for pre-dialysis and peritoneal dialysis patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "149"
          "paginaFinal" => "157"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Aproximación metodológica al diseño de un sistema de teleasistencia para pacientes en prediálisis y diálisis peritoneal"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "12115_16025_54278_en_3.12115_02i.pdf1_copy1.jpg"
              "Alto" => 1445
              "Ancho" => 998
              "Tamanyo" => 1281491
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Methodology for applying the healthcare information and communications technologies is incremental and user-centred."
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jorge Calvillo Arbizu, Jorge Calvillo-Arbizu, Laura María Roa Romero, Laura M. Roa-Romero, José A. Milán Martín, José A. Milán-Martín, Nuria Aresté Fosalba, Nuria Aresté-Fosalba, Fernando Tornero Molina, Fernando Tornero-Molina, Manuel Macía Heras, Manuel Macía-Heras, Nicanor Vega Díaz, Nicanor Vega-Díaz"
          "autores" => array:14 [
            0 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Calvillo Arbizu"
            ]
            1 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Calvillo-Arbizu"
            ]
            2 => array:2 [
              "nombre" => "Laura María"
              "apellidos" => "Roa Romero"
            ]
            3 => array:2 [
              "nombre" => "Laura M."
              "apellidos" => "Roa-Romero"
            ]
            4 => array:2 [
              "nombre" => "José A."
              "apellidos" => "Milán Martín"
            ]
            5 => array:2 [
              "nombre" => "José A."
              "apellidos" => "Milán-Martín"
            ]
            6 => array:2 [
              "nombre" => "Nuria"
              "apellidos" => "Aresté Fosalba"
            ]
            7 => array:2 [
              "nombre" => "Nuria"
              "apellidos" => "Aresté-Fosalba"
            ]
            8 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Tornero Molina"
            ]
            9 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Tornero-Molina"
            ]
            10 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Macía Heras"
            ]
            11 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Macía-Heras"
            ]
            12 => array:2 [
              "nombre" => "Nicanor"
              "apellidos" => "Vega Díaz"
            ]
            13 => array:2 [
              "nombre" => "Nicanor"
              "apellidos" => "Vega-Díaz"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699514053829"
        "doi" => "10.3265/Nefrologia.pre2014.Jan.12115"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699514053829?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053826?idApp=UINPBA000064"
    "url" => "/20132514/0000003400000002/v0_201502091616/X2013251414053826/v0_201502091616/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Designing a method to assess and improve the quality of healthcare in Nephrology by means of the Delphi technique"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "158"
        "paginaFinal" => "174"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "José Miguel Arce, José M. Arce, Luis Hernando, Alberto Ortiz, Mónica Díaz, Milagros Polo, María Lombardo, Antonio Robles"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "José Miguel"
            "apellidos" => "Arce"
            "email" => array:1 [
              0 => "jmarce@fjd.es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Jos&#233; M&#46;"
            "apellidos" => "Arce"
            "email" => array:1 [
              0 => "jmarce&#64;fjd&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Luis"
            "apellidos" => "Hernando"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Alberto"
            "apellidos" => "Ortiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "M&#243;nica"
            "apellidos" => "D&#237;az"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Milagros"
            "apellidos" => "Polo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Lombardo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Antonio"
            "apellidos" => "Robles"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Documentación Clínica, Hospital Universitario Fundación Jiménez Díaz, Madrid,  Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Documentación Clínica, Hospital Universitario Fundación Jiménez Díaz, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario Fundación Jiménez Díaz, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Dise&#241;o de un m&#233;todo de evaluaci&#243;n y mejora de la calidad asistencial en Nefrolog&#237;a mediante t&#233;cnica Delphi"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56456_en_t1i2.jpg"
            "Alto" => 1053
            "Ancho" => 2174
            "Tamanyo" => 1556889
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Agreements on criteria&#47;indicators for the assessment of healthcare quality&#46;"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">&#160;<span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Spanish Law 41&#47;2002&#44; also known as the Patient Autonomy Law<span class="elsevierStyleSup">1</span>&#44; defines free choice as the power of the patient or user to choose freely and voluntarily between two or more healthcare alternatives&#44; various doctors and healthcare facilities&#46; It also establishes that patients and National Health System users have the right to receive information on available healthcare departments and units&#44; their quality and access requirements&#46;</p><p class="elsevierStylePara">However&#44; currently there is not enough information for patients to freely choose between different hospital departments&#46; Therefore&#44; methods are required to assess the quality of care provided by specific hospital departments and generate specific&#44; comprehensive&#44; reliable and easy to understand information for patients&#46;</p><p class="elsevierStylePara">Hospitals often use different models for managing and improving quality&#44; mainly following the Joint Commission Accreditation Model<span class="elsevierStyleSup">2</span>&#44; the ISO certification<span class="elsevierStyleSup">3&#44;4</span>&#44; and the European Foundation for Quality Management Model<span class="elsevierStyleSup">5</span>&#46; These models are very useful and&#44; both individually and collectively&#44; provide a lot of information on areas for improvement<span class="elsevierStyleSup">6</span>&#46; Yet&#44; they do not provide data on the specific quality of care provided by each hospital department&#46;</p><p class="elsevierStylePara">The use of the medical history as a basic source of information may provide data more in line with this aim<span class="elsevierStyleSup">7</span>&#46; This approach uses indicators provided by the Minimum Basic Data Set &#40;MBDS&#41;&#44; defined in 1981 for the first time by the European Economic Community&#44; with the support of the World Health Organization and the Hospital Committee of the European Communities&#46; In 1987&#44; the MBDS was endorsed in Spain by the National Health Service Interregional Council and implemented in the different autonomous communities in the early 1990s&#46;</p><p class="elsevierStylePara">Spain has recently approved the minimum data set for clinical reports<span class="elsevierStyleSup">8</span>&#44; which&#44; along with the audits on the quality of clinical coding of diagnoses and procedures&#44; will contribute to greater homogeneity of MBDS-based indicators<span class="elsevierStyleSup">9 </span>&#160;and will likely increase the reliability of comparative studies between hospitals&#46;</p><p class="elsevierStylePara">Examples of these indicators are some of those defined and used by the Agency for Healthcare Research and Quality<span class="elsevierStyleSup">10</span>&#44; the Organisation for Economic Cooperation and Development<span class="elsevierStyleSup">11</span>&#44; the Spanish Society of Healthcare Quality<span class="elsevierStyleSup">12</span>&#44; the Ministry of Health<span class="elsevierStyleSup">13 </span>and the autonomous communities<span class="elsevierStyleSup">14&#44;15</span>&#46; However&#44; in terms of free choice of specific healthcare departments and units&#44; this great abundance of indicators does not provide enough information on differences between specialties nor provide an overview of the quality of the different healthcare activities carried out in each hospital department&#46;</p><p class="elsevierStylePara">The main objective of this project was to develop a methodology for assessing the quality of healthcare in specific hospital departments&#44; in order to provide high quality and easy to understand information that allows patients to freely choose specific hospital departments&#46; A second objective was to define means and channels for improving the quality of healthcare&#46; This method had to be supported by the knowledge and experience of those who know best the quality of care in their departments&#44; that is&#44; medical specialists&#46; Our approach was to define and structure a model for assessing and improving the quality of healthcare<span class="elsevierStyleSup">16 </span>and subsequently submit it to specialists for their opinion&#46; We were also motivated by a desire for agreement and consensus&#44; as the only way to achieve stable and lasting paths to improvement&#46;</p><p class="elsevierStylePara">The recommendations of the Institute of Medicine for redesigning healthcare systems<span class="elsevierStyleSup">17</span>&#44; especially those related to improved quality and transparency&#44; also encouraged us to work along these lines&#46;</p><p class="elsevierStylePara">With this in mind&#44; we considered an assessment method that included two complementary systems&#44; one that assessed the quality of healthcare provided by hospital departments through outcome results and a survey asking medical specialists for the expert opinion on the best hospital departments in each field of medicine&#46; We suggested the survey based on our belief that specialists&#8217; opinions should be a new component of quality assessment models&#44; since many patients with serious illnesses ask medical specialists where they can be treated with the best chance of being cured<span class="elsevierStyleSup">18</span>&#46; We also wanted a useful model so we established the complementary requirement of seeking avenues for improving the quality of hospital departments&#44; not only for assessing them&#46; We thought that the usual absence of indicators on structural&#44; human and organisational resources prevented each hospital department from clearly seeing what it should or could do and the path it should follow to improve its quality of healthcare&#46;</p><p class="elsevierStylePara">To achieve our objectives&#44; we proposed a Delphi study<span class="elsevierStyleSup">19-23</span>&#44; since we were seeking first-hand&#44; freely expressed information&#44; and a consensus that could not be interfered with leaders stating their opinion&#46; We started the project with a pilot study in two specialties&#58; one medical &#40;Nephrology&#41; and the other surgical &#40;Otolaryngology&#41;&#46;</p><p class="elsevierStylePara">In this paper&#44; we present the results obtained in the specialty of Nephrology&#46; It is important to highlight the interesting studies published on this specialty<span class="elsevierStyleSup">24-26 </span>and specifically on the quality of healthcare in Nephrology<span class="elsevierStyleSup">27-32</span>&#44; which were very useful in developing our project&#46;</p><p class="elsevierStylePara">Amongst the results obtained&#44; we highlight the high rate of participation of the nephrologists involved in the study&#44; which was higher than expected for this type of studies<span class="elsevierStyleSup">33&#44;34</span>&#46; This may reflect a desire to define new methods to assess and improve the quality of healthcare in Nephrology&#46; We also highlight the large number of agreements obtained on indicators for assessing and means for improving the quality of healthcare&#46; Acceptance of the web platform was an essential study tool since it was a major communication facilitator&#46; Its use made defining and reviewing the model easier&#46; Both the expert opinion of specialists on the validity of medical advice on the best Nephrology departments for treating different diseases and the agreement obtained on the existing relationship between image or prestige and quality of healthcare&#44; were also significant results&#46;</p><p class="elsevierStylePara">The most important conclusions were&#58; first&#44; the possibility of obtaining&#44; by consensus&#44; a basic methodological proposal for assessing and improving healthcare quality&#59; and second&#44; the validity of expert opinion by specialists to identify the best Nephrology departments for specific kidney diseases&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHOD</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study design</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A questionnaire was developed to be assessed in a Delphi study by a panel of experts in Nephrology from around Spain&#46; The research team defined and structured a conceptual methodological proposal for assessing and improving the quality of healthcare in Nephrology<span class="elsevierStyleSup">11-16&#44;27-32</span>&#46; The questionnaire was developed over several meetings in which the model and structure were defined&#44; criteria and indicators were selected&#44; the requirements necessary to form part of the expert panel were agreed upon and the minimum consensus for the acceptance of each proposal was established&#46; The study was carried out in two rounds&#44; with a four-week interval&#44; in May and June 2012&#46; The first round included 242 questions grouped into different areas of criteria&#44; of which 203 were multiple-choice&#46; The second round included all of the multiple-choice questions&#46; In the second round&#44; before answering each question&#44; the panellists saw the group response percentages of the first round&#44; as well as their own response&#44; with the aim of facilitating the review of all their responses&#46;</p><p class="elsevierStylePara">The questionnaire was administered to the experts through a web platform specifically designed for the study&#44; with 24-hour open access&#46; In this questionnaire&#44; we requested the opinions and degree of agreement of the panellists with different statements in relation to the assessment and improvement of healthcare quality in Nephrology&#46; The estimated time for completing the questionnaire was 2-3 hours in each round&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Participants</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The expert panel consisted of nephrologists&#44; since they were considered to be the professionals who have the best knowledge of the healthcare situation in Nephrology Departments&#46; Panellists were selected using the following criteria&#58; representative of the different Nephrology subspecialties&#44; having at least ten years&#8217; experience as a specialist&#44; geographical diversity within Spain and a solid professional image for each expert in their main area of subspecialisation&#46; The selection was carried out with the collaboration of the Spanish Society of Nephrology &#40;S&#46;E&#46;N&#46;&#41;&#44; which conducted a pre-selection of experts who met the abovementioned criteria&#46; Each expert who agreed to participate did so individually and did not know the composition of the rest of the panel&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Sample size</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We initially planned for a minimum of 20 experts to participate&#46; The S&#46;E&#46;N&#46; provided a list of 40 nephrologists&#46; Once we verified that they met the requirements established&#44; we contacted them via post and e-mail&#44; with 37 agreeing to participate&#46; Of these 37&#44; 32 started the questionnaire &#40;86&#46;5&#37;&#41;&#46; The study was completed by 32 experts &#40;100&#37; of those starting the questionnaire&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Context of the questionnaire</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The questionnaire had three parts&#46; The first two parts were presented as a &#8220;management game&#8221;&#46; The experts were placed in a hypothetical situation&#46; They became the new Heads of the Nephrology Department in a Hospital of medium&#47;high complexity with the objective of improving the quality of healthcare while maintaining the previous year&#8217;s budget&#46; Firstly&#44; as Heads of the Nephrology Department&#44; they were asked to analyse the quality of care delivered by the Department&#46; For this purpose they were given the outcome results of the previous few years&#46; Next&#44; they prepared a scorecard with the indicators they deemed to be most important&#46; Secondly&#44; they were asked by the Hospital Administration to improve the quality of care&#46; Since the outcome results provided information on past performance&#44; the Heads of the Nephrology Department had to prepare a new scorecard with information on the resources available &#40;structural&#44; human and organisational resources&#41;&#46; In this manner&#44; they could manage existing resources better and request or implement those of a low cost that did not exist and thereby attempt to improve the quality of healthcare without changing the budget&#44; in accordance with the Hospital Administration&#8217;s objectives&#46;</p><p class="elsevierStylePara">The third part of the questionnaire was unrelated to the two previous parts&#46; The experts were presented with another theoretical scenario&#58; one of their relatives had been diagnosed with a nephrological disease and had asked the experts for their advice on the best Nephrology Department to treat their specific disease&#46; This question was repeated for different kidney diseases&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Structure of the questionnaire</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The questionnaire was divided into three sections&#58; Section A focussed on healthcare quality outcome results&#44; Section B on healthcare quality resources&#44; and Section C on expert opinion regarding medical advice to select the best Nephrology Departments to treat specific kidney diseases&#46;</p><p class="elsevierStylePara">In <span class="elsevierStyleBold">Section A &#40;Healthcare quality results&#41;</span> we included criteria and indicators&#44; or groups of indicators&#44; divided under the following headings&#58; <span class="elsevierStyleItalic">Health results </span>&#40;mortality&#44; complications&#44; re-admissions and patient safety&#41;&#44; <span class="elsevierStyleItalic">Process management results </span>&#40;length of hospitalisation stay &#44; outliers with regard to length of hospitalisation stay&#44; delays in care and management of arteriovenous fistulas&#41;&#44; <span class="elsevierStyleItalic">Economic results</span> &#40;costs&#44; productivity and work attendance rates&#41;&#44; <span class="elsevierStyleItalic">Perceived quality results </span>&#40;satisfaction survey and claims&#41; and <span class="elsevierStyleItalic">Scorecard of healthcare quality results </span>&#40;degree of updating&#44; transparency&#44; standards and weighting of criteria&#41;&#46;</p><p class="elsevierStylePara">In <span class="elsevierStyleBold">Section B</span><span class="elsevierStyleBold">&#40;Healthcare quality resources&#41;</span> we included criteria and indicators divided under the following headings&#58; <span class="elsevierStyleItalic">Structural resources </span>&#40;healthcare structuring&#44; technology and techniques&#44; use of medication&#44; medical history&#44; complementary healthcare activities&#44; educational programmes&#44; healthcare support and non-healthcare support within the hospital&#44; and information technology &#40;IT&#41; and telemedicine&#41;&#44; <span class="elsevierStyleItalic">Human resources </span>&#40;doctors&#44; nursing and assistant staff&#44; dieticians and nutritionists&#41;&#44; <span class="elsevierStyleItalic">Organisational resources </span>&#40;department organisation standards&#44; methods and assessment of healthcare quality for improvement&#41; and <span class="elsevierStyleItalic">Scorecard of resources for healthcare quality </span>&#40;need&#44; degree of updating&#44; transparency and weighting of criteria&#41;&#46;</p><p class="elsevierStylePara">In <span class="elsevierStyleBold">Section C &#40;Expert opinion on medical advice and the ability to select the best departments&#41;</span> different questions were asked about the ability of the expert to provide advice on the Nephrology departments where they thought the quality of care for specific diseases would be best&#44; as well as the potential relationship between the image or prestige of a Nephrology department and the quality of its healthcare&#46; Various questions were also included to determine the feasibility and relevance of a future survey to nephrologists about the image&#47;prestige&#47;quality of Nephrology departments&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Assessment scales</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In the questionnaire&#44; different assessment scales were used in accordance with the type of questions&#46; Likert-type scales with five categories were used for most of the questions&#46; We decided that for Section A the response categories would be &#8220;Essential&#44; Important&#44; Unnecessary&#44; Leads to confusion and I don&#8217;t know&#8221;&#46; No intermediate option between &#8220;Important&#8221; and &#8220;Unnecessary&#8221; was provided&#44; since a questionnaire to decide on criteria&#47;indicators that are necessary for knowing the quality of care provided by a department did not accept this intermediate option&#46; For the analysis&#44; these categories were grouped in order to perceive the results more clearly&#46; There were specific scales for some questions because as the use of generic scales was inadequate for their content&#46; In only a small number of questions more than one choice was possible&#46; In all of the multiple-choice questions&#44; we included a section for comments from the panellists&#46; Some questions were answered solely by comment&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical methods</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We agreed that&#44; as a minimum&#44; any criteria or proposal should obtain the support of 70&#37; of the experts in order to be included in the new method to assess quality of care&#46;</p><p class="elsevierStylePara">In each multiple-choice question in which only one response was allowed&#44; we obtained the percentage of responses in each category&#46; For those in which more than one answer was permitted&#44; we obtained the percentage of panellists who selected each category&#46;</p><p class="elsevierStylePara">At the end of Sections A and B&#44; the panellists gave a score between 0 and 10 to each group of criteria&#44; according to whether they thought that there was a lower or higher relationship between these criteria and the quality of healthcare&#46; The results were summarised using means and medians&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The study was completed by all 32 nephrologists who started it&#46; After concluding the two rounds of the Delphi questionnaire&#44; each panellist individually accepted that their name would be amongst those of the experts who had participated in the study&#46; The composition of the panel was not made public on this occasion either&#46;</p><p class="elsevierStylePara">In the first round&#44; the response rate was 99&#46;9&#37; for the questions of Section A&#44; 99&#46;7&#37; for those of Section B and 99&#46;6&#37; for those of Section C&#46; In the second round&#44; 26 experts &#40;81&#46;3&#37;&#41; changed some of their answers while 6 did not change anything&#46; The percentage of multiple-choice answers changed in the second round was 7&#37;&#44; since there were 453 changes in a total of 6496 questions &#40;203 multiple-choice questions given to 32 experts&#41;&#46; That is a mean of 14&#46;2 changes for each of the 32 panellists &#40;median 13&#46;5&#41;&#46;</p><p class="elsevierStylePara">The overall results of the study are presented in this paper&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Section A &#40;Healthcare quality results&#41;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">To perceive the results more clearly&#44; we grouped the five response categories in this section&#44; &#8220;Essential&#44; Important&#44; Unnecessary&#44; Leads to confusion and I don&#8217;t know&#8221;&#44; as follows&#58; the percentage of &#8220;Essential &#43; Important&#8221;&#44; the percentage of &#8220;Unnecessary &#43; Leads to confusion&#8221; and the percentage of the response &#8220;I don&#8217;t know&#8221;&#46; The experts accepted 55 of the 62 criteria&#47;indicators&#44; considering them essential or important&#44; with a mean acceptance percentage of 91&#46;3&#37;&#46; Seven criteria&#47;indicators were not considered essential or important by 70&#37; of the experts&#46; The results in this part of the study are summarised in Table 1 and in more detail in Addendum 1&#46;</p><p class="elsevierStylePara">With respect to the transparency of the results Scorecard&#44; 100&#37; of the experts believed that it was essential or important that all doctors in the department had access to this information&#46; 90&#46;6&#37; believed that it should also be available for the rest of the hospital departments&#46; In terms of access of citizens to healthcare quality results&#44; 62&#46;5&#37; thought it was essential or important&#46; There was an agreement of 71&#46;9&#37; when we proposed that the indicators for citizens would reflect the same reality&#44; but in a more positive manner&#46; For example&#44; the percentage of patients treated without complications&#44; compared with the percentage of patients treated with complications&#46; 75&#37; of the experts considered that it would be sufficient to update this Scorecard every three months&#46;</p><p class="elsevierStylePara">Finally&#44; in this part of the questionnaire&#44; we asked the experts to score the different groups of criteria assessed in Section A&#44; assigning each group a value &#40;between 0 and 10&#41; in accordance with a lesser or greater conceptual relationship with healthcare quality within their specialty &#40;Table 2&#41;&#46;</p><p class="elsevierStylePara">With respect to the comparison standards&#44; both for health criteria&#47;indicators and management and economic criteria&#47;indicators&#44; the experts mainly chose &#40;above 90&#37;&#41; national standards and&#44; in a lower proportion&#44; autonomous community and European standards&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Section B &#40;Healthcare quality resources&#41;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The five response categories in this section &#8220;A lot&#44; Quite a lot&#44; Little&#44; Nothing and I don&#8217;t know&#8221; are grouped in order to perceive as clearly as possible the degree of agreement&#46; We obtained the percentages for &#8220;A lot &#43; Quite a lot&#8221; and &#8220;Little &#43; Nothing&#8221; and that of &#8220;I don&#8217;t know&#8221;&#46;</p><p class="elsevierStylePara">The experts accepted 87 of the 92 resources proposed&#44; since they contributed or potentially contributed a lot or quite a lot to improving the quality of healthcare in Nephrology&#44; with a mean acceptance percentage of 93&#46;6&#37;&#46; In 5 proposals&#44; we did not obtain the minimum support of 70&#37; of the experts&#46; The results are summarised in Tables 3&#44; 4 and 5&#44; and in more detail in Addendum 2&#46;</p><p class="elsevierStylePara">With respect to obtaining a healthcare quality resources Scorecard&#44; 96&#46;9&#37; of the experts believed that it was necessary to complement the results Scorecard and&#44; of these&#44; 100&#37; believed that it was essential or important that all doctors of the department had access to this information&#46; 78&#46;1&#37; thought that it was also appropriate for the rest of the hospital departments to have access&#46; 75&#37; of the experts considered an annual updating of the resources Scorecard to be sufficient&#46;</p><p class="elsevierStylePara">At the end of Section B&#44; experts were also requested to score the different areas or groups of criteria assessed and had to assign each area a value &#40;between 0 and 10&#41; in accordance with the lesser or greater conceptual relationship of the resources proposed with the improvement in the quality of healthcare within their specialty &#40;Table 6&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Section C &#40;Expert opinion medical advice and the ability to select the best Nephrology </span><span class="elsevierStyleBold">department<span class="elsevierStyleBold">s&#41;</span></span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">81&#46;3&#37; of the nephrologists considered that&#44; when a patient has a serious illness&#44; the patient himself or a family member should ask for the advice of a specialist about the department where they can receive the best treatment for their illness&#46; Of these nephrologists&#44; 61&#46;5&#37; believed the reason was that the patient trusted the expert advice more than any other information system&#44; while the rest believed the reason was that no system offered clear information &#40;30&#46;8&#37;&#41; or that information systems were not transparent &#40;7&#46;7&#37;&#41;&#46;</p><p class="elsevierStylePara">All the experts thought that&#44; if they themselves or someone close to them required help&#44; they would ask a colleague in the relevant specialty for expert opinion on the best Hospital department for that problem&#46; 59&#46;4&#37; indicated that they would also use the healthcare quality indicators and publications&#46; None would search only for information&#44; without also asking for advice&#46;</p><p class="elsevierStylePara">We then asked them if they would be capable of offering advice or recommending a Nephrology information system for different diseases in their specialty &#40;Table 7&#41;&#46; We grouped the five response categories for this question &#8220;Yes&#44; I think so&#44; I am not sure&#44; No and Any department&#8221; in order to facilitate the reading of results&#46; We obtained the percentage of &#8220;Yes &#43; I think so&#8221;&#44; that of &#8220;I am not sure &#43; No&#8221; and the percentage of the response &#8220;Any department&#8221;&#46; We grouped options A and C in the last column&#44; since we understand that both express the possibility of giving advice to the patient&#44; which occurred in a mean of 87&#46;5&#37; cases&#46; Only in Fabry disease and the haemolytic-uraemic syndrome was there a certain degree of difficulty in making a recommendation&#46;</p><p class="elsevierStylePara">The experts believed that the reason for which an information system was more frequently recommended was mainly direct scientific visibility through conferences and publications &#40;73&#46;8&#37;&#41;&#46;</p><p class="elsevierStylePara">On the appropriateness of administering this type of surveys to nephrologists&#44; 86&#46;2&#37; thought it was appropriate and even include them as additional criteria in the assessment of healthcare quality&#44; since the Image&#47;Prestige concept&#44; according to 87&#46;5&#37; of the experts&#44; was very or quite related to that of healthcare quality&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#160;</span></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">There was a high participation rate and a high degree of involvement in the responses by the experts&#44; who on many occasions expanded on their answers with comments at the end of each question&#46; Their participation and involvement are two of the most valuable aspects&#44; taking into account that both are considered the main difficulties in any Delphi study&#46; The questionnaire&#8217;s length did not seem to have a negative influence&#44; which&#44; in our opinion&#44; shows the experts&#8217; high level of commitment to the study&#46;</p><p class="elsevierStylePara">The web platform also contributed to this study&#44; since it made completing the questionnaire convenient&#44; as it could be done from any location and at any time&#46; The remote interaction between experts facilitated an anonymous&#44; tension-free revision of the ideas as the result of individual reflection on the group&#8217;s opinions&#46; We believed it was important that the experts had the chance to address all the issues again in the second round and not only those selected due to a lack of agreement&#46; The changes and clarifications of several questions in the second round confirmed this&#46;</p><p class="elsevierStylePara">The broad agreement of the experts with most of the criteria and indicators proposed for the assessment and improvement of the quality of healthcare seems to be a consistent and solid basis for a future healthcare in Nephrology assessment and improvement model&#46; It is necessary to highlight the favourable opinion towards the need for better organisation in the departments and the incorporation of internal assessment of healthcare quality with the support of some central departments such as Medical Documentation or Quality or of some Clinical Commissions&#46; Furthermore&#44; we must highlight the desire for better knowledge of the costs as guidance for more efficient processes&#46;</p><p class="elsevierStylePara">Another important agreement was the validity of the specialist&#8217;s expert opinion advice as guidance for the patient on the best departments for different diseases&#46; Most experts related the image or prestige of a department with the quality of healthcare and declared their ability to identify the best departments for the treatment of specific diseases&#46; It should be noted that they considered scientific visibility as the main criterion for selecting the best departments and making a recommendation&#46; The experts demonstrated their support for the future development of surveys for specialists on the image&#47;prestige&#47;healthcare quality of departments&#44; which we considered to be important added value for finding the best departments for treating different diseases&#46;</p><p class="elsevierStylePara">Finally&#44; the great interest shown by nephrologists in participating in the construction of a methodology for assessing and improving the quality of healthcare&#44; and most probably&#44; its future implementation&#44; suggests that seeking a consensus is a correct approach&#46; The experts have shown their disposal and willingness to build Experience-based Quality together&#46;</p><p class="elsevierStylePara">This methodology could have the following practical applications&#58; internal assessment of healthcare quality in Nephrology departments&#44; the development of guidelines for improving healthcare quality in each Nephrology department&#44; comparative studies between Nephrology departments of different hospitals&#44; surveys for nephrologists as a complementary method for assessing the quality of healthcare delivered by a department and information for citizens on Nephrology departments&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study limitations</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The results of the study may have limitations in terms of their applicability to other geographical settings and specialties&#44; mainly with regard to the criteria&#47;indicators selected and the structure of the expert panel&#46; Further research is needed on the definition&#44; validation and feasibility of indicators in Nephrology&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara">&#160;</p><li>It is possible to obtain and develop&#44; by consensus&#44; a methodological proposal for the evaluation and improvement of healthcare quality in Nephrology&#44; given the high participation of experts&#44; their degree of involvement and the high number of agreements obtained on indicators of results and resources for healthcare quality&#46;</li><li>Surveys for specialists to identify the best departments may be useful to provide expert opinion advice based on the pooled opinion of different specialists&#44; thus decreasing the potential subjectivity of advice given by any individual specialist&#46; In this regard&#44; it is currently difficult for most patients to access valid expert opinion medical advice&#46;</li><li>The conceptual association that the experts established between the image&#47;prestige of a department and its healthcare quality makes us conclude that the complementary inclusion of these surveys in healthcare quality assessment models could be useful&#46;</li><li>The &#8220;construction&#8221; by specialists of a model that includes indicators of healthcare quality and expert opinion medical advice providing clear&#44; fast and direct information about the best Nephrology departments leads us to the conclusion that the integration model proposed may provide citizens with guidance that may facilitate free choice&#46;</li><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">ACKNOWLEDGEMENTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We would like to thank Marta Garc&#237;a&#44; Mercedes Guerra&#44; Caroline Hall&#44; Luis Miguel Molinero and Ricard Rosique for their important work in the different parts of this study&#46; AO belongs to the ISCIII RETIC REDINREN RD012&#47;0021 ERDF funds and has intensified the research activity of the ISCIII&#46;</p><p class="elsevierStylePara">We are also deeply grateful to the <span class="elsevierStyleBold">S&#46;E&#46;N&#46;</span> for the scientific support granted to this project and to the nephrologists who took part of the expert panel for their generous participation in the study &#40;Appendix 3&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46; The study was fully financed by the Institute of Health Research of the Jim&#233;nez D&#237;az Foundation &#40;IIS-FJD&#41;&#46; The responsibility for the contents of this article corresponds exclusively to its authors&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56456&#95;en&#95;t1i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56456_en_t1i2.jpg" alt="Agreements on criteria&#47;indicators for the assessment of healthcare quality&#46;"></img></a></p><p class="elsevierStylePara">Table 1&#46; Agreements on criteria&#47;indicators for the assessment of healthcare quality&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56457&#95;en&#95;t2i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56457_en_t2i2.jpg" alt="Weighting of criteria&#47;indicators for the assessment of healthcare quality&#46;"></img></a></p><p class="elsevierStylePara">Table 2&#46; Weighting of criteria&#47;indicators for the assessment of healthcare quality&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56458&#95;en&#95;t3i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56458_en_t3i2.jpg" alt="Resources that could contribute to improving the quality of healthcare&#46; Structural resources&#46;"></img></a></p><p class="elsevierStylePara">Table 3&#46; Resources that could contribute to improving the quality of healthcare&#46; Structural resources&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56459&#95;en&#95;t4i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56459_en_t4i2.jpg" alt="Resources that could contribute to improving the quality of healthcare&#46; Human resources&#46;"></img></a></p><p class="elsevierStylePara">Table 4&#46; Resources that could contribute to improving the quality of healthcare&#46; Human resources&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56460&#95;en&#95;t5i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56460_en_t5i2.jpg" alt="Resources that could contribute to improving the quality of healthcare&#46; Organisational resources&#46;"></img></a></p><p class="elsevierStylePara">Table 5&#46; Resources that could contribute to improving the quality of healthcare&#46; Organisational resources&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56461&#95;en&#95;4&#46;12286&#95;03itablas&#95;pgina&#95;06&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56461_en_4.12286_03itablas_pgina_06.gif" alt="Weighting of resource groups for improving the quality of healthcare&#46;"></img></a></p><p class="elsevierStylePara">Table 6&#46; Weighting of resource groups for improving the quality of healthcare&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56463&#95;en&#95;4&#46;12286&#95;03itablas&#95;pgina&#95;07&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56463_en_4.12286_03itablas_pgina_07.gif" alt="Medical advice&#46; Opinion on the specialist&#191;s ability to give guidance to patients who require treatment for certain nephrological diseases"></img></a></p><p class="elsevierStylePara">Table 7&#46; Medical advice&#46; Opinion on the specialist&#191;s ability to give guidance to patients who require treatment for certain nephrological diseases</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56464&#95;en&#95;addemdum&#46;pdf1&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56464_en_addemdum.pdf1.jpg" alt="Healthcare quality results&#58; proposals on Nephrology criteria&#47;indicators&#46;"></img></a></p><p class="elsevierStylePara">Healthcare quality results&#58; proposals on Nephrology criteria&#47;indicators&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56465&#95;en&#95;addemdum&#95;2&#46;pdf1&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56465_en_addemdum_2.pdf1.jpg" alt="Resources that could contribute to improving the quality of healthcare&#46;"></img></a></p><p class="elsevierStylePara">Resources that could contribute to improving the quality of healthcare&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56466&#95;en&#95;addemdum&#95;3&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56466_en_addemdum_3.jpg" alt="Expert panel of the Nephrology Delphi Study &#40;in alphabetical order&#41;"></img></a></p><p class="elsevierStylePara">Expert panel of the Nephrology Delphi Study &#40;in alphabetical order&#41;</p>"
    "pdfFichero" => "P1-E567-S4547-A12286-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:6 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438543"
          "palabras" => array:1 [
            0 => "T&#233;cnica Delphi"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438545"
          "palabras" => array:1 [
            0 => "Nefrolog&#237;a"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438547"
          "palabras" => array:1 [
            0 => "Indicadores de calidad de la atenci&#243;n de la salud"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438549"
          "palabras" => array:1 [
            0 => "Consenso"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438551"
          "palabras" => array:1 [
            0 => "Atenci&#243;n hospitalaria"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438553"
          "palabras" => array:1 [
            0 => "Calidad&#44; acceso y evaluaci&#243;n de la atenci&#243;n de la salud"
          ]
        ]
      ]
      "en" => array:6 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438544"
          "palabras" => array:1 [
            0 => "Delphi technique"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438546"
          "palabras" => array:1 [
            0 => "Nephrology"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438548"
          "palabras" => array:1 [
            0 => "Healthcare quality indicators"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438550"
          "palabras" => array:1 [
            0 => "Consensus"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438552"
          "palabras" => array:1 [
            0 => "Hospital care"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438554"
          "palabras" => array:1 [
            0 => "Quality&#44; access and assessment of healthcare"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58;</span> La libre elecci&#243;n no es f&#225;cil cuando se carece de informaci&#243;n adecuada&#46; Para ello son necesarios m&#233;todos de evaluaci&#243;n de la calidad asistencial que ofrezcan al paciente una informaci&#243;n integral y comprensible de los servicios hospitalarios&#46; <span class="elsevierStyleBold">Objetivos&#58;</span> Definir una propuesta metodol&#243;gica para evaluar la calidad asistencial de los servicios hospitalarios&#44; cuyos resultados sirvan para ofrecer una informaci&#243;n &#250;til al ciudadano&#46; La propuesta debe fundamentarse en el consenso y en la experiencia de los especialistas m&#233;dicos y definir complementariamente v&#237;as de mejora&#46; <span class="elsevierStyleBold">M&#233;todos&#58; </span>Estudio Delphi sobre calidad asistencial en Nefrolog&#237;a&#44; estructurado en tres apartados&#58; evaluaci&#243;n de resultados&#44; medios necesarios para la calidad&#44; e importancia del consejo m&#233;dico y de la encuesta a especialistas&#46; El cuestionario fue cumplimentado por un panel formado por 32 nefr&#243;logos&#46; <span class="elsevierStyleBold">Resultados&#58;</span> Los nefr&#243;logos aceptaron 55&#47;62 &#40;89&#160;&#37;&#41; de los criterios de resultados en calidad asistencial&#46; Tambi&#233;n aceptaron 87&#47;92 &#40;95&#160;&#37;&#41; de los medios propuestos para la calidad asistencial&#46; El 81&#160;&#37; de los nefr&#243;logos consider&#243; de actualidad el consejo m&#233;dico de un especialista a un paciente acerca del servicio donde podr&#237;an tratar mejor su enfermedad&#46; Un 86&#160;&#37; crey&#243; oportuno incluir encuestas sobre consejo m&#233;dico como criterio adicional en la evaluaci&#243;n de la calidad asistencial&#46; <span class="elsevierStyleBold">Conclusiones&#58; </span>Es posible<span class="elsevierStyleBold"> </span>obtener una propuesta metodol&#243;gica consensuada para la evaluaci&#243;n y mejora de la calidad asistencial que incluya resultados de calidad asistencial&#44; medios para la calidad asistencial y el consejo m&#233;dico derivado de encuestas a especialistas para identificar los mejores servicios&#46; Este m&#233;todo podr&#237;a facilitar una orientaci&#243;n fiable y comprensible para el ciudadano&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58; </span>Free choice is not easy when there is a lack of information&#46; Methods for evaluating quality of care to provide patients with comprehensive and understandable information on hospital departments are therefore necessary&#46;<span class="elsevierStyleBold"> Objectives&#58; </span>To draft a methodological proposal for evaluating quality of care of hospital departments&#44; the data of which can provide citizens with useful care quality information&#46; The proposal should be based on consensus and on the experience of medical specialists&#44; defining thus complementary paths to improvement&#46; <span class="elsevierStyleBold">Methods&#58; </span>A Delphi study on the quality of care in Nephrology&#44; comprising three phases&#58; assessment results&#44; necessary means for quality&#44; and importance of medical advice and surveys among specialists&#46; The questionnaire was administered to a panel of 32 nephrologists&#46; <span class="elsevierStyleBold">Results&#58; </span>The nephrologists accepted the outcome criteria on quality of care 55&#47;62 &#40;89&#37;&#41;&#44; as well as the proposed means for quality of care 87&#47;92 &#40;95&#37;&#41;&#46; 81&#37; of the nephrologists reported the validity and topicality of providing patients with specialist advice as to the most adequate department to better treat their kidney diseases&#46; 86&#37; of the panellists deemed appropriate to include surveys on medical advice as additional criteria for the evaluation of quality of care&#46; <span class="elsevierStyleBold">Conclusions&#58; </span>It is possible to obtain a consensus-based methodological proposal for the evaluation and improvement of quality of care which includes results on quality of care&#44; means for quality of care&#44; and medical advice based on surveys carried out among specialists to identify the best Nephrology departments&#46; This method could provide reliable and understandable guidance for citizens&#46;</p>"
      ]
    ]
    "multimedia" => array:10 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56456_en_t1i2.jpg"
            "Alto" => 1053
            "Ancho" => 2174
            "Tamanyo" => 1556889
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Agreements on criteria&#47;indicators for the assessment of healthcare quality&#46;"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56457_en_t2i2.jpg"
            "Alto" => 921
            "Ancho" => 2178
            "Tamanyo" => 1416640
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Weighting of criteria&#47;indicators for the assessment of healthcare quality&#46;"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig3"
        "etiqueta" => "Tab.  3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56458_en_t3i2.jpg"
            "Alto" => 1563
            "Ancho" => 2170
            "Tamanyo" => 2137840
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Resources that could contribute to improving the quality of healthcare&#46; Structural resources&#46;"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Tab.  4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56459_en_t4i2.jpg"
            "Alto" => 599
            "Ancho" => 2196
            "Tamanyo" => 1136295
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Resources that could contribute to improving the quality of healthcare&#46; Human resources&#46;"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig5"
        "etiqueta" => "Tab.  5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56460_en_t5i2.jpg"
            "Alto" => 993
            "Ancho" => 2173
            "Tamanyo" => 1499591
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Resources that could contribute to improving the quality of healthcare&#46; Organisational resources&#46;"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tablaImagen" => array:1 [
                0 => array:4 [
                  "imagenFichero" => "12286_16025_56461_en_4.12286_03itablas_pgina_06.jpg"
                  "imagenAlto" => 759
                  "imagenAncho" => 1443
                  "imagenTamanyo" => 289339
                ]
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Weighting of resource groups for improving the quality of healthcare&#46;"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tablaImagen" => array:1 [
                0 => array:4 [
                  "imagenFichero" => "12286_16025_56463_en_4.12286_03itablas_pgina_07.jpg"
                  "imagenAlto" => 890
                  "imagenAncho" => 1443
                  "imagenTamanyo" => 352048
                ]
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Medical advice&#46; Opinion on the specialist&#191;s ability to give guidance to patients who require treatment for certain nephrological diseases"
        ]
      ]
      7 => array:8 [
        "identificador" => "fig6"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56464_en_addemdum.pdf1.jpg"
            "Alto" => 4797
            "Ancho" => 2178
            "Tamanyo" => 2042220
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Healthcare quality results&#58; proposals on Nephrology criteria&#47;indicators&#46;"
        ]
      ]
      8 => array:8 [
        "identificador" => "fig7"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56465_en_addemdum_2.pdf1.jpg"
            "Alto" => 7948
            "Ancho" => 2165
            "Tamanyo" => 4607524
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Resources that could contribute to improving the quality of healthcare&#46;"
        ]
      ]
      9 => array:8 [
        "identificador" => "fig8"
        "etiqueta" => "Fig. 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56466_en_addemdum_3.jpg"
            "Alto" => 1730
            "Ancho" => 2169
            "Tamanyo" => 1297077
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Expert panel of the Nephrology Delphi Study &#40;in alphabetical order&#41;"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ley 41/2002 de 14 de noviembre, básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica. BOE núm. 274 de 15 de noviembre de 2002."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "The Joint Commission International. Acreditación para hospitales. Available at: http://es.jointcommissioninternational.org/enes/Programs-Hospitals/ (Accessed: 21-07-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "ISO International Standards. Available at: http://www.iso.org/iso/home/standards.htm (Accessed: 2-11-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Asociación Española de Normalización y Certificación. Gestión de la Sanidad. Available at: http://www.aenor.es/aenor/certificacion/sectores/sanidad.asp (Accessed: 2-11-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Modelo de excelencia de la European Foundation for Quality Management. Available at: http://www.efqm.org/en/tabid/392/default.aspx (Accessed: 21-07-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Simón R, Guix J, Nualart L, Surroca RM, Carbonell JM. Utilización de modelos como herramienta de diagnóstico y mejora de la calidad: EFQM y Joint Commission. Rev Calidad Asistencial 2001;16:308-12."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966;44:166-203."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Real Decreto 1093/2010, de 3 de septiembre, por el que se aprueba el conjunto mínimo de datos de los informes clínicos en el Sistema Nacional de Salud."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yetano-Laguna J, López-Arbeloa G, Guajardo-Remacha J, Barriola-Lerchundi MT, García-Urbaneja M, Ladrón de Guevara JM. Trescientos indicadores de calidad hospitalarios automáticos a partir del Conjunto Mínimo de Datos Básicos. Rev Calidad Asistencial 2006;21(4):207-12."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Quality Indicators. Agency for Healthcare Research and Quality. Available at: http://www.qualityindicators.ahrq.gov (Accessed: 24-11-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Organisation for Economic Co-operation and Development. Health Care Quality Indicators. Available at: http://www.oecd.org/health/health-systems/healthcarequalityindicators.htm (Accessed: 24-11-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Indicadores de calidad para Hospitales del Sistema Nacional de Salud. Marzo 2012. Sociedad Española Calidad Asistencial. ISBN: 13978-84-695-0740-7."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ministerio de Sanidad, Política Social e Igualdad. Indicadores y Ejes de Análisis del CMBD. Aplicación para el análisis y explotación del registro de altas hospitalarias. Available at: http://icmbd.es (Accessed: 10-01-2012)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Comunidad de Madrid. Consejería de Sanidad. Servicio Madrileño de Salud. Libre elección sanitaria. Indicadores de Atención Especializada (hospitales). Available at: http://www.libreeleccion.sanidadmadrid.org/Indicadores/AtencionEspecializada.aspx (Accessed: 13-01-2012)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Junta de Andalucía. Información sobre actividad y calidad de los hospitales. Indicadores para atención especializada: hospitales. Datos a 1 de Enero de 2009. Available at: http://mago.easp.es/hospitales2004/AtencionEspecializada.aspx?Periodo=2008 (Accessed: 13-01-2012)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Donabedian A. Criteria and standards for quality assessment and monitoring. QRB Qual Rev Bull 1986;12:99-108. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3085044" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Committee on Quality of Health Care in America. Washington, D.C.: National Academy Press; 2001."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Maloney MC, Trussell RE, Elinson J. Physicians choose medical care: A sociometric approach to quality appraisal. Am J Public Health Nations Health 1960;50:1678-86. <a href="http://www.ncbi.nlm.nih.gov/pubmed/13765925" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Braun BB. Delphi Process. A methodology used for the elicitation of opinions of experts. The RAND Corporation; 1968."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Jones J, Hunter D. Consensus methods for medical and health services research. BMJ 1995;311:376-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7640549" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fink A, Kosecoff J, Chassin M, Brook RH. Consensus methods: characteristics and guidelines for use. Am J Public Health 1984;74(9):979-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6380323" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hearnshaw HM, Harker RM, Cheater FM, Baker RH, Grimshaw GM. Expert consensus on the desirable characteristics of review criteria for improvement of health care quality. Qual Health Care 2001;10:173-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11533425" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Salvat Plana M, Abilleira S, Jiménez C, Marta J, Gallofré M. Priorización de indicadores de calidad de la atención al paciente con ictus a partir de un método de consenso. Rev Calid Asist 2011;26(3):174-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21458345" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sociedad Española de Nefrología. El libro blanco de la nefrología española (I). Nefrologia 2000;20(2):109-29."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sociedad Española de Nefrología. El libro blanco de la nefrología española (II). Nefrologia 2000;20(3):214-33."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sociedad Española de Nefrología. El libro blanco de la nefrología española (III). Nefrologia 2000;20(5):396-402."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Alcázar JM, Arenas MD, Álvarez-Ude F, Virto R, Rubio E, Maduell F, et al. Resultados del proyecto de mejora de la calidad de la asistencia en hemodiálisis: estudio multicéntrico de indicadores de calidad de la Sociedad Española de Nefrología (SEN). Nefrologia 2008;28(6):597-606. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19016632" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Santiñá M, Arrizabalaga P, Prat A, Alcaraz A, Campistol JM, Trilla A. Instituto de gestión clínica para las enfermedades nefrourológicas: utilidad de un programa de calidad asistencial. Nefrologia 2009;29(2):118-22. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19396316" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Castellano Cerviño I, Gallego Domínguez S, Gad N, Suárez Santisteban MA, Gómez-Martino Arroyo JR, Martín Mejías I, et al. Resultados de la aplicación del plan de calidad científico-técnica y de mejora continua de calidad en diálisis peritoneal. Nefrologia 2009;29(3):256-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19554060" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Portolés J, Ocaña J, López-Sánchez P, Gómez M, Rivera MT, del Peso G, et al.; Grupo Centro de Diálisis Peritoneal. Cumplimiento de objetivos de calidad y evolución de los pacientes incidentes en diálisis peritoneal. Nefrologia 2010;30(5):544-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20882093" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "López-Revuelta K, Barril G, Caramelo C, Delgado R, García-López F, García-Valdecasas J, et al. Desarrollo de un sistema de monitorización clínica para hemodiálisis: propuesta de indicadores del Grupo de Gestión de Calidad de la SEN. Nefrologia 2007;27(5):542-59. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18045030" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ballestero Zarraga JJ. Excelencia en Nefrología. Alcobendas: Mensor Consultoría y Estrategia; 2011."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Almansa C, Rey E, Bolaños E, Palma M, Álvarez-Sánchez A, Díaz-Rubio M. Opinión de los médicos españoles sobre el síndrome de intestino irritable: Resultados de un estudio utilizando el método Delphi. Rev Esp Enferm Dig 2007;99(4):210-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17590103" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gómez-Moreno N, Orozco-Beltrán, Carratalá-Munuera C, Gil-Guillén V. Evolución de la relación entre atención primaria y especializada 1992-2001: estudio Delphi 2001. Aten Primaria 2006;37(4):195-202. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16545263" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003400000002/v0_201502091616/X2013251414053818/v0_201502091616/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35441"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Originals"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003400000002/v0_201502091616/X2013251414053818/v0_201502091616/en/P1-E567-S4547-A12286-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053818?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Designing a method to assess and improve the quality of healthcare in Nephrology by means of the Delphi technique
Diseño de un método de evaluación y mejora de la calidad asistencial en Nefrología mediante técnica Delphi
José Miguel Arcea, José M. Arceb, Luis Hernandoc, Alberto Ortizc, Mónica Díazb, Milagros Polob, María Lombardob, Antonio Roblesb
a Documentación Clínica, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain,
b Servicio de Documentación Clínica, Hospital Universitario Fundación Jiménez Díaz, Madrid,
c Servicio de Nefrología, Hospital Universitario Fundación Jiménez Díaz, Madrid,
Read
15049
Times
was read the article
3639
Total PDF
11410
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251414053818"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2013.Dec.12286"
  "estado" => "S300"
  "fechaPublicacion" => "2014-03-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2014;34:158-74"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 9617
    "formatos" => array:3 [
      "EPUB" => 343
      "HTML" => 8225
      "PDF" => 1049
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699514053810"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2013.Dec.12286"
      "estado" => "S300"
      "fechaPublicacion" => "2014-03-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2014;34:158-74"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 13780
        "formatos" => array:3 [
          "EPUB" => 331
          "HTML" => 12535
          "PDF" => 914
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Dise&#241;o de un m&#233;todo de evaluaci&#243;n y mejora de la calidad asistencial en Nefrolog&#237;a mediante t&#233;cnica Delphi"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "158"
            "paginaFinal" => "174"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Designing a method to assess and improve the quality of healthcare in Nephrology by means of the Delphi technique"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Tab.  1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier Espa&#241;a"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "12286_19904_52780_es_12286_t1.jpg"
                "Alto" => 345
                "Ancho" => 700
                "Tamanyo" => 230952
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Acuerdos sobre criterios&#47;indicadores para la evaluaci&#243;n de la calidad asistencial&#46;"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Jos&#233; Miguel Arce, Jos&#233; M&#46; Arce, Luis Hernando, Alberto Ortiz, M&#243;nica D&#237;az, Milagros Polo, Mar&#237;a Lombardo, Antonio Robles"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "Jos&#233; Miguel"
                "apellidos" => "Arce"
              ]
              1 => array:2 [
                "nombre" => "Jos&#233; M&#46;"
                "apellidos" => "Arce"
              ]
              2 => array:2 [
                "nombre" => "Luis"
                "apellidos" => "Hernando"
              ]
              3 => array:2 [
                "nombre" => "Alberto"
                "apellidos" => "Ortiz"
              ]
              4 => array:2 [
                "nombre" => "M&#243;nica"
                "apellidos" => "D&#237;az"
              ]
              5 => array:2 [
                "nombre" => "Milagros"
                "apellidos" => "Polo"
              ]
              6 => array:2 [
                "nombre" => "Mar&#237;a"
                "apellidos" => "Lombardo"
              ]
              7 => array:2 [
                "nombre" => "Antonio"
                "apellidos" => "Robles"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251414053818"
          "doi" => "10.3265/Nefrologia.pre2013.Dec.12286"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053818?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699514053810?idApp=UINPBA000064"
      "url" => "/02116995/0000003400000002/v0_201502091349/X0211699514053810/v0_201502091349/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X201325141405380X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2014.Jan.12280"
    "estado" => "S300"
    "fechaPublicacion" => "2014-03-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2014;34:175-88"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8074
      "formatos" => array:3 [
        "EPUB" => 331
        "HTML" => 6937
        "PDF" => 806
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Spanish nephrologists and the management of mineral and bone metabolism disorders in chronic kidney disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "175"
          "paginaFinal" => "188"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Los nefr&#243;logos espa&#241;oles y el manejo de las alteraciones del metabolismo &#243;seo-mineral en la enfermedad renal cr&#243;nica"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "12280_16025_56452_en_t15.12280_04.jpg"
              "Alto" => 9292
              "Ancho" => 2168
              "Tamanyo" => 4635887
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Statistical results for the 86 statements&#46;"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jorge Cannata-And&#237;a, J&#46; Vicente Torregrosa"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Cannata-And&#237;a"
            ]
            1 => array:2 [
              "nombre" => "J&#46; Vicente"
              "apellidos" => "Torregrosa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699514053802"
        "doi" => "10.3265/Nefrologia.pre2014.Jan.12280"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699514053802?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141405380X?idApp=UINPBA000064"
    "url" => "/20132514/0000003400000002/v0_201502091616/X201325141405380X/v0_201502091616/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251414053826"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2014.Jan.12115"
    "estado" => "S300"
    "fechaPublicacion" => "2014-03-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2014;34:149-57"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 7130
      "formatos" => array:3 [
        "EPUB" => 315
        "HTML" => 6103
        "PDF" => 712
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Methodological approach to designing a telecare system for pre-dialysis and peritoneal dialysis patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "149"
          "paginaFinal" => "157"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Aproximaci&#243;n metodol&#243;gica al dise&#241;o de un sistema de teleasistencia para pacientes en predi&#225;lisis y di&#225;lisis peritoneal"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "12115_16025_54278_en_3.12115_02i.pdf1_copy1.jpg"
              "Alto" => 1445
              "Ancho" => 998
              "Tamanyo" => 1281491
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Methodology for applying the healthcare information and communications technologies is incremental and user-centred&#46;"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jorge Calvillo Arbizu, Jorge Calvillo-Arbizu, Laura Mar&#237;a Roa Romero, Laura M&#46; Roa-Romero, Jos&#233; A&#46; Mil&#225;n Mart&#237;n, Jos&#233; A&#46; Mil&#225;n-Mart&#237;n, Nuria Arest&#233; Fosalba, Nuria Arest&#233;-Fosalba, Fernando Tornero Molina, Fernando Tornero-Molina, Manuel Mac&#237;a Heras, Manuel Mac&#237;a-Heras, Nicanor Vega D&#237;az, Nicanor Vega-D&#237;az"
          "autores" => array:14 [
            0 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Calvillo Arbizu"
            ]
            1 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Calvillo-Arbizu"
            ]
            2 => array:2 [
              "nombre" => "Laura Mar&#237;a"
              "apellidos" => "Roa Romero"
            ]
            3 => array:2 [
              "nombre" => "Laura M&#46;"
              "apellidos" => "Roa-Romero"
            ]
            4 => array:2 [
              "nombre" => "Jos&#233; A&#46;"
              "apellidos" => "Mil&#225;n Mart&#237;n"
            ]
            5 => array:2 [
              "nombre" => "Jos&#233; A&#46;"
              "apellidos" => "Mil&#225;n-Mart&#237;n"
            ]
            6 => array:2 [
              "nombre" => "Nuria"
              "apellidos" => "Arest&#233; Fosalba"
            ]
            7 => array:2 [
              "nombre" => "Nuria"
              "apellidos" => "Arest&#233;-Fosalba"
            ]
            8 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Tornero Molina"
            ]
            9 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Tornero-Molina"
            ]
            10 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Mac&#237;a Heras"
            ]
            11 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Mac&#237;a-Heras"
            ]
            12 => array:2 [
              "nombre" => "Nicanor"
              "apellidos" => "Vega D&#237;az"
            ]
            13 => array:2 [
              "nombre" => "Nicanor"
              "apellidos" => "Vega-D&#237;az"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699514053829"
        "doi" => "10.3265/Nefrologia.pre2014.Jan.12115"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699514053829?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053826?idApp=UINPBA000064"
    "url" => "/20132514/0000003400000002/v0_201502091616/X2013251414053826/v0_201502091616/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Designing a method to assess and improve the quality of healthcare in Nephrology by means of the Delphi technique"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "158"
        "paginaFinal" => "174"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Jos&#233; Miguel Arce, Jos&#233; M&#46; Arce, Luis Hernando, Alberto Ortiz, M&#243;nica D&#237;az, Milagros Polo, Mar&#237;a Lombardo, Antonio Robles"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "Jos&#233; Miguel"
            "apellidos" => "Arce"
            "email" => array:1 [
              0 => "jmarce&#64;fjd&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Jos&#233; M&#46;"
            "apellidos" => "Arce"
            "email" => array:1 [
              0 => "jmarce&#64;fjd&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Luis"
            "apellidos" => "Hernando"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Alberto"
            "apellidos" => "Ortiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "M&#243;nica"
            "apellidos" => "D&#237;az"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Milagros"
            "apellidos" => "Polo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Lombardo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Antonio"
            "apellidos" => "Robles"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Documentación Clínica, Hospital Universitario Fundación Jiménez Díaz, Madrid,  Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Documentación Clínica, Hospital Universitario Fundación Jiménez Díaz, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario Fundación Jiménez Díaz, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Dise&#241;o de un m&#233;todo de evaluaci&#243;n y mejora de la calidad asistencial en Nefrolog&#237;a mediante t&#233;cnica Delphi"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56456_en_t1i2.jpg"
            "Alto" => 1053
            "Ancho" => 2174
            "Tamanyo" => 1556889
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Agreements on criteria&#47;indicators for the assessment of healthcare quality&#46;"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">&#160;<span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Spanish Law 41&#47;2002&#44; also known as the Patient Autonomy Law<span class="elsevierStyleSup">1</span>&#44; defines free choice as the power of the patient or user to choose freely and voluntarily between two or more healthcare alternatives&#44; various doctors and healthcare facilities&#46; It also establishes that patients and National Health System users have the right to receive information on available healthcare departments and units&#44; their quality and access requirements&#46;</p><p class="elsevierStylePara">However&#44; currently there is not enough information for patients to freely choose between different hospital departments&#46; Therefore&#44; methods are required to assess the quality of care provided by specific hospital departments and generate specific&#44; comprehensive&#44; reliable and easy to understand information for patients&#46;</p><p class="elsevierStylePara">Hospitals often use different models for managing and improving quality&#44; mainly following the Joint Commission Accreditation Model<span class="elsevierStyleSup">2</span>&#44; the ISO certification<span class="elsevierStyleSup">3&#44;4</span>&#44; and the European Foundation for Quality Management Model<span class="elsevierStyleSup">5</span>&#46; These models are very useful and&#44; both individually and collectively&#44; provide a lot of information on areas for improvement<span class="elsevierStyleSup">6</span>&#46; Yet&#44; they do not provide data on the specific quality of care provided by each hospital department&#46;</p><p class="elsevierStylePara">The use of the medical history as a basic source of information may provide data more in line with this aim<span class="elsevierStyleSup">7</span>&#46; This approach uses indicators provided by the Minimum Basic Data Set &#40;MBDS&#41;&#44; defined in 1981 for the first time by the European Economic Community&#44; with the support of the World Health Organization and the Hospital Committee of the European Communities&#46; In 1987&#44; the MBDS was endorsed in Spain by the National Health Service Interregional Council and implemented in the different autonomous communities in the early 1990s&#46;</p><p class="elsevierStylePara">Spain has recently approved the minimum data set for clinical reports<span class="elsevierStyleSup">8</span>&#44; which&#44; along with the audits on the quality of clinical coding of diagnoses and procedures&#44; will contribute to greater homogeneity of MBDS-based indicators<span class="elsevierStyleSup">9 </span>&#160;and will likely increase the reliability of comparative studies between hospitals&#46;</p><p class="elsevierStylePara">Examples of these indicators are some of those defined and used by the Agency for Healthcare Research and Quality<span class="elsevierStyleSup">10</span>&#44; the Organisation for Economic Cooperation and Development<span class="elsevierStyleSup">11</span>&#44; the Spanish Society of Healthcare Quality<span class="elsevierStyleSup">12</span>&#44; the Ministry of Health<span class="elsevierStyleSup">13 </span>and the autonomous communities<span class="elsevierStyleSup">14&#44;15</span>&#46; However&#44; in terms of free choice of specific healthcare departments and units&#44; this great abundance of indicators does not provide enough information on differences between specialties nor provide an overview of the quality of the different healthcare activities carried out in each hospital department&#46;</p><p class="elsevierStylePara">The main objective of this project was to develop a methodology for assessing the quality of healthcare in specific hospital departments&#44; in order to provide high quality and easy to understand information that allows patients to freely choose specific hospital departments&#46; A second objective was to define means and channels for improving the quality of healthcare&#46; This method had to be supported by the knowledge and experience of those who know best the quality of care in their departments&#44; that is&#44; medical specialists&#46; Our approach was to define and structure a model for assessing and improving the quality of healthcare<span class="elsevierStyleSup">16 </span>and subsequently submit it to specialists for their opinion&#46; We were also motivated by a desire for agreement and consensus&#44; as the only way to achieve stable and lasting paths to improvement&#46;</p><p class="elsevierStylePara">The recommendations of the Institute of Medicine for redesigning healthcare systems<span class="elsevierStyleSup">17</span>&#44; especially those related to improved quality and transparency&#44; also encouraged us to work along these lines&#46;</p><p class="elsevierStylePara">With this in mind&#44; we considered an assessment method that included two complementary systems&#44; one that assessed the quality of healthcare provided by hospital departments through outcome results and a survey asking medical specialists for the expert opinion on the best hospital departments in each field of medicine&#46; We suggested the survey based on our belief that specialists&#8217; opinions should be a new component of quality assessment models&#44; since many patients with serious illnesses ask medical specialists where they can be treated with the best chance of being cured<span class="elsevierStyleSup">18</span>&#46; We also wanted a useful model so we established the complementary requirement of seeking avenues for improving the quality of hospital departments&#44; not only for assessing them&#46; We thought that the usual absence of indicators on structural&#44; human and organisational resources prevented each hospital department from clearly seeing what it should or could do and the path it should follow to improve its quality of healthcare&#46;</p><p class="elsevierStylePara">To achieve our objectives&#44; we proposed a Delphi study<span class="elsevierStyleSup">19-23</span>&#44; since we were seeking first-hand&#44; freely expressed information&#44; and a consensus that could not be interfered with leaders stating their opinion&#46; We started the project with a pilot study in two specialties&#58; one medical &#40;Nephrology&#41; and the other surgical &#40;Otolaryngology&#41;&#46;</p><p class="elsevierStylePara">In this paper&#44; we present the results obtained in the specialty of Nephrology&#46; It is important to highlight the interesting studies published on this specialty<span class="elsevierStyleSup">24-26 </span>and specifically on the quality of healthcare in Nephrology<span class="elsevierStyleSup">27-32</span>&#44; which were very useful in developing our project&#46;</p><p class="elsevierStylePara">Amongst the results obtained&#44; we highlight the high rate of participation of the nephrologists involved in the study&#44; which was higher than expected for this type of studies<span class="elsevierStyleSup">33&#44;34</span>&#46; This may reflect a desire to define new methods to assess and improve the quality of healthcare in Nephrology&#46; We also highlight the large number of agreements obtained on indicators for assessing and means for improving the quality of healthcare&#46; Acceptance of the web platform was an essential study tool since it was a major communication facilitator&#46; Its use made defining and reviewing the model easier&#46; Both the expert opinion of specialists on the validity of medical advice on the best Nephrology departments for treating different diseases and the agreement obtained on the existing relationship between image or prestige and quality of healthcare&#44; were also significant results&#46;</p><p class="elsevierStylePara">The most important conclusions were&#58; first&#44; the possibility of obtaining&#44; by consensus&#44; a basic methodological proposal for assessing and improving healthcare quality&#59; and second&#44; the validity of expert opinion by specialists to identify the best Nephrology departments for specific kidney diseases&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHOD</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study design</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A questionnaire was developed to be assessed in a Delphi study by a panel of experts in Nephrology from around Spain&#46; The research team defined and structured a conceptual methodological proposal for assessing and improving the quality of healthcare in Nephrology<span class="elsevierStyleSup">11-16&#44;27-32</span>&#46; The questionnaire was developed over several meetings in which the model and structure were defined&#44; criteria and indicators were selected&#44; the requirements necessary to form part of the expert panel were agreed upon and the minimum consensus for the acceptance of each proposal was established&#46; The study was carried out in two rounds&#44; with a four-week interval&#44; in May and June 2012&#46; The first round included 242 questions grouped into different areas of criteria&#44; of which 203 were multiple-choice&#46; The second round included all of the multiple-choice questions&#46; In the second round&#44; before answering each question&#44; the panellists saw the group response percentages of the first round&#44; as well as their own response&#44; with the aim of facilitating the review of all their responses&#46;</p><p class="elsevierStylePara">The questionnaire was administered to the experts through a web platform specifically designed for the study&#44; with 24-hour open access&#46; In this questionnaire&#44; we requested the opinions and degree of agreement of the panellists with different statements in relation to the assessment and improvement of healthcare quality in Nephrology&#46; The estimated time for completing the questionnaire was 2-3 hours in each round&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Participants</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The expert panel consisted of nephrologists&#44; since they were considered to be the professionals who have the best knowledge of the healthcare situation in Nephrology Departments&#46; Panellists were selected using the following criteria&#58; representative of the different Nephrology subspecialties&#44; having at least ten years&#8217; experience as a specialist&#44; geographical diversity within Spain and a solid professional image for each expert in their main area of subspecialisation&#46; The selection was carried out with the collaboration of the Spanish Society of Nephrology &#40;S&#46;E&#46;N&#46;&#41;&#44; which conducted a pre-selection of experts who met the abovementioned criteria&#46; Each expert who agreed to participate did so individually and did not know the composition of the rest of the panel&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Sample size</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We initially planned for a minimum of 20 experts to participate&#46; The S&#46;E&#46;N&#46; provided a list of 40 nephrologists&#46; Once we verified that they met the requirements established&#44; we contacted them via post and e-mail&#44; with 37 agreeing to participate&#46; Of these 37&#44; 32 started the questionnaire &#40;86&#46;5&#37;&#41;&#46; The study was completed by 32 experts &#40;100&#37; of those starting the questionnaire&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Context of the questionnaire</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The questionnaire had three parts&#46; The first two parts were presented as a &#8220;management game&#8221;&#46; The experts were placed in a hypothetical situation&#46; They became the new Heads of the Nephrology Department in a Hospital of medium&#47;high complexity with the objective of improving the quality of healthcare while maintaining the previous year&#8217;s budget&#46; Firstly&#44; as Heads of the Nephrology Department&#44; they were asked to analyse the quality of care delivered by the Department&#46; For this purpose they were given the outcome results of the previous few years&#46; Next&#44; they prepared a scorecard with the indicators they deemed to be most important&#46; Secondly&#44; they were asked by the Hospital Administration to improve the quality of care&#46; Since the outcome results provided information on past performance&#44; the Heads of the Nephrology Department had to prepare a new scorecard with information on the resources available &#40;structural&#44; human and organisational resources&#41;&#46; In this manner&#44; they could manage existing resources better and request or implement those of a low cost that did not exist and thereby attempt to improve the quality of healthcare without changing the budget&#44; in accordance with the Hospital Administration&#8217;s objectives&#46;</p><p class="elsevierStylePara">The third part of the questionnaire was unrelated to the two previous parts&#46; The experts were presented with another theoretical scenario&#58; one of their relatives had been diagnosed with a nephrological disease and had asked the experts for their advice on the best Nephrology Department to treat their specific disease&#46; This question was repeated for different kidney diseases&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Structure of the questionnaire</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The questionnaire was divided into three sections&#58; Section A focussed on healthcare quality outcome results&#44; Section B on healthcare quality resources&#44; and Section C on expert opinion regarding medical advice to select the best Nephrology Departments to treat specific kidney diseases&#46;</p><p class="elsevierStylePara">In <span class="elsevierStyleBold">Section A &#40;Healthcare quality results&#41;</span> we included criteria and indicators&#44; or groups of indicators&#44; divided under the following headings&#58; <span class="elsevierStyleItalic">Health results </span>&#40;mortality&#44; complications&#44; re-admissions and patient safety&#41;&#44; <span class="elsevierStyleItalic">Process management results </span>&#40;length of hospitalisation stay &#44; outliers with regard to length of hospitalisation stay&#44; delays in care and management of arteriovenous fistulas&#41;&#44; <span class="elsevierStyleItalic">Economic results</span> &#40;costs&#44; productivity and work attendance rates&#41;&#44; <span class="elsevierStyleItalic">Perceived quality results </span>&#40;satisfaction survey and claims&#41; and <span class="elsevierStyleItalic">Scorecard of healthcare quality results </span>&#40;degree of updating&#44; transparency&#44; standards and weighting of criteria&#41;&#46;</p><p class="elsevierStylePara">In <span class="elsevierStyleBold">Section B</span><span class="elsevierStyleBold">&#40;Healthcare quality resources&#41;</span> we included criteria and indicators divided under the following headings&#58; <span class="elsevierStyleItalic">Structural resources </span>&#40;healthcare structuring&#44; technology and techniques&#44; use of medication&#44; medical history&#44; complementary healthcare activities&#44; educational programmes&#44; healthcare support and non-healthcare support within the hospital&#44; and information technology &#40;IT&#41; and telemedicine&#41;&#44; <span class="elsevierStyleItalic">Human resources </span>&#40;doctors&#44; nursing and assistant staff&#44; dieticians and nutritionists&#41;&#44; <span class="elsevierStyleItalic">Organisational resources </span>&#40;department organisation standards&#44; methods and assessment of healthcare quality for improvement&#41; and <span class="elsevierStyleItalic">Scorecard of resources for healthcare quality </span>&#40;need&#44; degree of updating&#44; transparency and weighting of criteria&#41;&#46;</p><p class="elsevierStylePara">In <span class="elsevierStyleBold">Section C &#40;Expert opinion on medical advice and the ability to select the best departments&#41;</span> different questions were asked about the ability of the expert to provide advice on the Nephrology departments where they thought the quality of care for specific diseases would be best&#44; as well as the potential relationship between the image or prestige of a Nephrology department and the quality of its healthcare&#46; Various questions were also included to determine the feasibility and relevance of a future survey to nephrologists about the image&#47;prestige&#47;quality of Nephrology departments&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Assessment scales</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In the questionnaire&#44; different assessment scales were used in accordance with the type of questions&#46; Likert-type scales with five categories were used for most of the questions&#46; We decided that for Section A the response categories would be &#8220;Essential&#44; Important&#44; Unnecessary&#44; Leads to confusion and I don&#8217;t know&#8221;&#46; No intermediate option between &#8220;Important&#8221; and &#8220;Unnecessary&#8221; was provided&#44; since a questionnaire to decide on criteria&#47;indicators that are necessary for knowing the quality of care provided by a department did not accept this intermediate option&#46; For the analysis&#44; these categories were grouped in order to perceive the results more clearly&#46; There were specific scales for some questions because as the use of generic scales was inadequate for their content&#46; In only a small number of questions more than one choice was possible&#46; In all of the multiple-choice questions&#44; we included a section for comments from the panellists&#46; Some questions were answered solely by comment&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical methods</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We agreed that&#44; as a minimum&#44; any criteria or proposal should obtain the support of 70&#37; of the experts in order to be included in the new method to assess quality of care&#46;</p><p class="elsevierStylePara">In each multiple-choice question in which only one response was allowed&#44; we obtained the percentage of responses in each category&#46; For those in which more than one answer was permitted&#44; we obtained the percentage of panellists who selected each category&#46;</p><p class="elsevierStylePara">At the end of Sections A and B&#44; the panellists gave a score between 0 and 10 to each group of criteria&#44; according to whether they thought that there was a lower or higher relationship between these criteria and the quality of healthcare&#46; The results were summarised using means and medians&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The study was completed by all 32 nephrologists who started it&#46; After concluding the two rounds of the Delphi questionnaire&#44; each panellist individually accepted that their name would be amongst those of the experts who had participated in the study&#46; The composition of the panel was not made public on this occasion either&#46;</p><p class="elsevierStylePara">In the first round&#44; the response rate was 99&#46;9&#37; for the questions of Section A&#44; 99&#46;7&#37; for those of Section B and 99&#46;6&#37; for those of Section C&#46; In the second round&#44; 26 experts &#40;81&#46;3&#37;&#41; changed some of their answers while 6 did not change anything&#46; The percentage of multiple-choice answers changed in the second round was 7&#37;&#44; since there were 453 changes in a total of 6496 questions &#40;203 multiple-choice questions given to 32 experts&#41;&#46; That is a mean of 14&#46;2 changes for each of the 32 panellists &#40;median 13&#46;5&#41;&#46;</p><p class="elsevierStylePara">The overall results of the study are presented in this paper&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Section A &#40;Healthcare quality results&#41;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">To perceive the results more clearly&#44; we grouped the five response categories in this section&#44; &#8220;Essential&#44; Important&#44; Unnecessary&#44; Leads to confusion and I don&#8217;t know&#8221;&#44; as follows&#58; the percentage of &#8220;Essential &#43; Important&#8221;&#44; the percentage of &#8220;Unnecessary &#43; Leads to confusion&#8221; and the percentage of the response &#8220;I don&#8217;t know&#8221;&#46; The experts accepted 55 of the 62 criteria&#47;indicators&#44; considering them essential or important&#44; with a mean acceptance percentage of 91&#46;3&#37;&#46; Seven criteria&#47;indicators were not considered essential or important by 70&#37; of the experts&#46; The results in this part of the study are summarised in Table 1 and in more detail in Addendum 1&#46;</p><p class="elsevierStylePara">With respect to the transparency of the results Scorecard&#44; 100&#37; of the experts believed that it was essential or important that all doctors in the department had access to this information&#46; 90&#46;6&#37; believed that it should also be available for the rest of the hospital departments&#46; In terms of access of citizens to healthcare quality results&#44; 62&#46;5&#37; thought it was essential or important&#46; There was an agreement of 71&#46;9&#37; when we proposed that the indicators for citizens would reflect the same reality&#44; but in a more positive manner&#46; For example&#44; the percentage of patients treated without complications&#44; compared with the percentage of patients treated with complications&#46; 75&#37; of the experts considered that it would be sufficient to update this Scorecard every three months&#46;</p><p class="elsevierStylePara">Finally&#44; in this part of the questionnaire&#44; we asked the experts to score the different groups of criteria assessed in Section A&#44; assigning each group a value &#40;between 0 and 10&#41; in accordance with a lesser or greater conceptual relationship with healthcare quality within their specialty &#40;Table 2&#41;&#46;</p><p class="elsevierStylePara">With respect to the comparison standards&#44; both for health criteria&#47;indicators and management and economic criteria&#47;indicators&#44; the experts mainly chose &#40;above 90&#37;&#41; national standards and&#44; in a lower proportion&#44; autonomous community and European standards&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Section B &#40;Healthcare quality resources&#41;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The five response categories in this section &#8220;A lot&#44; Quite a lot&#44; Little&#44; Nothing and I don&#8217;t know&#8221; are grouped in order to perceive as clearly as possible the degree of agreement&#46; We obtained the percentages for &#8220;A lot &#43; Quite a lot&#8221; and &#8220;Little &#43; Nothing&#8221; and that of &#8220;I don&#8217;t know&#8221;&#46;</p><p class="elsevierStylePara">The experts accepted 87 of the 92 resources proposed&#44; since they contributed or potentially contributed a lot or quite a lot to improving the quality of healthcare in Nephrology&#44; with a mean acceptance percentage of 93&#46;6&#37;&#46; In 5 proposals&#44; we did not obtain the minimum support of 70&#37; of the experts&#46; The results are summarised in Tables 3&#44; 4 and 5&#44; and in more detail in Addendum 2&#46;</p><p class="elsevierStylePara">With respect to obtaining a healthcare quality resources Scorecard&#44; 96&#46;9&#37; of the experts believed that it was necessary to complement the results Scorecard and&#44; of these&#44; 100&#37; believed that it was essential or important that all doctors of the department had access to this information&#46; 78&#46;1&#37; thought that it was also appropriate for the rest of the hospital departments to have access&#46; 75&#37; of the experts considered an annual updating of the resources Scorecard to be sufficient&#46;</p><p class="elsevierStylePara">At the end of Section B&#44; experts were also requested to score the different areas or groups of criteria assessed and had to assign each area a value &#40;between 0 and 10&#41; in accordance with the lesser or greater conceptual relationship of the resources proposed with the improvement in the quality of healthcare within their specialty &#40;Table 6&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Section C &#40;Expert opinion medical advice and the ability to select the best Nephrology </span><span class="elsevierStyleBold">department<span class="elsevierStyleBold">s&#41;</span></span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">81&#46;3&#37; of the nephrologists considered that&#44; when a patient has a serious illness&#44; the patient himself or a family member should ask for the advice of a specialist about the department where they can receive the best treatment for their illness&#46; Of these nephrologists&#44; 61&#46;5&#37; believed the reason was that the patient trusted the expert advice more than any other information system&#44; while the rest believed the reason was that no system offered clear information &#40;30&#46;8&#37;&#41; or that information systems were not transparent &#40;7&#46;7&#37;&#41;&#46;</p><p class="elsevierStylePara">All the experts thought that&#44; if they themselves or someone close to them required help&#44; they would ask a colleague in the relevant specialty for expert opinion on the best Hospital department for that problem&#46; 59&#46;4&#37; indicated that they would also use the healthcare quality indicators and publications&#46; None would search only for information&#44; without also asking for advice&#46;</p><p class="elsevierStylePara">We then asked them if they would be capable of offering advice or recommending a Nephrology information system for different diseases in their specialty &#40;Table 7&#41;&#46; We grouped the five response categories for this question &#8220;Yes&#44; I think so&#44; I am not sure&#44; No and Any department&#8221; in order to facilitate the reading of results&#46; We obtained the percentage of &#8220;Yes &#43; I think so&#8221;&#44; that of &#8220;I am not sure &#43; No&#8221; and the percentage of the response &#8220;Any department&#8221;&#46; We grouped options A and C in the last column&#44; since we understand that both express the possibility of giving advice to the patient&#44; which occurred in a mean of 87&#46;5&#37; cases&#46; Only in Fabry disease and the haemolytic-uraemic syndrome was there a certain degree of difficulty in making a recommendation&#46;</p><p class="elsevierStylePara">The experts believed that the reason for which an information system was more frequently recommended was mainly direct scientific visibility through conferences and publications &#40;73&#46;8&#37;&#41;&#46;</p><p class="elsevierStylePara">On the appropriateness of administering this type of surveys to nephrologists&#44; 86&#46;2&#37; thought it was appropriate and even include them as additional criteria in the assessment of healthcare quality&#44; since the Image&#47;Prestige concept&#44; according to 87&#46;5&#37; of the experts&#44; was very or quite related to that of healthcare quality&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">&#160;</span></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">There was a high participation rate and a high degree of involvement in the responses by the experts&#44; who on many occasions expanded on their answers with comments at the end of each question&#46; Their participation and involvement are two of the most valuable aspects&#44; taking into account that both are considered the main difficulties in any Delphi study&#46; The questionnaire&#8217;s length did not seem to have a negative influence&#44; which&#44; in our opinion&#44; shows the experts&#8217; high level of commitment to the study&#46;</p><p class="elsevierStylePara">The web platform also contributed to this study&#44; since it made completing the questionnaire convenient&#44; as it could be done from any location and at any time&#46; The remote interaction between experts facilitated an anonymous&#44; tension-free revision of the ideas as the result of individual reflection on the group&#8217;s opinions&#46; We believed it was important that the experts had the chance to address all the issues again in the second round and not only those selected due to a lack of agreement&#46; The changes and clarifications of several questions in the second round confirmed this&#46;</p><p class="elsevierStylePara">The broad agreement of the experts with most of the criteria and indicators proposed for the assessment and improvement of the quality of healthcare seems to be a consistent and solid basis for a future healthcare in Nephrology assessment and improvement model&#46; It is necessary to highlight the favourable opinion towards the need for better organisation in the departments and the incorporation of internal assessment of healthcare quality with the support of some central departments such as Medical Documentation or Quality or of some Clinical Commissions&#46; Furthermore&#44; we must highlight the desire for better knowledge of the costs as guidance for more efficient processes&#46;</p><p class="elsevierStylePara">Another important agreement was the validity of the specialist&#8217;s expert opinion advice as guidance for the patient on the best departments for different diseases&#46; Most experts related the image or prestige of a department with the quality of healthcare and declared their ability to identify the best departments for the treatment of specific diseases&#46; It should be noted that they considered scientific visibility as the main criterion for selecting the best departments and making a recommendation&#46; The experts demonstrated their support for the future development of surveys for specialists on the image&#47;prestige&#47;healthcare quality of departments&#44; which we considered to be important added value for finding the best departments for treating different diseases&#46;</p><p class="elsevierStylePara">Finally&#44; the great interest shown by nephrologists in participating in the construction of a methodology for assessing and improving the quality of healthcare&#44; and most probably&#44; its future implementation&#44; suggests that seeking a consensus is a correct approach&#46; The experts have shown their disposal and willingness to build Experience-based Quality together&#46;</p><p class="elsevierStylePara">This methodology could have the following practical applications&#58; internal assessment of healthcare quality in Nephrology departments&#44; the development of guidelines for improving healthcare quality in each Nephrology department&#44; comparative studies between Nephrology departments of different hospitals&#44; surveys for nephrologists as a complementary method for assessing the quality of healthcare delivered by a department and information for citizens on Nephrology departments&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study limitations</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The results of the study may have limitations in terms of their applicability to other geographical settings and specialties&#44; mainly with regard to the criteria&#47;indicators selected and the structure of the expert panel&#46; Further research is needed on the definition&#44; validation and feasibility of indicators in Nephrology&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara">&#160;</p><li>It is possible to obtain and develop&#44; by consensus&#44; a methodological proposal for the evaluation and improvement of healthcare quality in Nephrology&#44; given the high participation of experts&#44; their degree of involvement and the high number of agreements obtained on indicators of results and resources for healthcare quality&#46;</li><li>Surveys for specialists to identify the best departments may be useful to provide expert opinion advice based on the pooled opinion of different specialists&#44; thus decreasing the potential subjectivity of advice given by any individual specialist&#46; In this regard&#44; it is currently difficult for most patients to access valid expert opinion medical advice&#46;</li><li>The conceptual association that the experts established between the image&#47;prestige of a department and its healthcare quality makes us conclude that the complementary inclusion of these surveys in healthcare quality assessment models could be useful&#46;</li><li>The &#8220;construction&#8221; by specialists of a model that includes indicators of healthcare quality and expert opinion medical advice providing clear&#44; fast and direct information about the best Nephrology departments leads us to the conclusion that the integration model proposed may provide citizens with guidance that may facilitate free choice&#46;</li><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">ACKNOWLEDGEMENTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We would like to thank Marta Garc&#237;a&#44; Mercedes Guerra&#44; Caroline Hall&#44; Luis Miguel Molinero and Ricard Rosique for their important work in the different parts of this study&#46; AO belongs to the ISCIII RETIC REDINREN RD012&#47;0021 ERDF funds and has intensified the research activity of the ISCIII&#46;</p><p class="elsevierStylePara">We are also deeply grateful to the <span class="elsevierStyleBold">S&#46;E&#46;N&#46;</span> for the scientific support granted to this project and to the nephrologists who took part of the expert panel for their generous participation in the study &#40;Appendix 3&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46; The study was fully financed by the Institute of Health Research of the Jim&#233;nez D&#237;az Foundation &#40;IIS-FJD&#41;&#46; The responsibility for the contents of this article corresponds exclusively to its authors&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56456&#95;en&#95;t1i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56456_en_t1i2.jpg" alt="Agreements on criteria&#47;indicators for the assessment of healthcare quality&#46;"></img></a></p><p class="elsevierStylePara">Table 1&#46; Agreements on criteria&#47;indicators for the assessment of healthcare quality&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56457&#95;en&#95;t2i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56457_en_t2i2.jpg" alt="Weighting of criteria&#47;indicators for the assessment of healthcare quality&#46;"></img></a></p><p class="elsevierStylePara">Table 2&#46; Weighting of criteria&#47;indicators for the assessment of healthcare quality&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56458&#95;en&#95;t3i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56458_en_t3i2.jpg" alt="Resources that could contribute to improving the quality of healthcare&#46; Structural resources&#46;"></img></a></p><p class="elsevierStylePara">Table 3&#46; Resources that could contribute to improving the quality of healthcare&#46; Structural resources&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56459&#95;en&#95;t4i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56459_en_t4i2.jpg" alt="Resources that could contribute to improving the quality of healthcare&#46; Human resources&#46;"></img></a></p><p class="elsevierStylePara">Table 4&#46; Resources that could contribute to improving the quality of healthcare&#46; Human resources&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56460&#95;en&#95;t5i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56460_en_t5i2.jpg" alt="Resources that could contribute to improving the quality of healthcare&#46; Organisational resources&#46;"></img></a></p><p class="elsevierStylePara">Table 5&#46; Resources that could contribute to improving the quality of healthcare&#46; Organisational resources&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56461&#95;en&#95;4&#46;12286&#95;03itablas&#95;pgina&#95;06&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56461_en_4.12286_03itablas_pgina_06.gif" alt="Weighting of resource groups for improving the quality of healthcare&#46;"></img></a></p><p class="elsevierStylePara">Table 6&#46; Weighting of resource groups for improving the quality of healthcare&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56463&#95;en&#95;4&#46;12286&#95;03itablas&#95;pgina&#95;07&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56463_en_4.12286_03itablas_pgina_07.gif" alt="Medical advice&#46; Opinion on the specialist&#191;s ability to give guidance to patients who require treatment for certain nephrological diseases"></img></a></p><p class="elsevierStylePara">Table 7&#46; Medical advice&#46; Opinion on the specialist&#191;s ability to give guidance to patients who require treatment for certain nephrological diseases</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56464&#95;en&#95;addemdum&#46;pdf1&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56464_en_addemdum.pdf1.jpg" alt="Healthcare quality results&#58; proposals on Nephrology criteria&#47;indicators&#46;"></img></a></p><p class="elsevierStylePara">Healthcare quality results&#58; proposals on Nephrology criteria&#47;indicators&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56465&#95;en&#95;addemdum&#95;2&#46;pdf1&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56465_en_addemdum_2.pdf1.jpg" alt="Resources that could contribute to improving the quality of healthcare&#46;"></img></a></p><p class="elsevierStylePara">Resources that could contribute to improving the quality of healthcare&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12286&#95;16025&#95;56466&#95;en&#95;addemdum&#95;3&#46;jpg" class="elsevierStyleCrossRefs"><img src="12286_16025_56466_en_addemdum_3.jpg" alt="Expert panel of the Nephrology Delphi Study &#40;in alphabetical order&#41;"></img></a></p><p class="elsevierStylePara">Expert panel of the Nephrology Delphi Study &#40;in alphabetical order&#41;</p>"
    "pdfFichero" => "P1-E567-S4547-A12286-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:6 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438543"
          "palabras" => array:1 [
            0 => "T&#233;cnica Delphi"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438545"
          "palabras" => array:1 [
            0 => "Nefrolog&#237;a"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438547"
          "palabras" => array:1 [
            0 => "Indicadores de calidad de la atenci&#243;n de la salud"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438549"
          "palabras" => array:1 [
            0 => "Consenso"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438551"
          "palabras" => array:1 [
            0 => "Atenci&#243;n hospitalaria"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438553"
          "palabras" => array:1 [
            0 => "Calidad&#44; acceso y evaluaci&#243;n de la atenci&#243;n de la salud"
          ]
        ]
      ]
      "en" => array:6 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438544"
          "palabras" => array:1 [
            0 => "Delphi technique"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438546"
          "palabras" => array:1 [
            0 => "Nephrology"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438548"
          "palabras" => array:1 [
            0 => "Healthcare quality indicators"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438550"
          "palabras" => array:1 [
            0 => "Consensus"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438552"
          "palabras" => array:1 [
            0 => "Hospital care"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438554"
          "palabras" => array:1 [
            0 => "Quality&#44; access and assessment of healthcare"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58;</span> La libre elecci&#243;n no es f&#225;cil cuando se carece de informaci&#243;n adecuada&#46; Para ello son necesarios m&#233;todos de evaluaci&#243;n de la calidad asistencial que ofrezcan al paciente una informaci&#243;n integral y comprensible de los servicios hospitalarios&#46; <span class="elsevierStyleBold">Objetivos&#58;</span> Definir una propuesta metodol&#243;gica para evaluar la calidad asistencial de los servicios hospitalarios&#44; cuyos resultados sirvan para ofrecer una informaci&#243;n &#250;til al ciudadano&#46; La propuesta debe fundamentarse en el consenso y en la experiencia de los especialistas m&#233;dicos y definir complementariamente v&#237;as de mejora&#46; <span class="elsevierStyleBold">M&#233;todos&#58; </span>Estudio Delphi sobre calidad asistencial en Nefrolog&#237;a&#44; estructurado en tres apartados&#58; evaluaci&#243;n de resultados&#44; medios necesarios para la calidad&#44; e importancia del consejo m&#233;dico y de la encuesta a especialistas&#46; El cuestionario fue cumplimentado por un panel formado por 32 nefr&#243;logos&#46; <span class="elsevierStyleBold">Resultados&#58;</span> Los nefr&#243;logos aceptaron 55&#47;62 &#40;89&#160;&#37;&#41; de los criterios de resultados en calidad asistencial&#46; Tambi&#233;n aceptaron 87&#47;92 &#40;95&#160;&#37;&#41; de los medios propuestos para la calidad asistencial&#46; El 81&#160;&#37; de los nefr&#243;logos consider&#243; de actualidad el consejo m&#233;dico de un especialista a un paciente acerca del servicio donde podr&#237;an tratar mejor su enfermedad&#46; Un 86&#160;&#37; crey&#243; oportuno incluir encuestas sobre consejo m&#233;dico como criterio adicional en la evaluaci&#243;n de la calidad asistencial&#46; <span class="elsevierStyleBold">Conclusiones&#58; </span>Es posible<span class="elsevierStyleBold"> </span>obtener una propuesta metodol&#243;gica consensuada para la evaluaci&#243;n y mejora de la calidad asistencial que incluya resultados de calidad asistencial&#44; medios para la calidad asistencial y el consejo m&#233;dico derivado de encuestas a especialistas para identificar los mejores servicios&#46; Este m&#233;todo podr&#237;a facilitar una orientaci&#243;n fiable y comprensible para el ciudadano&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58; </span>Free choice is not easy when there is a lack of information&#46; Methods for evaluating quality of care to provide patients with comprehensive and understandable information on hospital departments are therefore necessary&#46;<span class="elsevierStyleBold"> Objectives&#58; </span>To draft a methodological proposal for evaluating quality of care of hospital departments&#44; the data of which can provide citizens with useful care quality information&#46; The proposal should be based on consensus and on the experience of medical specialists&#44; defining thus complementary paths to improvement&#46; <span class="elsevierStyleBold">Methods&#58; </span>A Delphi study on the quality of care in Nephrology&#44; comprising three phases&#58; assessment results&#44; necessary means for quality&#44; and importance of medical advice and surveys among specialists&#46; The questionnaire was administered to a panel of 32 nephrologists&#46; <span class="elsevierStyleBold">Results&#58; </span>The nephrologists accepted the outcome criteria on quality of care 55&#47;62 &#40;89&#37;&#41;&#44; as well as the proposed means for quality of care 87&#47;92 &#40;95&#37;&#41;&#46; 81&#37; of the nephrologists reported the validity and topicality of providing patients with specialist advice as to the most adequate department to better treat their kidney diseases&#46; 86&#37; of the panellists deemed appropriate to include surveys on medical advice as additional criteria for the evaluation of quality of care&#46; <span class="elsevierStyleBold">Conclusions&#58; </span>It is possible to obtain a consensus-based methodological proposal for the evaluation and improvement of quality of care which includes results on quality of care&#44; means for quality of care&#44; and medical advice based on surveys carried out among specialists to identify the best Nephrology departments&#46; This method could provide reliable and understandable guidance for citizens&#46;</p>"
      ]
    ]
    "multimedia" => array:10 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56456_en_t1i2.jpg"
            "Alto" => 1053
            "Ancho" => 2174
            "Tamanyo" => 1556889
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Agreements on criteria&#47;indicators for the assessment of healthcare quality&#46;"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56457_en_t2i2.jpg"
            "Alto" => 921
            "Ancho" => 2178
            "Tamanyo" => 1416640
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Weighting of criteria&#47;indicators for the assessment of healthcare quality&#46;"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig3"
        "etiqueta" => "Tab.  3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56458_en_t3i2.jpg"
            "Alto" => 1563
            "Ancho" => 2170
            "Tamanyo" => 2137840
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Resources that could contribute to improving the quality of healthcare&#46; Structural resources&#46;"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Tab.  4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56459_en_t4i2.jpg"
            "Alto" => 599
            "Ancho" => 2196
            "Tamanyo" => 1136295
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Resources that could contribute to improving the quality of healthcare&#46; Human resources&#46;"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig5"
        "etiqueta" => "Tab.  5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56460_en_t5i2.jpg"
            "Alto" => 993
            "Ancho" => 2173
            "Tamanyo" => 1499591
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Resources that could contribute to improving the quality of healthcare&#46; Organisational resources&#46;"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tablaImagen" => array:1 [
                0 => array:4 [
                  "imagenFichero" => "12286_16025_56461_en_4.12286_03itablas_pgina_06.jpg"
                  "imagenAlto" => 759
                  "imagenAncho" => 1443
                  "imagenTamanyo" => 289339
                ]
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Weighting of resource groups for improving the quality of healthcare&#46;"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tablaImagen" => array:1 [
                0 => array:4 [
                  "imagenFichero" => "12286_16025_56463_en_4.12286_03itablas_pgina_07.jpg"
                  "imagenAlto" => 890
                  "imagenAncho" => 1443
                  "imagenTamanyo" => 352048
                ]
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Medical advice&#46; Opinion on the specialist&#191;s ability to give guidance to patients who require treatment for certain nephrological diseases"
        ]
      ]
      7 => array:8 [
        "identificador" => "fig6"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56464_en_addemdum.pdf1.jpg"
            "Alto" => 4797
            "Ancho" => 2178
            "Tamanyo" => 2042220
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Healthcare quality results&#58; proposals on Nephrology criteria&#47;indicators&#46;"
        ]
      ]
      8 => array:8 [
        "identificador" => "fig7"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56465_en_addemdum_2.pdf1.jpg"
            "Alto" => 7948
            "Ancho" => 2165
            "Tamanyo" => 4607524
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Resources that could contribute to improving the quality of healthcare&#46;"
        ]
      ]
      9 => array:8 [
        "identificador" => "fig8"
        "etiqueta" => "Fig. 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12286_16025_56466_en_addemdum_3.jpg"
            "Alto" => 1730
            "Ancho" => 2169
            "Tamanyo" => 1297077
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Expert panel of the Nephrology Delphi Study &#40;in alphabetical order&#41;"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ley 41/2002 de 14 de noviembre, básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica. BOE núm. 274 de 15 de noviembre de 2002."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "The Joint Commission International. Acreditación para hospitales. Available at: http://es.jointcommissioninternational.org/enes/Programs-Hospitals/ (Accessed: 21-07-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "ISO International Standards. Available at: http://www.iso.org/iso/home/standards.htm (Accessed: 2-11-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Asociación Española de Normalización y Certificación. Gestión de la Sanidad. Available at: http://www.aenor.es/aenor/certificacion/sectores/sanidad.asp (Accessed: 2-11-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Modelo de excelencia de la European Foundation for Quality Management. Available at: http://www.efqm.org/en/tabid/392/default.aspx (Accessed: 21-07-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Simón R, Guix J, Nualart L, Surroca RM, Carbonell JM. Utilización de modelos como herramienta de diagnóstico y mejora de la calidad: EFQM y Joint Commission. Rev Calidad Asistencial 2001;16:308-12."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966;44:166-203."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Real Decreto 1093/2010, de 3 de septiembre, por el que se aprueba el conjunto mínimo de datos de los informes clínicos en el Sistema Nacional de Salud."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yetano-Laguna J, López-Arbeloa G, Guajardo-Remacha J, Barriola-Lerchundi MT, García-Urbaneja M, Ladrón de Guevara JM. Trescientos indicadores de calidad hospitalarios automáticos a partir del Conjunto Mínimo de Datos Básicos. Rev Calidad Asistencial 2006;21(4):207-12."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Quality Indicators. Agency for Healthcare Research and Quality. Available at: http://www.qualityindicators.ahrq.gov (Accessed: 24-11-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Organisation for Economic Co-operation and Development. Health Care Quality Indicators. Available at: http://www.oecd.org/health/health-systems/healthcarequalityindicators.htm (Accessed: 24-11-2011)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Indicadores de calidad para Hospitales del Sistema Nacional de Salud. Marzo 2012. Sociedad Española Calidad Asistencial. ISBN: 13978-84-695-0740-7."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ministerio de Sanidad, Política Social e Igualdad. Indicadores y Ejes de Análisis del CMBD. Aplicación para el análisis y explotación del registro de altas hospitalarias. Available at: http://icmbd.es (Accessed: 10-01-2012)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Comunidad de Madrid. Consejería de Sanidad. Servicio Madrileño de Salud. Libre elección sanitaria. Indicadores de Atención Especializada (hospitales). Available at: http://www.libreeleccion.sanidadmadrid.org/Indicadores/AtencionEspecializada.aspx (Accessed: 13-01-2012)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Junta de Andalucía. Información sobre actividad y calidad de los hospitales. Indicadores para atención especializada: hospitales. Datos a 1 de Enero de 2009. Available at: http://mago.easp.es/hospitales2004/AtencionEspecializada.aspx?Periodo=2008 (Accessed: 13-01-2012)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Donabedian A. Criteria and standards for quality assessment and monitoring. QRB Qual Rev Bull 1986;12:99-108. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3085044" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Committee on Quality of Health Care in America. Washington, D.C.: National Academy Press; 2001."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Maloney MC, Trussell RE, Elinson J. Physicians choose medical care: A sociometric approach to quality appraisal. Am J Public Health Nations Health 1960;50:1678-86. <a href="http://www.ncbi.nlm.nih.gov/pubmed/13765925" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Braun BB. Delphi Process. A methodology used for the elicitation of opinions of experts. The RAND Corporation; 1968."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Jones J, Hunter D. Consensus methods for medical and health services research. BMJ 1995;311:376-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7640549" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fink A, Kosecoff J, Chassin M, Brook RH. Consensus methods: characteristics and guidelines for use. Am J Public Health 1984;74(9):979-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6380323" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hearnshaw HM, Harker RM, Cheater FM, Baker RH, Grimshaw GM. Expert consensus on the desirable characteristics of review criteria for improvement of health care quality. Qual Health Care 2001;10:173-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11533425" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Salvat Plana M, Abilleira S, Jiménez C, Marta J, Gallofré M. Priorización de indicadores de calidad de la atención al paciente con ictus a partir de un método de consenso. Rev Calid Asist 2011;26(3):174-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21458345" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sociedad Española de Nefrología. El libro blanco de la nefrología española (I). Nefrologia 2000;20(2):109-29."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sociedad Española de Nefrología. El libro blanco de la nefrología española (II). Nefrologia 2000;20(3):214-33."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sociedad Española de Nefrología. El libro blanco de la nefrología española (III). Nefrologia 2000;20(5):396-402."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Alcázar JM, Arenas MD, Álvarez-Ude F, Virto R, Rubio E, Maduell F, et al. Resultados del proyecto de mejora de la calidad de la asistencia en hemodiálisis: estudio multicéntrico de indicadores de calidad de la Sociedad Española de Nefrología (SEN). Nefrologia 2008;28(6):597-606. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19016632" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Santiñá M, Arrizabalaga P, Prat A, Alcaraz A, Campistol JM, Trilla A. Instituto de gestión clínica para las enfermedades nefrourológicas: utilidad de un programa de calidad asistencial. Nefrologia 2009;29(2):118-22. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19396316" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Castellano Cerviño I, Gallego Domínguez S, Gad N, Suárez Santisteban MA, Gómez-Martino Arroyo JR, Martín Mejías I, et al. Resultados de la aplicación del plan de calidad científico-técnica y de mejora continua de calidad en diálisis peritoneal. Nefrologia 2009;29(3):256-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19554060" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Portolés J, Ocaña J, López-Sánchez P, Gómez M, Rivera MT, del Peso G, et al.; Grupo Centro de Diálisis Peritoneal. Cumplimiento de objetivos de calidad y evolución de los pacientes incidentes en diálisis peritoneal. Nefrologia 2010;30(5):544-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20882093" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "López-Revuelta K, Barril G, Caramelo C, Delgado R, García-López F, García-Valdecasas J, et al. Desarrollo de un sistema de monitorización clínica para hemodiálisis: propuesta de indicadores del Grupo de Gestión de Calidad de la SEN. Nefrologia 2007;27(5):542-59. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18045030" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ballestero Zarraga JJ. Excelencia en Nefrología. Alcobendas: Mensor Consultoría y Estrategia; 2011."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Almansa C, Rey E, Bolaños E, Palma M, Álvarez-Sánchez A, Díaz-Rubio M. Opinión de los médicos españoles sobre el síndrome de intestino irritable: Resultados de un estudio utilizando el método Delphi. Rev Esp Enferm Dig 2007;99(4):210-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17590103" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gómez-Moreno N, Orozco-Beltrán, Carratalá-Munuera C, Gil-Guillén V. Evolución de la relación entre atención primaria y especializada 1992-2001: estudio Delphi 2001. Aten Primaria 2006;37(4):195-202. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16545263" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003400000002/v0_201502091616/X2013251414053818/v0_201502091616/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35441"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Originals"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003400000002/v0_201502091616/X2013251414053818/v0_201502091616/en/P1-E567-S4547-A12286-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053818?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 7 11 18
2024 October 59 74 133
2024 September 76 53 129
2024 August 72 102 174
2024 July 52 34 86
2024 June 59 52 111
2024 May 56 35 91
2024 April 57 39 96
2024 March 50 28 78
2024 February 42 294 336
2024 January 67 26 93
2023 December 53 31 84
2023 November 75 41 116
2023 October 40 42 82
2023 September 40 48 88
2023 August 40 40 80
2023 July 47 51 98
2023 June 41 42 83
2023 May 87 52 139
2023 April 28 26 54
2023 March 95 25 120
2023 February 69 23 92
2023 January 30 28 58
2022 December 97 48 145
2022 November 78 43 121
2022 October 68 68 136
2022 September 53 46 99
2022 August 74 63 137
2022 July 61 59 120
2022 June 59 42 101
2022 May 42 40 82
2022 April 44 59 103
2022 March 52 66 118
2022 February 24 53 77
2022 January 54 52 106
2021 December 68 57 125
2021 November 40 50 90
2021 October 53 43 96
2021 September 35 51 86
2021 August 36 37 73
2021 July 49 35 84
2021 June 51 32 83
2021 May 46 38 84
2021 April 82 78 160
2021 March 67 42 109
2021 February 56 34 90
2021 January 54 20 74
2020 December 62 19 81
2020 November 48 20 68
2020 October 46 25 71
2020 September 37 19 56
2020 August 54 14 68
2020 July 60 18 78
2020 June 54 29 83
2020 May 78 47 125
2020 April 78 25 103
2020 March 62 12 74
2020 February 56 21 77
2020 January 77 23 100
2019 December 90 26 116
2019 November 118 24 142
2019 October 68 15 83
2019 September 105 28 133
2019 August 64 11 75
2019 July 82 25 107
2019 June 115 20 135
2019 May 100 27 127
2019 April 157 75 232
2019 March 102 42 144
2019 February 75 25 100
2019 January 73 42 115
2018 December 183 67 250
2018 November 226 36 262
2018 October 222 21 243
2018 September 292 29 321
2018 August 169 26 195
2018 July 173 21 194
2018 June 131 21 152
2018 May 203 18 221
2018 April 132 13 145
2018 March 119 9 128
2018 February 104 12 116
2018 January 97 14 111
2017 December 133 13 146
2017 November 85 19 104
2017 October 73 12 85
2017 September 96 21 117
2017 August 99 53 152
2017 July 120 28 148
2017 June 152 35 187
2017 May 216 25 241
2017 April 108 36 144
2017 March 112 19 131
2017 February 178 19 197
2017 January 63 18 81
2016 December 121 11 132
2016 November 148 13 161
2016 October 213 17 230
2016 September 344 6 350
2016 August 478 14 492
2016 July 285 8 293
2016 June 173 0 173
2016 May 178 0 178
2016 April 190 0 190
2016 March 143 0 143
2016 February 158 0 158
2016 January 156 0 156
2015 December 164 0 164
2015 November 126 0 126
2015 October 120 0 120
2015 September 118 0 118
2015 August 105 0 105
2015 July 120 0 120
2015 June 60 0 60
2015 May 63 0 63
2015 April 15 0 15
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?