Carles Blay - Academia.edu (original) (raw)
Papers by Carles Blay
TDX (Tesis Doctorals en Xarxa), Apr 28, 2017
Xavier Gómez-Batiste i Joan Carles Martori, els seus directors, els quals han estat permanentment... more Xavier Gómez-Batiste i Joan Carles Martori, els seus directors, els quals han estat permanentment donant-me llum i suport. Esther Limón, motor important del projecte que, juntament amb Alberto Meléndez, han fet de revisors externs i han aportat el seu talent i les seves valuoses contribucions.
International Journal of Integrated Care, Oct 23, 2018
International Journal of Integrated Care, 2016
Providing integrated care to persons with severe intellectual disabilities living in a residentia... more Providing integrated care to persons with severe intellectual disabilities living in a residential facility .
International Journal of Integrated Care, 2016
Comparing complex chronic patients to advanced chronic patients with palliative care needs: cross... more Comparing complex chronic patients to advanced chronic patients with palliative care needs: cross-sectional study 16
FMC - Formación Médica Continuada en Atención Primaria, 1997
Palliative Medicine, Jan 8, 2014
Background: Of deaths in high-income countries, 75% are caused by progressive advanced chronic co... more Background: Of deaths in high-income countries, 75% are caused by progressive advanced chronic conditions. Palliative care needs to be extended from terminal cancer to these patients. However, direct measurement of the prevalence of people in need of palliative care in the population has not been attempted. Aim: Determine, by direct measurement, the prevalence of people in need of palliative care among advanced chronically ill patients in a whole geographic population. Design: Cross-sectional, population-based study. Main outcome measure: prevalence of advanced chronically ill patients in need of palliative care according to the NECPAL CCOMS-ICO© tool. NECPAL+ patients were considered as in need of palliative care. Setting/participants: County of Osona, Catalonia, Spain (156,807 inhabitants, 21.4% > 65 years). Three randomly selected primary care centres (51,595 inhabitants, 32.9% of County’s population) and one district general hospital, one social-health centre and four nursing homes serving the patients. Subjects were all patients attending participating settings between November 2010 and October 2011. Results: A total of 785 patients (1.5% of study population) were NECPAL+: mean age = 81.4 years; 61.4% female. Main disease/ condition: 31.3% advanced frailty, 23.4% dementia, 12.9% cancer (ratio of cancer/non-cancer = 1/7), 66.8% living at home and 19.7% in nursing home; only 15.5% previously identified as requiring palliative care; general clinical indicators of severity and progression present in 94% of cases. Conclusions: Direct measurement of prevalence of palliative care needs on a population basis is feasible. Early identification and prevalence determination of these patients is likely to be the cornerstone of palliative care public health policies
International Journal of Integrated Care, Dec 16, 2016
The case conference as a tool to improve shared care and to focus on personalized care 16
BMJ supportive & palliative care, Sep 1, 2015
Background Care models for advanced chronic patients present two key aspects: early identificatio... more Background Care models for advanced chronic patients present two key aspects: early identification and advanced care planning (ACP). In 2014, Catalonia arranged the ACP Model (ACPM), addressed to chronic patient’s complex needs, into a public health-social system (HSS). Aims Describe the implementation process (IP) of an ACPM. Methods A core group of professionals (n = 55) was convened to develop the ACPM with the co-participation of patients, caregivers, social agents and healthy persons. Inclusion criteria included: solid professional trajectory, equal representation as for territory and professional profile, Four work levels were defined: conceptual document (CD) and implementation guide (IG) elaboration; training program (ITP) development; building-up of patients, professionals and healthy persons discussion groups (DG). The CD and IG were written with the agreement of expert professionals in legislation, ethics, medical specialities, nursing, anthropology, social work and psychology. The ITP is being created, as a key aspect of the IP. Results CD and IG have been published. Simultaneously, DGs are established so as to make the CD a work product of high quality. The ITP is currently being developed, based on CD and IG contents. These documents have been reviewed by around 100 professionals from the Catalan HSS. The ITP contents focus on communication skills; legal and ethical aspects; patient and family needs. Discussion ACP is a challenge for the model of care towards advanced chronic patients. Conclusion The ACPM establishes the conceptual and need for systematic ACP implementation and promotes the training of the professionals daily taking care of such type of patients.
International Journal of Integrated Care, 2016
International Journal of Integrated Care, 2016
BMJ Supportive & Palliative Care, 2015
Background Patients living in our nursing home facility suffer from severe intellectual disabilit... more Background Patients living in our nursing home facility suffer from severe intellectual disabilities (SID), need a widespread support, have total legal incapacitation and their health status is characterised by progressive ageing and high complexity needs. So end-of-life related decisions are a common concern in a context where there’s a lack of evidence about advance care planning (ACP). Aim Develop and implement a fair and systematic ACP process to promote best practices in SID population. Methods After reviewing the literature, a multidisciplinary team (manager, senior nurse, social worker and family physicians) developed a structured consensus based on formal national ACP recommendations and subsequently validated by external experts. The resulting procedure describes best practices in interpersonal communication strategies, professional roles and ACP contents to be discussed between legal patient representatives and professional team. Results Since November 2013, ACP has been launched in 20% of patients living in our centre, prioritising those with advanced conditions and limited life prognosis. All directives are placed in their electronic clinical charts as well in national health information platforms, accessible to all Catalonian health care settings. Systematic feedback from family surveys, centre and related health professionals is positive. Our ACP procedure is now the gold standard for SID centres in Catalonia. Discussion/conclusion ACP in persons having SID is feasible and useful for end-of-life decisions, and able to fit values, preferences and satisfaction of patient’s relatives and legal representatives, as well to promote better clinical decisions.
Palliative Medicine, Nov 4, 2016
The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO(©... more The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO(©) (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown. To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality. Longitudinal, prospective and observational cohort study. Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months. Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ-) and 45.8% (NECPAL+) versus 18.3% (NECPAL-) (p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7-94.1 and 87.5, CI: 84.3-90.7) with high negative predictive values (84.2, CI: 79.4-89.0 and 81.7, CI: 77.2-86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL. SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.
International Journal of Integrated Care
Objective: Characterize subgroups of Complex Chronic Patients (CCPs) with cluster analysis from t... more Objective: Characterize subgroups of Complex Chronic Patients (CCPs) with cluster analysis from the general practitioner's perspective. Study design: Cross-sectional population-based study. Setting: Three Primary Care urban centres for a reference population of 43,647 inhabitants over 14 years old in Sabadell, Catalonia, Spain. Methods: Complexity is defined by the independent clinical judgment of general practitioners with the aid of complexity domains (both clinical and social). We used a Two-Step Cluster method to identify relevant subgroups of CCPs. Results: Three relevant subgroups were identified. The first one was mainly managed by primary care professionals, and 63% of its CCPs belonged to the high-risk stratum of the Adjusted Morbidity Groups (GMA). The second subgroup included younger patients than the other two clusters, and showed the highest ratios of social deprivation and severe mental disease; 48% of its CCPs belonged to the high-risk stratum of the GMA. A third cluster included patients who belonged to the high-risk stratum of the GMA. Their age was similar to that of the patients in the first cluster, but they showed the highest values in the following areas: (i) risk of admission; (ii) proportion of advanced chronic disease and limited-life prognosis; (iii) functional loss and (iv) geriatric syndromes, along with special uncertainty in decision-making and clinical management. Conclusions: Characterization of CCPs shows clearly distinct profiles of needs, which provides an improved epidemiological picture by identifying clusters of patients who are likely to benefit from targeted interventions.
FMC - Formación Médica Continuada en Atención Primaria, 2018
FMC - Formación Médica Continuada en Atención Primaria, 2019
TDX (Tesis Doctorals en Xarxa), Apr 28, 2017
Xavier Gómez-Batiste i Joan Carles Martori, els seus directors, els quals han estat permanentment... more Xavier Gómez-Batiste i Joan Carles Martori, els seus directors, els quals han estat permanentment donant-me llum i suport. Esther Limón, motor important del projecte que, juntament amb Alberto Meléndez, han fet de revisors externs i han aportat el seu talent i les seves valuoses contribucions.
International Journal of Integrated Care, Oct 23, 2018
International Journal of Integrated Care, 2016
Providing integrated care to persons with severe intellectual disabilities living in a residentia... more Providing integrated care to persons with severe intellectual disabilities living in a residential facility .
International Journal of Integrated Care, 2016
Comparing complex chronic patients to advanced chronic patients with palliative care needs: cross... more Comparing complex chronic patients to advanced chronic patients with palliative care needs: cross-sectional study 16
FMC - Formación Médica Continuada en Atención Primaria, 1997
Palliative Medicine, Jan 8, 2014
Background: Of deaths in high-income countries, 75% are caused by progressive advanced chronic co... more Background: Of deaths in high-income countries, 75% are caused by progressive advanced chronic conditions. Palliative care needs to be extended from terminal cancer to these patients. However, direct measurement of the prevalence of people in need of palliative care in the population has not been attempted. Aim: Determine, by direct measurement, the prevalence of people in need of palliative care among advanced chronically ill patients in a whole geographic population. Design: Cross-sectional, population-based study. Main outcome measure: prevalence of advanced chronically ill patients in need of palliative care according to the NECPAL CCOMS-ICO© tool. NECPAL+ patients were considered as in need of palliative care. Setting/participants: County of Osona, Catalonia, Spain (156,807 inhabitants, 21.4% > 65 years). Three randomly selected primary care centres (51,595 inhabitants, 32.9% of County’s population) and one district general hospital, one social-health centre and four nursing homes serving the patients. Subjects were all patients attending participating settings between November 2010 and October 2011. Results: A total of 785 patients (1.5% of study population) were NECPAL+: mean age = 81.4 years; 61.4% female. Main disease/ condition: 31.3% advanced frailty, 23.4% dementia, 12.9% cancer (ratio of cancer/non-cancer = 1/7), 66.8% living at home and 19.7% in nursing home; only 15.5% previously identified as requiring palliative care; general clinical indicators of severity and progression present in 94% of cases. Conclusions: Direct measurement of prevalence of palliative care needs on a population basis is feasible. Early identification and prevalence determination of these patients is likely to be the cornerstone of palliative care public health policies
International Journal of Integrated Care, Dec 16, 2016
The case conference as a tool to improve shared care and to focus on personalized care 16
BMJ supportive & palliative care, Sep 1, 2015
Background Care models for advanced chronic patients present two key aspects: early identificatio... more Background Care models for advanced chronic patients present two key aspects: early identification and advanced care planning (ACP). In 2014, Catalonia arranged the ACP Model (ACPM), addressed to chronic patient’s complex needs, into a public health-social system (HSS). Aims Describe the implementation process (IP) of an ACPM. Methods A core group of professionals (n = 55) was convened to develop the ACPM with the co-participation of patients, caregivers, social agents and healthy persons. Inclusion criteria included: solid professional trajectory, equal representation as for territory and professional profile, Four work levels were defined: conceptual document (CD) and implementation guide (IG) elaboration; training program (ITP) development; building-up of patients, professionals and healthy persons discussion groups (DG). The CD and IG were written with the agreement of expert professionals in legislation, ethics, medical specialities, nursing, anthropology, social work and psychology. The ITP is being created, as a key aspect of the IP. Results CD and IG have been published. Simultaneously, DGs are established so as to make the CD a work product of high quality. The ITP is currently being developed, based on CD and IG contents. These documents have been reviewed by around 100 professionals from the Catalan HSS. The ITP contents focus on communication skills; legal and ethical aspects; patient and family needs. Discussion ACP is a challenge for the model of care towards advanced chronic patients. Conclusion The ACPM establishes the conceptual and need for systematic ACP implementation and promotes the training of the professionals daily taking care of such type of patients.
International Journal of Integrated Care, 2016
International Journal of Integrated Care, 2016
BMJ Supportive & Palliative Care, 2015
Background Patients living in our nursing home facility suffer from severe intellectual disabilit... more Background Patients living in our nursing home facility suffer from severe intellectual disabilities (SID), need a widespread support, have total legal incapacitation and their health status is characterised by progressive ageing and high complexity needs. So end-of-life related decisions are a common concern in a context where there’s a lack of evidence about advance care planning (ACP). Aim Develop and implement a fair and systematic ACP process to promote best practices in SID population. Methods After reviewing the literature, a multidisciplinary team (manager, senior nurse, social worker and family physicians) developed a structured consensus based on formal national ACP recommendations and subsequently validated by external experts. The resulting procedure describes best practices in interpersonal communication strategies, professional roles and ACP contents to be discussed between legal patient representatives and professional team. Results Since November 2013, ACP has been launched in 20% of patients living in our centre, prioritising those with advanced conditions and limited life prognosis. All directives are placed in their electronic clinical charts as well in national health information platforms, accessible to all Catalonian health care settings. Systematic feedback from family surveys, centre and related health professionals is positive. Our ACP procedure is now the gold standard for SID centres in Catalonia. Discussion/conclusion ACP in persons having SID is feasible and useful for end-of-life decisions, and able to fit values, preferences and satisfaction of patient’s relatives and legal representatives, as well to promote better clinical decisions.
Palliative Medicine, Nov 4, 2016
The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO(©... more The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO(©) (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown. To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality. Longitudinal, prospective and observational cohort study. Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months. Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ-) and 45.8% (NECPAL+) versus 18.3% (NECPAL-) (p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7-94.1 and 87.5, CI: 84.3-90.7) with high negative predictive values (84.2, CI: 79.4-89.0 and 81.7, CI: 77.2-86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL. SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.
International Journal of Integrated Care
Objective: Characterize subgroups of Complex Chronic Patients (CCPs) with cluster analysis from t... more Objective: Characterize subgroups of Complex Chronic Patients (CCPs) with cluster analysis from the general practitioner's perspective. Study design: Cross-sectional population-based study. Setting: Three Primary Care urban centres for a reference population of 43,647 inhabitants over 14 years old in Sabadell, Catalonia, Spain. Methods: Complexity is defined by the independent clinical judgment of general practitioners with the aid of complexity domains (both clinical and social). We used a Two-Step Cluster method to identify relevant subgroups of CCPs. Results: Three relevant subgroups were identified. The first one was mainly managed by primary care professionals, and 63% of its CCPs belonged to the high-risk stratum of the Adjusted Morbidity Groups (GMA). The second subgroup included younger patients than the other two clusters, and showed the highest ratios of social deprivation and severe mental disease; 48% of its CCPs belonged to the high-risk stratum of the GMA. A third cluster included patients who belonged to the high-risk stratum of the GMA. Their age was similar to that of the patients in the first cluster, but they showed the highest values in the following areas: (i) risk of admission; (ii) proportion of advanced chronic disease and limited-life prognosis; (iii) functional loss and (iv) geriatric syndromes, along with special uncertainty in decision-making and clinical management. Conclusions: Characterization of CCPs shows clearly distinct profiles of needs, which provides an improved epidemiological picture by identifying clusters of patients who are likely to benefit from targeted interventions.
FMC - Formación Médica Continuada en Atención Primaria, 2018
FMC - Formación Médica Continuada en Atención Primaria, 2019