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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 1985, the World Health Organization defined quality as ensuring that each patient receives the most appropriate collection of diagnostic and therapeutic services to achieve optimal healthcare, considering all of the patient factors and knowledge and that of the medical service and achieving the best result with the minimum risk of iatrogenic effects and the maximum patient satisfaction with the process.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This definition covers the measures of quality described by Dr. Palmer<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a>: effectiveness, efficiency, accessibility, satisfaction, professional competence and appropriateness. Taking into account the stages of the “cycle of quality”, we should understand that this is what we perform based on compliance with indicators that, according to Donabedian, can be classified into indicators of structure, processes and results.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2–5</span></a> We can thereby detect those areas or activities needing improvement and improve things daily.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In collaboration with various scientific societies, the Spanish Institute for Improving Health Care (<span class="elsevierStyleItalic">Instituto para la Mejora de la Asistencia Sanitaria</span>, IMAS) has implemented the RECAL projects to analyze the relationship between resources and activity and health results in healthcare units. The projects analyze the minimum basic data set provided by the Ministry of Health (MBDS) and the data obtained through a survey directed at heads of internal medicine units (IMUs). Several specialties have participated in these strategies of quality since the first RECAL project in 2012 with the Spanish Society of Cardiology (RECALCAR). These include the gastrointestinal, oncology, pulmonology, endocrinology and, of course, internal medicine societies, whose directors have in recent years supported clinical management and the development of strategies in the search for quality.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The first RECALMIN report was prepared in 2015.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Although we already had some previous experience on the activity data of Spanish internal medicine,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> this study revealed more realistically the activities, available resources and results of the various IMUs in Spain. In 2017, the second RECALMIN study was published, which demonstrated the differences between 2007 and 2014.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The current issue of <span class="elsevierStyleSmallCaps">Revista Clínica Española</span> published the latest RECALMIN study, which compared the IMUs in 2013 and 2016. Although data on the indicators studied in the RECALMIN project have been distributed based on hospital size, we can say that, in general, the mean number of internists per unit is 14, that each internist conducts an average of 239 discharges annually and that the mean stay per discharge episode is 8 days. Sixty-one percent of IMUs implemented an interconsultation unit that dealt with an estimated 800 interconsultations annually, with a mean of 1.7 physicians dedicated to this activity. In terms of outpatient activity, the average number of first consultations was 2000, with a successive/first ratio of 3.6. RECALMIN also laid out lines that should be improved in the future. For example, only 41% of the units had implemented a systematic care program for complex chronic patients, with a population coverage of 56%. This is one of the future challenges of our specialty.</p><p id="par0030" class="elsevierStylePara elsevierViewall">When comparing these results with those of 2014, we see that the total number of discharges from internal medicine departments has increased 10.7% in these 4 years, the number of first consultations has increased 16%, the mean stay has decreased 10% (almost 1 day) despite a continuous increase in patient comorbidity; the mortality rate also remained stable. These data reinforce the increasingly essential role of this specialty.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We can see how the weight of internal medicine on all hospital activity is still highly relevant and increasing rapidly: the number of discharges by internal medicine represents 19% of all hospital discharges. The age of hospitalized patients has also increased; the median age has increased by 3 years, and the mean age is 77 years.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This improvement in some key indicators could reflect the importance of efforts directed toward understanding what we do so as to establish measures that improve these health results.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The question is whether all IMUs in Spain operate similarly. From what we have learned from RECALMIN, the answer is apparently no. There are significant differences in indicators as important as mortality; thus, the importance of this report, not only for the heads of IMUs but also for healthcare providers.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The RECALMIN study also created an indicator, the internal medicine weighted activity index (IMWAI), which compares the healthcare and scientific “production” of IMUs adjusted for the number of medical personnel, which also enables comparisons among departments and among hospitals of different sizes.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The study also detected a number of indicators that have barely improved from 2013 to 2016, such as the systematic healthcare programs for complex chronic patients, multidisciplinary rounds and early planning for discharges.</p><p id="par0060" class="elsevierStylePara elsevierViewall">It is important to understand the activity of IMUs and define their standards of organization and operation, as reflected in the document developed by SEMI and the IMAS foundation.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> One of this project's objectives helped start the accreditation process by SEMI, comparing the proposed standards and recommendations with the units’ indicators of quality and efficiency. This study concluded with the SEMI Excellent accreditation system with which SEMI proposed to contribute to the continuous improvement of healthcare quality, becoming a reality in 2018 with the accreditation of 17 IMUs. All these projects seek to offer greater quality in patient care.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although it has been a long process since the first study in 2009 by the Clinical Management Workgroup,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> the results have been outstanding. The circle of quality has been completed with an example of collective work that will surely result in better patient care. In future, we need to increase the participation of IMUs in surveys and convince them that measuring their activities will help improve them. SEMI also wants to extend this methodology to most specialized care units in various areas of training such as autoimmune diseases, cardiovascular risk, infectious diseases, thromboembolism disease, chronic and polypathological patients and rare diseases, to name a few, and thereby certify their quality, search for excellence and facilitate our residents’ training.</p><p id="par0070" class="elsevierStylePara elsevierViewall">I am convinced this will be achieved. As to the initial question, I hope everyone from now on will answer yes.</p></span>"
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