<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0213-9111</journal-id>
<journal-title><![CDATA[Gaceta Sanitaria]]></journal-title>
<abbrev-journal-title><![CDATA[Gac Sanit]]></abbrev-journal-title>
<issn>0213-9111</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS)]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0213-91112024000100500</article-id>
<article-id pub-id-type="doi">10.1016/j.gaceta.2024.102428</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Implantación de una estrategia para gestionar la multifrecuentación de urgencias hospitalarias en una zona de Barcelona]]></article-title>
<article-title xml:lang="en"><![CDATA[Implementing a strategy to manage frequent emergency room visits in a district of Barcelona]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Giménez]]></surname>
<given-names><![CDATA[Emmanuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Abadías]]></surname>
<given-names><![CDATA[María José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[San-José]]></surname>
<given-names><![CDATA[Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Losada]]></surname>
<given-names><![CDATA[Marta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Acezat]]></surname>
<given-names><![CDATA[Jordi]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ibáñez]]></surname>
<given-names><![CDATA[Jordi]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marte]]></surname>
<given-names><![CDATA[Luis]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Barrecheguren]]></surname>
<given-names><![CDATA[Miriam]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Belén Méndez]]></surname>
<given-names><![CDATA[Ana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aguayo-Álvarez]]></surname>
<given-names><![CDATA[Marta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Arranz]]></surname>
<given-names><![CDATA[María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ramos]]></surname>
<given-names><![CDATA[Rosa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Universitari Vall d&#8217;Hebron Vall d&#8217;Hebron Institut de Recerca Grup de Recerca en Serveis Sanitaris]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Universitari Vall d&#8217;Hebron Sistemas de Información y Apoyo a la Decisión ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital Universitari Vall d&#8217;Hebron Servicio de Medicina Interna ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Hospital Universitari Vall d&#8217;Hebron Servicio de Geriatría Área de Conocimiento de Alternativas a la Hospitalización]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Institut Català de la Salut Equipo de Atención Primaria de Casernes ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Hospital San Rafael Departamento Asistencial Hospital de Día, Medicina Interna]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af7">
<institution><![CDATA[,Hospital Universitari Vall d&#8217;Hebron Servicio de Neumología ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af8">
<institution><![CDATA[,Hospital Universitari Vall d&#8217;Hebron Servicio de Cardiología ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af9">
<institution><![CDATA[,Vall d&#8217;Hebron Institut de Recerca Departamento de Calidad, Procesos e Innovación ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="A10">
<institution><![CDATA[,Hospital Universitari Vall d&#8217;Hebron Servicio de Urgencias ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<volume>38</volume>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S0213-91112024000100500&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S0213-91112024000100500&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S0213-91112024000100500&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN Las visitas de pacientes con multimorbilidad, cronicidad compleja y fragilidad a los servicios de urgencias hospitalarios son un desafío creciente. Se presenta una estrategia local, basada en listados de preselección automatizada, una enfermera gestora de casos con experiencia específica y un consenso de derivación multinivel. Se muestra la factibilidad con 368 alertas identificadas, el 85% (n=315) bien seleccionadas. La edad, la fragilidad, el porcentaje de atención domiciliaria, el índice de Barthel y la cognición fueron consistentes con los niveles de atención/derivación (primaria, intermedia y especializada) según criterios previamente consensuados. Con la generalización actual de los sistemas de información y análisis de datos, el rol creciente de enfermería avanzada y unos recursos sanitarios bien estructurados entre niveles, una selección automatizada, junto al consenso en circuitos y perfiles clínicos y la valoración autónoma de enfermería gestionando casos multifrecuentadores, podría mejorar, de forma proactiva y sencilla, una distribución entre niveles de las alertas más coherente con las necesidades sociosanitarias.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Visits to hospital emergency departments by patients with multimorbidity, complex chronic conditions, and frailty are becoming an increasing challenge. A territorial strategy has been developed, based on automated preselection lists, a nurse case manager with specialized experience, and a multi-level territorial referral consensus. The feasibility of this approach has been demonstrated, with 368 alerts detected, 85% of which were well-selected. Age, frailty, home care percentage, Barthel index, and cognition were progressively aligned with levels of care/referral (primary, intermediate, and specialized) according to previously agreed criteria. In 2024, there is extensive structured technical information, an expanding role for advanced nursing, and well-established inter-level service resources. Therefore, through automated selection, a consensual territorial protocol of pathways and clinical profiles, and autonomous nursing assessments managing multi-frequent cases, it would be possible to achieve, in a proactive, simple, and scalable manner, an appropriate distribution of alerts across levels, consistent with the social and healthcare needs of the patients.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Visitas frecuentes a urgencias]]></kwd>
<kwd lng="es"><![CDATA[Paciente crónico complejo]]></kwd>
<kwd lng="es"><![CDATA[Listados automatizados]]></kwd>
<kwd lng="es"><![CDATA[Coordinación asistencial]]></kwd>
<kwd lng="es"><![CDATA[Resultados en salud]]></kwd>
<kwd lng="en"><![CDATA[Multiple emergency department visit]]></kwd>
<kwd lng="en"><![CDATA[Chronic complex patient]]></kwd>
<kwd lng="en"><![CDATA[Automated lists]]></kwd>
<kwd lng="en"><![CDATA[Care coordination]]></kwd>
<kwd lng="en"><![CDATA[Health outcomes]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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