Browsing by Author "Suarez, Francisco"
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- ItemEconomic evaluation of a multimorbidity patient centered care model implemented in the Chilean public health system(2023) Zamorano Pichard, Paula Francisca; Espinoza Sepúlveda, Manuel Antonio; Varela, Teresita; Abbott, Tomás; Tellez, Alvaro; Armijo Escalona, Nicolás Andrés; Suarez, FranciscoMultimorbidity and patient-centered care approaches are growing challenges for health systems and patients. The cost of multimorbidity patients and the transition to a new care strategy is still sightly explored. In Chile, more than 70% of the adult population suffer from multimorbidity, opening an opportunity to implement a Multimorbidity patient-centered care model. The objective of this study was to perform an economic evaluation of the model from the public health system perspective. The methodology used a cost-consequence evaluation comparing seven exposed with seven unexposed primary care centers, and their reference hospitals. It followed three steps. First, we performed a Time-Driven Activity-Based Costing with routinely collected data routinely collected. Second, we run a comparative analysis through a propensity score matching and an estimation of the attributable costs to health services utilization at primary, secondary and tertiary care and health outcomes. Third, we estimated implementation and transaction costs. Results showed savings in aggregate costs of the total population (-0.12 (0.03) p?
- ItemEvaluation of a Transitional Care Strategy Implemented in Adults With High-Risk and Multimorbidity in Chile(2023) Varela, Teresita; Zamorano, Paula; Munoz, Paulina; Espinoza, Manuel; Tellez, Alvaro; Irazoqui, Esteban; Suarez, FranciscoObjectives: Fragmentation of continuity of care impacts the health system's efficiency and increases inequity. It severely affects high-risk patients with multimorbidity, requiring coordinated care to avoid preventable complications. The Centro de Fund, implemented a transitional care strategy for high-risk adults with multimorbidity at 3 hospitals in the southeast of Santiago. The study aimed to evaluate the impact on length of hospital stay, consultations with primary care physicians and contacts after discharge, and also to describe the implementation process of the transition nurse activities.Methods: A cohort study was performed between 2017 and 2019, with 137 hospitalizations from exposed patients and 167 hospitalizations from unexposed patients. The results of the study showed a significant decrease in the length of hospital stays and an increase in consultations with physicians.Results: The results of the implementation process showed that the transition nurse followed-up in a mean of 24 hospitalizations monthly, and 91% of the discharged patients were contacted via the telephone within 7 days. The implementation process showed that the transition nurse's tasks merged with the daily clinical activities in which training on case management, transition care, and continuous support were key aspects of success.Conclusion: We conclude that transitional care intervention has a strong potential in addressing fragmentation of care and is feasible to install and sustain over time in the Chilean context. Finally, this study provides a detailed description of the intervention strategy contributing to its spread and scale-up.
- ItemEvaporation Driven by Atmospheric Boundary Layer Processes over a Shallow Saltwater Lagoon in the Altiplano(2024) Aguirre-Correa, Francisca; De Arellano, Jordi Vila-Guerau; Ronda, Reinder; Lobos-Roco, Felipe; Suarez, Francisco; Hartogensis, OscarObservations over a saltwater lagoon in the Altiplano show that evaporation E is triggered at noon, concurrent to the transition of a shallow, stable atmospheric boundary layer (ABL) into a deep mixed layer. We investigate the coupling between the ABL and E drivers using a land-atmosphere conceptual model, observations, and a regional model. Additionally, we analyze the ABL interaction with the aerodynamic and radiative components of evaporation using the Penman equation adapted to saltwater. Our results demonstrate that nonlocal processes are dominant in driving E. In the morning, the ABL is controlled by the local advection of warm air (similar to 5 K h(-1)), which results in a shallow (<350 m), stable ABL, with virtually no mixing and no E (<50 W m(-2)). The warm-air advection ultimately connects the ABL with the residual layer above, increasing the ABL height h by similar to 1 km. At midday, a thermally driven regional flow arrives to the lagoon, which first advects a deeper ABL from the surrounding desert (similar to 1500 m h(-1)) that leads to an extra similar to 700-m h increase. The regional flow also causes an increase in wind (similar to 12 m s(-1)) and an ABL collapse due to the entrance of cold air (similar to-2 K h(-1)) with a shallower ABL (similar to-350 m h(-1)). The turbulence produced by the wind decreases the aerodynamic resistance and mixes the water body releasing the energy previously stored in the lake. The ABL feedback on E through vapor pressure enables high evaporation values (similar to 450 W m(-2) at 1430 LT). These results contribute to the understanding of E of water bodies in semiarid conditions and emphasize the importance of understanding ABL processes when describing evaporation drivers.
- ItemImpact evaluation of an interdisciplinary approach to patients with chronic non-cancer pain in Chilean primary care(2025) Zamorano, Paula; Varela Yuraszeck, Teresita Ines; Salvatierra Matzner, Isidora; Tellez, Álvaro; Espinoza Sepúlveda, Manuel Antonio; Torres Riveros, Gustavo Andrés; Rodríguez, Victoria; Figueroa, María José; Rodríguez, Alejandro; Figueroa, Denisse; Silva, Leonardo; Salazar, Sheila; Lucero, Víctor; Suarez, FranciscoIntroduction Chronic non-cancer pain affects one-third of the global population. In Chile, its prevalence is estimated at 34%, surpassing the prevalence of diabetes mellitus and hypertension. Its high costs reveal that clinical treatment causes the greatest economic impact, followed by days of work absenteeism. Objective This study aims to evaluate the impact on resource consumption, quality of life, and pain perception in patients with CNCP, an interdisciplinary approach implemented in Chilean primary care public health. Methods A concurrent cohort study was conducted with patients aged 25 to 64 with chronic non-cancer musculoskeletal pain. The population studied was 698 patients receiving primary health services in centers with similar size and territorial proximity. The clinical intervention introduced patient-centered care, psychotherapy and physiotherapy from the perspective of the neuroscience of pain. The impact analysis was conducted using negative binomial regression models, generalized linear models, and ordered logistic regressions. Results Results show that the patients who were intervened increased the number of physician consultations at primary care (IRR: 1.56; 95% CI 1.30–1.87) and increased medication consumption (coef 2.38; 95% CI 2.10–2.67) compared to control patients. Intervened patients improved their quality of life (COEF 0.14; 95% CI 0.09–0.19), and pain perception was statistically significant. Despite the health system’s structural, cultural, and organizational barriers, the intervention was implemented and consolidated in daily operation, providing learnings for a further scale-up. Conclusion The study demonstrates that an interdisciplinary approach to chronic non-cancer pain management in Chilean primary care improves quality of life and pain perception while increasing healthcare resource use. Despite system barriers, the intervention was successfully implemented and sustained within patient-centered care. These findings highlight the need for resource reallocation to ensure long-term sustainability and scalability through the public health system.
- ItemImpact of a high-risk multimorbidity integrated care implemented at the public health system in Chile(2022) Zamorano, Paula; Munoz, Paulina; Espinoza, Manuel; Tellez, Alvaro; Varela, Teresita; Suarez, Francisco; Fernandez, Maria JoseDuring recent years, multimorbidity has taken relevance because of the impact of causes in the system, people, and their families, which has been a priority in the health care plan. Interventions strategies and their implementation are still an emerging topic. In this context, Centro de Innovacion en Salud ANCORA UC, together with Servicio de Salud Metropolitano Sur Oriente, implemented as a pilot study High-Risk Multimorbidity Integrated Care strategy. This study aimed to evaluate the impact of this strategy in terms of health services utilization and mortality. A cohort study was conducted with high-risk patients with multimorbidity, stratified by ACG (R), intervened between April 2017 and December 2019. The studied population was 3,933 patients who belonged to similar size and location primary care centers. The impact analysis was performed used generalized linear models. Results showed that intervened patients had a significantly lower incidence in mortality (OR 0.56; 95% CI 0.40-0.77), hospital admissions, length of stay, and the number of hospital emergency consultancies. With the proper barriers and facilitators of a real context intervention, the implementation process allowed the systematization and consolidation of the intervention provided in this study. The training for new roles and the constant implementation support from the Centro de Innovacion en Salud ANCORA UC team were essential in the progress and success of the intervention. A complete description of the high-risk intervention strategy is provided to contribute to this emerging topic and facilitate its scale-up. We can conclude that this complex intervention was feasible to be implemented in a real context. The Ministry of Health has taken the systematization and consolidation of the conditions for the national scale-up.
- ItemIntegrated Water Resource Management and Energy Requirements for Water Supply in the Copiapo River Basin, Chile(MDPI, 2014) Suarez, Francisco; Munoz, Jose F.; Fernandez, Bonifacio; Dorsaz, Jean Marc; Hunter, Christian K.; Karavitis, Christos A.; Gironas, Jorge; CEDEUS (Chile)Population and industry growth in dry climates are fully tied to significant increase in water and energy demands. Because water affects many economic, social and environmental aspects, an interdisciplinary approach is needed to solve current and future water scarcity problems, and to minimize energy requirements in water production. Such a task requires integrated water modeling tools able to couple surface water and groundwater, which allow for managing complex basins where multiple stakeholders and water users face an intense competition for limited freshwater resources. This work develops an integrated water resource management model to investigate the water-energy nexus in reducing water stress in the Copiapo River basin, an arid, highly vulnerable basin in northern Chile. The model was utilized to characterize groundwater and surface water resources, and water demand and uses. Different management scenarios were evaluated to estimate future resource availability, and compared in terms of energy requirements and costs for desalinating seawater to eliminate the corresponding water deficit. Results show a basin facing a very complex future unless measures are adopted. When a 30% uniform reduction of water consumption is achieved, 70 GWh over the next 30 years are required to provide the energy needed to increase the available water through seawater desalination. In arid basins, this energy could be supplied by solar energy, thus addressing water shortage problems through integrated water resource management combined with new technologies of water production driven by renewable energy sources.
- ItemModeling present and future ice covers in two Antarctic lakes(2020) Echeverría Alar, Sebastián Ignacio; Hausner, M.B.; Bambach Ortiz, Nicolás Eduardo; Vicuña Díaz, Sebastián; Suarez, Francisco; CEDEUS (Chile)
- ItemTransport of simazine in unsaturated sandy soil and predictions of its leaching under hypothetical field conditions(ELSEVIER, 2007) Suarez, Francisco; Bachmann, Jaime; Munoz, Jose F.; Ortiz, Cristian; Tyler, Scott W.; Alister, Claudio; Kogan, MarceloThe potential contamination of groundwater by herbicides is often controlled by processes in the vadose zone, through which herbicides travel before entering groundwater. In the vadose zone, both physical and chemical processes affect the fate and transport of herbicides, therefore it is important to represent these processes by mathematical models to predict contaminant movement. To simulate the movement of simazine, a herbicide commonly used in Chilean vineyards, batch and miscible displacement column experiments were performed on a disturbed sandy soil to quantify the primary parameters and processes of simazine transport. Chloride (Cl-) was used as a non-reactive tracer, and simazine as the reactive tracer. The Hydrus-1D model was used to estimate the parameters by inversion from the breakthrough curves of the columns and to evaluate the potential groundwater contamination in a sandy soil from the Casablanca Valley, Chile. The two-site, chemical non-equilibrium model was observed to best represent the experimental results of the miscible displacement experiments in laboratory soil columns. Predictions of transport under hypothetical field conditions using the same soil from the column experiments were made for 40 years by applying herbicide during the first 20 years, and then halting the application and considering different rates of groundwater recharge. For recharge rates smaller than 84 mm year(-1), the predicted concentration of simazine at a depth of I m is below the U.S. EPA's maximum contaminant levels (4 mu g L-1). After eight years of application at a groundwater recharge rate of 180 mm year I (approximately 50% of the annual rainfall), simazine was found to reach the groundwater (located at 1 m depth) at a higher concentration (more than 40 mu g L-1) than the existing guidelines in the USA and Europe. (c) 2007 Elsevier B.V.. All rights reserved.
- ItemUse of fiber-optic distributed temperature sensing to investigate erosion of the non-convective zone in salt-gradient solar ponds(2018) Sarabia, Andres; Meza, Francisco Javier; Suarez, Francisco; CEDEUS (Chile)