Care Needs of Highly Complex Chronic Patients in the Canary Islands: An Observational Study

Round 1

Reviewer 1 Report

Dear authors, in the attached document you can find the considerations and suggestions for improving your work.
Best regards.

Comments for author File: Comments.pdf

Author Response

Dear reviewer,

thanks for your comments. Thanks to your indications, the article presented has improved. We have modified each of the points suggested in the review. You can check the changes in red color. Thank you, we hope that the article meets the requirements to be published.
Regards, Dr. Rodríguez-Álvaro.

Author Response File: Author Response.docx

Reviewer 2 Report

Dear authors,

Please find my report in the document attached.

Kind regards

Comments for author File: Comments.pdf

Author Response

Dear reviewer,

thanks for your comments. Thanks to your indications, the article presented has improved. We have modified each of the points suggested in the review. You can check the changes in red color. Thank you, we hope that the article meets the requirements to be published.

Author Response File: Author Response.docx

Reviewer 3 Report

Recommended Revisions

Abstract

1)      Of all patients, 84.4% had received a nursing assessment using health patterns.

a.       Do you mean “related to” health patterns?

b.       Please clarify

2)      Three diagnoses in 25%: Readiness for enhanced health management, Impaired skin integrity, and Risk for falls. Significant differences by age, most importantly in Impaired skin integrity (39% of under-80s).

a.       Do you mean these three nursing diagnoses were found in 25% of the sample?

b.       Clarify under-80’s (I believe you mean patients under 80, but it should be more formally stated).

Introduction

1)      Paragraph 1 – Chronic Diseases

a.       Consider listing a few diseases as examples.

2)      Paragraph 1 – Consequently, care models should be reviewed

a.       Recommend using instead of reviewed.

3)      Paragraph 1 – Care is not capitalized.

4)      Paragraph 2 - reports having some kind of chronic limitation

a.       Recommend revising to: having a chronic limitation.

5)      Paragraph 3 – excessive spacing after SNHS and highlights.

6)      Paragraph 6 - This group of people

a.       Recommend revising to: These patients require

7)      Paragraph 6 - improve the quality of life of patients and caregivers, and avoid emergency admissions

a.       Sentence structure/tenses – recommend revising to: improved quality of life of patients and caregivers, and avoidance of emergency admissions….

8)      Paragraph 8 - … have been keeping records of patient care in the electronic health record…

a.       Recommend revision to have maintained patient records in…

9)      Paragraph 8 -  Furthermore, the professional

a.       Recommend revision to:  Additionally, the…

Materials and Methods

1)      2.1 - one of these two conditions

a.       Recommend revision to criteria

2)      2.4 - A database was generated for use in the dumping and subsequent analysis of HCCP information obtained from the EHR. This database is anonymised with alphanumeric encoding, which ….

a.       Dumping is not correct terminology, please reword this sentence to describe the entry of data for analysis.

b.       Was this database also where your tests were performed via use of SPSS? Or only used to store the raw data prior to analysis?

                                                               i.      Was the data from the EHR deidentified (or in other words, identifying patient information was redacted) prior to entry into this database?

                                                             ii.      Identifying data is anonymized, not the database itself, which is how it reads.

1.       Need to rewrite these 2 sentences in the first paragraph to clarify.

3)      2.4 - with the help of the IBM® Statistical Packag

a.       Recommend revision to using IBM…

Results

1)      3.2 - . cognitive screening.

a.       Cognitive needs to be capitalized.

2)      3.2 - Of these, 7% (n=299) presented severe cognitive impairment, 27% (n=1196) with deficits to intellectual functioning, and 67% with normal functions.

a.       Recommended revision to:  Of these, 7% (n=299) presented with severe cognitive impairment, 27% (n=1196) deficits to intellectual functioning, and 67% with normal cognitive and intellectual functioning.

3)      3.3 - 23% of participants present problems..

a.       Recommend revision to: presented with problems…

4)      3.3 - …10 NDs;; 12% (n=1640) between 11 and 20 NDs,, and 1% (n=112), more than 20 NDs.

a.       Excess punctuation as highlighted.

5)      3.3 - These three NDs…

a.       Recommend revision to: The following three NDs

6)      3.3 - In relation to NDs, associations by age (80+ years old), living alone, and dependence are described in Table 6.

a.       Recommend revision to:  The relationship between NDs and associations by age….

7)      3.3 - There is a group of NDs… which is Impaired skin integrity, which presents in 39% of under-80s….

a.       Recommend revision to:  A group of..

b.       Recommend revision to: including Impaired Skin Integrity, is present in 39% of those under 80.

8)      3.3 - who, despite not being diagnosed with this label, meet two

a.       Recommend revision to: despite not receiving these NDs, meet…

9)      3.3 - Combining these two group…

a.       Recommend revision to: In combining these

10)   3.3 – It is notable

a.       Recommend revision to:  It is noteworthy.

Discussion

1)      Paragraph 1

a.       HCCP have been identified in the literature.

                                                               i.      Recommend revision to: HCCP are well identified in…

b.       Among these characteristics is the presence of comorbidities, use of emergency services, several hospitalisations during one year, the loss of personal independence..

                                                               i.      Recommend revision to: Within these characteristics …., increased use of emergency… hospitalizations per year, loss of personal independence….

c.       This is shown by the large variability in healthcare…

                                                               i.      Recommend revision to: This is demonstrated [alternative: highlighted) by..

2)      Paragraph 2

a.       care of the HCCP and should help

                                                              i.      HCCP can and should ..

3)      Paragraph 3

a.       This is especially true in relation to psychosocial issues such as loss and mourning [30] [31], and also in frail and dependent patients in particular….

                                                               i.      Recommend revision to: true as it relates to psychosocial…., as well as the frail and….

4)      Paragraph 4

a.       Therefore, with regards to the functional status assessment using HPs, it should be highlighted that information about at least one HP is recorded.in more than 84% of HCCPs.

                                                               i.      This sentence can be simplified

                                                             ii.      Incorrect period as highlighted.

b.       The results of this study point in the same direction as those carried out previously, in which the

                                                               i.      Recommended revision for formality and clarity: This study’s results are consistent with previously reported studies, which identifies the most assessed HP is…

5)      Paragraph 7

a.       An appropriate comparison framework for the findings of this investigation could be the study on the

                                                               i.      Suggested revision to strengthen your claim:  However, the most appropriate comparative framework for this study’s findings is the study on the…

6)      Paragraph 10

a.       Remove “we” and rewrite sentence.

                                                               i.      Avoid first person.

b.       ..easier to identify the records of each ND that makes up the syndrome than the syndrome itself.

                                                               i.      Suggested revision to:  syndrome, rather than the syndrome itself.

7)      Paragraph 12

a.       …loneliness of older people sits between..

                                                               i.      Informal wording.

1.       In Spain, 20%-40% of older people experience social isolation and loneliness.

8)      Paragraph 15

a.       broad. it may be

                                                               i.      Excessive spacing, capitalize “it.”

b.       DCs

                                                               i.      What are DC’s??

c.       …each one of their dimensions should be examined with instead of just their final score.

                                                               i.      Grammar revision:  examined with, instead of just, their final score.

d.       Remove “we” and “us” from last sentence and rewrite,

                                                               i.      Avoid first person, for formality.

Conclusions

1)      Planning of HCCP care is varied in nature, as aspects like level of dependence and frailty..

a.       Recommend revision to one sentence: Planning of HCCP care is varied in nature.

b.       Separate sentence for the 2^nd part of this:…. healthcare components, such as level of dependence and frailty.

                                                               i.      Avoid “like” – too informal.  May use “such as.”

2)      The use of stratify is confusing in the last sentence.

a.       Is not the goal to better understand this population to improve healthcare and health outcomes?

                                                               i.      Stratify means to arrange or classify.

A more positive ending might strengthen your conclusion, as it relates to (a). Talking about future studies is a nod to your study’s limitations.

Author Response

Dear reviewer,

thanks for your comments. Thanks to your indications, the article presented has improved. We have modified each of the points suggested in the review. You can check the changes in red color. Thank you, we hope that the article meets the requirements to be published.
Regards, Dr. Rodríguez-Álvaro.

Author Response File: Author Response.docx