Adaptation au codage CIM-10 de 15 indicateurs de la sécurité des patients proposés par l'Agence étasunienne pour la recherche et la qualité des soins de santé (AHRQ) [ICD-10 adaptation of 15 Agency for Healthcare Research and Quality patient safety indicators].

BACKGROUND: In the United States, the Agency for Healthcare Research and Quality (AHRQ) has developed 20 Patient Safety Indicators (PSIs) to measure the occurrence of hospital adverse events from medico-administrative data coded according to the ninth revision of the international classification of disease (ICD-9-CM). The adaptation of these PSIs to the WHO version of ICD-10 was carried out by an international consortium. METHODS: Two independent teams transcoded ICD-9-CM diagnosis codes proposed by the AHRQ into ICD-10-WHO. Using a Delphi process, experts from six countries evaluated each code independently, stating whether it was "included", "excluded" or "uncertain". During a two-day meeting, the experts then discussed the codes that had not obtained a consensus, and the additional codes proposed. RESULTS: Fifteen PSIs were adapted. Among the 2569 proposed diagnosis codes, 1775 were unanimously adopted straightaway. The 794 remaining codes and 2541 additional codes were discussed. Three documents were prepared: (1) a list of ICD-10-WHO codes for the 15 adapted PSIs; (2) recommendations to the AHRQ for the improvement of the nosological frame and the coding of PSI with ICD-9-CM; (3) recommendations to the WHO to improve ICD-10. CONCLUSIONS: This work allows international comparisons of PSIs among the countries using ICD-10. Nevertheless, these PSIs must still be evaluated further before being broadly used.

Le financement des hôpitaux suisses par APDRGs

Dans le cadre du projet de modification du financement des hôpitaux, les partenaires de deux des plus grands cantons suisses - Vaud (Lausanne) et Zürich - ont décidé d'expérimenter le mode de système de paiement par cas traité dès le mois de janvier 2002, en utilisant la classification "All patient diagnosis related groups" (APDRGs). Pourquoi a t-on choisi les APDRGs? Ce système de classification des patients est-il adapté au contexte helvétique? Quelles en sont les caractéristiques? Quelles précautions doit-on prendre pour limiter les risques attendus? Quelles adaptations implique ce nouveau financement pour les différents acteurs?

Financement des hôpitaux par APDRG et compensation des risques entre assureurs

Ce rapport analyse les données (coût par patient et par assureur) du CHUV (Centre hospitalier universitaire vaudois) pour 2002 et 2003 et conclue que la facturation en APDRG n'a pas n'effet de désolidarisation entre les assureurs.

Adaptation du "GROUPER" aux statistiques médicales VESKA (1980-1986)

Le présent cahier qui termine une série consacrée à l'adaptation du "grouper" aux statistiques médicales VESKA des années 1980-1986, a pour but de donner une vue d'ensemble des procédures nécessaires à cette adaptation.

Groupes diagnostiques utilisés sur SIMULIT 13

La nomenclature des diagnostics est celle de la Classification internationale des maladies (9e révision), utilisée par la Statistique médicale VESKA depuis 1980. Les trois premiers chiffres du code ont été utilisés; seul le premier diagnostic a été retenu.

Effects of age, birth cohort and period of death on Swiss cancer mortality, 1951-1984.

Swiss death certification data over the period 1951-1984 for total cancer mortality and 30 major cancer sites in the population aged 25 to 74 years were analysed using a log-linear Poisson model with arbitrary constraints on the parameters to isolate the effects of birth cohort, calendar period of death and age. The overall pattern of total cancer mortality in males was stable for period values and showed some moderate decreases in cohort values restricted to the generations born after 1930. Cancer mortality trends were more favourable in females, with steady, though moderate, declines in both cohort and period values. According to the estimates from the model, the worst affected generation for male lung cancer was that born around 1910, and a flattening of trends or some moderate decline was observed for more recent cohorts, although this decline was considerably more limited than in other European countries. There were decreases in cohort and period values for stomach, intestine and oesophageal cancer in both sexes and (cervix) uteri in females. Increases were observed in both cohort and period trends for pancreas and liver in males and for several other neoplasms, including prostate, brain, leukaemias and lymphomas, restricted, however, for the latter sites, to the earlier cohorts and hence partly attributable to improved diagnosis and certification in the elderly. Although age values for lung cancer in females were around 10-times lower than in males, upward trends in female lung cancer cohort values were observed in subsequent cohorts and for period values from the late 1960's onwards. Therefore, future trends in female lung cancer mortality should continue to be monitored. The application of these age/period/cohort models thus provides a summary guide for the reading and interpretation of cancer mortality trends, although it cannot replace careful inspection of single age-specific rates.

Concurrence et régulation dans le secteur hospitalier

Pour mettre en évidence le rôle respectif de la concurrence et de la régulation, cet article traitera essentiellement de la question du financement des hôpitaux. Après une section 1 consacrée aux justifications de la régulation, les modalités de celles-ci seront analysées dans la section 2 avant d'étudier la place de la concurrence dans la section 3. [Auteur, p. 62] [Table des matières] 1. Les fondements de la régulation du système de santé. 1A. Pourquoi réguler (assurance-maladie ; la production de soins). 1B. Comment réguler. - 2. La régulation des tarifs hospitaliers. 2A. Principes généraux de paiement. 2B. La tarification à l'activité. 3. Concurrence et régulation. 3A. Concurrence fictive, spécialisations, et concurrence privé-public. 3B. La concurrence par la qualité. 3C. La concurrence en prix.

DRGs in hospital management.

One of the traditional tasks of district and hospital managers has been to attempt to explain variations in average length of stay, average cost per day and average cost per case, between different hospitals. The need for such explanations has become more acute as a result of the recent emphasis on 'performance indicators' as measures of the efficiency of hospitals. The task of explaining these differences has not been rendered easier by the lack of appropriate management information for this purpose.

Measuring potentially avoidable hospital readmissions.

The objectives of this study were to develop a computerized method to screen for potentially avoidable hospital readmissions using routinely collected data and a prediction model to adjust rates for case mix. We studied hospital information system data of a random sample of 3,474 inpatients discharged alive in 1997 from a university hospital and medical records of those (1,115) readmitted within 1 year. The gold standard was set on the basis of the hospital data and medical records: all readmissions were classified as foreseen readmissions, unforeseen readmissions for a new affection, or unforeseen readmissions for a previously known affection. The latter category was submitted to a systematic medical record review to identify the main cause of readmission. Potentially avoidable readmissions were defined as a subgroup of unforeseen readmissions for a previously known affection occurring within an appropriate interval, set to maximize the chance of detecting avoidable readmissions. The computerized screening algorithm was strictly based on routine statistics: diagnosis and procedures coding and admission mode. The prediction was based on a Poisson regression model. There were 454 (13.1%) unforeseen readmissions for a previously known affection within 1 year. Fifty-nine readmissions (1.7%) were judged avoidable, most of them occurring within 1 month, which was the interval used to define potentially avoidable readmissions (n = 174, 5.0%). The intra-sample sensitivity and specificity of the screening algorithm both reached approximately 96%. Higher risk for potentially avoidable readmission was associated with previous hospitalizations, high comorbidity index, and long length of stay; lower risk was associated with surgery and delivery. The model offers satisfactory predictive performance and a good medical plausibility. The proposed measure could be used as an indicator of inpatient care outcome. However, the instrument should be validated using other sets of data from various hospitals.

L'impact du nouveau financement hospitalier sur les hôpitaux publics : exemple de l'Hôpital du Valais

L'objectif de ce mémoire est d'évaluer les conséquences du nouveau financement hospitalier de la LAMaI sur les hôpitaux publics et plus particulièrement sur l'Hôpital du Valais. Les nouvelles dispositions votées le 21 décembre 2007 par le Parlement ont pour but d'accroître la concurrence entre les hôpitaux et de mettre sur un pied d'égalité les établissements privés et publics. Ce document traite des principales modifications législatives et de leur entrée en vigueur, des nouveautés concernant le calcul des coûts et des tarifs à la charge de l'assurance obligatoire des soins avec l'inclusion des investissements et la nouvelle défmition des frais de formation, de l'introduction des forfaits par pathologie SwissDRG, des problématiques de l'ouverture des frontières cantonales et de la concurrence. Selon les hypothèses retenues, des effets peu importants sont à prévoir en Valais pour l'ouverture des frontières, la liste hospitalière et la répartition du tarif entre assureurs et cantons. Par contre on estime que la prise en compte des investissements augmentera les coûts de l'Hôpital du Valais de 5 à 13% alors les activités d'intérêt général se chiffrent entre 4 et 22 Mio. Les conséquences de l'introduction de la concurrence voulue par le législateur sont plus difficiles à évaluer, car elles dépendent de paramètres encore inconnus tels que le gain espéré et le comportement des parties. Une concurrence par les prix prétéritera les hôpitaux publics si leurs spécificités, telles que les urgences, les soins intensifs et l'obligation d'admission, ne sont pas prises en compte dans la structure tarifaire, le prix ou la planification. Le changement de comportement du patient, des assureurs, des médecins traitants voire des cantons ou des médias constitue également une inconnue qui pourrait avoir de fortes conséquences et contraindre les hôpitaux publics à développer leurs concepts de marketing et de communication. [Auteur, p. 2]

Prenatal and perinatal risk factors for bipolar disorder

Bipolar disorder (BPD) is a severe mental disorder associated with considerable morbidity and mortality. Prenatal insults have been shown to be associated with later development of mental disorders and there is a growing interest in the potential role of prenatal and perinatal risk factors in the development of BPD. The aims of this thesis were to describe the overall study design of the Finnish Prenatal Study of Bipolar Disorders (FIPS-B) and demographic characteristics of the sample. Furthermore, it was aimed to examine the association of parental age, parental age difference, perinatal complications and maternal smoking during pregnancy with BPD. This thesis is based on FIPS-B, a nested case-control study using several nationwide registers. The cases included all people born in Finland between January 1st 1983 and December 31st 1998 and diagnosed with BPD according to the Finnish Hospital Discharge Register (FHDR) before December 31st 2008. Controls for this study were people who were without BPD, schizophrenia or diagnoses related to these disorders, identified from the Population Register Centre (PRC), and matched two-fold to the cases on sex, date of birth (+/- 30 days), and residence in Finland on the first day of diagnosis of the matched case. Conditional logistic regression models were used to examine the association between risk factors and BPD. This study included 1887 BPD cases and 3774 matched controls. The mean age at diagnosis was 19.3 years and females accounted for 68% of the cases. Mothers with the lowest educational level had the highest odds of having BPD in offspring. Being born in Eastern and Southern region of Finland increased the odds of having BPD later in life. A U-shaped distribution of odds ratio was observed between paternal age and BPD in the unadjusted analysis. Maternal age and parental age difference was not associated with BPD. Birth by planned caesarean section was associated with increased odd of BPD. Smoking during pregnancy was not associated with BPD in the adjusted analyses. Region of birth and maternal educational level were associated with BPD. Both young and old father’s age was associated with BPD. Most perinatal complications and maternal smoking during pregnancy were not associated with BPD. The findings of this thesis, considered together with previous literature, suggest that the pre- and perinatal risk factor profile varies among different psychiatric disorders.