Suchergebnisse

Cet article propose une méthode pour détecter les comportements opportunistes des établissements de santé français soumis à la tarification à l'activité à partir de 2004, paiement prospectif basé sur les groupes homogènes de malades. Outre une définition précise du concept de «trajectoire patient» et son positionnement par rapport aux notions de filières et réseaux de soins, nous montrons comment les autorités sanitaires pourraient s'appuyer sur ce concept pour réduire l'asymétrie d'information en contrôlant deux formes d'opportunisme, d'une part la multiplication des séjours pour un même patient, d'autre part l'affectation non justifiée des séjours dans des groupes homogènes mieux rémunérés. Le caractère opérationnel du concept de «trajectoire patient » apparaît distinctement dans notre application à la cancérologie pédiatrique, même si sa généralisation impose la mise en place de procédures automatisées.

International audience ; Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.

International audience ; Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.

International audience ; Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.

International audience ; Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.

International audience ; Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.

International audience ; Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.

International audience ; Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.

Our study uses the 2010 Medical Monitoring Survey of Professional Risks (Surveillancemédicale des expositions aux risques, SUMER) to assess French employees' exposure to carcinogenic, mutagenic and reprotoxic (CMR) chemicals at work. Nearly 2.2 million people, i.e. 10.2 % of employees were exposed to one or more CMR during the week before their medical visit. Among them, 70,000 experienced multiple exposures in the workplace, bringing to 3.5 million the number of exposure situations identified in 2010. Exposure to asbestos represents only 2.3% of the exposures to CMR, or 10 times less than the exposure to diesel exhaust. Our results show that there are jobs and employees profiles that face multiple disadvantages in the labor market, including the high risk of exposure to substances that are hazardous to health. These include workers, employees working at night and with precarious employment contracts, which should therefore be high priority targets for prevention. ; Notre étude exploite l'édition 2010 de l'enquête Surveillance médicale des expositions aux risques professionnels (SUMER) pour dresser un état des lieux des expositions des salariés français aux agents CMR sur leur lieu de travail. Au total, 2,2 millions de personnes, soit 10,2% des salariés, ont été exposés à un ou plusieurs produits CMR lors de la semaine précédant leur visite médicale. Parmi eux, 70000 connaissaient une multi-exposition sur leur lieu de travail, ce qui porte à 3,5 millions le nombre de situations d'expositions recensées en 2010. Les situations des expositions à l'amiante ne représentent que 2,3% des expositions aux produits CMR, soit 10 fois moins que les expositions aux gaz d'échappement diesel. Nos résultats montrent qu'il existe des emplois et des profils de salariés qui cumulent les préjudices sur le marché du travail, y compris de forts risques d'exposition à des produits dangereux pour la santé. Il s'agit notamment des ouvriers, des travailleurs de nuit et des salariés à contrats précaires, qui devraient donc constituer des cibles prioritaires pour les mesures de prévention.

Our study uses the 2010 Medical Monitoring Survey of Professional Risks (Surveillancemédicale des expositions aux risques, SUMER) to assess French employees' exposure to carcinogenic, mutagenic and reprotoxic (CMR) chemicals at work. Nearly 2.2 million people, i.e. 10.2 % of employees were exposed to one or more CMR during the week before their medical visit. Among them, 70,000 experienced multiple exposures in the workplace, bringing to 3.5 million the number of exposure situations identified in 2010. Exposure to asbestos represents only 2.3% of the exposures to CMR, or 10 times less than the exposure to diesel exhaust. Our results show that there are jobs and employees profiles that face multiple disadvantages in the labor market, including the high risk of exposure to substances that are hazardous to health. These include workers, employees working at night and with precarious employment contracts, which should therefore be high priority targets for prevention. ; Notre étude exploite l'édition 2010 de l'enquête Surveillance médicale des expositions aux risques professionnels (SUMER) pour dresser un état des lieux des expositions des salariés français aux agents CMR sur leur lieu de travail. Au total, 2,2 millions de personnes, soit 10,2% des salariés, ont été exposés à un ou plusieurs produits CMR lors de la semaine précédant leur visite médicale. Parmi eux, 70000 connaissaient une multi-exposition sur leur lieu de travail, ce qui porte à 3,5 millions le nombre de situations d'expositions recensées en 2010. Les situations des expositions à l'amiante ne représentent que 2,3% des expositions aux produits CMR, soit 10 fois moins que les expositions aux gaz d'échappement diesel. Nos résultats montrent qu'il existe des emplois et des profils de salariés qui cumulent les préjudices sur le marché du travail, y compris de forts risques d'exposition à des produits dangereux pour la santé. Il s'agit notamment des ouvriers, des travailleurs de nuit et des salariés à contrats précaires, qui devraient donc constituer des ...

Our study uses the 2010 Medical Monitoring Survey of Professional Risks (Surveillancemédicale des expositions aux risques, SUMER) to assess French employees' exposure to carcinogenic, mutagenic and reprotoxic (CMR) chemicals at work. Nearly 2.2 million people, i.e. 10.2 % of employees were exposed to one or more CMR during the week before their medical visit. Among them, 70,000 experienced multiple exposures in the workplace, bringing to 3.5 million the number of exposure situations identified in 2010. Exposure to asbestos represents only 2.3% of the exposures to CMR, or 10 times less than the exposure to diesel exhaust. Our results show that there are jobs and employees profiles that face multiple disadvantages in the labor market, including the high risk of exposure to substances that are hazardous to health. These include workers, employees working at night and with precarious employment contracts, which should therefore be high priority targets for prevention. ; Notre étude exploite l'édition 2010 de l'enquête Surveillance médicale des expositions aux risques professionnels (SUMER) pour dresser un état des lieux des expositions des salariés français aux agents CMR sur leur lieu de travail. Au total, 2,2 millions de personnes, soit 10,2% des salariés, ont été exposés à un ou plusieurs produits CMR lors de la semaine précédant leur visite médicale. Parmi eux, 70000 connaissaient une multi-exposition sur leur lieu de travail, ce qui porte à 3,5 millions le nombre de situations d'expositions recensées en 2010. Les situations des expositions à l'amiante ne représentent que 2,3% des expositions aux produits CMR, soit 10 fois moins que les expositions aux gaz d'échappement diesel. Nos résultats montrent qu'il existe des emplois et des profils de salariés qui cumulent les préjudices sur le marché du travail, y compris de forts risques d'exposition à des produits dangereux pour la santé. Il s'agit notamment des ouvriers, des travailleurs de nuit et des salariés à contrats précaires, qui devraient donc constituer des cibles prioritaires pour les mesures de prévention.

Our study uses the 2010 Medical Monitoring Survey of Professional Risks (Surveillancemédicale des expositions aux risques, SUMER) to assess French employees' exposure to carcinogenic, mutagenic and reprotoxic (CMR) chemicals at work. Nearly 2.2 million people, i.e. 10.2 % of employees were exposed to one or more CMR during the week before their medical visit. Among them, 70,000 experienced multiple exposures in the workplace, bringing to 3.5 million the number of exposure situations identified in 2010. Exposure to asbestos represents only 2.3% of the exposures to CMR, or 10 times less than the exposure to diesel exhaust. Our results show that there are jobs and employees profiles that face multiple disadvantages in the labor market, including the high risk of exposure to substances that are hazardous to health. These include workers, employees working at night and with precarious employment contracts, which should therefore be high priority targets for prevention. ; Notre étude exploite l'édition 2010 de l'enquête Surveillance médicale des expositions aux risques professionnels (SUMER) pour dresser un état des lieux des expositions des salariés français aux agents CMR sur leur lieu de travail. Au total, 2,2 millions de personnes, soit 10,2% des salariés, ont été exposés à un ou plusieurs produits CMR lors de la semaine précédant leur visite médicale. Parmi eux, 70000 connaissaient une multi-exposition sur leur lieu de travail, ce qui porte à 3,5 millions le nombre de situations d'expositions recensées en 2010. Les situations des expositions à l'amiante ne représentent que 2,3% des expositions aux produits CMR, soit 10 fois moins que les expositions aux gaz d'échappement diesel. Nos résultats montrent qu'il existe des emplois et des profils de salariés qui cumulent les préjudices sur le marché du travail, y compris de forts risques d'exposition à des produits dangereux pour la santé. Il s'agit notamment des ouvriers, des travailleurs de nuit et des salariés à contrats précaires, qui devraient donc constituer des cibles prioritaires pour les mesures de prévention.

Résumé Pour analyser la variabilité des évaluations de coûts en santé, la démarche proposée consiste à étudier la « variabilité » des facteurs de coûts, i.e. des variables sur lesquelles s'appuie l'estimation des coûts dans les différentes localisations. Deux méthodes validées sont utilisées, le calcul de la distance euclidienne et l'analyse en composantes principales ( acp ). La démarche comprend quatre étapes : (i) l'identification des facteurs potentiels de variabilité, la sélection des facteurs finaux de variabilité et la constitution des aires de variabilité ; (ii) la mesure des distances inter-aires de variabilité ; (iii) l'utilisation d'une acp pour analyser ces distances ; (iiii) la mesure des distances intra-aire de variabilité. L'application, qui porte sur un traitement innovant et coûteux, témoigne de l'opérationnalité de cette démarche.

Background : Seasonal influenza concerns the worldwide population every year, whilst pandemic influenza is an unpredictable threat. Due to an important socioeconomic impact, mitigation measures must be specified. Governments elaborate vaccination policy based on scientific evidence. However, this process is, in general, not transparent. Objectives : To study the decision-making process related to the influenza vaccination policy, identifying the actors involved, the decisions made and describing the information used by type and level of importance. Methods : Six major databases were searched in seven languages, without time limit, using keywords related to influenza vaccination, decision-making and health policy. Titles and abstracts were screened according to three established criteria. Selected articles were analysed and compared against a checklist for context, stakeholders and evidence. Results : 111 articles were retrieved since the 1990s, most of them (40%) were conducted in the USA. The decision-making process mainly concerned vaccination strategies (53%) and pandemic preparedness (28%). Stakeholders were identified at an institutional, production and consumer level. Evidence used by policy-makers was similar (e.g. logistics of vaccines), but the factors influencing were different (e.g. social conditions). Conclusion : Considering the imminent risk of socio-economic disruption and media pressure, the pandemic threat needs to be integrated into an analysis of decision making processes regarding seasonal influenza vaccination.

Background : Seasonal influenza concerns the worldwide population every year, whilst pandemic influenza is an unpredictable threat. Due to an important socioeconomic impact, mitigation measures must be specified. Governments elaborate vaccination policy based on scientific evidence. However, this process is, in general, not transparent. Objectives : To study the decision-making process related to the influenza vaccination policy, identifying the actors involved, the decisions made and describing the information used by type and level of importance. Methods : Six major databases were searched in seven languages, without time limit, using keywords related to influenza vaccination, decision-making and health policy. Titles and abstracts were screened according to three established criteria. Selected articles were analysed and compared against a checklist for context, stakeholders and evidence. Results : 111 articles were retrieved since the 1990s, most of them (40%) were conducted in the USA. The decision-making process mainly concerned vaccination strategies (53%) and pandemic preparedness (28%). Stakeholders were identified at an institutional, production and consumer level. Evidence used by policy-makers was similar (e.g. logistics of vaccines), but the factors influencing were different (e.g. social conditions). Conclusion : Considering the imminent risk of socio-economic disruption and media pressure, the pandemic threat needs to be integrated into an analysis of decision making processes regarding seasonal influenza vaccination.