ABSTRACT: Unlike Anglo-Saxon countries, the rate of preventable readmissions is not a national quality indicator in France. In the context of the European research project Performance Assessment Tool for quality improvement in Hospitals (PATH), this pilot study provides a tool for health professionals to more easily identify preventable readmissions in order to analyze their causes. The objective of this work was to show the reliability of this tool.
We compared the rate of preventable readmissions occurring within 30 days, for a given disease, collected by analyzing medical reports (the gold standard rate of this study) to the rates of preventable readmissions occurring within 30 days, measured from algorithms using data from the French Programme of Medicalization of Information Systems (PMSI). The data were derived from PMSI data of the Lariboisiere-Fernand-Widal Hospital, a university hospital in Paris.
The community-acquired pneumonia gold standard rate of preventable readmissions occurring within 30 days was 6.3 %. Five algorithmic tools were used and measured rates between 2.9 % and 7.9 %. The positive likelihood ratios of these tools range from 8 to 308.
This work presents a tool aimed at the health professionals that takes into account the diversity and complexity of the causes of avoidable readmissions, resulting from the quality of medical practice, the variability of the organization of hospital pathways and the links with ambulatory care.
La Presse Médicale 07/2011; 41(1):e1-9. · 0.67 Impact Factor
ABSTRACT: To assess whether comparison of quality of hip fracture care among three teams located in different hospitals is associated with improvement in process and outcomes.
A baseline assessment was performed using quality indicators selected by professionals.
were discussed among the three teams followed by a post-comparison assessment of the same indicators.
Three hospitals in North Western France.
Professionals caring for patients operated on for a low-impact hip fracture.
Review and discussion of comparative performance results by three teams followed by implementation of quality improvement as deemed necessary by each team.
Fifteen quality indicators of health care during orthopedic and rehabilitation stay, mobility, dependence and place of residence before hip fracture and 3 months after discharge, 3 month post-surgery mortality and readmission rates.
Major differences were observed among hospitals throughout the care process during baseline period. Comparison of performance and discussion among the three teams were followed by corrective action in 11 areas. After comparison, a significant improvement was observed in 10 areas, seven of which corresponded to quality improvement areas chosen for improvement action by professionals. A significant decrease in readmission rate (6.7% vs. 15.7%, P < 0.001) was observed but there was no change in mortality, functional outcome or length of stay.
Comparison of performance among voluntary teams, on fields selected by health-care professionals, was associated with improvement in the care process and with improvement of some related outcomes.
International Journal for Quality in Health Care 08/2009; 21(5):321-9. · 1.96 Impact Factor
ABSTRACT: To develop and validate a list of objective criteria to assess the appropriateness of hospital days for patients admitted to rehabilitation centres and sub-acute care units.
Sixteen appropriateness criteria were defined by a multidisciplinary panel of 33 experts using a formalized consensus method. A single ticked criterion classifies the hospital day as appropriate. Reliability was studied by measuring concordance between two independent and simultaneous ratings using the instrument. External validity was tested by comparing conclusions derived from the instrument with the individual judgements of one, two or three experts on the same random sample of hospital days.
The assessment on these criteria was performed on a randomized sample of 406 hospital days from 17 French wards.
Inter-rater reliability and external validity were evaluated using the kappa statistic and prevalence-adjusted and bias-adjusted kappa (PABAK).
The inter-rater reliability test showed a kappa-value of 0.71 [95% confidence interval (95% CI) 0.63-0.78] and a PABAK of 0.77 (95% CI 0.70-0.83). There was a good agreement between the conclusions reached using the instrument and the individual judgements of experts with a kappa coefficient of 0.42 (95% CI 0.35-0.50) and a PABAK of 0.60 (95% CI 0.52-0.67).
The instrument is reliable and valid for assessing appropriateness of hospital days in rehabilitation centres and sub-acute care units. The next step in this study is the development of a tool for the analysis of causes of inappropriateness.
International Journal for Quality in Health Care 02/2009; 21(3):198-205. · 1.96 Impact Factor
ABSTRACT: Patient age is the main socio-demographic factor influencing patient satisfaction with care but the nature of the relationship between age and patient satisfaction is controversial.
This study aims to clarify whether the association of age with satisfaction is linear or shows some other configuration.
Data were obtained from two different satisfaction studies conducted in 27 short-stay teaching hospitals. Study 1 included 1547 inpatients, who completed the EQS-H questionnaire at the time of discharge. Study 2 included 7624 inpatients interviewed by phone at home after discharge, who answered the SAPHORA questionnaire. On the basis of the results of the exploratory analysis, three models for adjustment of age on satisfaction were compared: a simple linear model, a five-group step function and a linear model with a change in slope.
The most suitable model for adjusting patient age to satisfaction scores for quality of medical and nursing care, whether for the EQS-H or the SAPHORA scale, was not a linear relationship: patient age was linearly and positively correlated to satisfaction before 65 years and negatively thereafter. Adjustment of patient age to accommodation and premises satisfaction scores proved to be different, closer to a linear relationship.
These results suggest considering the patient age variable as a non-linear factor for adjusting satisfaction scores, in particular in relation to care. Further studies are needed to confirm the evidence of a threshold around 65 years beyond which satisfaction scores for the quality of medical and nursing care decrease.
International Journal for Quality in Health Care 01/2008; 19(6):382-9. · 1.96 Impact Factor