[Quality assessment of the medical information on the standardized discharge summary]. / Evaluation de la qualité de l'information médicale des Résumés de Sortie Standardisés.

BACKGROUND: DRG-based management of public hospitals in France involves the use of standardised discharge abstracts for the "Medicalisation of Information Systems Program". METHODS: To assess the quality of the medical information in these abstracts, a sample of 649 abstracts for 1994 was collected from the Hospices Civils de Lyon's data base. To validate the information in these abstracts, we reviewed the medical records of each patient. RESULTS: The results showed an error rate of 32% (CI: 28-36) for the diagnosis-related group and an error rate of 40% (CI: 36-44) for the principal diagnosis. There was no significant difference between these error rates and the calculation of "Indices Synthétiques d'Activité" (French system for attributing points to hospital stays according to DRGs categories). CONCLUSIONS: The quality of the medical information for the "Medicalisation of Information Systems Program" remains a major challenge not only for budget allocation, but also for the study of the case-mix in hospitals.

[Development of the indications for extra-corporeal lithotripsy and the impact of organizational methods on the indications]. / Evolution des indications de la lithotripsie extra-corporelle et impact du mode d'organisation sur les indications.

A technology assessment of ESWL for renal stones has been conducted. The development of lithotripsy during the early phase of diffusion of the technique was studied retrospectively for 1985 and 1986. This study permitted the comparison of lithotripsy practice in Paris with that in Lyon. Results show that the proportion of small (less than 10 mm) stones increased from 39% at the beginning of the period to 60% at the end in Paris and simultaneously from 41% to 53% in Lyon. The location of the calculi treated by ESWL changed significantly over the period, but only in Paris where the number of caliceal stones went from 62% to 38% and that of ureteral stones from 1% to 8%. Neither the number of stones treated during one ESWL session, nor the length of hospital stay, changed significantly during the first years of use of this treatment. However, if one excludes hospital stays of more than 15 days, the average hospital stay in Paris decreased where as the opposite was observed in Lyon. The impact of the organization of ESWL users upon medical practice is obvious in relation to the size of stones: in Lyon, where one team provides ESWL therapy for all hospital urology departments, treatment practice is more homogeneous than in Paris and more closely a resembles the international consensus.

Data quality in a DRG-based information system.

The aim of this study initiated in May 1990 was to evaluate the quality of the medical data collected from the main hospital of the "Hospices Civils de Lyon", Edouard Herriot Hospital. We studied a random sample of 593 discharge abstracts from 12 wards of the hospital. Quality control was performed by checking multi-hospitalized patients' personal data, checking that each discharge abstract was exhaustive, examining the quality of abstracting, studying diagnoses and medical procedures coding, and checking data entry. Assessment of personal data showed a 4.4% error rate. It was mainly accounted for by spelling mistakes in surnames and first names, and mistakes in dates of birth. The quality of a discharge abstract was estimated according to the two purposes of the medical information system: description of hospital morbidity per patient and Diagnosis Related Group's case mix. Error rates in discharge abstracts were expressed in two ways: an overall rate for errors of concordance between Discharge Abstracts and Medical Records, and a specific rate for errors modifying classification in Diagnosis Related Groups (DRG). For abstracting medical information, these error rates were 11.5% (SE +/- 2.2) and 7.5% (SE +/- 1.9) respectively. For coding diagnoses and procedures, they were 11.4% (SE +/- 1.5) and 1.3% (SE +/- 0.5) respectively. For data entry on the computerized data base, the error rate was 2% (SE +/- 0.5) and 0.2% (SE +/- 0.05). Quality control must be performed regularly because it demonstrates the degree of participation from health care teams and the coherence of the database.(ABSTRACT TRUNCATED AT 250 WORDS)