In France, the organization of perinatal care has a direct influence on the outcome of the mother and the newborn: Contribution from a French nationwide study.

OBJECTIVE: To investigate maternal and neonatal outcomes after a delivery in France in 2019, according to hospital characteristics and the impact of distance and time of travel on mother and newborn. METHODS: All parturients above 18 years of age who delivered in 2019 and were identified in the French health insurance database were included, with their newborns, in this retrospective cohort study. Main outcome measures were Severe Maternal Morbidity score and the Neonatal Adverse Outcome Indicator (NAOI). RESULTS: Among the 733 052 pregnancies included, 10 829 presented a severe maternal morbidity (1.48%) and 77 237 had a neonatal adverse outcome (10.4%). Factors associated with an unfavorable maternal or neonatal outcome were Obstetric Comorbidity Index, primiparity, and cesarean or instrumental delivery. Prematurity was associated with less severe maternal morbidity but more neonatal adverse outcomes. Time of travel above 30 min was associated with a higher NAOI rate. CONCLUSIONS: Results suggest the efficiency of regionalization of perinatal care in France, although a difference in both outcomes persists according to unit volume, suggesting the need for a further step in concentrating perinatal care. Perinatal care organization should focus on mapping the territory with high-level, high-volume maternity throughout the territory; this suggests closing down high-volume units and improving low-volume ones to maintain coherent mapping.

In France, distance from hospital and health care structure impact on outcome after arthroplasty of the hip for proximal fractures of the femur.

BACKGROUND: Hip arthroplasty is a frequently performed procedure in orthopedic surgery, carried out in almost all health structures for two main issues: fracture and coxarthrosis. Even if volume-outcome relationship appeared associated in many surgeries recently, data provided are not sufficient to set surgical thresholds neither than closing down low-volumes centers. QUESTION: With this study, we wanted to identify surgical, health care-related and territorial factors influencing patient' mortality and readmission after a HA for a femoral fracture in 2018 in France. PATIENTS AND METHODS: Data were anonymously collected from French nationwide administrative databases. All patients who underwent a hip arthroplasty for a femoral fracture through 2018 were included. Patient outcome was 90-day mortality and 90-day readmission rate after surgery. RESULTS: Of the 36,252 patients that underwent a HA for fracture in France in 2018, 0.7% died within 90-day year and 1.2% were readmitted. Male and Charlson comorbidity index were associated with a higher 90-day mortality and readmission rate in multivariate analysis. High volume was associated with a lower mortality rate. Neither time of travel nor distance upon health facility were associated with mortality nor with readmission rate in the analysis. CONCLUSION: Even if volume appears to be associated with lower mortality rate even for longer distance and time of travel, the persistence of exogenous factors not documented in the French databases suggests that regionalization of hip arthroplasty should be organized with caution. CLINICAL RELEVANCE: As volume-outcome relationship must be interpreted with caution, policy makers should not regionalize such surgery without further investigation.

Definition of a Practical Taxonomy for Referencing Data Quality Problems in Health Care Databases.

INTRODUCTION: Health care information systems can generate and/or record huge volumes of data, some of which may be reused for research, clinical trials, or teaching. However, these databases can be affected by data quality problems; hence, an important step in the data reuse process consists in detecting and rectifying these issues. With a view to facilitating the assessment of data quality, we developed a taxonomy of data quality problems in operational databases. MATERIAL: We searched the literature for publications that mentioned "data quality problems," "data quality taxonomy," "data quality assessment," or "dirty data." The publications were then reviewed, compared, summarized, and structured using a bottom-up approach, to provide an operational taxonomy of data quality problems. The latter were illustrated with fictional examples (though based on reality) from clinical databases. RESULTS: Twelve publications were selected, and 286 instances of data quality problems were identified and were classified according to six distinct levels of granularity. We used the classification defined by Oliveira et al to structure our taxonomy. The extracted items were grouped into 53 data quality problems. DISCUSSION: This taxonomy facilitated the systematic assessment of data quality in databases by presenting the data's quality according to their granularity. The definition of this taxonomy is the first step in the data cleaning process. The subsequent steps include the definition of associated quality assessment methods and data cleaning methods. CONCLUSION: Our new taxonomy enabled the classification and illustration of 53 data quality problems found in hospital databases.

The impact of including a medication review in an integrated care pathway: A pilot study.

AIM: The objective of the present study was to measure the impact of the intervention of combining a medication review with an integrated care approach on potentially inappropriate medications (PIMs) and hospital readmissions in frail older adults. METHODS: A cohort of hospitalized older adults enrolled in the French PAERPA integrated care pathway (the exposed cohort) was matched retrospectively with hospitalized older adults not enrolled in the pathway (unexposed cohort) between January 1st, 2015, and December 31st, 2018. The study was an analysis of French health administrative database. The inclusion criteria for exposed patients were admission to an acute care department in a general hospital, age 75 years or over, at least three comorbidities or the prescription of diuretics or oral anticoagulants, discharge alive and performance of a medication review. RESULTS: For the study population (n = 582), the mean ± standard deviation age was 82.9 ± 4.9 years, and 380 (65.3%) were women. Depending on the definition used, the overall median number of PIMs ranged from 2 [0;3] on admission to 3 [0;3] at discharge. The intervention was not associated with a significant difference in the mean number of PIMs. Patients in the exposed cohort were half as likely to be readmitted to hospital within 30 days of discharge relative to patients in the unexposed cohort. CONCLUSION: Our results show that a medication review was not associated with a decrease in the mean number of PIMs. However, an integrated care intervention including the medication review was associated with a reduction in the number of hospital readmissions at 30 days.

Accuracy of the French Administrative Database to Describe Patients' Medication and Primary Care Visits: A Validation Study.

OBJECTIVE: To evaluate the accuracy of the French health administrative database to describe patients' medication and primary care visits, in the context of a transitional care intervention including an in-hospital medication reconciliation followed by a structured community follow-up by the patient's general practitioner and pharmacist. DESIGN: A retrospective cohort study of older persons enrolled in the transitional care intervention between January 1st, 2015 and December 31st, 2018. RESULTS: Only 46.1% of the community follow-up were timely billed, in the 3 months after the patient discharge. The sensitivity of the health administrative database to identify medications was 90.0%. Its positive predictive value was 50.1%. CONCLUSION: This study reveals that the French health administrative database was poorly reliable to identify both community follow-up and chronic medications.

PoleSat's Modelling a Reorganization of Vascular Catheterization Provision at the Territorial Hospital Grouping Level.

Since a French organization (2016) has defined "the territorial hospital groupings", public hospitals must share medical-economic knowledge and decision-makers expect prospective analyses. PoleSat aims, quick hospital-catchment area modellings, completed by population analyses. Modellings are based on "diagnostic and interventional vascular catheterizations" acts and Nouvelle-Aquitaine, and they are carried out 3 times, through the graphical user interface's main-setting values, coupled with 3 activity-scenarios. Scenario results cannot confirm the NA02-Atlantique's H0. The experts have approved PoleSat's method as a robust help-tool; therefore they project to repeat its usages.

Community-Acquired Acute Kidney Injury Induced By Drugs In Older Patients: A Multifactorial Event.

PURPOSE: Community-acquired acute kidney injury (CA-AKI) is a frequent and severe adverse drug reaction (ADR) among older patients. The combination of drugs and other CA-AKI risk factors was barely evaluated. The objectives of our study were to both accurately identify CA-AKI induced by drugs in older patients, and to describe their combination with other risk factors. PATIENTS AND METHODS: We conducted a retrospective, single-center study in a general hospital over a two-year period. An automated detection identified CA-AKI according to KDIGO criteria, amongst 4,767 eligible inpatient stays among patients aged 75 years or older. Two independent experts reviewed all CA-AKI events to adjudicate drug involvement (Naranjo scale), identify inappropriate prescriptions (STOPP criteria), evaluate avoidability (Hallas criteria) and identify combined risk factors. RESULTS: An expert review confirmed 713 CA-AKI (15.0% of inpatient stays) and determined that 419 (58.8%) CA-AKI were induced by drugs. A multifactorial cause (i.e., at least one drug with a precipitating factor) was found in 63.2% of drug-induced CA-AKI. Most of the drug-induced events were avoidable (66.8%), mainly in relation to a multifactorial cause. CONCLUSION: Drug-induced CA-AKI were frequent, multifactorial events in hospitalized older patients and their prevention should focus on combinations with precipitating factors.

Polesat-Web-2018: A Simulation IT Tool with Immediate Prospective and Strategic Views of Hospital Spatial Planning.

Medical geo-informatics allows the Health world to address major challenges thanks to attractive concepts, methods and user-friendly IT. PoleSat-web-2018 presents a decision support system - a modelling "variable geometry" IT tool for simulation of hospital spatial planning. The outputs enable quasi-instantaneous analytic visualization at several geographic levels. PoleSat-web-2018 provides prospective views of hospital catchments (by grouping, closing) and proves to be relevant for the French planners of the Ministry of Health.

PoleSat_2018: A Strategic IT Tool for Spatial Simulation Modelling of Hospital Planning.

Geomatics becomes a major field of science facing challenges to assist medical informatics and health decision makers thanks to attractive concepts, methods and easy, user-friendly-way IT technologies. PoleSat_2018 presents a web-based graphical user interface with an embedded optimized and automated algorithm. It is primarily geared for geomatics non-specialists and allows computer simulations by modelling scenarios of hospital grouping and/or closure. The consultation, reflection, prospective views, offered in a very short time to policy makers will find a successful support for health planning strategic decisions.

Underuse of Oral Anticoagulants and Inappropriate Prescription of Antiplatelet Therapy in Older Inpatients with Atrial Fibrillation.

BACKGROUND: Several studies have shown that the prescription of antiplatelet therapy (APT) is associated with an increased risk of oral anticoagulant (OAC) underuse in patients aged 75 years and over with atrial fibrillation (AF). An associated atheromatous disease may be the underlying reason for APT prescription. The objective of the study was to determine whether the association between underuse of OAC and APT prescription was explained by the presence of an atheromatous disease. METHODS AND RESULTS: We performed a retrospective, observational, single-centre study between 2009 and 2013 based on administrative data. Patients aged 75 years and over with non-valvular AF were identified in a database of 72,090 hospital stays. Prescriptions of anti-thrombotic medications and their association with the presence of atheromatous disease were evaluated by the mean of a logistic regression. A total of 2034 hospital stays were included (mean age 84.3 ± 5.2 years). The overall prevalence of known atheromatous disease was 25.9%. OAC underuse was observed in 58.5% of the stays. In multivariable analysis, the prescription of an APT was associated with an increased risk of OAC underuse [odds ratio (OR) 6.85; 95% confidence interval (CI) 5.50-8.58], independently of the presence of a concomitant known atheromatous disease (OR 0.78; 95% CI 0.60-1.01). Among the 692 stays with APT monotherapy (34.0%), 232 (33.5%) displayed an atheromatous disease. CONCLUSIONS: The underuse of OAC is associated with the prescription of APT in older patients with AF, regardless of the presence or absence of known atheromatous disease. Our results suggest that APT is often inappropriately prescribed instead of OAC.

POLESAT an Innovative e-Geoplatform in Health Management.

UNLABELLED: Health geography and geomatics have become major disciplines in the last few years and are the source of attractive concepts for medical informatics. POLESAT's e-geoplatform was built to present information and support decision-making during medical consultation. We have improved its usability with innovative and modern methodology. Results show five steps of the process. 1: we select one of three hospitals. 2: thanks to PiNoKio's anatomy, the related activity segments are displayed. 3: the activity segment "AB-Orthopedics, Rheumatology" is displayed. 4: click on "AB02-Amputations" product line and 5: go to hospital activity choropleth map. CONCLUSION: This third e-geoplatform version is a showcase for advanced open-source geomatics via web-mapping possibilities. Health management based on geography concepts, geomatics, an amusing avatar for children, health and/or geographic open data represent the technology of tomorrow. This e-geoplatform concept presents an opportunity for the serious games industry, education and will reduce health access inequalities.

POLESAT an Innovative e-Geoplatform in Health Management.

UNLABELLED: Health geography and geomatics have become major disciplines in the last few years and are the source of attractive concepts for medical informatics. POLESAT's e-geoplatform was built to present information and support decision-making during medical consultation. We have improved its usability with innovative and modern methodology. Results show five steps of the process. 1: we select one of three hospitals. 2: thanks to PiNoKio's anatomy, the related activity segments are displayed. 3: the activity segment "AB-Orthopedics, Rheumatology" is displayed. 4: click on "AB02-Amputations" product line and 5: go to hospital activity choropleth map. CONCLUSION: This third e-geoplatform version is a showcase for advanced open-source geomatics via web-mapping possibilities. Health management based on geography concepts, geomatics, an amusing avatar for children, health and/or geographic open data represent the technology of tomorrow. This e-geoplatform concept presents an opportunity for the serious games industry, education and will reduce health access inequalities.