[Cause of non-pertinent hospital stays: interobserver concordance using the French version of the Appropriateness Evaluation Protocol]. / Etude de la concordance inter-observateurs des raisons de non-pertinence des journées d'hospitalisation identifiée par la version française de l'Appropriateness Evaluation Protocol (2e partie).

BACKGROUND: The modified French version of the Appropriateness Evaluation Protocol (AEPf) has been validated. Inappropriate days according to simple medical and technical criteria are identified with this tool. The aim of this study is to highlight the interest of investigating the reasons for inappropriate days and to assess the inter-observers reliability of the questionnaire developed for this purpose. METHODS: This questionnaire collects on one hand the needs of patients - distinguishing health care and accommodation needs - and on the other hand the reasons for inappropriate hospital days. The data were collected from January to September 1998 in nine voluntary medical and surgical departments. For each day of study randomly selected, each inappropriate hospital day according to AEPf has been included. Data were collected by two health professionals (a nurse and a physician), using a concurrent design. RESULTS: The reliability of the over-ride option of the appropriateness assessment of the 345 hospital days was good (overall Kappa coefficient: 0.66; 95% CI: 0.55-0.78). The comparison of the two expert judgments on health care needs fulfilled during the hospital day was acceptable; the Kappa coefficient was 0.62 (95% CI: 0.52-0.72). The reliability of expert assessment on patient accommodation needs (home, housing facilities or hospital) was good (Kappa coefficient: 0.67; 95% CI: 0.60-0.75). When hospital was not the accommodation the most adapted for patient, the reliability of the reasons for inappropriate days was high (Kappa coefficient: 0.75; 95% CI: 0.61-0.80). Kappa coefficients were different between hospitals, indicating a center effect. CONCLUSION: This instrument has been found to be reliable and should be used in complement of the first part of the AEPf which assess the prevalence of inappropriate days. It might help to detect dysfunctions within or outside the hospital and thus be used for evaluation or planning of health care.

[Reliability and validity of the French version of the first part of the Appropriateness Evaluation Protocol (AEPf): pertinent criteria of hospitalization stay]. / Reproductibilité et validité de la version française de la première partie de l'Appropriateness Evaluation Protocol (AEPf): critères de pertinence des journées d'hospitalisation.

BACKGROUND: The Appropriateness Evaluation Protocol (AEP) is a tool used to identify hospitalization days that are appropriate with respect to simple technical criteria, and the reasons for hospitalization days that do not meet these criteria. The goal of the study was to validate the clinical criteria of AEPf, required for identifying the reasons which explain these inappropriate hospital days. METHODS: The validity of a French version of criteria of appropriateness (AEPf) was assessed in a sample of 502 hospital days in medical and surgical wards of six French teaching hospitals. The reliability of the AEPf-based conclusions was studied by the measure of the concordance between two independent measures of AEPf for the same hospital day. Validity of AEPf was studied by the measure of the concordance between AEPf-based conclusions and the judgments of physicians using implicit criteria to assess the necessity of the hospital day studied. The degree of concordance was estimated by the Kappa coefficient. RESULTS: AEPf reproducibility was high (Kappa coefficient: 0.81; 95% confidence interval (95% CI): 0.76-0.87). Validity was also high (Kappa coefficient: 0.61; 95% CI: 0.53-0.68). CONCLUSION: The French version of the AEP was thus shown to be both reliable and valid to identify hospitalisation days appropriate with respect to hospital's technical equipment and specific resources. However, the reproducibility of the assessment of reasons for hospital days that did not meet AEP criteria will require a validation.

Effectiveness and prognostic factors of success in 12 smoking cessation clinics in the hospitals of Assistance publique-Hôpitaux de Paris.

We evaluated whether the location of a smoking cessation clinic in a hospital enhances the success rate compared to that found in the literature, regardless of the type of treatment. We assessed the results and identified prognostic factors of success in 12 smoking cessation clinics situated in 12 hospitals of the Assistance publique-Hôpitaux de Paris (AP-HP). The clinics were included in the study after a call for participation. The response rate was 60%. The study design was prospective, multicentric and descriptive. The study lasted 9 months. Follow-up took place 3 and 6 months after the first visit. The definition of success was self-reported total abstinence from cigarette smoking during the month preceding the 6-month follow-up. Success rate was 27%, failures were 66%, and 7% were lost to follow-up. Prognostic factors of success were not related to the hospital setting. We conclude that for a number of structural reasons that we explain, according to this study, the location of smoking cessation clinics in hospitals does not enhance their success rate compared to that found in the literature.

Appropriateness of admissions: the French experience.

The French studies using the Appropriateness Evaluation Protocol (AEP) were developed within the framework of medical audit by local teams, analysing their own practice, in order to improve the quality of care. Four studies were analysed in this review. They were performed in emergency departments and data were collected concurrently. The reliability and validity of this French version of the AEP was assessed. The high reliability of the AEP was found to be useful to measure trends or differences between groups. The percentages of inappropriate admissions observed in the studies ranged from 18 to 25%. The hypothesis that the rate of inappropriate admissions would be highest among the elderly was not confirmed in Paris. Homelessness was the only social factor related to a high rate of inappropriate admissions in three of the studies. In one study, age and lack of social support were found to be risk factors for inappropriate admissions. The study of the causes of inappropriate admissions was important, since they were to be used as an indicator of systemic problems in the organization of health care delivery. A distinction was made between appropriate and justified admissions on both a systemic and an individual level. In conclusion, AEP was found to be an indicator that was both reliable and useful to identify quality of care problems. Among the factors found to be related to inappropriate admissions, the internal organization of the hospital proved to be one of the main reasons and a target for improvement.

[Evaluation of FIVNAT 1992]. / Bilan FIVNAT 1992.

FIVNAT registry collected information on 21,960 individual assisted reproductive technology (ART) cycles in 1992. The present analysis concerns 15,557 cycles arrived on time to be incorporated, 97.9% being in vitro fertilization (IVF) cycles. The transfer rate was 80.9% and the clinical pregnancy rate was 19.2% per oocyte recovery cycle and 23.7% per transfer. The mean oocyte number slightly increased compared to 1991 (8.5 +/- 5.6 vs 8.2 +/- 5.6, p < 0.001) whereas the mean number of embryos obtained was not modified and the mean number of transferred oocytes slightly decreased. The mean fertilization rate slightly increased (53.0% +/- 30.2% vs 48.3% +/- 32.7%, p < 0.001). Infertility of tubal origin represented 59.1% of infertilities, and cycles realised with donor semen were associated to the highest pregnancy rate. GnRH analogues were widely used (87.5%), but those using a short blocking period tended to decrease, replaced by protocols without GnRH analogues. Stimulation regimen using a long blockage phase were associated to a higher pregnancy rate than the others (19.8% per recovery). The proportion of transfers involving 4 or more embryos decreased in 1991 to 22.9%. The analysis of 7,960 pregnancy forms resulting of recoveries realised from 1987 to 1991 showed a preterm birth rate of 9.2% for singleton, but a still high rate for twins and multiple pregnancies. For singleton pregnancies, in utero mortality concerned 6.9/1000 of the children, and the neonatal mortality rate (< 7 days) was 6.7/1000. The overall malformation rate was 2.8%.