[Main issues and contributions of the evaluation of health care networks]. / Les problématiques et les apports de l'evaluation d'un réseau de santé.

Health care networks correspond to a form of horizontal and flexible organisation, which consists in dealing with complex problems of health and long-term care. Networks rest entirely on the mechanisms of coordination between the various actors of care, whose keystone is the medical information flow. The challenge of the health networks evaluation is to prove the added value of a network organization, instead of a conventional disease-centred health care. The evaluation of health care networks is legally required but not sustained by specialists. Evaluation must ensure the existence of a real management; measure the interest of health care professionals and the impact of the network on professional practices. Moreover, evaluation accompanies the development of the network and offers the advisability to the decision maker of obtaining a tool for control of management, i.e. an information tool and a decision-making help, with the aim of a continuous improvement of the quality of care. However the absence of formation of the medical coordinators to management, makes networks management problematic. Thus, health care networks cannot make the saving in a good administrative and management base. In the same way health care networks must obtain an information system adapted to their type of coordination, allowing the evaluation required by the financier.

Vena Tech-LGM filter: long-term results of a prospective study.

Efficiency and tolerance of the Vena Tech-LGM filter were assessed in 142 patients prospectively studied during a 2-6-year follow-up period. No patients were lost to follow-up, and 137 (91.3%) scheduled control examinations were performed. Fifty-three patients died of causes unrelated to thromboembolic disease. Pulmonary embolism was suspected in five surviving patients (3.5%). Sixteen retractions (18.4%), 16 intracaval migrations (18.4%), and one tilt were observed. Filter patency studied at Doppler ultrasonography, with or without phlebocavography, gave the following results according to the Kaplan-Meier actuarial method: 92% patency after 2 years of follow-up, 80% after 4 years, and 70% after 6 years. Vena Tech-LGM filter obstruction was related to retraction (P < 10(-6)) or distal migration (P < .004). Occurrence of trophic disease in the lower limbs during the follow-up period was related to the initial level of deep venous thrombosis (P = .03) and had no relation to the patency of the filter. The filter was effective in preventing pulmonary embolism, with 70% demonstrating long-term patency, and no deleterious effects were imputed to obstructions observed during follow-up.