Hospitalizations for Stroke in France During the COVID-19 Pandemic Before, During, and After the National Lockdown.

Background and Purpose: In France, the entire population was put under a total lockdown from March 17 to May 11, 2020 during the peak of the coronavirus disease 2019 (COVID-19) pandemic. Whether the lockdown had consequences on the management of medical emergencies such as stroke and transient ischemic attack (TIA) has yet to be fully evaluated. This article describes hospitalization rates for acute stroke in 2 French regions that experienced contrasting rates of COVID-19 infection, before, during, and after the nationwide lockdown (January to June 2020). Methods: All patients admitted for acute stroke/TIA into all public and private hospitals of the 2 study regions were included. Data wer…

Risque augmenté de ré-hospitalisation chez les personnes atteintes de diabète de type 1 et de schizophrénie

Introduction La morbidite et mortalite associees au diabete comme a la schizophrenie suggerent que leur combinaison puisse generer de graves problemes. L’objectif de l’etude etait d’estimer le risque de re-hospitalisation pour complications aigues du diabete et tentative de suicide a trois ans chez des personnes atteintes de diabete et de schizophrenie. Methodes A partir des donnees nationales d’hospitalisation, l’etude en population s’est interessee aux personnes âgees de 15 a 35 ans pour lesquelles une hospitalisation mentionnait un diabete de type 1, entre 2009 et 2012. Pour identifier les personnes atteintes de schizophrenie, un code correspondant a ete recherche pendant ou dans les deu…

Les réadmissions après résection pulmonaire en France : la base de données du PMSI

BACKGROUND Readmission within 30 days is an indicator of the quality of care, because it often reflects post-discharge care that is not optimal. The objective of this work is to measure over time on the one hand the readmission rate and on the other hand the number of hospitals with a standardized readmission rate beyond the national average. METHOD All patients with major pulmonary resection for lung cancer in France were extracted from the PMSI national database. Readmission within 30 days was defined as any new hospitalization either in the same hospital or in another establishment. RESULTS From January 1, 2005 to December 31, 2018, 110,603 patients were included. The 30-day all-cause re…

The use of national administrative data to describe the spatial distribution of in-hospital mortality following stroke in France, 2008-2011.

International audience; Background: In the context of implementing the National Stroke Plan in France, a spatial approach was used to measure inequalities in this disease. Using the national PMSI-MCO databases, we analyzed the in-hospital prevalence of stroke and established a map of in-hospital mortality rates with regard to the socio-demographic structure of the country.Methods: The principal characteristics of patients identified according to ICD10 codes relative to stroke (in accordance with earlier validation work) were studied. A map of standardized mortality rates at the level of PMSI geographic codes was established. An exploratory analysis (principal component analysis followed by …

Mesure de la qualité des soins à partir de la base de données nationale du PMSI. Étude de la mortalité hospitalière après résections pulmonaires pour cancer

Introduction En 2009, les centres prenant en charge des cancers ont ete soumis a autorisation suite au premier plan cancer. Cinq annees plus tard, il nous paraissait interessant de connaitre l’impact de cette nouvelle organisation. L’objectif est d’estimer l’effet periode et d’evaluer l’influence du volume d’activite sur la mortalite. Methodes De la base de donnees PMSI ont ete extraits pour tous les patients ayant eu une resection pulmonaire pour cancer bronchique. Les caracteristiques des centres comprennent le volume d’activite annuel et le type d’etablissement : publiques non universitaires, prives et CHU. L’indicateur de qualite utilise est la mortalite hospitaliere definie comme tout …

Soins ambulatoires et facteurs associés à la réhospitalisation précoce des sujets âgés (65+) après un infarctus du myocarde : étude observationnelle à partir des données nationales de l’Échantillon généraliste de bénéficiaires (EGB)

Etat de la question Les rehospitalisations precoces (RHP), dans les 30 jours suivant la sortie d’hospitalisation, sont frequentes chez les sujets âges, notamment apres un infarctus du myocarde (IDM). Elles augmentent la morbi-mortalite et les depenses de sante. Il a ete demontre qu’une meilleure organisation de la sortie d’hospitalisation reduit significativement le risque de RHP. Neanmoins, il n’existe aucune recommandation sur le suivi ambulatoire en sortie d’hospitalisation. L’objectif de l’etude etait d’analyser les soins ambulatoires post-hospitaliers et les facteurs associes a la RHP des sujets âges apres un IDM. Materiel et methodes Etude observationnelle retrospective a partir des d…

Proposition d’une méthode d’exploitation d’une base de données nationales : le PMSI, pour estimer la fréquence, repérer les situations à risques et les conséquences, des maltraitances physiques à enfants en France

Introduction L’objectif de ce travail est de reperer les situations de maltraitances physiques a enfants et d’evaluer leurs consequences, en termes de mortalite, a partir des donnees du PMSI. Methodes Ont ete incluse, tous les enfants âges de 0 a 2 ans, hospitalises en France entre 2007 et 2014. A partir des codes CIM-10, generes pour le PMSI a chaque sejour hospitalier, trois groupes d’enfants ont ete definis : 1) ceux ayant un code dedie aux maltraitances physiques ; 2) ceux ayant un code de lesions suspectes de mauvais traitement, 3) les autres enfants hospitalises. Une estimation de la frequence nationale de ces maltraitances physiques a ete calculee, selon deux methodes, l’une conduisa…

Does age over 80 years have to be a contraindication for lung cancer surgery—a nationwide database study

IF 1.804 (2017); International audience; Background: Nowadays surgery remains the best treatment for localized lung cancer (LC). However, patients over 80 years old are often denied surgery because of the postoperative risk of death. This study aimed to estimate in-hospital mortality (IHM) and determine whether age over 80 is the most important predictor of IHM after LC surgery.Methods: From January 2005 to December 2015, 97,440 patients, including 4,438 patients over 80 years old, were operated on for LC and recorded in the French Administrative Database. Characteristics of patients, hospitals and surgery were analysed.Results: Crude IHM was 3.73% (n=3,639) and 7.77% (n=345) for the over 8…

Spatules de Thierry ou forceps : comparaison des morbidités materno-fœtales

Resume Objectif Comparer la morbidite materno-fœtale immediate lors d’une l’extraction par forceps ou par spatules de Thierry. Methodes Etude retrospective, descriptive, monocentrique de 2006 a 2012. Les extractions etaient realisees par spatules ou forceps pour defaut de progression du mobile fœtale, sur singleton, en presentation cephalique, a terme, sans anomalies du rythme cardiaque fœtal et sans pathologie gravidique associee. Resultats Notre serie comprenait 65 extractions par spatules contre 77 par forceps. Nos populations etaient comparables. Au niveau maternel, on retrouvait davantage de perinees intacts (5,19 % versus 15,38 %, p = 0,04), autant de dechirures vaginales et moins de …

Étude de prévalence de l’endométriose à la Réunion et en métropole à partir du PMSI

Introduction Objectif principal : determiner la prevalence des hospitalisations pour endometriose a la Reunion et en metropole. Objectif secondaire : apprecier l’evolution des soins chirurgicaux pour cette pathologie dans l’ile comparee a la metropole. L’endometriose est une maladie de la femme reglee. Les principaux modes de decouverte sont la douleur et l’infertilite. Le diagnostic de certitude repose sur la cœlioscopie et donc sur une hospitalisation. Methodes Du 1/01/2008 au 31/12/2012, a partir du PMSI national, nous avons releve les codes de diagnostic principal concernant l’endometriose (N800 a N809). Dans cette population, nous avons consulte les actes realises et ceux qui concernai…

Combined effects of increasing maternal age and nulliparity on hypertensive disorders of pregnancy and small for gestational age

The mean age of women delivering for the first time is increasing, and this combination could lead to an increased risk of perinatal complications.The objective was to evaluate the potential combined effects of nulliparity and increasing maternal age on small for gestational age (SGA  10th percentile) and hypertensive disorders of pregnancy (HDP).A population-based cohort study was conducted using data routinely collected on all births in 11 hospitals in the Burgundy perinatal network between 2007 and 2016. Pregnant women with singleton deliveries aged 20 years or older were included at delivery and divided into groups according to maternal age (20 to 24-year-old group as a reference). Mult…

Évaluation de la qualité métrologique des données du Programme de médicalisation du système d’information (PMSI) en périnatalité. Étude pilote réalisée dans les CHU de Dijon, Port-Royal et Nancy

Introduction Le plan de perinatalite et les recommandations europeennes expriment la necessite de fournir des informations fiables indispensables a la realisation de travaux de recherche et a la production d’indicateurs nationaux. Parmi les multiples sources de donnees perinatales, les donnees du PMSI offrent la potentialite de fournir des informations systematiques et standardisees pour l’ensemble des naissances. L’objectif de l’etude etait de mesurer la faisabilite de valider la qualite metrologique des donnees du PMSI pour des indicateurs de base de sante perinatale dans trois centres hospitaliers universitaires pilotes, avant de mener une etude a l’echelon national. Methodes Dans trois …

Classification of hospital pathways in the management of cancer: application to lung cancer in the region of burgundy.

Abstract Context : The evaluation of national cancer plans is an important aspect of their implementation. For this evaluation, the principal actors in the field (doctors, nurses, etc.) as well as decision-makers must have access to information that is reliable, synthetic and easy to interpret, and which reflects the implementation process in the field. We propose here a methodology to make this type of information available in the context of reducing inequalities with regard to access to healthcare for patients with lung cancer in the region of Burgundy. Methods : We used the national medico-administrative DRG-type database, which gathers together all hospital stays. By using this database…

Depression and obesity, data from a national administrative database study: Geographic evidence for an epidemiological overlap

BackgroundDepression and obesity are two major conditions with both psychological and somatic burdens. Some data suggest strong connections between depression and obesity and more particularly associated prevalence of both disorders. However, little is known about the geographical distribution of these two diseases. This study aimed to determine if there is spatial overlap between obesity and depression using data from the entire French territory.MethodsData for 5,627 geographic codes for metropolitan France were collected from the two national hospital databases (PMSI-MCO and RIM-P) for the year 2016. We identified people who were depressed, obese or both registered in the two public medic…

Évaluation de la pratique chirurgicale dans le traitement du cancer bronchique en France à partir de la base nationale du PMSI

Background - In recent years, improving the quality of care has been a concern for health professionals in France, through the certification of institutions, accreditation and continuous professional development. Evaluation of these different measures has rarely been carried out. The objective of the study was to evaluate the quality of surgical management of lung cancer in different regions using hospital mortality as an indicator. Method - From the national database of the Program of Medical Information Systems (PMSI), data on all patients who had undergone surgery for lung cancer were extracted as well as the characteristics of the centers. The main outcome criterion was hospital mortali…

sj-pdf-1-pmj-10.1177_02692163211019299 – Supplemental material for Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data

Supplemental material, sj-pdf-1-pmj-10.1177_02692163211019299 for Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data by Michael K. Gusmano, Victor G. Rodwin, Daniel Weisz, Jonathan Cottenet and Catherine Quantin in Palliative Medicine

Évaluation de la qualité métrologique des données du programme de médicalisation du système d’information (PMSI) en périnatalité : étude pilote réalisée dans 3 CHU

Resume Position du probleme La France est l’un des derniers pays europeens a ne pas pouvoir fournir d’informations perinatales fiables, indispensables a la realisation de travaux de recherche et a la production d’indicateurs nationaux. Le systeme d’information perinatale en France est fragmente et les donnees, difficiles a regrouper, ne repondent pas aux exigences d’Europeristat. Les donnees du PMSI offrent la potentialite de fournir des informations systematiques et standardisees pour l’ensemble des naissances. L’objectif etait d’etudier la qualite metrologique des donnees du PMSI pour construire des indicateurs de base en sante perinatale dans trois centres hospitaliers universitaires, av…

Comparaison France-Suisse des taux hospitaliers standardisés d’événements thromboemboliques et hémorragiques après arthroplastie totale primaire programmée de hanche ou de genou

Introduction La Suisse et la France ne contribuent pas aux comparaisons internationales de l’OCDE sur la securite des arthroplasties de hanche (PTH) et de genou (PTG) utilisant les taux standardises de thromboses veineuses profondes (TVP) ou d’embolies pulmonaires (EP) a 30 jours. L’objectif principal de cette etude etait d’estimer et de comparer les taux hospitaliers standardises d’evenements indesirables (TSEI) thromboemboliques et hemorragiques survenant apres une PTH/PTG primaire programmee chez les patients âges hospitalises en Suisse et en France. Methodes Nous avons mene deux etudes transversales basees sur des donnees medico-administratives nationales chainees (periode 2011–2014) de…

Emergence des pathologies pulmonaires non infectieuses chez les patients vivant avec le virus de l’immunodéficience humaine (VIH) : étude sur la base nationale des données du PMSI de 2007 à 2013

Introduction Une modification de l’epidemiologie des pathologies respiratoires a ete constatee chez les patients infectes par le VIH depuis la mise en place des therapies antiretrovirales. Les objectifs de notre travail sont de determiner la prevalence francaise des pathologies respiratoires chez les personnes infectees par le VIH et d’evaluer le risque que represente l’infection par le VIH dans la survenue de pathologies respiratoires non infectieuses. Methodes A partir de la base nationale de donnees du Programme de medicalisation des systemes d’information (PMSI), nous avons calcule la prevalence hospitaliere d’un panel de pathologies respiratoires chez les patients infectes par le VIH h…

Qualité de la surveillance de l’hémoglobine glyquée après un infarctus cérébral ou un accident ischémique transitoire : une étude nationale

Etat de la question Chez les patients diabetiques, la prevention de la recidive d’un infarctus cerebral (IC) et d’un accident ischemique transitoire (AIT) necessite l’equilibre glycemique. Notre etude s’interesse a l’association entre la survenue d’un IC ou d’un AIT et la realisation d’un suivi de l’HbA1c acceptable ou optimal selon les recommandations actuelles. Materiel et methodes Les patients diabetiques victimes d’un IC ou d’un AIT durant l’annee 2011 (exposes) ont ete identifies a partir des donnees du Programme de medicalisation des systemes d’information, et compares a un groupe de patients diabetiques indemnes d’IC ou d’AIT (non exposes) issus de l’echantillon general des beneficia…

Hospital Readmission after Major Pulmonary Resection for Lung Cancer in France: A Nationwide Medico-Administrative Database

Objectives: After major pulmonary resection for lung cancer, hospital readmission is considered an indicator of the quality of care. Our main objective was to define the readmission rate at 30 days after pulmonary resection. Secondary objectives were to determine the causes and predictive factors. Methods: Data for all patients operated for lung cancer were extracted from the national medico-administrative database of the Programme de Medicalisation des Systemes d'Information (PMSI). Thirty-days hospital readmission was defined as any new hospitalization within 30 days after discharge from the surgical department following major lung resection, regardless of the reason for readmission. Resu…

Haemoptysis: a frequent diagnostic challenge

We appreciate and agree with the comments of M. Mondoni and colleagues, that the results of the ongoing prospective Italian multicentre trial ([www.ClinicalTrial.gov][1] identifier [NCT02045394][2]) will be of considerable interest for the management of haemoptysis, a frequent and severe symptom, especially since there is no clear consensus concerning aetiology and treatment. Interestingly, beyond determining the prevalence of diseases that may present with haemoptysis, their epidemiological results will be analysed according to the severity of the symptom. More importantly, their trial will hopefully make it possible to analyse the sensitivity and specificity of complementary tests, such a…

Early cardiovascular events in women with a history of gestational diabetes mellitus

International audience; Background: The effect of gestational diabetes mellitus (GDM) on cardiovascular diseases (CVD) is not assessed within the first 10 years postpartum, regardless of subsequent diabetes. The aim of this study was to determine the risk of CVD events related to GDM within 7 years of postpartum.Methods: This nationwide population-based study of deliveries in 2007 and 2008 with a follow-up of 7 years was based on data from the French medico-administrative database. Two groups were formed: women with a history of GDM and women without GDM or previous diabetes. CVD included angina pectoris, myocardial infarction, stroke, heart bypass surgery, coronary angioplasty, carotid end…

Précocité des pathologies cardiovasculaires chez les femmes ayant un antécédent de diabète gestationnel

Introduction La precocite de dysfonctions cardiaques et du syndrome metabolique apres une grossesse marquee par un diabete gestationnel (DG) est un sujet d’actualite. L’objectif de l’etude etait de determiner, a partir des donnees hospitalieres, l’association entre antecedent de DG et maladies cardiovasculaires (MCV) dans les six annees du post-partum. Methodes Cette etude concerne l’ensemble des accouchements reperes dans la base nationale du PMSI en 2007 et 2008. Parmi ces femmes, ont ete distinguees celles ayant presente un DG au cours de leur grossesse (en 2007 ou 2008), et celles sans DG. Ces femmes ont ete suivies via le chainage des resumes PMSI, jusqu’en 2013. Une analyse par regres…

Hypoproteinemia on the first day of life and adverse outcome in very preterm infants admitted to the neonatal intensive care unit

International audience; OBJECTIVE: We aimed to investigate the relationship between day-1 hypoproteinemia and severe adverse outcome (SAO) in very preterm infants admitted to the neonatal intensive care unit (NICU). STUDY DESIGN: Retrospective study of all patients born from 24 to 31 weeks gestation and cared for in our NICU over an 8-year period. Infants were excluded if the serum protein value on the first day of life was not available. RESULT: A total of 913 patients were included. In all, 14.6% presented with SAO (death or severe neurological injury on cranial ultrasound). Hypoproteinemia (total protein level \textless40 g l(-1)) on day 1 of life occurred in 19.5 % of all patients. The …

Hémorragie sévère du post-partum et distance domicile-hôpital : étude en population à partir des données hospitalières

Introduction Afin de diminuer la mortalite et morbidite severe maternelle, une attention particuliere merite d’etre portee a l’hemorragie severe du post-partum (HPP), notamment a la recherche de nouveaux facteurs de risque. L’objectif de l’etude etait d’estimer le risque d’HPP severe lie a la distance entre le domicile et le service d’obstetrique et de decrire les facteurs de risque de l’HPP severe identifies par le Programme de medicalisation des systemes d’information (PMSI). Methodes Une cohorte retrospective en population a ete realisee a partir de la base nationale du PMSI de 2011, via le code Z37. La variable d’interet etait l’HPP severe par atonie uterine identifiee par le code corre…

Customized and non-customized live-born birth-weight curves of single and uncomplicated pregnancies from the Burgundy perinatal network. Part I – methodology

International audience; Objectives: To establish non-customized and customized birth-weight curves of single and uncomplicated pregnancies according to gestational age.Materials and methods: We used data for 64,173 mother-infants pairs from the Burgundy perinatal network database (France) over the period 2005-2013. A validated procedure was used to link mothers with their newborns, and maternal and fetal pathologies likely to affect birth weight were excluded. Multiple regression analysis with covariate selection was used to build a customized growth curve with maternal and fetal parameters.Results: Using this methodology, three different curves were generated: an unadjusted curve for birth…

Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data.

Background: Many studies explore the clinical and ethical dimensions of care at the end-of-life, but fewer use administrative data to examine individual and geographic differences, including the use of palliative care. Aim: Provide a population-based perspective on end-of-life and hospital palliative care among local authorities and hospitals in France. Design: Retrospective cohort study of care received by 17,928 decedents 65 and over (last 6 months of life), using the French national health insurance database Results: 55.7% of decedents died in acute-care hospitals; 79% were hospitalized in them at least once; 11.7% were admitted at least once for hospital palliative care. Among 31 academ…

Outcomes after acute myocardial infarction in HIV-infected patients: analysis of data from a French nationwide hospital medical information database.

Background— We aimed to assess in-hospital case fatality and 1-year prognosis in HIV-infected patients with acute myocardial infarction. Methods and Results— From the PMSI (Program de Medicalisation des Systèmes d’informatique) database, data from 277 303 consecutive acute myocardial infarction patients hospitalized from January 1, 2005, to December 31, 2009, were analyzed. Surviving patients were followed up for 1 year after discharge. HIV-infected patients were compared with uninfected patients. Among the cohort, HIV-infected patients (n=608) accounted for 0.22%. All-cause hospital and 1-year mortality rates were lower in the HIV-infected group than in uninfected patients (3.1% versus 8.…

Is an activity volume threshold really realistic for lung cancer resection?

IF 1.804 (2017); International audience; Background:We analyzed volume as a continuous variable to estimate threshold, which is a methodology rarely seen in the literature. The objective of this work was to assess hospital volume for lung cancer (LC) surgery and to establish the associated threshold for acceptable in-hospital mortality (IHM). Data was obtained from the French national medico-administrative database.Methods:From January 2005 to December 2016, data from 108,571 patients operated for LC in France were collected from the national administrative database. To estimate the volume threshold, hierarchical logistic regression models were developed.Results:The crude IHM rate was 5.2% …

Analyse géographique de la prévalence de l’obésité et de la dépression à partir des bases du Programme de médicalisation des systèmes d’information et du RIM-P

Introduction La prise en charge de l’obesite et de la depression represente un poids consequent et en augmentation pour le systeme de soins. Plusieurs etudes ont montre que ces deux pathologies partagent des mecanismes physiopathologiques communs. Par ailleurs, aux Etats-Unis, la repartition spatiale des zones de forte prevalence des deux pathologies presente des similitudes. Cette repartition etant meconnue en France, nous avons cherche si les deux pathologies touchaient les memes territoires. Methodes Nous avons identifie dans le PMSI-MCO les patients presentant un diagnostic d’obesite ou un diagnostic principal de depression. A partir du RIM-P, nous avons identifie les patients presentan…

Risque de maladie thromboembolique veineuse dans l’année qui suit le diagnostic de cancer du poumon en France

Etat de la question La maladie thromboembolique veineuse (MTEV) comprend la thrombose veineuse profonde (TVP) et sa principale complication l’embolie pulmonaire (EP). La MTEV est une pathologie frequente chez les patients atteints de cancer et est responsable d’une morbi-mortalite importante. L’objectif de notre etude etait d’estimer la frequence de la MTEV chez les patients atteints d’un cancer du poumon en France et d’en identifier des facteurs de risque. Materiel et methodes Les donnees ont ete extraites de la base de donnees de l’echantillon generaliste des beneficiaires (EGB), qui est un echantillon permanent des donnees de l’Assurance maladie francaise (incluant des donnees d’hospital…

Apport de l’utilisation des données médico-administratives pour une politique de santé territorialisée : l’exemple de la mortalité hospitalière des accidents vasculaires cérébraux, 2008–2011

Introduction La mise en œuvre du Plan national AVC prevoit l’utilisation des grandes bases de donnees medico-administratives pour etablir et suivre certains indicateurs de prise en charge des personnes victimes d’AVC. A partir des bases nationales du PMSI-MCO 2008–2011, nous avons etabli une analyse de la prevalence hospitaliere des AVC ischemiques et hemorragiques ainsi qu’une cartographie des taux de mortalite hospitaliere. Methodes Les principales caracteristiques des patients identifies selon une liste de codes CIM10 relatifs a un AVC (retenus suite a des travaux de validation anterieurs) ont ete etudiees. Une cartographie des taux de mortalite standardises a ete effectuee a l’echelle d…

Gestational age and 1-year hospital admission or mortality: a nation-wide population-based study

International audience; Background: Describe the 1-year hospitalization and in-hospital mortality rates, in infants born after 31 weeks ofgestational age (GA).Methods: This nation-wide population-based study used the French medico-administrative database to assess thefollowing outcomes in singleton live-born infants (32–43 weeks) without congenital anomalies (year 2011): neonatalhospitalization (day of life 1 – 28), post-neonatal hospitalization (day of life 29 – 365), and 1-year in-hospital mortalityrates. Marginal models and negative binomial regressions were used.Results: The study included 696,698 live-born babies. The neonatal hospitalization rate was 9.8%. Up to 40 weeks,the lower the…

Cancer du sein chez l’homme en France

Introduction En France, il n’existe pas de donnees decrivant les caracteristiques cliniques ainsi que les traitements des hommes atteints de cancer du sein. L’objectif de cette etude etait de decrire les caracteristiques cliniques et les traitements des hommes atteints de cancer du sein en France entre 2007 et 2013 et identifies grâce aux donnees du PMSI national. Methodes Les cas de cancer du sein infiltrant chez l’homme entre 2007 et 2013 ont ete identifies grâce aux donnees du PMSI national. La prevalence par annee a ete calculee en faisant le rapport entre le nombre de cas prevalents par annee et la population francaise pour l’annee correspondante. Les donnees cliniques : âge, la presen…

A Comparative Analysis of Hospital Readmissions in France and the US

International audience; Policymakers in the US and France are struggling to improve coordination among hospitals and other health care providers. A comparison of hospital readmission rates, and the factors that may explain them, can provide important insights about the French and US health care systems. In addition, it illustrates a methodological approach to comparative research: how an empirical inquiry along a single indicator can reveal broader issues about system-wide differences across health care systems and policy. Using data from three French regions, the article extends a previous national-level comparison indicating that rates of hospital readmission for the population aged 65+ a…

Estimation of National Colorectal-Cancer Incidence Using Claims Databases

Background.The aim of the study was to assess the accuracy of the colorectal-cancer incidence estimated from administrative data.Methods.We selected potential incident colorectal-cancer cases in 2004-2005 French administrative data, using two alternative algorithms. The first was based only on diagnostic and procedure codes, whereas the second considered the past history of the patient. Results of both methods were assessed against two corresponding local cancer registries, acting as “gold standards.” We then constructed a multivariable regression model to estimate the corrected total number of incident colorectal-cancer cases from the whole national administrative database.Results.The firs…

Increased Risk of Rehospitalization for Acute Diabetes Complications and Suicide Attempts in Patients With Type 1 Diabetes and Comorbid Schizophrenia

OBJECTIVE The aim of this large retrospective cohort study was to estimate the supplementary morbidity and mortality risks conferred by the co-occurrence of schizophrenia among young people with type 1 diabetes. RESEARCH DESIGN AND METHODS This nationwide population-based study included individuals aged 15–35 years hospitalized in France for type 1 diabetes from 2009 to 2012 with or without schizophrenia. For assessment of the occurrence of rehospitalization for acute diabetes complications, suicide attempts, and hospital mortality, multivariate logistic regressions and survival analysis adjusted for age, sex, and Charlson comorbidity index scores were performed. The association between ho…

Haemoptysis in adults: a 5-year study using the French nationwide hospital administrative database.

Haemoptysis is a serious symptom with various aetiologies. Our aim was to define the aetiologies, outcomes and associations with lung cancer in the entire population of a high-income country.This retrospective multicentre study was based on the French nationwide hospital medical information database collected over 5 years (2008–2012). We analysed haemoptysis incidence, aetiologies, geographical and seasonal distribution and mortality. We studied recurrence, association with lung cancer and mortality in a 3-year follow-up analysis.Each year, ∼15 000 adult patients (mean age 62 years, male/female ratio 2/1) were admitted for haemoptysis or had haemoptysis as a complication of their hospital s…

Impact of video-assisted thoracic surgery approach on postoperative mortality after lobectomy in octogenarians.

The number of octogenarians who present with localized lung cancer eligible for surgical resection is increasing. Video-assisted thoracic surgery lobectomy has been widely accepted, but the potential benefit in octogenarians is not well established, especially for postoperative mortality. This study aimed to assess the impact of a video-assisted thoracic surgery approach on postoperative mortality after lobectomy for lung cancer in octogenarians.From January 2005 to December 2016, all patients aged more than 80 years who received lobectomy treatment for lung cancer were retrieved from the French Administrative Database. The end point was 30-day postoperative death. A propensity score was ge…

Prevalence and incidence of kidney diseases leading to hospital admission in people living with HIV in France: an observational nationwide study.

ObjectivesTo describe hospitalisations for kidney disease (KD) among people living with HIV (PLHIV) in France and to identify the factors associated with such hospitalisations since data on the epidemiology of KD leading to hospitalisation are globally scarce.DesignObservational nationwide study using the French Programme de Médicalisation des Systèmes d’Information database.SettingFrance 2008–2013.ParticipantsAround 10 862 PLHIV out of a mean of 5 210 856 patients hospitalised each year. All hospital admissions with a main diagnosis code indicating KD (International Classification of Diseases, 10th revision codes, N00 to –N39) were collected.Main outcome measuresThe prevalence and incidenc…

Dépistage précoce du diabète après une grossesse marquée par un diabète gestationnel

Introduction Les femmes ayant presente un diabete gestationnel (DG) ont ulterieurement un risque eleve de diabete de type 2 (DT2). Le taux de depistage du DT2 apres un antecedent de DG est estime entre 3,4 et 92,6 % selon les etudes. L’objectif de notre etude etait de decrire le depistage precoce du DT2 apres une grossesse marquee par un DG entre 2007 et 2013. Methodes L’etude s’est interessee aux femmes ayant presente un DG a partir de l’echantillon generaliste des beneficiaires des donnees de l’assurance maladie obligatoire. Dans les donnees hospitalieres, les accouchements ont ete reperes a partir des codes Z37 de la CIM-10 et le diabete gestationnel a partir du code O24.4. Les examens d…

Prevalence of patients hospitalised for male breast cancer in France using the French nationwide hospital administrative database

BACKGROUND Breast cancer (BC) in men is a rare and neglected disease representing <1% of all cancers in men and only 1% of all incident BC in western countries. OBJECTIVE This study aimed to describe trends in the prevalence of patients hospitalised for male BC in France from 2009 to 2013, using the national administrative database (PMSI). METHODS We included all men aged ≥18 admitted to hospital for BC during this period and estimated the prevalence of male breast cancer hospitalised in France over 5 years. We also describe clinical characteristics and treatments in men with surgery for BC over the 5-year period of the study. RESULTS The prevalence of patients hospitalised for BC significa…

In-hospital mortality following lung cancer resection: nationwide administrative database.

Our aim was to determine the effect of a national strategy for quality improvement in cancer management (the “Plan Cancer”) according to time period and to assess the influence of type and volume of hospital activity on in-hospital mortality (IHM) within a large national cohort of patients operated on for lung cancer.From January 2005 to December 2013, 76 235 patients were included in the French Administrative Database. Patient characteristics, hospital volume of activity and hospital type were analysed over three periods: 2005–2007, 2008–2010 and 2011–2013.Global crude IHM was 3.9%: 4.3% during 2005–2007, 4% during 2008–2010 and 3.5% during 2011–2013 (p&lt;0.01). 296, 259 and 209 centres p…

Comparative Metrics and Policy Learning: End-of-Life Care in France and the US

AbstractComparative policy analysis sometimes relies on the use of metrics to foster policy learning. We compare health care for patients at the end of life (EOL) in the US and France. The analysis...

The Impact of World and European Football Cups on Stroke in the Population of Dijon, France: A Longitudinal Study from 1986 to 2006

Background: Acute stress may trigger vascular events. We aimed to investigate whether important football competitions involving the French football team increased the occurrence of stroke. Methods: We retrospectively retrieved data of fatal and nonfatal stroke during 4 World Football Cups (1986, 1998, 2002, and 2006) and 4 European Championships (1992, 1996, 2000, and 2004), based on data from the population-based Stroke Registry of Dijon, France. One period of exposure was analyzed: the period of competition extended to 15 days before and after the competitions. The number of strokes was compared between exposed and unexposed corresponding periods of preceding and following years using Poi…

530: Intrauterine balloon tamponade (IUBT) for management of severe postpartum hemorrhage (PPH) within a perinatal network: efficacy and factors predicting failure

Comparison of rehospitalization rates in France and the United States

Objective To compare rates of 30-day all-cause rehospitalization in France and the US among patients aged 65 years and older and explain any difference between the countries. Methods To calculate rehospitalization rates in France, we use an individual identifying variable in the national hospital administrative dataset to track unique individuals aged 65 years or more hospitalized in France in 2010. To calculate the proportion of rehospitalized patients (65+) who received outpatient visits between the time of initial discharge and rehospitalization, we linked the hospital database with a database that includes all medical and surgical admissions. We used step by step regression models to pr…

Qualité de la surveillance de l’hémoglobine glyquée après un infarctus cérébral, un accident ischémique transitoire ou une hémorragie intra-cérébrale chez des patients diabétiques : une étude nationale

Introduction Chez les patients diabetiques, l’equilibre glycemique est un element cle de la prevention des accidents neuro-vasculaires, notamment de la recidive d’un infarctus cerebral (IC) et d’un accident ischemique transitoire (AIT). Notre etude s’interesse a l’association entre la survenue d’un IC, d’un AIT ou d’une hemorragie intra-cerebrale (HIC) et la realisation d’un suivi de l’HbA1c acceptable ou optimal selon les recommandations actuelles. Methodes Les patients diabetiques victimes d’un IC, d’un AIT ou d’une HIC en 2011 (exposes) ont ete identifies a partir des donnees du systeme national d’information interregimes de l’assurance maladie (Sniiram), et compares a un groupe de patie…

Identification of Infant Victims of Abusive Head Trauma Hospitalised in France from 2015 to 2017

sj-pdf-1-pmj-10.1177_02692163211019299 – Supplemental material for Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data

Supplemental material, sj-pdf-1-pmj-10.1177_02692163211019299 for Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data by Michael K. Gusmano, Victor G. Rodwin, Daniel Weisz, Jonathan Cottenet and Catherine Quantin in Palliative Medicine