How did episiotomy rates change from 2007 to 2014? Population-based study in France

International audienceBACKGROUND: Since the 2000s, selective episiotomy has been systematically recommended worldwide. In France, the recommended episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with episiotomy.METHODS: This population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with episiotomy for non-operative vaginal deliveries and the risk factors related to the women's characteristics and the birth environment.RESULTS: There were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23-1.30]), epidural analgesia (aOR = 1.45 [1.43-1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47-1.49]), and giving birth for the first time (aOR = 3.85 [3.84-4.00]).CONCLUSIONS: The episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant

Hospitalizations of patients in Burgundy and in nine other french regions, spatial analysis of interregional flows from french hospital claims data

Introduction / présentation du contexte : La création des ARS s’est accompagnée d’un pilotage régionalisé de la gouvernance sanitaire. Si les modalités administratives de découpage des territoires sanitaires sont connues, nous proposons une analyse géographique des logiques de fréquentation effectives des établissements hospitaliers qui semblent échapper à ce cadre réglementaire.Méthodes employées et sources de donnéesA partir du PMSI-MCO, nous avons étudié les flux inter-régionaux hospitaliers pour dix motifs de recours. L’analyse a été complétée par une analyse cartographique associant les mobilités à différents découpages géographiques et historiques, en Bourgogne et pour neuf autres régions test.Principaux résultats : La cartographie des mobilités hospitalières en Bourgogne et pour chaque région test montre que les flux de patients s’insèrent dans des ensembles territoriaux souvent cohérents au regard des limites que nous avons utilisées. Nos résultats indiquent que les frontières administratives régionales ne délimitent pas toujours des territoires homogènes. Pour chaque région test, des frontières invisibles apparaissent, héritées de la sédimentation historique et façonnées par des interfaces géographiques multiples.Discussion/Conclusion : La géographie aide à mieux comprendre l’organisation des flux hospitaliers, qui échappent aux logiques administratives régionales de la planification actuelle. A l’heure de la création de nouvelles grandes régions, l’outil géographique apparaît essentiel pour contribuer à l’instauration d’une gouvernance sanitaire plus pragmatique.Introduction / presentation of the context : The creation of ARS (Regional Healthcare Agencies) was accompanied by the regionalized organization of healthcare. Even though the administrative procedures for dividing the country into areas for healthcare coverage are well known, we propose a geographic analysis of the reasons why patients attend one hospital rather than another, which seem to escape the logic used by the authorities.Methods employed and sources of data : Using the PMSI-MCO, we studied the flow of patients living in one region to hospitals in other regions according to ten reasons for visiting hospitals. The analysis was completed by a cartographic analysis, which related the flow to different geographical and historical divisions in Burgundy and in nine other test regions.Main results : The cartography of hospital flow in Burgundy and for each test region showed that the choices made by patients were often coherent with regard to the limits that we used. Our results indicate that regional administrative boundaries do not always create homogeneous territories. For each test region, invisible boundaries appear. They stem from historical sedimentation and were shaped by numerous geographic dynamics.Discussion/ConclusionGeography makes it easier to understand hospital flow, which escapes the logic of current regional administrative planning. Now, with the creation of new super-regions, geography appears to be an essential tool to establish more pragmatic healthcare coverage

Out-of-maternity deliveries in France: A nationwide population-based study

International audienceINTRODUCTION:In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality.MATERIALS AND METHODS:We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions.RESULTS:The distance to the nearest maternity unit was the main factor for OMD. OMD were associated with maternal death (aRR 6.5 [1.6-26.3]) and all of the neonatal adverse outcomes: stillbirth (3.3 [2.8-3.8]), neonatal death (1.9 [1.2-3.1]), neonatal hospitalization (1.2 [1.1-1.3]), newborn hypothermia (5.9 [5.2-6.6]) and newborn polycythemia (4.8 [3.5-6.4]).DISCUSSION:In France, OMD increased over the study period. OMD were associated with all the adverse outcomes studied for mothers and newborns. Caregivers, including emergency teams, need to be better prepared for the management these at-risk cases. Furthermore, the increase in adverse outcomes, and the additional generated costs, should be considered carefully by the relevant authorities before any decisions are made to close or merge existing maternity units

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

International audienceBackground: 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 GA, the higher the hospitalization rate and the greater the likelihood of requiring the highest levelof neonatal care (both p < 0.001). The relative risk adjusted for sex and pregnancy-related diseases (aRR) reached21.1 (95% confidence interval [CI]: 19.2-23.3) at 32 weeks. The post-neonatal hospitalization rate was 12.1%. Theraw rates for post-neonatal hospitalization fell significantly from 32 – 40 and increased at 43 weeks and thispersisted after adjustment (aRR = 3.6 [95% CI: 3.3–3.9] at 32 and 1.5 [95% CI: 1.1–1.9] at 43 compared to 40 weeks).The main causes of post-neonatal hospitalization were bronchiolitis (17.2%), gastroenteritis (10.4%) ENT diseases(5.4%) and accidents (6.2%). The in-hospital mortality rate was 0.85‰, with a significant decrease (p < 0.001)according to GA at birth (aRR = 3.8 [95% CI: 2.4–5.8] at 32 and 6.6 [95% CI: 2.1–20.9] at 43, compared to 40 weeks.Conclusion: There’s a continuous change in outcome in hospitalized infants born above 31 weeks. Birth at 40 weeksgestation is associated with the lowest 1-year morbidity and mortality

Did case-based payment influence surgical readmission rates in France? A retrospective study

International audienceOBJECTIVES: To determine whether implementation of a case-based payment system changed all-cause readmission rates in the 30 days following discharge after surgery, we analysed all surgical procedures performed in all hospitals in France before (2002-2004), during (2005-2008) and after (2009-2012) its implementation. SETTING: Our study is based on claims data for all surgical procedures performed in all acute care hospitals with >300 surgical admissions per year (740 hospitals) in France over 11 years (2002-2012; n=51.6 million admissions). INTERVENTIONS: We analysed all-cause 30-day readmission rates after surgery using a logistic regression model and an interrupted time series analysis. RESULTS: The overall 30-day all-cause readmission rate following discharge after surgery increased from 8.8% to 10.0% (PCONCLUSION: In France, the increase in the readmission rate appears to be relatively steady in both the private and public sector but appears not to have been affected by the introduction of a case-based payment system after accounting for changes in care practices in the public sector

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

International audienceBACKGROUND: Depression 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.METHODS: Data 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 medico-administrative databases, and we assessed their location. In addition, a multivariable analysis was performed in order to determine geographic interactions between obesity and depression after controlling for age, sex, environmental and socio-economic factors (social/material deprivation, urbanicity/rurality).RESULTS: 1,045,682 people aged 18 years and older were identified. The mapping analysis showed several cold and hot regional clusters of coinciding obesity and depression. The multivariable analysis demonstrated significant geographic interactions, with an increasing probability of finding a high prevalence of obesity in regions with major depression (OR 1.29 95% CI 1.13-1.49, p = 0.0002) and an increased probability of finding a high prevalence of depression in regions with a high ration of obesity (OR 1.32, 95% CI 1.15-1.52, p<0.0001).CONCLUSION: Our study confirms the significant bidirectional relationships between obesity and depression at a group level. French geographic patterns reveal a partial overlap between obesity and depression, suggesting these two diseases can be included in a common approach. Further studies should be done to increase the understanding of this complex comorbidity

Étude des algorithmes de repérage de la schizophrénie dans le SNIIR-AM par le réseau REDSIAM

International audienceBACKGROUND:The aim of the REDSIAM network is to foster communication between users of French medico-administrative databases and to validate and promote analysis methods suitable for the data. Within this network, the working group "Mental and behavioral disorders" took an interest in algorithms to identify adult schizophrenia in the SNIIRAM database and inventoried identification criteria for patients with schizophrenia in these databases.METHODS:The methodology was based on interviews with nine experts in schizophrenia concerning the procedures they use to identify patients with schizophrenia disorders in databases. The interviews were based on a questionnaire and conducted by telephone.RESULTS:The synthesis of the interviews showed that the SNIIRAM contains various tables which allow coders to identify patients suffering from schizophrenia: chronic disease status, drugs and hospitalizations. Taken separately, these criteria were not sufficient to recognize patients with schizophrenia, an algorithm should be based on all of them. Apparently, only one-third of people living with schizophrenia benefit from the longstanding disease status. Not all patients are hospitalized, and coding for diagnoses at the hospitalization, notably for short stays in medicine, surgery or obstetrics departments, is not exhaustive. As for treatment with antipsychotics, it is not specific enough as such treatments are also prescribed to patients with bipolar disorders, or even other disorders. It seems appropriate to combine these complementary criteria, while keeping in mind out-patient care (every year 80,000 patients are seen exclusively in an outpatient setting), even if these data are difficult to link with other information. Finally, the experts made three propositions for selection algorithms of patients with schizophrenia.CONCLUSION:Patients with schizophrenia can be relatively accurately identified using SNIIRAM data. Different combinations of the selected criteria must be used depending on the objectives and they must be related to an appropriate length of time.Position du problèmeLe réseau REDSIAM a pour objectif de favoriser la communication entre les utilisateurs des bases de données contenues dans le Sniiram, de valider et de promouvoir les méthodes d’analyses de ces données. Au sein de ce réseau, le groupe de travail « Troubles mentaux et du comportement » s’est intéressé aux algorithmes d’identification de la schizophrénie de l’adulte dans le Sniiram et a recensé au cours d’entretiens avec des experts, les critères d’identification des patients souffrant de cette pathologie.MéthodeAprès un travail de bibliographie, neuf experts de la schizophrénie ont été interrogés sur leurs procédés de repérage des patients vivant avec un trouble schizophrénique dans le Sniiram. Les entretiens ont eu lieu par téléphone, à partir d’un questionnaire.RésultatsLa synthèse des entretiens montre que le Sniiram contient différentes bases permettant le repérage des patients souffrant de schizophrénie : celle des ALD, celle des hospitalisations et celle relative aux traitements médicamenteux. Pour être le plus complet possible, un algorithme devrait s’appuyer sur l’ensemble des critères de repérage évoqués par les partenaires et présents dans ces bases. En effet, seul un tiers des personnes vivant avec un trouble schizophrénique semble bénéficier d’une ALD. Tous les patients ne sont pas hospitalisés et le codage des diagnostics lors d’hospitalisations, notamment en court-séjour MCO, n’est pas exhaustif. Pris séparément, les traitements antipsychotiques ne peuvent être employés comme critère de repérage car ils sont également délivrés à des patients souffrant de troubles bipolaires, voire à des patients présentant d’autres troubles. Il semble opportun de combiner ces critères complémentaires. Les experts ont attiré l’attention sur les prises en charge en ambulatoire, qui concernent près de 80 000 patients sans autre forme de suivi, même si celles-ci sont difficiles à chaîner avec les autres informations. Trois propositions d’algorithmes ont été faites par des experts, chacune combinant l’ensemble des critères évoqués.ConclusionUne identification des patients atteints de schizophrénie et pris en charge pour cette pathologie semble possible dans le Sniiram. Différentes combinaisons des critères retenus doivent être utilisées en fonction des objectifs poursuivis, sur une période adaptée

Additional file 1: of How did episiotomy rates change from 2007 to 2014? Population-based study in France

ICD-10 codes and CCMP codes. Description of codes used for identification of delivery modes and risk factors. (DOCX 14 kb

Additional file 3: of How did episiotomy rates change from 2007 to 2014? Population-based study in France

Table: Hierarchical logistic regressions, all vaginal deliveries. The table presents the association between the episiotomy and risk factors, for all vaginal deliveries. (DOCX 18 kb