Enjeux de l'introduction du parcours de soins coordonné en France par la Loi du 13 août 2004

Pour répondre à ces questions sur les enjeux du parcours de soins, nous allons estimer les recours aux médecins ambulatoires en 2003 à partir de l'enquête Santé Insee. Nous nous attacherons plus particulièrement à l'étude de la demande de consultations hors parcours de soins en fonction des déterminants sociodémographiques, économiques et éducatifs. L'objectif est d'évaluer si le cadre de la loi à la potentialité de bouleverser les pratiques de recours aux médecins ambulatoires, et d'évaluer les personnes qui ne s'inscrivent pas dans le schéma du parcours de soins coordonné et d'estimer les impacts possibles des incitations financières mises en place. Nous essayerons ensuite, au regard de nos résultats, de comprendre les objectifs de politique publique de cette réforme. [P. 15]]]> Gatekeeping ; Health Care Reform fre https://serval.unil.ch/resource/serval:BIB_473B0FCBD5AD.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_473B0FCBD5AD3 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_473B0FCBD5AD3 info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_473C4C41A5D4 2022-05-07T01:17:03Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_473C4C41A5D4 Impaired left ventricular function as a predictive factor for mid-term survival in octogenarians after primary coronary artery bypass surgery. info:doi:10.4414/smw.2012.13704 info:eu-repo/semantics/altIdentifier/doi/10.4414/smw.2012.13704 info:eu-repo/semantics/altIdentifier/pmid/23135871 Berdajs, D. Marinakis, S. Kessler, U. Muradbegovic, M. Ferrari, E. von Segesser, L.K. info:eu-repo/semantics/article article 2012 Swiss Medical Weekly, vol. 142, pp. 0 info:eu-repo/semantics/altIdentifier/eissn/1424-3997 urn:issn:0036-7672 <![CDATA[BACKGROUND: The impact of preoperative impaired left ventricular ejection fraction (EF) in octogenarians following coronary bypass surgery on short-term survival was evaluated in this study. METHODS: A total of 147 octogenarians (mean age 82.1 ± 1.9 years) with coronary artery diseases underwent elective coronary artery bypass graft between January 2000 and December 2009. Patients were stratified into: Group I (n = 59) with EF &gt;50%, Group II (n = 59) with 50% &gt; EF &gt;30% and in Group III (n = 29) with 30% &gt; EF. RESULTS: There was no difference among the three groups regarding incidence of COPD, renal failure, congestive heart failure, diabetes, and preoperative cerebrovascular events. Postoperative atrial fibrillation was the sole independent predictive factor for in-hospital mortality (odds ratio (OR), 18.1); this was 8.5% in Group I, 15.3% in Group II and 10.3% in Group III. Independent predictive factors for mortality during follow up were: decrease of EF during follow-up for more that 5% (OR, 5.2), usage of left internal mammary artery as free graft (OR, 18.1), and EF in follow-up lower than 40% (OR, 4.8). CONCLUSIONS: The results herein suggest acceptable in-hospital as well short-term mortality in octogenarians with impaired EF following coronary artery bypass grafting (CABG) and are comparable to recent literature where the mortality of younger patients was up to 15% and short-term mortality up to 40%, respectively. Accordingly, we can also state that in an octogenarian cohort with impaired EF, CABG is a viable treatment with acceptable mortality

Readiness for Hospital Discharge Scale for older people: psychometric testing and short form development with a three country sample

Aim To develop and psychometrically test Readiness for Hospital Discharge Scale for older people and to reduce the scale to a more practical short form. Background The Readiness for Hospital Discharge Scale is the only available and validated scale measuring patients\u27 perceived readiness just prior to discharge. Design Secondary analysis of hospital studies data from three countries. Method Data were collected between 2008–2012. The study sample comprised 998 medical-surgical older patients. Factor analysis was undertaken to identify the factor structure of the Readiness for Hospital Discharge Scale. Group comparisons for construct validity and predictive validity for readmission were also conducted. Results The Readiness for Hospital Discharge Scale original four factor solution does not appear to be consistent with the observed data of older people in the three countries. Confirmatory factor analysis revealed that a 17-item scale with three factors produced the best model fit. Nine items, three from each factor, loaded consistently on their respective factors in each country sample. Confirmatory factor analysis of this short form model indicated that the model adequately fit the data. Patients who lived alone, were older, or who indicated ‘not ready’ for discharge had lower Readiness for Hospital Discharge Scale for Older People scores, which were also associated with readmission risk. Conclusion The revised three factor structure of the Readiness for Hospital Discharge Scale for Older People in long and short forms more adequately assesses core components of discharge readiness in the older adult population than the original adult form

Implementation and Preliminary Testing of a Theory-guided Nursing Discharge Teaching Intervention for Adult Inpatients Aged 50 and Over with Multimorbidity: A Pragmatic Feasibility Study Protocol

Background Discharge teaching by nurses during hospitalization is essential to provide multimorbid inpatients with the knowledge and skills to self-manage their health conditions. However, available disease-specific teaching guidelines do not address the cumulative complexity of multiple chronic diseases that occur with greater frequency in older adults. Therefore, there is a need for a discharge teaching intervention which uses concepts that specifically address the needs of these patients, such as considering their level of activation (i.e. knowledge, skills and confidence to self-manage their health) and the burden of multimorbid disease. The objectives of this pragmatic study will be to (1) test the feasibility of implementing a nursing discharge teaching intervention and (2) conduct a preliminary test of this novel discharge teaching intervention with adult inpatients age 50 or greater who have multiple comorbid conditions. Methods This study uses a two-group pre-posttest design. Participants are drawn from medical units in three hospitals in the French-speaking part of Switzerland. The implementation of the intervention will be facilitated by implementation strategies from the Theoretical Domains Framework and the Behavior Change Wheel and will target change in nurses’ teaching behaviours. Implementation outcomes will include measures of feasibility of the implementation strategies and the intervention process. Participants in the intervention group will receive tailored discharge teaching by trained teaching nurses. Patient outcomes will inform the preliminary testing of the intervention and will be measured with validated questionnaires assessing patients’ activation level, health confidence, perceived readiness for discharge, experience with the discharge process and rate of and time to readmission. Discussion The study takes a pragmatic approach to examining the feasibility of implementing the discharge teaching intervention to contribute to the knowledge development within the context of the real-world practice setting. Results will provide the foundation for clinical trials to build evidence for widespread adoption of this intervention. Trial registration The trial is registered at ClinicalTrials.gov (ID: NCT04253665) on the 30 of January 2020 and has been approved by the Cantonal Ethics Committee Vaud in Switzerland (2020-00141)

Retrospective Analysis of Geriatric Major Trauma Patients Admitted in the Shock Room of a Swiss Academic Hospital: Characteristics and Prognosis

Increased life expectancy exposes a great number of elderly people to serious accidents, thus increasing the amount of major geriatric trauma cases. The aim of our study was to determine the profile of elderly patients undergoing major trauma, and the contributing factors predicting mortality in this specific patient group, compared to the younger population. Retrospective analysis of 1051 patients with major trauma admitted over ten years in a Level-1 trauma center was performed. Data collected were: history, nature and type of trauma; age and sex; vital signs on admission; injury severity score; shock index; comorbidities; coagulation diathesis; injury patterns; emergency measures taken; main diagnosis; mortality; and length of hospital and intensive care unit (ICU) stay. Geriatric patients admitted for major trauma have a mortality rate almost four times greater (47%) than their younger counterparts (14%) with the same ISS. According to statistical regression analysis, anti-platelet therapy (OR 3.21), NACA (National Advisory Committee for Aeronautics) score (OR 2.23), GCS (OR 0.83), ISS (OR 1.07) and age (OR 1.06) are the main factors predicting mortality. Conclusion: Geriatric major trauma patients admitted to our trauma resuscitation area have a high mortality rate. Age, GCS, ISS and NACA scores as well as anti-platelet therapy are the main factors predicting mortality

Transitional nursing care for older inpatients: a person-centred research programme

The models and theories presented in this article underpin our various research projects, either philosophically or by their concrete application in the interventions developed, enabling us to understand through the lens of person-centredness how transitional care can adapt to meet the older person’s specific needs

Valeur prédictive de l'échelle de Braden pour les lésions de pression nosocomiales et l'association avec les interventions de prévention

Introduction : Les lésions de pression nosocomiales (LPN) sont considérées comme des événements indésirables liés aux soins infirmiers. Pour l’amélioration de la qualité des soins, les interventions comme le dépistage et la mobilisation sont essentielles. Objectifs : Comparer les valeurs prédictives du score total de Braden et du score de la dimension mobilité sur le développement de LPN. Mesurer l’effet modérateur des interventions de prévention entre le niveau de risque et le taux des LPN. Méthodes : Étude descriptive corrélationnelle basée sur l’analyse secondaire de données de routine issues des dossiers informatisés entre le 1er mars 2016 et le 31 mars 2018. Des statistiques descriptives et des régressions logistiques univariables et multivariables ont été effectuées. Résultats : Sur 22 833 épisodes de soins, le taux des LPN était de 3,6 %. Le score mobilité était prédicteur du développement des LPN (RC = 17,2, p < 0,01) ainsi que le score total (RC = 13,9, p < 0,01). Lorsque des interventions de mobilisation étaient mises en place, la probabilité de développer une LPN diminuait pour le niveau de risque faible (RC = 0,6, p < 0,01) ou modéré (RC = 0,5, p <0,01) selon le score total de Braden, mais pas pour un niveau de risque élevé. Discussion et conclusion : Cette étude confirme l’association entre le développement de LPN et les interventions préventives. Elle démontre l’importance d’utiliser des outils valides pour dépister le risque et mettre en place des interventions de mobilisation afin d’avoir un impact positif sur les résultats et ainsi d’améliorer la qualité des soins.Introduction: Hospital-acquired pressure injuries (HAPI) are considered adverse events related to nursing care. As part of improving the quality of care, preventive nursing interventions such as screening and mobilization are essential. Objectives: To compare the predictive values of the Braden total score and the mobility dimension score on the development of HAPI. To measure the moderating effect of prevention interventions between the level of risk and the prevalence of HAPI. Methods: The design was correlational descriptive. A secondary analysis was done with routine data from electronics health records between March 1, 2016 and March 31, 2018. Descriptive statistics and univariable and multivariable logistic regression were performed. Results: HAPI prevalence among the 22,883 care episodes studied was 3.6%. The mobility score was predictive of the development of HAPI (OR=17.2, p < 0.01) as well as the total score (OR=13.9, p < 0.01). The mobilization interventions had a moderating effect when the interaction was considered low risk (OR=0.6, p < 0.01) and moderate risk (OR=0.5, p < 0.01) by Braden’s total score, but not for a high risk level. Discussion and conclusion: This study confirms the association between the development of HAPI and preventive interventions. It demonstrates the importance of using valid tools to screen for risk and implement mobilization interventions in order to have a positive impact on outcomes and thus improve the quality of care

Analyse des séjours hospitaliers : apport des données infirmières

Background: In Switzerland the aim of health insurance (LAMaI) is to control rising health costs. One method is to institute a prospective payment system (DRGs) for all Swiss hospitals in 2012, according to which hospital funding will be based only on medical and administrative data. Question: What is the contribution of nursing to the analysis of hospital stays? Method: On the basis of aIl patient hospital stays in the CHUV (Lausanne) during 2005 and 2006, we have compared a medico-administrative data model and a nursing data model. We used a logistic regression on the probability of patient exit. Results: The capacity of discrimination of the model is appreciably improved since the surface under curve O.C.R. passes from 0.712 with the casemix data and the rang of day to 0.785 if it's adds data on heaviness of care (pseudo R² respectively 0.096 and 0.152). Discussion: This approach provides evidence on the feasibility of using standards of care pathway allowing managers to analyse the organisation of patient care and securing a better estimate of hospital funding