Mission d'expertise sur la restructuration de la filière pêche à Saint Pierre et Miquelon

L’objet de la mission consiste à proposer un projet technique de restructuration de la filière pêche à Saint Pierre et Miquelon. A cette fin, à la demande du Ministère de l’Outre-Mer, une mission d’expertise composée de trois experts (Camille KNOCKAERT / IFREMER Nantes ; Bruno LE FUR / Plate-Forme d’Innovation NOUVELLES VAGUES ; Yvon BONNIOU / ODYSSEE DEVELOPPEMENT) s’est déplacée sur Saint Pierre et Miquelon du 11 au 18 Février 2012 pour réaliser une évaluation du volume disponible de produits de la mer sur les deux îles, et proposer une activité de transformation, se positionnant dans le cadre d’un projet de pôle unique de transformation « bi localisé ». Une visite des différents sites industriels a permis d’en déterminer un projet de « refonte » des infrastructures prenant en compte leur dimension ainsi que leur vétusté et l’équipement présent. Concernant les mesures prioritaires, la mission a identifié les urgences, tant sur le plan investissements prioritaires pour permettre à la filière de travailler sur l’année en cours, que sur le volet « mesures conservatoires ». Pour effectuer son travail, la mission s’est appuyée sur l’antenne Ifremer locale et les services de l’Etat, ainsi que sur l’audition de tous les acteurs de la filière depuis les pêcheurs jusqu’aux transformateurs. Enfin, ce travail se réfère aux préconisations de trois rapports de mission réalisés en 2011 : · Mission d’audit de la société « SPMSeafood International » du 12 au 21 Mars 2011 (CGAAER/AFD: Fourgeaud P et Darpoux J.) · La restructuration de la filière pêche et aquaculture de l’archipel de SPM du 27 au 1 Juillet 2011 (CGAAER: Berger A.) · La restructuration de la filière pêche et aquaculture de l’archipel de SPM du 29 au 1 Juillet 2011 (ID.MER: Allaume P.) · La restructuration de la filière pêche et aquaculture de l'archipel de Saint-Pierre et Miquelon / Constitution d'un pôle de transformation unique / Jacques BRULHET / Vice-président du CGAAER / février 2012 · Rapport de restitution de la mission Saint-Pierre et Miquelon / Volet: restructuration de la pêche artisanale / janvier 201

Heparin-induced thrombocytopenia: an estimate of the average cost in the hospital setting in France.

International audienceHeparin-induced thrombocytopenia is a severe drug adverse effect with possible dramatic consequences. The risk is 0.1% to 5%. The costs of heparin-induced thrombocytopenia in France were estimated using the Programme Médicalisé des Systèmes d'Information (PMSI) national discharge database. Hospitalizations with heparin-induced thrombocytopenia were identified using diagnostic codes. Costs were assessed from the perspective of the French Sickness Fund or hospitals. Heparin-induced thrombocytopenia could be the reason of admission or could occur during the stay and lead to a different tariff or to additional costs associated with extra length of stay. Direct costs were also estimated from experts' opinions. A sensitivity analysis was performed from data collected in 1 center. During 2005, 445 hospitalizations with heparin-induced thrombocytopenia codes were identified. For 45 patients, the main diagnosis was heparin-induced thrombocytopenia; for the remaining 400 patients, heparin-induced thrombocytopenia occurred during the hospital stay. Tariffs and extra costs were used to estimate an overall average cost of 3230 for heparin-induced thrombocytopenia. For patients with heparin-induced thrombocytopenia as main diagnosis, the average cost was 3400; for the patients with heparin-induced thrombocytopenia that occurred during the stay, 1910 was due to an increased of the tariff and 3348 to an increased length of stay. Estimated direct costs of an episode were 3350 to 3700. Different methods were used to arrive at an estimated cost of 3500 for a heparin-induced thrombocytopenia episode for inpatients. One limitation of the study is that heparin-induced thrombocytopenia tends to be underreported by physicians during hospitalization

Care pathway, towards the establishment of tailored funding: Reasons and criteria for success

International audienceCare pathways are often at the forefront of political thinking about health care practices in France without ever finding a durable means for their extension. Closely linked to funding of healthcare system, they have, once again, been the object of so many economical discussions in 2017, as part of a more optimistic climate of governance which is therefore more open to change. Our changing system, the development and increasingly chronic nature of diseases, the scale of technological breakthroughs, these are all factors driving this topic forward. The object of this work, after a necessary study of the semantics of the term "pathway" and even "funding", was to identify all prerequisites and good practices for the stakeholders to develop a pilot pathway and then its relevant implementation in France. To do so, the members of the Round Table have relied on the presentation of examples of care pathways in order to identify triggers to a progressive, adapted extension to the whole territory. The group has identified key elements and priorities for the establishment of public funding beyond existing funding to incentive team work, particularly in the case of treatment rupture points and/or when they have diverging interests. Finally, creating a climate of confidence among patients, professionals, hospitals, the ARS, payers and manufacturers in handling change management will become the key challenges of the implementation of future pathways

Parcours de soins, vers la mise en place d’un financement adapté : raisons et conditions de réussite

International audienc