Search

Objective To investigate a new approach to calculating cause-related standardized mortality rates that involves assigning weights to each cause of death reported on death certificates. Methods We derived cause-related standardized mortality rates from death certificate data for France in 2010 using: (i) the classic method, which considered only the underlying cause of death; and (ii) three novel multiple-cause-of-death weighting methods, which assigned weights to multiple causes of death mentioned on death certificates: the first two multiple-cause-of-death methods assigned non-zero weights to all causes mentioned and the third assigned non-zero weights to only the underlying cause and other contributing causes that were not part of the main morbid process. As the sum of the weights for each death certificate was 1, each death had an equal influence on mortality estimates and the total number of deaths was unchanged. Mortality rates derived using the different methods were compared. Findings On average, 3.4 causes per death were listed on each certificate. The standardized mortality rate calculated using the third multiple-cause-of-death weighting method was more than 20% higher than that calculated using the classic method for five disease categories: skin diseases, mental disorders, endocrine and nutritional diseases, blood diseases and genitourinary diseases. Moreover, this method highlighted the mortality burden associated with certain diseases in specific age groups. Conclusion A multiple-cause-of-death weighting approach to calculating cause-related standardized mortality rates from death certificate data identified conditions that contributed more to mortality than indicated by the classic method. This new approach holds promise for identifying underrecognized contributors to mortality. Objectif Etudier une nouvelle approche permettant de calculer des taux comparatifs de mortalite due a differentes causes en ponderant chaque cause de deces declaree sur les certificats de deces. Methodes Nous avons calcule des taux comparatifs de mortalite due a differentes causes a partir des donnees de certificats de deces emis en France en 2010 suivant: (i) la methode classique, oli nous avons uniquement tenu compte de la cause sous-jacente de deces; et (ii) trois nouvelles methodes de ponderation de causes multiples de deces, qui conslstaient a appliquer une ponderation aux differentes causes de deces mentionnees sur les certificats de deces: les deux premieres methodes tenant compte de plusleurs causes de deces consistalent a appliquer une ponderation autre que zero a toutes les causes mentionnees et la troisieme consistait a appliquer une ponderation autre que zero uniquement a la cause sous-jacente et a d'autres causes aggravantes, exterieures au processus pathologlque principal. La somme des ponderations pour chaque certlficat de deces etait de 1. Ainsi, chaque deces avalt la meme influence sur les estimations de la mortalite, sans changer le nombre total de deces. Les taux de mortalite obtenus suivant ces differentes methodes ont ensulte ete compares. Resultats En moyenne, 3,4 causes etaient mentionnees sur chaque certificat de deces. Le taux comparatlf de mortalite calcule selon la troisieme methode de ponderation de causes multiples de deces etait plus de 20% superieur a celui calcule selon la methode classique pour cinq categories de maladies: maladies de la peau, troubles mentaux, maladies endocriniennes et nutritionnelles, maladies du sang et maladies uro-genitales. En outre, cette methode a mis en relief la charge de mortalite associee a certaines maladies dans des groupes d'age specifiques. Conclusion L'approche consistant a ponderer des causes multiples de deces afin de calculer des taux comparatifs de mortalite due a differentes causes a partir des donnees figurant sur des certificats de deces a permis de reperer les pathologies qui contribuaient plus a la mortalite que ce qu'indlqualt la methode classique. Cette nouvelle approche devrait permettre d'identifier les facteurs peu reconnus qui contribuem pourtant a la mortalite. Objetivo Investigar un nuevo enfoque para calcular las tasas estandarizadas de mortalidad relacionada con las causas que implique la asignacion de variables de cada causa de muerte Indicada en los certificados de defuncion. Metodos Se derivaron las tasas estandarizadas de mortalidad relacionada con las causas de certificados de defuncion en Francia en 2010 utilizando: (i) el metodo clasico, que consideraba unicamente la causa subyacente de la muerte; y (ii) tres nuevos metodos de evaluacion de multiples causas de muerte, que asignaban variables a varias causas de muerte mencionadas en los certificados de defuncion: los primeros dos metodos de multiples causas de muerte asignaron variables no nulas en todas las causas mencionadas y el tercero asigno las mismas variables solo a la causa subyacente y otras causas contribuyentes que no formaban parte del proceso morbido principal. Dado que la suma de las variables de cada certificado era 1, cada defuncion tenia la misma influencia en las estimaciones de mortalidad y el numero total de muertes permanecio Intacto. Se compararon las tasas de mortalidad derivadas utilizando los distintos metodos. Resultados De media, cada certificado enumeraba 3,4 causas por muerte. La tasa de mortalidad estandarizada calculada utilizando el tercer metodo de evaluacion de multiples causas de muerte fue mas de un 20% superior a la calculada utilizando el metodo clasico para cinco categorias de enfermedades: enfermedades cutaneas, trastornos mentales, enfermedades endocrinas y nutricionales, enfermedades sanguineas y enfermedades genitourinarias. Asimismo, este metodo destaco el umbral de mortalidad relacionado con determinadas enfermedades de grupos de edades en particular. Conclusion Un enfoque de evaluacion de multiples causas de muerte para calcular las tasas estandarizadas de mortalidad relacionada con las causas de datos recopilados de certificados de defuncion identifico las condiciones que contribuyeron mas a la mortalidad que las indicadas en el metodo clasico. Este nuevo enfoque promete identificar contribuyentes no reconocidos a la mortalidad., Introduction Good understanding of mortality data is essential for developing and evaluating health policies. The causes of any death are usually reported on parts I and II of a death [...]

Background: Results of associations between process and mortality indicators, both used for the external assessment of hospital care quality or public reporting, differ strongly across studies. However, most of those studies were conducted in North America or United Kingdom. Providing new evidence based on French data could fuel the international debate on quality of care indicators and help inform French policy-makers. The objective of our study was to explore whether optimal care delivery in French hospitals as assessed by their Hospital Process Indicators (HPIs) is associated with low Hospital Standardized Mortality Ratios (HSMRs).Methods: The French National Authority for Health (HAS) routinely collects for each hospital located in France, a set of mandatory HPIs. Five HPIs were selected among the process indicators collected by the HAS in 2009. They were measured using random samples of 60 to 80 medical records from inpatients admitted between January 1st, 2009 and December 31, 2009 in respect with some selection criteria. HSMRs were estimated at 30, 60 and 90 days post-admission (dpa) using administrative health data extracted from the national health insurance information system (SNIIR-AM) which covers 77% of the French population. Associations between HPIs and HSMRs were assessed by Poisson regression models corrected for measurement errors with a simulation-extrapolation (SIMEX) method.Results: Most associations studied were not statistically significant. Only two process indicators were found associated with HSMRs. Completeness and quality of anesthetic records was negatively associated with 30 dpa HSMR (0.72 [0.52-0.99]). Early detection of nutritional disorders was negatively associated with all HSMRs: 30 dpa HSMR (0.71 [0.54-0.95]), 60 dpa HSMR (0.51 [0.39-0.67]) and 90 dpa HSMR (0.52 [0.40-0.68]).Conclusion: In absence of gold standard of quality of care measurement, the limited number of associations suggested to drive in-depth improvements in order to better determine associations between process and mortality indicators. A smart utilization of both process and outcomes indicators is mandatory to capture aspects of the hospital quality of care complexity. [ABSTRACT FROM AUTHOR]

Aims The objectives of this study were to describe annual trends in patients hospitalized for heart failure ( HF) and HF-associated mortality rates in France between 2000 and 2012. Methods and results Hospital discharge data were extracted from the French National Hospitalization Database ( PMSI). Mortality data were obtained from the French National Mortality Database. HF events constituting the underlying or associated cause of death were selected. Rates were age standardized using the 2010 European census population as the standard population. Time trends were tested using a Poisson regression model. In 2012, the overall age-standardized rate of patients hospitalized for HF was 246.2 per 100 000 inhabitants. The age-standardized rate of HF-associated mortality was 113.8 per 100 000 inhabitants in 2010. Hospitalized patient rates remained steady between 2002 and 2012, whereas mortality decreased by 3.3% annually from 2000 to 2010. Trends in hospitalized patients and mortality differed significantly between men and women, particularly among the 45- to 55- and 65- to 74-year-old age groups, with a smaller decrease observed in women. Conclusion Among men, a slight decrease in patients hospitalized for HF and a substantial reduction in mortality were observed. Among women, only a large decrease in HF mortality was observed. HF remains one of the leading causes of death and hospitalization in France, particularly in the elderly. [ABSTRACT FROM AUTHOR]

Background In the age of big data in healthcare, automated comparison of medical diagnoses in large scale databases is a key issue. Our objectives were: 1) to formally define and identify cases of independence between last hospitalization main diagnosis (MD) and death registry underlying cause of death (UCD) for deceased subjects hospitalized in their last year of life; 2) to study their distribution according to socio-demographic and medico-administrative variables; 3) to discuss the interest of this method in the specific context of hospital quality of care assessment. Methods 1) Elaboration of an algorithm comparing MD and UCD, relying on Iris, a coding system based on international standards. 2) Application to 421,460 beneficiaries of the general health insurance regime (which covers 70% of French population) hospitalized and deceased in 2008-2009. Results 1) Independence, was defined as MD and UCD belonging to different trains of events leading to death 2) Among the deaths analyzed automatically (91.7%), 8.5% of in-hospital deaths and 19.5% of out-of-hospital deaths were classified as independent. Independence was more frequent in elder patients, as well as when the discharge-death time interval grew (14.3% when death occurred within 30 days after discharge and 27.7% within 6 to 12 months) and for UCDs other than neoplasms. Conclusion Our algorithm can identify cases where death can be considered independent from the pathology treated in hospital. Excluding these deaths from the ones allocated to the hospitalization process could contribute to improve post-hospital mortality indicators. More generally, this method has the potential of being developed and used for other diagnoses comparisons across time periods or databases. [ABSTRACT FROM AUTHOR]

Background: Electronic death certification was established in France in 2007. A methodology based on intrinsic characteristics of death certificates was designed to compare the quality of electronic versus paper death certificates. Methods: All death certificates from the 2010 French mortality database were included. Three specific quality indicators were considered: (i) amount of information, measured by the number of causes of death coded on the death certificate; (ii) intrinsic consistency, explored by application of the International Classification of Disease (ICD) General Principle, using an international automatic coding system (Iris); (iii) imprecision, measured by proportion of death certificates where the selected underlying cause of death was imprecise. Multivariate models were considered: a truncated Poisson model for indicator (i) and binomial models for indicators (ii) and (iii). Adjustment variables were age, gender, and cause, place, and region of death. Results: 533,977death certificates were analyzed. After adjustment, electronic death certificates contained 19% [17%-20%] more codes than paper death certificates for people deceased under 65 years, and 12% [11%-13%] more codes for people deceased over 65 years. Regarding deceased under and over 65 respectively, the ICD General Principle could be applied 2% [0%-4%] and 6% [5%-7%] more to electronic than to paper death certificates. The proportion of imprecise death certificates was 51% [46%-56%] lower for electronic than for paper death certificates. Conclusion: The method proposed to evaluate the quality of death certificates is easily reproducible in countries using an automatic coding system. According to our criteria, electronic death certificates are better completed than paper death certificates. The transition to electronic death certificates is positive in many aspects and should be promoted. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of care in patients with pain who visit the emergency department of a university hospital and the evolution of their pain during their emergency department stay., Methods: A cross-sectional survey was performed using two valid scales (a numerical descriptor scale or a verbal pain intensity scale), and a structured questionnaire to patients and use of patient charts to collect information on pain intensity on arrival and before discharge, characteristics of pain and of its management., Results: In the 726 participating patients, median age was 37 years (range: 18-97), and 54% of the patients were men. Upon arrival, 563 patients presented with pain (78%), rated > or =7 in 35% of the 390 patients evaluated using numerical descriptor scale. Forty-four percent had taken analgesics before arrival. Their median waiting time before initial medical examination was 30 min. Pain was identified by triage nurses (70%) or by physicians (77%) and was rated by nurses (23%) and physicians (11%). Forty-seven percent also experienced pain during care and 27% received analgesics during their stay. Pain intensity remained unchanged in 70% of patients, increased in 7% and decreased in 23%. Of the 480 patients with pain on arrival evaluated before discharge, 395 (82%) patients were unrelieved before going home, rated > or =7 in 32% of the 390 patients evaluated using numerical descriptor scale. Analgesics were ordered before leaving the emergency department in 81%., Conclusion: Even if pain has been identified, its assessment and management remains inadequate. The quality of care may be improved by educating the personnel in developing protocols and in evaluating pain management.