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Background: Since 2008, in France, hospital funding is determined by the nature of activities provided (activity-based funding). Quality control of hospital activity coding is essential to optimize hospital remuneration. There is a need for reliable tools to allocate human resources wisely in order to improve these controls., Methods: The main objective of this study was to identify the determinants of time needed by medical information technicians to control hospital activity coding in a Regional Hospital Center. From March 2016 to the beginning of January 2017, medical information technicians reported the time they spent on each quality control, and the time they needed when they had to code the entire stay. Multiple linear regressions were performed to identify the determinants of quality control or coding duration. A split sample validation was used: model was created on one half of the sample and validated on the remaining half., Results: Among the controls, 5431 were included in the analysis of determinants of control duration (2715 kept aside for model validation). Seven determinants have been identified (stay duration, level of complexity, month of control, type of control, medical information technician, rank of classing information, and major diagnostic category). The correlation coefficient between predicted and real control duration was 0.71 (P<10 -4 ); 808 stays were included in the analysis of determinants of coding duration (404 kept aside for model validation). Two determinants have been identified. The correlation coefficient, between predicted and real coding duration, was 0.47 (P<10 -3 ). We performed the same multiple regression, on 2017 activity data, to estimate the weight of each hospital activity pole, regarding quality control of hospital activity coding., Conclusion: We succeeded in modeling time needed for quality control of hospital stays. These results helped to estimate human resources required for quality control of each hospital pole. Nevertheless, the second analysis did not give satisfactory results: we failed in modeling time needed to code hospital stays., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

The "Hospital, patients, health and territories" law marks a paradigm shift in the establishing of the regulatory framework of healthcare professionals' practice in France. From the current situation of national homogeneity, an evolution towards the emergence of regional regulatory frameworks could take place.

The system which allows the creation of cooperation protocols between healthcare professions, as provided for the article 51 of the "Hospital, patients, health and regions" Law, has been in force with the setting up of procedures designed to receive, review and ensure the monitoring of these protocols.

Background: For twenty years, most of industrial countries developed recommendations on regionalization of perinatal care. Perinatal regionalization is particularly aimed at improving morbidity and mortality outcomes of low birth weight newborns by transferring pregnant women to the maternity units having a medical or neonatal environment suited to the risks incurred by mothers or babies. Perinatal regionalization cannot be effective without being well accepted by the majority of professionals. The objectives of this study were then to identify professionals'expectations and objections to perinatal regionalisation and to compare them from a professional group to another one., Methods: Professionals of 3 French perinatal networks were under consideration: the Rhône, the Auvergne and the Gard-Lozère networks. The study included two stages: 1) a psychosociological qualitative study, based on professionals'interviews, aimed at identifying main concerns of professionals and developing a questionnaire; then 2) an epidemiological quantitative study, using this questionnaire within French networks. In the questionnaire, 8 dimensions explored the professionals'views: constraints related to regulation aspects and to the setting up of maternity units care levels, risk of loss of professionals' competence and prestige, consequences on medical practices, on inter-professional relationship, on work organization and financial aspects, and related to the new role of 'private practice'professionals, legal consequences., Results: The response rate of the epidemiological study was 80%. The results permitted to construct 8 dimension scores describing the reasons of poor acceptability of regionalization. After taking into account the age, the sex, the network and the juridical status of the institution, the study revealed a significant poorer acceptability of regionalization by most of medical specialty groups (anesthetists, obstetricians, midwives and "private practice" professionals) compared with neonatologists, or by "private" professionals (professionals working in private clinics and "private practice" professionals) compared with professionals working in university or community hospitals. The study described also network setting up conditions related to its functioning., Conclusion: By identifying clearly professionals 'objections and expectations, this study should facilitate improvement in the organization of studied perinatal networks.

The need for public health planning in France, recently led to the development of a Regional Program in Public Health Organisation (SROS) to describe geographical distribution of facilities and health care activities, in accordance with population needs. Isere Cancer Registry, using its own mortality and morbidity data, evaluated incidence (16,000 new cases each year) and prevalence (100,000 cases) in the Rh-one-Alpes area. Thus, knowing incidence and prevalence of cancer within each district by age and sex, it became much easier for public and private hospitals to quantify their future activities. Today, French cancer registries are conducting methodological studies to improve prevalence estimates, in order to use them in predicting future costs of health care in oncology.

Epidemiological surveillance in Quebec is part of the integral system of this activity throughout the whole of Canada and the United States. Since surveillance is aimed mainly at the ecosystem of the disease rather than just the cases, the activities are insured from the horizontal point of view by several organisations, aided by various Ministeries (health, agriculture, industry and commerce). The vertical structure (besides the Center for Disease Control in Atlanta as coordinator) includes the federal Laboratory Centre for Disease Control, its epidemiology and surveillance bureaus, as well as its territorial epidemiologists, provincial epidemiologists and their teams. Quebec has recently been given a new health structure, introduced in conjunction with the traditional organisations by the new Departments of Community Health, and the Social Centres of Community Services. This structure which is new to North America is characterised mostly by its close integration with community health. Moreover, it represents an excellent opportunity for developing an epidemiological surveillance complementary to local problems and for heightening their responsibility.