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Older people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient's level of care and the organisation of specific networks is essential. To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level.To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist.To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service. This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: Oral anticancer drugs have disrupted hospital and community practices. A better coordination and patient support for medication and adverse events management by primary care providers (general practitioner, community pharmacist and liberal nurse) could improve the situation. The CHIMORAL study evaluated a model of coordination by territorial health networks., Methods: A here and elsewhere, prospective and multicentric study, comparing coordinated care with standard care. Primary outcome was the use of the hospital structure for adverse events within 6 months of initiating treatment., Results: In all, 283 patients were included. 92% had at least one adverse event, with a higher median number in the coordinated group (12.5 vs. 9.0, P=0.02). No difference in hospital use by arm (P=0.502). Increase in the use of community care for adverse events in the coordinated group (27% vs. 16%, P=0.009). No observed impact on progression rates, quality of life and treatment adherence. The overall survival rate at 6 months is numerically higher in the coordinated group (87% vs. 76%, P=0.064)., Discussion: This model does not show any difference on the primary endpoint. The lack of randomization, patient selection, power loss, and local initiatives to monitor these patients may have biased the analysis. A large number of uses of the healthcare system were observed. These results confirm the need for a dedicated care pathway for the patient with oral anticancer drugs., (Copyright © 2019 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Fluoroquinolones (FQs) are major antibiotics but their wide use in hospital and community settings has led to an increased bacterial resistance against this antibiotic class. We aimed to assess the efficiency of an antibiotic stewardship program targeting FQs in a local hospital, and its impact on bacterial resistance., Methods: This observational study was conducted in the local hospital of Morteau (Franche-Comté region, East of France). The hospital has 166 beds with health and medico-social sectors and a medical home affiliated with the facility. Local guidelines on empirical treatment regimens were released in 2007 aiming to reduce the use of FQs, especially for urinary tract infections. The following monitoring indicators were assessed: total consumption of antibiotics and of FQs (DDD/1,000 hospital patient-days), and resistance to nalidixic acid among Escherichia coli strains. Changes in the number of FQ packs sold in a community pharmacy were also recorded., Results: The FQ consumption decreased by 85.6% between 2006 and 2015 (from 41.1 to 5.9 DDD/1,000 patient-days). The resistance to nalidixic acid among E. coli strains substantially decreased after remaining steady until 2011 (-57.2% between 2007 and 2015). The number of norfloxacin packs sold in the assessed community pharmacy decreased by 88%., Conclusion: Setting up an antibiotic stewardship program in a local hospital can lead to a substantial reduction in FQ use and in E. coli resistance to FQs. It may also have a positive impact on community prescriptions., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

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 French health care system implemented several corporate management recipes such as diagnostic-related groups (DRGs), benchmarking, and activity-based management in a bid to restore fiscal discipline and to "reassert the center." The government also regrouped health policy decisions with the Regional Health Agencies and opted for a top-down line of command to ensure policy implementation. Though reforms emphasized evidenced-based policy and outputs measurement, outcomes were below expectations in many areas and led to a shift in values. Professional autonomy and patient engagement receded. This leads us to a critical evaluation of the French audit society., (© 2019 John Wiley & Sons, Ltd.)

Malignant tumors of the upper aerodigestive tract may be rare by their histology (sarcoma, variants of conventional squamous cell carcinomas) and/or location (sinuses, salivary glands, ear, of various histologies themselves). They represent less than 10% of head and neck neoplasms. The confirmation of their diagnosis often requires a medical expertise and sometimes biomolecular techniques complementary to classical histology and immunohistochemistry. Due to their location, their treatment often requires a specific surgical technique. Radiation therapy is indicated based on histoclinical characteristics common to other head and neck neoplasms but also incorporate grade. Further, the technique must often be adapted to take into account the proximity of organs at risk. For most histologies, chemotherapy is relatively inefficient but current molecular advances may allow to consider pharmaceutical developments in the coming years. The REFCOR, the French Network of head and neck cancers aims to organize and promote the optimal management of these rare and heterogeneous diseases, to promote research and clinical trials.

Management of NSCLC patients is more and more individualized especially on the base of bioguided treatments. In order to guarantee an access for all the patients too this type of strategy, the French NCI supports since 2006 a nationwide network of 28 regional genetics center. The financial support is based on public funds. The French NCI recommends today the assessment of seven biomarkers for all stage IV non squamous NSCLC patients. Due to financial and technical reasons, this recommendation must be followed. However, the molecular profiling of lung cancer patients would ideally be extended across all stages and all histological types of the disease in order to improve our knowledge in this field and provides the patient with an opportunity to access a bioguided treatment as frequently as possible.

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.

Unlabelled: In 1997 a large French epidemiological study (Epipage) showed increased mortality and morbidity in Languedoc Roussillon when compared to other regions of France. In order to update information, we set up a regional database about very preterm infants born in Languedoc-Roussillon since 2003. Our objective was to analyze the evolution of mortality and of the morbidity in very preterm infants between 1997 and 2003-2005., Methods: We analyzed mortality and the morbidity (respiratory, neurological, digestive) of the very preterm infants born alive between 22 and 32 weeks amenorrhea and admitted alive in neonatology included in Epipage study in 1997 and of those included in the regional database in 2003-2005. Between these 2 periods, professional practices were significantly improved as the perinatal network was set up and perinatal care was regionalized., Results: We analyzed the data collected in 3121 subjects of Epipage study and 1111 subjects of the regional database. We observed a significant reduction (P<0.05) of neonatal mortality (8% versus 23%), rate of bronchopulmonary dysplasia (9% versus 19%) and of periventricular leukomalacia (9% versus 18%). During this period, there were significant increases (P<0.05) in the rates of antenatal corticotherapy (87% versus 61%) and caesarean section (72% versus 38%)., Conclusion: We observed a significant improvement of morbidity of very preterm infants and a decreased mortality for the youngest subjects which was concomitant of an improvement of the professional's practices. It is necessary to take into account these results to propose relevant informations to the professionals with and thus indirectly to the parents.

Three generations of regional health organisation plans (SROS) were established in France by the Ministry responsible for health over a time span of 15 years. Given that many other types of reforms are being implemented concurrently, this offers a timely opportunity for their assessment and reflection on issues to be considered for future proposals. The research strategy is based on the correlation of data resulting from semi-directed interviews, legislative text, and documents regarding the development, implementation and follow-up of the SROS. The study shows that from 1991 to 2006 the SROS became the fulcrum of health planning in France. Thus, it gradually served to unite and federate institutions, professionals and actors around a shared objective to design and implement medical projects at the territorial level with adequate services to meet the health needs of the population. An analysis concerning an international frame of reference and future prospects is proposed.

The development of the Regional Plan for Health Organisation (SROS III) in the Nord-Pas-de-Calais has provided an opportunity for further reflection on the operation and organisation of professionals and structures in the field of prenatal diagnoses. The alleged claims resulting from this reflection process are not only integrated in the perinatal stream of the SROS but also in the objectives of the regional public health plan. The study which was carried out takes into account the regional data available, complemented by interviews with professionals working on the ground, which are then compared with national data. All of these elements contributed to the construction of proposals for an improved organisation of this regional management system, on the one hand curative and on the other preventive.

Objectives: To examine the effect of maternal origin and distance between maternal residence and the nearest maternity ward with a neonatal surgical center in the same hospital, on prenatal diagnosis, elective termination of pregnancy, delivery in an adequate place and neonatal mortality for pregnancies with severe malformations requiring neonatal surgery, and to examine the effect of the place of delivery on neonatal mortality., Methods: This was a retrospective study, through the France Central-East malformation registry, of 706 fetuses with omphalocele (n = 123), gastroschisis (n = 99), diaphragmatic hernia (n = 222), or spina bifida (n = 262), but without chromosomal anomalies. Maternal origin was classified as Western European and non-Western European. Adequate place for delivery was defined as birth in a Level-III maternity ward with a neonatal surgical center in the same hospital., Results: The prenatal diagnosis rate was 67.7% in 1990-1995 and 80.2% in 1996-2001 (odds ratio (OR), 2.07 (95% CI, 1.24-3.45)). On multivariate analysis, the rate was significantly lower for women living 11-50 km (adjusted OR, 0.49 (95% CI, 0.25-0.94)), or > 50 km (adjusted OR, 0.39 (0.20-0.74)) from the closest adequate place of delivery, compared with those living < 11 km from it, but there was no difference for maternal origin. Non-Western European women had fewer elective terminations of pregnancy (adjusted OR, 0.34 (95% CI, 0.14-0.81)) and fewer deliveries in an adequate place (adjusted OR, 0.40 (95% CI, 0.18-0.89)). Neonatal mortality was lower in the case of delivery in an adequate place (adjusted OR, 0.22 (95% CI, 0.07-0.72)) and was not associated with maternal origin and distance from nearest maternity ward with a neonatal surgical center., Conclusion: Rate of prenatal diagnosis decreases with increasing distance between parental residence and referral center. Non-Western European women are diagnosed prenatally as often as are Western Europeans, but terminate their pregnancy less often, perhaps for cultural reasons. Non-Western European women with malformed fetuses deliver in adequate centers less often, probably because of the way the perinatal care system is run.

Objective: Perinatal regionalization has been organized into 3 ascending levels of care, fitting increasing degrees of pathology. Current recommendations specify that very premature infants be referred prenatally to level III facilities, yet not all very preterm neonates require level III intensive care. The objective of our study was to determine the antenatal factors that, in association with gestational age, predict the need for neonatal intensive care in preterm infants, to match the size of birth with the level of care required., Methods: Data were analyzed from a cohort of very preterm infants born in nine French regions in 1997. We defined the need for neonatal intensive care as follows: (1) the requirement for specialized management (mechanical ventilation for >48 hours, high frequency oscillation, or inhaled nitric oxide) or (2) poor outcome (transfer to a level III facility within the first 2 days of life or early neonatal death). Triplet pregnancies and pregnancies marked by fetal malformations or intensive care requirements for the mother before delivery were excluded., Results: We focused our study on 1262 neonates aged 30, 31 and 32 weeks' gestation, where the need for intensive care was 42.8%, 33.2%, and 22.8%, respectively. Multivariate analysis showed that the risk factors for intensive care requirement with low gestational age were twin pregnancies, maternal hypertension, antepartum hemorrhage, infection, and male gender. Antenatal steroid therapy and premature rupture of membranes were protective factors against intensive care requirement., Conclusion: Infants <31 weeks' gestation should be referred to level III facilities. From 31 weeks' gestation, some infants can be safely handled in level IIb facilities. However, the quality of perinatal regionalization may only be fully assessed by long-term follow-up.

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.

Objective: The aim of the study is to assess the transfer from one hospital to another in patients with myocardial infarction in the Provence Alpes CBte d'Azur (PACA)., Methods: To apply a methodology initially used in sociology "social network analysis" which allow us to describe and model the relational structure of a whole of actors, represented in this work by the establishments of care. Flows between the actors are represented by the transfers of patients. This approach is innovating in the analysis of the medical system., Results: - A total of 2049 patients were admitted in 74 hospitals. The average age is 68.9 years. The density of the hospital network is 0.12. The number of click is 51. Multivariate analysis showed that the following factors were associated with decreased mortality: prestige, age < 65 years, angioplasty alone or thrombolysis associated to angioplasty., Conclusion: Social Network Analysis offers a synthetic sight of the relational systems in the health system. It constitutes an open field of search in Public health, and can also be applied to the evaluation of the networks.

From donor to recipient, raw blood will undergo a succession of processing events before eventually becoming a qualified, recipient-adapted finished product. The integrity of the transfusion chain and its various links will determine the final quality of blood transfusion, a key element for a number of medical disciplines. The recent reform of blood transfusion has brought about a national system based on a single body, the French Blood Institution, with regional branches ensuring effective networking of the entire country. Keeping a permanent scientific watch, this Donor-to-Recipient set-up warrants optimal quality according to current knowledge, and close links with the single hemovigilance network which continually analyses events that may affect transfusion safety and takes immediate action accordingly.

The hospital system has seen itself transformed by the regulations of April 24, 1996. The appearance of new structures and a new logic modified the links between actors: recourse to the contract became an instrument of regulation, the regionalization through the creation of ARH (regional hospitalisation agencies) defined in a new manner the responsibilities in matters of hospital management, the implementation of the ANAES is accompanied by the implementation of an accreditation procedure and pursues the missions of evaluations that, until now, were ensured by the ANDEM.

This paper intends to add to the debate about the efficient use of Accident & Emergency (A & E) services by providing an outline of a recent regional initiative, and then exploring the emergency health care system in France. The latter is explored as a system for consideration in relation to emergency provision within the UK. A glossary of terms is provided in Table I.