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Resume Une etude menee, en 2013, aupres de 127 etudiants de l’Institut national medico-sanitaire (INMeS) a Cotonou, au Benin, identifie leur perception du processus de gestion et de la qualite de l’encadrement clinique. Les donnees ont ete recueillies a l’aide d’un questionnaire auto-administre et ont fait l’objet d’une analyse de contenu. D’apres les etudiants, aucune explication n’est prealablement fournie sur les objectifs et modalites de deroulement des stages, lesquels debutent sans visite medicale, ni livret d’accueil, dans un environnement de peur cree et entretenu par certains encadreurs. Ils denoncent leur manque d’integration, l’insuffisance de materiel et des activites d’apprentissage, l’inexistence de moyens de transport, ainsi que l’absence quasi permanente des enseignants de l’INMeS sur leurs lieux de stage. L’evaluation sommative est realisee en leur absence sans qu’aucune explication, ni information, ne leur soient donnees sur ces criteres. Ces resultats demontrent la faible qualite de l’encadrement clinique. Des pistes de recommandations ont ete emises pour son amelioration.

Resume Dans les pays ou l’euthanasie active volontaire (EAV) est depenalisee conditionnellement, la loi precise le role du medecin, mais evoque peu ou pas celui de l’infirmier. Il nous parait essentiel de garantir un accompagnement humaniste et de qualite aux personnes de plus en plus nombreuses qui y recourent. Au moyen d’une revue de la litterature ciblee, nous avons identifie une serie de roles infirmiers tout au long du processus d’EAV. Ainsi, l’infirmier est-il susceptible d’entendre la demande d’EAV et d’avoir a la partager avec l’equipe interdisciplinaire. Il peut etre associe a la prise de decision. Dans ces moments decisifs, son role d’« advocacy » (qui plaide en faveur du respect de la volonte de la personne ou de ses proches) est mis en evidence. Il assure la continuite des soins dans l’attente de l’acte d’EAV, durant lequel il assiste la personne, les proches et ses collegues. Il accompagne ensuite les proches et veille a ce que l’EAV soit declaree dans les formes prescrites par la loi.

Depuis plusieurs dizaines d’annees, les infirmiers de pratique avancee (IPA) s’investissent dans de nouveaux roles au sein des systemes de soins de sante et cette tendance va en s’amplifiant.Formes au cours d’un deuxieme cycle universitaire, les IPA interviennent en contact direct avec la personne – entendue au sens de l’individu et de sa famille – dans de nombreux champs de pratique et dans un esprit de collaboration avec leurs collegues infirmiers et les autres professionnels de sante.Les benefices potentiels des interventions de l’IPA ont ete demontres dans de nombreux domaines. L’IPA est notamment un acteur de sante publique susceptible de participer a la reponse interdisciplinaire dans l’accompagnement de patients atteints de maladies chroniques.Mais developper la pratique infirmiere avancee (PIA) au sein d’un systeme de soins de sante complexe necessite une approche systemique en harmonie avec les differents niveaux de formation des praticiens infirmiers et les autres professionnels de sante. C’est la un effort indispensable pour permettre a l’IPA de s’investir dans de nouveaux roles en pleine aptitude (habilitation legale, formation de haut niveau et orientee, modalites de collaboration, etc.).Pour aboutir a une plus-value pour les patients, pour le systeme en termes de resultats de sante et garantir des conditions d’exercice adequates, les auteurs soulignent l’importance de developper la PIA de facon structuree. Les auteurs proposent de passer par une phase d’eveil comportant l’adoption d’un modele conceptuel de PIA et l’etablissement d’un cadastre structure des pratiques infirmieres existantes pour se preparer a une strategie d’implantation methodique.

The aim of this study is (1) to describe the characteristics of the organ harvesting activity conducted in 2012 at the Erasme's Hospital, Brussels University Hospital, (2) to highlight the different combinations " type of donor/types of organ's retrieved " in relation to organ harvestings carried out within the hospital, and (3) to calculate the organ harvesting's cost of acts.The study is conducted according to the hospital perspective. It assesses the consumption of medical and nursing staff resources, disposable material costs, medical device costs, drugs costs, sterile instruments and biomedical equipment costs, of the 34 organ harvesting procedures that has been conducted this year. Costs are calculated by procedure, by donor's type, by organ and by combinations.Total cost is 99.442 €, with an average cost per donor of 3.016 €, 3.292 € for DBD postmortem donor (Donor Brain Death) and 2.456 € for DCD type (Donor Cardio-Circulatory Death). The average cost per organ leading to a transplantation is 1.842 € for DCD type and 1.297 € for DBD.The results show that there is as many costs as the number of organ harvesting's combinations. Integrate the revenue generated by organ harvestings could establish whether funding sources cover the costs generated by this activity or if a reform of the nomenclature should be considered.Les objectifs de ce travail sont (1) de décrire les caractéristiques de l’activité de prélèvement d’organes réalisée en 2012 par l’Hôpital Erasme, Cliniques Universitaires de Bruxelles, (2) de mettre en évidence les différentes combinaisons " type de donneur/types d’organes prélevés " rencontrées dans le cadre des prélèvements d’organes effectués au sein de l’institution, et (3) de calculer le coût de revient des actes de prélèvement d’organes. Matériel et méthodes : L’évaluation du coût est menée du point de vue du fournisseur de soins. Elle évalue la consommation des ressources en personnel médical et soignant, produits médicaux courants, dispositifs médicaux de viscérosynthèse, spécialités pharmaceutiques, instruments stériles et équipements biomédicaux, de 34 procédures de prélèvement d’organes. Les coûts sont calculés par type de donneur, par organe et par combinaison de prélèvement. Résultats : Le coût total calculé s’élève à 99.442 €, avec un coût moyen par donneur vivant à 3.016 €, par donneur post-mortem de type DBD (Donor Brain Death) à 3.292 €, et de type DCD (Donor Cardio-Circulatory Death) à 2.456 €. Par organe prélevé ayant abouti à la transplantation, le coût moyen est de 1.842 € lorsqu’il provient d’un donneur de type DCD, et de 1.297 € s’il provient d’un donneur de type DBD.Les résultats montrent qu’il y a autant de coûts de prélèvement que de combinaisons de prélèvement. Intégrer les recettes générées par les prélèvements permettrait d’établir si les sources de financement couvrent les frais engendrés par cette activité, ou si une réforme de la nomenclature devrait être envisagée dans ce secteur d’activité.

The use of a Nursing Model (NM) for nursing administration offers direct and indirect benefits for patients as for nurses. Depending the chosen NM, the concepts of person, health, nursing and environment are very different. Each NM has its special vision of the practice of nursing. The study investigated whether the Chief Nursing Officers (CNO) of the bilingual and French speaking Belgian hospitals integrate Nursing Models in the politics of their department. A quantitative descriptive and correlational survey was conducted. 97.5 % of the concerned CNO (78/80) participated to the research. It appears that a Nursing Model underlies the action of the nursing department in only 38 % of the departments (30/78). Where a Nursing Model is used, it is explicitly communicated to staff (26/30). Among the Models used, that of Virginia Henderson dominates (26/30). The seniority of the CNO in its function as well as variables related to educational courses and clinical context appear to influence the results. The Nursing Models of the paradigm of transformation remain rarely used. A qualitative research would be relevant to deepen the understanding of the experience of CNO related to Nursing Models.

Le systeme de financement du personnel soignant travaillant au sein des services d’urgences a ete recemment modifie en Belgique. Les nouvelles regles tiennent compte du nombre annuel de passages dans les services d’urgences et de points complementaires determines sur base de criteres senses augmenter l’activite du personnel soignant. L’objectif de cette etude est d’identifier les facteurs influencant l’activite des infirmieres dans un service d’urgences et d’evaluer si la reforme du financement mise en place en Belgique est ou non basee sur des indicateurs refletant l’activite. Les soins realises aupres de 689 patients passes dans un service d’urgences d’un hopital general ont permis de conclure qu’un patient consomme en moyenne 18,57 minutes de soins et que l’activite peut etre tres variable d’un patient a l’autre. Une hospitalisation, apres le passage par les urgences, augmente significativement la consommation en soins. La consommation en soins varie en fonction du diagnostic medical. Une variabilite importante existe cependant au sein d’un meme diagnostic. Les resultats de cette etude ne permettent pas de conclure que les criteres choisis pour financer les services d’urgences sont correles a l’activite du personnel soignant.

Evaluation de l’impact financier des bacteriemies nosocomiales Contexte : Il existe peu de donnees recentes sur l’impact financier des bacteriemies nosocomiales en Belgique et en Europe.Objectif : Evaluer l’impact financier des bacteriemies nosocomiales dans un hopital general au cours du temps.Methode : Les donnees de laboratoire ont ete la source d’information utilisee pour identifier les patients ayant eu une bacteriemie nosocomiale. Les couts ont ete calcules selon la perspective hospitaliere.Resultats : Le taux de bacteriemies nosocomiales varie entre 0.34% et 0.58% selon l’annee etudiee. Les taux les plus importants sont observes chez les patients admis pour des pathologies liees aux systemes circulatoire, respiratoire ou du systeme musculo-squelettique. L’augmentation de la mortalite des cas varie entre 21 et 30%. L’augmentation de la duree de sejour des cas varie entre 21 et 32 jours. L’augmentation des couts varie entre €17 711 et €24 510 par patient. L’augmentation des couts lies aux actes medicaux varie entre €3 492 et €5 033. En ce qui concerne les produits pharmaceutiques, l’augmentation varie entre €3 446 et €6 367, ce qui est explique par une consommation d’antibiotiques couteux. Excepte en 2006, chaque cas genere une perte pour l’hopital variant de €1 427 a €10 588€ par patient. L’ensemble des cas ont genere pour l’hopital une perte de €41 039.10 en 2003, de €217 091.24 en 2004 et de €376 808.50 en 2008.Conclusion : Ces resultats devraient stimuler, une reflexion sur l’importance des mesures de prevention afin de reduire le taux des infections nosocomiales.

the reform of nursing education requires to focus on the quality of clinical supervision.to identify the perception of internship supervisors of the management process and the quality of the clinical supervision of students of the National Institute Health Services (INMES).a qualitative and quantitative descriptive cross-sectional study was conducted among the supervisors of the National Hospital and University and the Hospital of the Mother and Child Lagoon Benin. Data collected using a self-administered questionnaire was treated with EPI INFO Version 3.5.4 and according to a content analysis.92 % of supervisors have not received any specific training in coaching. There is no formal and regulatory framework conducive to coaching or mentoring repository. Collaboration between INMES and internship sites is low. The supervision is not integrated in the service missions, but rather related to a contextual occasion. The daily training period is considered short for a real learning. Summative assessment tool whose criteria are non adapted is done in the absence of the student.these results demonstrate the low quality of clinical supervision.the shortcomings identified will serve as basis for improving the quality of clinical supervision.

The objective of this study was to compare costs data by diagnosis related group (DRG) between Belgium and Switzerland. Our hypotheses were that differences between countries can probably be explained by methodological differences in cost calculations, by differences in medical practices and by differences in cost structures within the two countries.Classifications of DRG used in the two countries differ (AP-DRGs version 1.7 in Switzerland and APR-DRGs version 15.0 in Belgium). The first step of this study was to transform Belgian summaries into Swiss AP-DRGs. Belgian and Swiss data were calculated with a clinical costing methodology (full costing). Belgian and Swiss costs were converted into US$ PPP (purchasing power parity) in order to neutralize differences in purchasing power between countries.The results of this study showed higher costs in Switzerland despite standardization of cost data according to PPP. The difference is not explained by the case-mix index because this was similar for inliers between the two countries. The length of stay (LOS) was also quite similar for inliers between the two countries. The case-mix index was, however, higher for high outliers in Belgium, as reflected in a higher LOS for these patients. Higher costs in Switzerland are thus probably explained mainly by the higher number of agency staff by service in this country or because of differences in medical practices.It is possible to make international comparisons but only if there is standardization of the case-mix between countries and only if comparable accountancy methodologies are used. Harmonization of DRGs groups, nomenclature and accountancy is thus required.

Introduction Depuis sa derniere reforme en 1986, le systeme de financement des hopitaux belges est devenu de plus en plus complexe et de moins en moins transparent. Le gouvernement a annonce une modification du financement hospitalier inspire des recommandations de l’OCDE (financement forfaitaire prospectif a la pathologie). Notre etude visait a estimer s’il est possible de transposer, dans l’environnement belge, la methodologie developpee pour calculer les tarifs de la T2A et a evaluer les impacts d’une telle tarification sur les resultats financiers d’un echantillon d’hopitaux belges. Methode Nous disposons d’une base de donnees de cout par pathologie pour plusieurs hopitaux belges. En nous inspirant de la methode developpee par l’ATIH, nous avons determine une base tarifaire a partir des budgets d’une dizaine de ces hopitaux en 2012. Il a ete necessaire d’extraire tous les postes budgetaires qui ne pouvaient faire l’objet d’un financement a la pathologie en se basant sur des analogies avec le modele francais. La documentation decrivant la technique tarifaire de la T2A et les conseils de l’ATIH nous ont aides pour la construction d’une echelle de valeurs relatives de couts et pour le calcul des forfaits tarifaires par groupe homogene de patients (APR DRG 1 ). Resultats Si l’on se concentre sur le perimetre MCO des 10 hopitaux de l’echantillon, la base tarifaire susceptible d’etre financee par des tarifs a la pathologie represente 65,2 % du chiffre d’affaires alloue en 2012. Les tarifs ont ete calcules pour 556 APRDRG/SEVERITE representant 95,5 % des sejours de l’echantillon. Le chiffre d’affaires realise par chaque hopital en 2012 a ete compare avec le montant qu’il aurait percu s’il avait ete finance par la methode T2A (a base budgetaire constante pour l’ensemble de l’echantillon). Le financement de quatre hopitaux diminue sensiblement (jusqu’a -12,1 %) tandis que six hopitaux profitent de ce nouveau systeme de financement (jusqu’a +15,3 %). Discussion/conclusion Un systeme de tarification forfaitaire base sur la pathologie aura des effets importants sur le financement de nombreux hopitaux belges.

Introduction Les hopitaux constatent regulierement que la duree de sejour a l’hopital de certains patients est prolongee bien que leur presence ne soit plus justifiee par des raisons medicales. Le manque d’infrastructures extrahospitalieres pouvant accueillir des patients apres une hospitalisation, ainsi que la diminution de la disponibilite des aidants-proches peuvent avoir un impact important sur les couts hospitaliers. L’objectif de l’etude est d’etablir les profils medico-administratifs des patients « bed blockers », d’identifier les raisons et les obstacles a leur sortie et le besoin en structures d’accueil adequates apres l’hospitalisation, de calculer la duree excedentaire du sejour, et d’en evaluer les couts associes selon la perspective hospitaliere. Methodes Une enquete a ete realisee dans quatre hopitaux belges. Les patients qui sont toujours hospitalises, alors que l’autorisation medicale de sortie remonte a plus de 24 heures, ont ete recenses sur une periode de 30 jours. L’etude se concentre sur 93 patients. Resultats Nous distinguons quatre profils de patients « bed blockers ». Les patients en attente d’une maison de repos (groupe A) representent 33 % de la population etudiee. Ils ont une duree de sejour excedentaire moyenne (ecart type) de 12,29 jours (11,45), ce qui represente un cout moyen par patient de 7531,10 EUR pour l’hopital. Les patients du groupe B ont besoin d’un accueil temporaire pour leur permettre de restaurer leur autonomie avant de retourner dans leur environnement familial naturel (20 % de la population). Ils ont une duree excedentaire moyenne de 2,87 jours (1,67), ce qui represente un cout moyen de 2164,52 EUR. Les patients du groupe C (36 %) necessitent des soins de revalidation, ils ont une duree de sejour excedentaire de 11,17 jours (17,36) et un cout moyen de 7182,76 EUR. Le groupe D (11 %) reprend les patients necessitant une solution de placement plus specifique. Discussion/conclusion Les resultats montrent la necessite de developper des lits de revalidation et de maisons de repos comme premiere solution permettant la sortie de patients dans des delais raisonnables.

Objectives of this article are to evaluate the possibility to create a CW scale by pathology on the basis of cost data from Belgian hospitals, to compare several methodologies to create this CW scale, and to evaluate the financial impact of a modification of the financing system on hospitals’ income. CW scales were elaborated according to various methodologies in order to isolate the scale allowing the most adequate financing system, i.e. approaching the real costs as much as possible. Twelve scales were created. They vary according to the type of data used, according to DRGs and severities of illness included within the scale, and according to the variable used in order to isolate outliers. For a similar case-mix, Hospitals H2 and H5 would see their financing increased through a prospective system based on the selected CW scale (No. 6). This modification would generate a reduction in financing going from −1 to −9% according to hospitals. The cost database created made it possible to create a CW scale according to a technique which could constitute the first step of a PPS if advantages of a such financing system were established. In the Belgian context, it would be probably judicious to envisage regional databases allowing diversified methodological approaches whose results would be confronted, discussed, and coordinated at the federal level.

Introduction Les resultats des analyses economiques par pathologie dependent des methodologies utilisees pour calculer les couts. Les modeles « top-down/gross-costing (TD/GC) » imputent les ressources globales de l’hopital sur les pathologies en utilisant des donnees externes a l’hopital (echelles de valeurs relatives developpees en dehors de l’hopital). Les modeles analytiques « bottom-up/microcosting (BU/MC) » repartissent les couts en se basant sur les quantites de ressources reellement consommees par les patients. Les resultats obtenus en appliquant les deux methodes conduisent-ils aux memes conclusions ? Methodes Le cout moyen par pathologie est calcule dans 11 hopitaux selon une approche BU/MC. Les resultats de cette methode analytique sont a la base des echelles de valeurs relatives par pathologie qui seront appliquees aux ressources globales des memes hopitaux comme des « EVR externes ». Les resultats des deux methodologies ont ete compares pour 758 APR-DRG-indices de severite representant la majorite des pathologies prises en charge par les onze hopitaux. Resultats 1. L’ampleur des differences entre les couts moyens obtenus par les deux methodes est importante (erreur quadratique moyenne egale a 35 %). 2. Pour chaque APR-DRG-indices de severite, le cout moyen calcule pour chaque hopital avec chacune des deux methodes a ete compare avec le cout moyen de l’hopital de reference (moyenne des couts moyens des hopitaux calcules sur la base de la meme methodologie). Si le cout moyen de l’hopital X est moins eleve que celui de l’hopital de reference, l’hopital est note « performant » et inversement ; 21 % des APR-DRG-indices de severite presentent des resultats contradictoires en fonction des methodes utilisees. Discussion/Conclusion Par hypothese, la methode la plus precise de calcul des couts est celle qui se rapproche le plus des couts reels (BU/MC). On doit donc conclure que la methode globale TD/GC produit des resultats relativement eloignes de la realite. De plus, contrairement a la methode BU/MC, la methode TD/GC ne permet aucune explication des ecarts constates entre les couts des pathologies calcules dans differents hopitaux, et ceux de l’hopital de reference.

Introduction L’etude vise a (1) detailler le cout hospitalier des procedures liees au remplacement de la hanche chez le patient âge de 65 ans et plus et (2) a isoler les facteurs qui influencent le cout. Methodes L’etude se base sur 961 sejours de patients âges de 65 ans et plus hospitalises pour un remplacement d’articulation de hanche (APR-DRG 301) engendre par un probleme d’arthrose ou une fracture. Les donnees ont ete collectees en 2014 dans neuf hopitaux generaux belges. Une regression quantile a ete realisee afin d’identifier les predicteurs de cout. Les analyses statistiques ont ete realisees avec le software STATA. Resultats Les patients âges hospitalises pour un remplacement de la hanche proviennent le plus souvent du domicile (87,63 %), sont admis de maniere planifiee (65,92 %), ont un indice de comorbidites de Charlson faible, et la severite de la pathologie est mineure (36,73 %) ou moderee (44,64 %). Dans 9,16 % des cas, les patients passent par un service de geriatrie durant leur sejour. Apres l’hospitalisation, les patients retournent a domicile (76,62 %) ou vont en maison de repos (13,73 %). Le cout median (P25–P75) pour l’hopital est de 8023,91 € (6678,32–13 670,78) et la duree de sejour s’eleve a 8,93 jours (6,29–20,91). Le cout total d’hospitalisation par sejour se compose des couts administratifs (mediane ; P25–P75) (1815,75 ; 1276,93–4254,59), des couts lies aux actes medicaux (2883,63 ; 2422,96–3891,24), des couts lies aux protheses (2012,92 ; 1609,07–2263,11), et d’autres couts. Une analyse multivariee revele que la duree de sejour, le passage par un service de geriatrie, le recours aux soins intensifs, un deces lors de l’hospitalisation, et une severite importante sont des facteurs qui accroissent le cout pour l’hopital. Au contraire, un âge eleve (85+) diminue le cout median d’hospitalisation, et plus precisement le cout des actes medicaux. Discussion/Conclusion L’augmentation de l’âge entraine une diminution du cout pour l’hopital, principalement au niveau du cout des actes medicaux. La severite, le recours aux soins intensifs, et la duree de sejour augmentent le cout pour l’hopital.

Over the last few decades, advanced nursing practitioners (ANP) have developed new roles in health care systems and this tendency is continuing to grow. Postgraduate trainedANP interact directly with the person, i.e. the individual and his/her family - in many fields of practice and in a context of collaboration withfellow nurses and other health care professionals. The potential benefits of ANP interventions have been demonstrated in many fields. In particular, ANP are public health actors, able to participate in the interdisciplinary response to supportive care ofpatients with chronic diseases. However, the development of advanced practice nursing (APN) in a complex health care system requires a systemic approach coordinated with the various levels of training of nursing practitioners and other health care professionals. This is an essential prerequisite to allow ANPs to develop new roles adapted to their capacities (legal qualification, high level, specialist training, modalities of collaboration, etc.). To achieve an added value for patients, for the health care system in terms ofresults and to ensure adequate nursing conditions, the authors emphasize the importance of structured development of APN and propose an awareness phase comprising adoption of a conceptual model of APN and the establishment of a structured list of existing nursing practices in order to prepare a methodical implementation strategy.

A prospective payment system per DRG is announced in Belgium. Is this kind of financing system adequate for oncology? Objectives of this study are: to analyze medical and economical characteristics of oncological inpatients and evaluate the homogeneity of costs and length of stay per DRG.The study was realized in 14 Belgian hospitals, with 2010 data. Inpatients with primary diagnosis of neoplasms were selected in medical and administrative databases. Characteristics of patients as well as length of stay and cost (hospital perspective) were analyzed. The homogeneity of costs and length of stay is measured by calculating the coefficient of variation (standard deviation divided by the mean).The length of stay (standard deviation) is 9.72 days (12.64). The variation is high per DRG. The average cost (standard deviation) is 7689.28€ (10,418) and is also variable from one DRG to another one. There are 5% of high-length of stay outliers and 0.2% of low-length of stay outliers. There are 4.7% of high-cost outliers and 0.2% of low-cost outliers. The withdrawal of outliers improves the homogeneity of cost and length of stay per APR-DRG.There is a homogeneity of costs and length of stay per DRG and per severity of illness. A prospective payment system per DRG would probably be applicable for these patients. It is however necessary to plan an appropriate and additional financing of all elements susceptible to stimulate innovation in the management of oncology and to stimulate the quality of care by adding financial stimulants.

Thirty percent of people aged 65 and older, living at home fall at least once a year. Few economic data are available in Belgium on this issue. We evaluated the cost borne by social security. 823 inpatient stays aged 65 and more, from home and admitted for injuries after a fall were selected. We observe an average (SD) age of 81 years. The proportion of women is 76%. 75% of admissions are related to fractures. 18% of patients are 'institutionalized' after falls. The death rate is 6%. The median (Q1-Q3) of cost is € 4.182 (2.385-6.820), for a length of stay median (Q1-Q3) of 11 days (4-25). The cost of hospital stays is estimated at €135 millions. Based on population projections, the cost could be estimated at € 243 millions in 2050. The overall cost of the treatment of these lesions is much more important, because costs are also generated after the hospitalization.

Introduction L’alcool est un probleme de sante publique. En 2013, l’abus d’alcool, de par ses consequences sur le cout des soins de sante ou judiciaire, representait un cout annuel de 4,2 milliards d’euros pour la societe belge. L’Organisation mondiale de la sante (OMS) estime que l’alcool est la cause de plus de 3,3 millions de deces chaque annee et represente 5,1 % de la charge de morbidite mondiale. L’objectif de cette etude est d’evaluer l’impact de la dependance a l’alcool sur le cout et la duree de sejour des sejours hospitaliers. Methodes La population etudiee reprend 129 712 sejours hospitalises dans neuf institutions hospitalieres. La selection des sejours dependants a l’alcool a ete faite sur base des diagnostics secondaires et non primaires (classification ICD9CM), codes dans le resume hospitalier minimum (RHM). Les differentes variables etudiees proviennent d’une part du RHM et d’autre part de la base de donnees PACHA (couts par sejour et par pathologie). Le cout a ete evalue selon la perspective hospitaliere pour l’annee 2014. Resultats Au total, 3815 sejours ont un diagnostic secondaire de dependance a l’alcool. Ils representent 2,9 % des sejours hospitalises dans les neuf hopitaux toutes pathologies confondues. Le cout median (P25–P75) pour ces sejours avec un diagnostic secondaire de dependance a l’alcool est de 3976,84€ (2116,76€–7985,51€) et leur duree de sejour mediane (P25–P75) est de 6,79 jours (2,84 jours–13,89 jours). A contrario, le cout median (P25–P75) des sejours sans ce diagnostic secondaire est de 2767,08€ (1249,58€–5116,81€) et leur duree de sejour mediane (P25–P75) est de 3,27 jours (1,26 jours–6,48 jours). On observe egalement que ce diagnostic secondaire augmente le risque de passage aux soins intensifs (14,3 % versus 6,2 %–p-valeur p -valeur Discussion/conclusion Les premiers resultats de cette etude semblent confirmer que le diagnostic secondaire de la dependance a l’alcool a un impact sur le cout et la duree de sejour. Ils semblent egalement confirmer un parcours hospitalier different a APR-DRG identique.

Objectives The objectives of this study are to analyze the variation of the surgical time and of disposable costs per surgical procedure and to analyze the association between disposable costs and the surgical time. Methods The registration of data was done in an operating room of a 419 bed general hospital, over a period of three months (n = 1556 surgical procedures). Disposable material per procedure used was recorded through a barcode scanning method. Results The average cost (standard deviation) of disposable material is €183.66 (€183.44). The mean surgical time (standard deviation) is 96 min (63). Results have shown that the homogeneity of operating time and DM costs was quite good per surgical procedure. The correlation between the surgical time and DM costs is not high (r = 0.65). Conclusions In a context of Diagnosis Related Group (DRG) based hospital payment, it is important that costs information systems are able to precisely calculate costs per case. Our results show that the correlation between surgical time and costs of disposable materials is not good. Therefore, empirical data or itemized lists should be used instead of surgical time as a cost driver for the allocation of costs of disposable materials to patients.

Objectives. Investigating injuries in terms of occurrences and patient and hospital stay characteristics. Methods. 17370 stays, with at least one E code, were investigated based on data from 13 Belgian hospitals. Pearson’s chi-square and Kruskal-Wallis tests were used to assess the variations between distributions of the investigated factors according to the injury’s types. Results. Major injuries were accidental falls, transport injuries, and self-inflicted injuries. There were more men in the transport injuries group and the accidental falls group was older. For the transport injuries, there were more arrivals with the support of a mobile intensive care unit and/or a paramedic intervention team and a general practitioner was more implicated for the accidental falls. In three-quarters of cases, it was a primary diagnostic related to injury and poisoning which was made. The median length of stay was nearly equal to one week and for accidental falls, this value is three times higher. The median cost, from the social security point of view, for all injuries was equal to €1377 and there was a higher median cost within the falls group. Conclusion. This study based on hospitals data provides important information both on factors associated with and on hospital costs generated by injuries., SCOPUS: ar.j, info:eu-repo/semantics/published

Aims: Investigating the E codes related to suicide and self-inflicted injuries through the prevalence, the patient characteristics, the methods and means employed and the characteristics of the hospital stays; and compare them with the others E codes group. Study Design: Retrospective hospital-based analytical study. Place and Duration of Study: This study was based on the 2010 data of 13 Belgian hospitals. Methodology: Based on 16406 cases of patients with a least an E code (ICD-9-CM); Pearson’s chi-squaretests, simple logistic regressions and Wilcoxon rank sum tests were used to assess the variations between distributions of the investigated factors according to the injury’s groups. Results: Among all the E codes, prevalence of suicide and self-inflicted injury was equal to 10.6%. The poisoning was the major reported diagnosis. There were significantly more discharges without consent in the suicide group than in the others. The length of stay was lowest in the suicide group compared to the others E codes group. The several median costs were always highest among the men, but, regarding the median percentage of the pharmaceutical products, the value was highest among the women. Conclusion: The epidemiological use of hospital data is complementary to the use of both the population-based data and the death certificates; each data source participating to a better comprehension and a better surveillance of the complex continuum of suicidality., info:eu-repo/semantics/published

The number of hospitalizations for atrial fibrillation has increased dramatically. This increase, in the number of hospital stays will continue, given the growth projections based on epidemiological data, and will contribute to significantly increase expenses for the social security system.The objective of this study was to evaluate the length of hospital stay, the average cost borne by social security, and the types of hospital stay expenditures for patients admitted through the emergency department for atrial fibrillation.Patients were identified by using the minimal clinical summaries of seven general hospitals in Belgium in 2008. Only hospitalized patients having as primary diagnosis code ICD-9-CM 42731 'atrial fibrillation'were selected for this study. Hospital billing files were analysed in order to isolate the costs borne by social security. Outliers were isolated in order not to have results influenced by patients having an atypical length of stay.Results show that the mean length of stay was 8.6 days and the mean cost charged to social security was euro 3,066.02 per hospital stay.The mean cost of care was strongly associated with the degree of severity index related to the APR-DRG. Approximately 85% of the total cost was related to the cost of hospital days and medical procedures with medical imaging and laboratory tests being the two main cost inductors. 18% of patients had cardioversion during their hospital stay, including 4% who had only that treatment. 19% of patients used amiodarone. Flecainide and propafenone were also used, but less frequently.The mean cost of care for AF patients admitted via the emergency department is strongly associated with the degree of severity. Approximately 85% of the total cost is related to the cost of hospital days and medical procedures. Hypertension is the most common secondary diagnosis. An optimal treatment of this risk factor could help to reduce the risk of atrial fibrillation, and thereby reduce the morbidity and costs associated with this disease.

As soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that DRG were not very homogeneous with regard to nursing care. However, few studies are based on All Patient refined Diagnosis related Groups (APR-DRGs) and few of them use recent data. Objectives of this study are: (1) to evaluate if nursing activity is homogeneous by APR-DRG and by severity of illness (SOI) (2) to evaluate the outlier's rate associated with the nursing activity and (3) to compare nursing cost homogeneity per DRG and SOI., JOURNAL ARTICLE, SCOPUS: ar.j, info:eu-repo/semantics/published

In 2010, a Belgian study [1] explored the feasibility of introducing all-inclusive case-based payments for Belgian hospitals. In this kind of financing system, hospital services and patient mix are described in a simplified way through Diagnosis Related Groups (DRGs). A tariff is fixed in advance for each DRG. DRGs are groups of patients based on economic and clinical homogeneity. Clinical homogeneity is achieved on the basis of medical diagnosis, co-morbidities, medical procedures, complications, etc. Economic homogeneity is achieved by using, first of all, the length of stay (LOS) or cost (or charges) of hospitalization as a classification criterion. As soon as DRGs were introduced, most nursing research revealed that DRGs were not very amenable to homogeneous integration with nursing care. DRGs only explained 20% to 40% of the variability in nursing care. Coefficients of variation for nursing care per DRG have been reported as varying from 0,22 to 2,56 [2-5]. This is the reason why some researchers try to refine DRG classification into classes of nursing cost per DRG [6]. However, it is difficult to find recent data that deals with this. The objectives of this study are to: • Discover if nursing activity is homogeneous by DRG and severity of illness. • Evaluate the correlation between LOS of patients and nursing activity per patient.

Cost outliers account for 6 to 8% of hospital inpatient stays and concentrate 22 to 30% of inpatient costs. Explanatory factors were highlighted in various studies. They are the lenght of stay, an intensive care unit stay, the severity of illness index related to DRG and social factors. Patients are not always explained by these factors. The objective of this study is to analyse cases not explained by those factors, through a detailed analysis of medical files. In the studied hospital, there are 6,3% high cost outliers and 1,1% low cost outliers. These stays were isolated on the basis of a rule based on percentiles. Extra costs generated by high cost outliers are 6.999 euro per stay. The extra lenght of stay for these patients is 20,42 days. Among the 454 patients high cost outliers, 334 patients are explained by factors extracted from a statistical analysis based on a logistic regression (intensive care unit stay, severity of illness index, lenght of stay and social factors). The analysis of medical files of the 120 not explained inpatient stays highlights new explanatory factors (coding errors, heterogeneity of DRGs, etc.). At the end of this study, the conclusion is that a statistical analysis combined with a precise analysis of medical files allowed to explain the majority of cost outliers. An explanation is however not necessarily synonymous with medical justification.

This study examined the impact of cost outliers in term of hospital resources consumption, the financial impact of the outliers under the Belgium casemix-based system, and the validity of two "proxies" for costs: length of stay and charges. The cost of all hospital stays at three Belgian general hospitals were calculated for the year 2001. High resource use outliers were selected according to the following rule: 75th percentile +1.5 xinter-quartile range. The frequency of cost outliers varied from 7% to 8% across hospitals. Explanatory factors were: major or extreme severity of illness, longer length of stay, and intensive care unit stay. Cost outliers account for 22-30% of hospital costs. One-third of length-of-stay outliers are not cost outliers, and nearly one-quarter of charges outliers are not cost outliers. The current funding system in Belgium does not penalize hospitals having a high percentage of outliers. The billing generated by these patients largely compensates for costs generated. Length of stay and charges are not a good approximation to select cost outliers.

Context and objectives The objective of this study was to find factors that could explain high and low resource use outliers, by associating an explanatory analysis with a statistical analysis. Method High resource use outliers were selected according to the following rule: 75th percentile + 1.5* inter-quartile range. Low resource use outliers were selected according to: 25th percentile − 1.5* inter-quartile range. The statistical approach was based on a multivariate analysis using logistic regression. A decision tree approach using predictors from this analysis (intensive care unit (ICU) stay, high severity of illness and social factors associated with longer length of stay) was also tested as a more intuitive tool for use by hospitals in focussing review efforts on “not explained” cost outliers. Results High resource use outliers accounted for 6.31% of the hospital stays versus 1.07% for low resource use outliers. The probability of a patient being a high resource use outlier was higher with an increase in the length of stay (odds ratios (OR) = 1.08), when the patient was treated in an intensive care unit (OR = 3.02), with a major or extreme severity of illness (OR = 1.46), and with the presence of social factors (OR = 1.44). The probability of being a low outlier is lower for older patients (OR = 0.98). The probability of being a low outlier is also lower without readmission within the year (OR = 0.55). The more intuitive decision tree method identified 92.26% of the cases identified through residuals of the regression model. One quarter of the high cost outliers were flagged for additional review (“not justified” on the basis of the model), with nearly three-quarters “justified” by clinical and social factors. Conclusion The analysis of cost outliers can meet different aims (financing of justifiable outliers, improvement of the care process for the outliers not justifiable on medical or social grounds). The two methods are complementary, by proposing a statistical and a didactic approach to achieve the goal of high quality care using fewer resources.

Studies from around the world have shown that hospital-acquired infections increase the costs of medical care due to prolongation of hospital stay, and increased morbidity and mortality. The aim of this study was to determine the extra costs associated with hospital-acquired bacteraemias in a Belgian hospital in 2001 using administrative databases and, in particular, coded discharge data. The incidence was 6.6 per 10 000 patient days. Patients with a hospital-acquired bacteraemia experienced a significantly longer stay (average 21.1 days, P

La comparaison des hôpitaux sur la performance des coûts et de la qualité semble indispensable pour permettre aux directions hospitalières de s’inscrire dans des programmes d’amélioration de la qualité. Objectif. Cette étude vise à réaliser un benchmarking hospitalier combinant des indicateurs qualitatifs issus de l’Agency for Healthcare Research and Quality, et des coûts pour l’« arthroplastie de la hanche ». Méthode. Notre échantillon repose sur les données administratives et financières de 7 hôpitaux belges (PACHA). Du point de vue hospitalier, deux types de coûts ont été constitués : les coûts d’hospitalisation et les coûts des prestations médicales et des produits pharmaceutiques. La régression linéaire sur le coût des prestations a été réalisée à l’aide du logiciel SPSS version 25. Résultats. Les taux de complications et de mortalité sont de 11,9% et de 1,9%. Pour les patients sans complication, la durée médiane (P25-P75) du séjour est de 7,81 jours (5 – 13 jours) pour un coût médian (P25-P75) de 7.219 € (6.248 € – 9.610 €). Pour les patients avec complication, la durée médiane (P25-P75) du séjour passe à 20,74 jours (10,53-38,80 jours) (p(p

The last few years have seen major changes in the Belgian medical planning. The paper aims to describe them and to assess how they will affect the medical demography.Grey literature review and federal and federated entities legislation summary.A new dynamic register allows a better knowledge of medical workforce in all sectors of labour market. Recent legislation evolutions induce fragmentation of competences related to human resource for health planning : federal authorities are responsive for the fixation of number of GP and specialists and community authorities for registration of health professionals and fixation of sub-quotas in different branches of specialised medicine. Finally, the French Community has setting up a multiple selection system of medical students that have to past an 'orientation test', a possible reorientation after January examinations and then a numerus fixus at the end of the first academic year.Dynamic register improves the knowledge of medical workforce repartition. However, the assessment of its volume shows methodological limitations. From an operational viewpoint, the fragmentation of competences will ask coordination effort from all authority levels to avoid impairment in planning process. Finally, French Community has to consider evaluation and ambitious revision of medical workforce planning in their region.Ces dernières années, la planification de l’offre médicale belge a connu des bouleversements majeurs. Cet article propose de les décrire et d’en apprécier l’impact pour le futur de la démographie médicale.Revue de la littérature grise et des textes législatifs nationaux et de la Communauté française.La mise en place d’un cadastre dynamique a permis de mieux connaître la force de travail des médecins au sein des différents secteurs d’activité sur le marché de travail. Les récentes évolutions législatives montrent un morcellement accru des compétences en termes de planification : le Fédéral étant compétent pour la fixation des quotas de généralistes et de spécialistes, et les Communautés pour l’enregistrement des professionnels de santé et des sousquotas par disciplines. Enfin, la Communauté française a mis en place un système d’hyper-sélection des candidats aux études de médecine soumis successivement au test d’orientation, à la session de janvier suivi d’une éventuelle réorientation, et à la session de juin accompagnée de l’épreuve de classement du numerus fixus.La mise en place du cadastre dynamique améliore grandement la connaissance de la répartition de la force de travail médicale. Cependant, l’évaluation de son volume pose d’importantes questions méthodologiques. D’un point de vue opérationnel, le morcellement des compétences demandera des efforts de coordination entre les différents niveaux de pouvoir pour ne pas porter préjudice au processus de planification. Enfin, la Communauté française ne pourra faire l’économie d’une évaluation et d’une révision ambitieuse de la planification des médecins sur son territoire.

Objectives of the study were to evaluate the missed appointments rate in a consultation of gastroenterology of a general hospital situated in the south part of the country, to evaluate financial consequences and to evaluate preventive strategies. During this study, the missed appointments rate was 19.4%. The risk to have a missed appointment is higher for patients that come for the first time in the hospital, coming for a visit, having an appointment in the afternoon, having less than 26 years and that have taken an appointment a long time ago. The loss of income in gastro-enterology was 77 Euro and 32 Euro outside gastro-enterology for a loss of income of 109.20 Euro by patient. The estimated loss of income for 711 patients that have missed their appointment is 71,984 Euro. Two preventive strategies of reminders were tested: the telephone reminder and the mail reminder. The non-attendance rate was lower for patients with a mail reminder. The percentage of deferred or cancelled appointments is higher for patients with a telephone reminder. The low cost of a reminder (telephone or mail) should stimulate the hospital direction to develop a system of reminders to limit the non-attendance rate, at least for patients with a higher risk of non-attendance.

Optimal duration of immunotherapy treatment by BCG for the prevention of recurrences of superficial bladder cancer is still unknown. We have studied the evolution and duration of the cellular immunity response at the peripheral level after BCG intravesical instillations. Our results show that immunity activation after BCG is of short duration and don't take more than 6 months. Our results support, strengthen and partially allow to explain the utility of maintenance treatment by BCG following 6-weekly instillations.