Christine Peyron

Evaluation of the possible impact of a care network for stroke and transient ischemic attack on rates of recurrence.

We aimed to demonstrate that a stroke network is able to reduce the proportion of recurrent cerebrovascular events. In 2003, we set up a care network with the aim to reduce the proportion of stroke recurrence. For the statistical analysis, recurrent cerebrovascular events observed from 1985 to 2002 within the population of Dijon made it possible to model trends using Poisson logistic regression. From 1985 to 2002, we recorded 172 recurrent cerebrovascular events which were used to model trends before the creation of the care network. Within the period 2003–2007, we observed 162 recurrent cerebrovascular events compared with 196.7 expected cerebrovascular events with a significant standardized incidence rate of 0.82 (0.70–0.96; p = 0.01). After eliminating the role of some environmental factors, the possible hypothesis for the fall in recurrent stokes is probably the positive effect of the stroke care network.

Heterogeneity in general practitioners’ preferences for quality improvement programs: a choice experiment and policy simulation in France

Despite increasing popularity, quality improvement programs (QIP) have had modest and variable impacts on enhancing the quality of physician practice. We investigate the heterogeneity of physicians’ preferences as a potential explanation of these mixed results in France, where the national voluntary QIP – the CAPI – has been cancelled due to its unpopularity. We rely on a discrete choice experiment to elicit heterogeneity in physicians’ preferences for the financial and non-financial components of QIP. Using mixed and latent class logit models, results show that the two models should be used in concert to shed light on different aspects of the heterogeneity in preferences. In particular, the mixed logit demonstrates that heterogeneity in preferences is concentrated on the pay-for-performance component of the QIP, while the latent class model shows that physicians can be grouped in four homogeneous groups with specific preference patterns. Using policy simulation, we compare the French CAPI with other possible QIPs, and show that the majority of the physician subgroups modelled dislike the CAPI, while favouring a QIP using only non-financial interventions. We underline the importance of modelling preference heterogeneity in designing and implementing QIPs.