Maryse Gadreau

A data mining approach for grouping and analyzing trajectories of care using claim data: the example of breast cancer.

BackgroundWith the increasing burden of chronic diseases, analyzing and understanding trajectories of care is essential for efficient planning and fair allocation of resources. We propose an approach based on mining claim data to support the exploration of trajectories of care.MethodsA clustering of trajectories of care for breast cancer was performed with Formal Concept Analysis. We exported Data from the French national casemix system, covering all inpatient admissions in the country. Patients admitted for breast cancer surgery in 2009 were selected and their trajectory of care was recomposed with all hospitalizations occuring within one year after surgery. The main diagnoses of hospitalizations were used to produce morbidity profiles. Cumulative hospital costs were computed for each profile.Results57,552 patients were automatically grouped into 19 classes. The resulting profiles were clinically meaningful and economically relevant. The mean cost per trajectory was 9,600€. Severe conditions were generally associated with higher costs. The lowest costs (6,957€) were observed for patients with in situ carcinoma of the breast, the highest for patients hospitalized for palliative care (26,139€).ConclusionsFormal Concept Analysis can be applied on claim data to produce an automatic classification of care trajectories. This flexible approach takes advantages of routinely collected data and can be used to setup cost-of-illness studies.

Séroconversion toxoplasmique chez la femme enceinte: Les différentes attitudes françaises

INTRODUCTION Since 1992 France has been running a toxoplasmosis prevention program based on the serological detection of infections during pregnancy. In the absence of a consensus, the seroconversions discovered are managed in different ways, varying from one centre to another. OBJECTIVE To describe the habits of the specialised centres in France and propose means to reduce the heterogeneity. METHODS A survey using a questionnaire mailed to the centres of parasitology in France specialised in the management of toxoplasmosis seroconversion during pregnancy. RESULTS All the 30 centres surveyed replied. Five of them do not provide recommendations for treatment and were excluded from analysis. The attitudes of the 25 other centres varied greatly with regard to the indications for therapeutic abortion and amniocentesis, treatment protocols with pyrimethamine and sulfamides, as well as in the frequency of sonographical monitoring. CONCLUSION In the absence of National guidelines, the management of seroconversions discovered during the prenatal prevention of congenital toxoplasmosis program is left to the discretion of the specialised centre. This results in variations from one town to the next. This heterogeneity underlines the lack of knowledge on the most efficient and acceptable means of preventing and treating congenital toxoplasmosis. In order to improve this situation, the French parasitologists have launched a program of consensual meetings aimed at harmonising the treatment protocols and identifying the points that require further studies.Resume Introduction La France possede depuis 1992 un programme de prevention de la toxoplasmose reposant sur la detection serologique des infections en cours de grossesse. En l’absence de consensus, les seroconversions depistees sont prises en charge de facon variable selon les centres. Objectif Decrire les pratiques des centres experts francais et faire des propositions pour reduire leur heterogeneite. Methode Enquete postale par questionnaire aupres des centres de parasitologie francais de reference pour la prise en charge des seroconversions toxoplasmiques en cours de grossesse. Resultats La totalite des 30 centres interroges ont repondu. Cinq d’entre eux ne font pas de recommandations therapeutiques et ont ete exclus de l’analyse. Les attitudes des 25 autres centres varient largement en qui concerne les indications d’interruption de grossesse et d’amniocenteses, les protocoles de traitement par pyrimethamine et sulfamides, ainsi que le rythme de surveillance echographique. Conclusion En l’absence de recommandations nationales, la prise en charge des seroconversions depistees grâce au programme de prevention prenatale de la toxoplasmose congenitale est laissee a l’initiative de chacun des centres experts. Il en ressort une variation de pratique d’une ville a l’autre. Cette heterogeneite traduit le manque de connaissances sur la facon la plus efficace et la plus acceptable de prevenir et de traiter la toxoplasmose congenitale. Afin d’ameliorer cette situation, les parasitologues francais ont lance un programme de reunions consensuelles qui a pour but d’harmoniser les protocoles de prise en charge et d’identifier les points necessitant des etudes complementaires.

Market Empowerment of the Patient: The French Experience

Abstract Through analysis of the French experience, this article explores the way economic policy has sought to encourage active, well-informed patients by giving them market power. The new status of the patient as consumer is based on two foundations: the endeavour to build a healthcare market and the activation of demand-based policies. The keystone of this new system is a conception of the market as a process constructed by economic policy. Recent measures such as the standardization of care and the introduction of incentives to respect a treatment pathway then constitute effective levers to establish a free-market rationale.