Sandrine Couray-Targe

Molecular evidence of interhuman transmission of Pneumocystis pneumonia among renal transplant recipients hospitalized with HIV-infected patients.

Molecular evidence indicates that P. jirovecii may be nosocomially transmitted to severely immunosuppressed patients.

Temporal variation in surgical mortality within French hospitals.

Background:Surgical mortality varies widely across hospitals, but the degree of temporal variation within individual hospitals remains unexplored and may reflect unsafe care. Objectives:To add a longitudinal dimension to large-scale profiling efforts for interpreting surgical mortality variations over time within individual hospitals. Design:Longitudinal analysis of the French nationwide hospital database using statistical process control methodology. Subjects:A total of 9,474,879 inpatient stays linked with open surgery from 2006 through 2010 in 699 hospitals. Measures:For each hospital, a control chart was designed to monitor inpatient mortality within 30 days of admission and mortality trend was determined. Aggregated funnel plots were also used for comparisons across hospitals. Results:Over 20 successive quarters, 52 hospitals (7.4%) experienced the detection of at least 1 potential safety issue reflected by a substantial increase in mortality momentarily. Mortality variation was higher among these institutions compared with other hospitals (7.4 vs. 5.0 small variation signals, P<0.001). Also, over the 5-year period, 119 (17.0%) hospitals reduced and 36 (5.2%) increased their mortality rate. Hospitals with improved outcomes had better control of mortality variation over time than those with deteriorating trends (5.2 vs. 6.3 signals, P=0.04). Funnel plots did not match with hospitals experiencing mortality variations over time. Conclusions:Dynamic monitoring of outcomes within every hospital may detect safety issues earlier than traditional benchmarking and guide efforts to improve the value of surgical care nationwide.

Elderly patients hospitalized in the ICU in France: a population-based study using secondary data from the national hospital discharge database

RATIONALE, AIMS AND OBJECTIVES In the global context of population ageing, understanding and monitoring intensive care use by the elderly is a strategic issue. National-level data are needed to overcome sampling biases that often limit epidemiologic studies of the critically ill elderly. The objective of this study was to describe intensive care use for hospitalized elderly patients using secondary data from the French national hospital discharge database. METHOD Structured assessment of the national database coverage and accuracy; cross-sectional analysis of hospitalizations including at least one admission in an intensive care unit (ICU) for patients aged ≥ 80 years from 1 January to 31 December 2009. RESULTS In 2009, people aged ≥ 80 years accounted for 5.4% of the population but 15.3% of the 215 210 adult hospitalizations involving intensive care in France. In this elderly group, the mean age was 84.0 (± 3.56) years, and 51.6% were male. In-hospital mortality was 33.9%. The median time spent in the ICU was 3 [interquartile range (IQR), 2-8] days, the median time spent in hospital was 14 (IQR, 8-24) days and 9% of hospitalizations ended by the patients death involved intensive care. A surgical procedure was included in 43% of hospitalizations. Medical and surgical diagnosis-related group hospitalizations were characterized by significant differences in volume, mortality, ICU days and costs. CONCLUSIONS There was marked clinical heterogeneity in the population of elderly patients hospitalized in the ICU. These data provide baseline information and prompt further studies comparing intensive care utilization across age groups, between countries and over time.

Elderly patients hospitalized in the ICU in France

RATIONALE, AIMS AND OBJECTIVES In the global context of population ageing, understanding and monitoring intensive care use by the elderly is a strategic issue. National-level data are needed to overcome sampling biases that often limit epidemiologic studies of the critically ill elderly. The objective of this study was to describe intensive care use for hospitalized elderly patients using secondary data from the French national hospital discharge database. METHOD Structured assessment of the national database coverage and accuracy; cross-sectional analysis of hospitalizations including at least one admission in an intensive care unit (ICU) for patients aged ≥ 80 years from 1 January to 31 December 2009. RESULTS In 2009, people aged ≥ 80 years accounted for 5.4% of the population but 15.3% of the 215 210 adult hospitalizations involving intensive care in France. In this elderly group, the mean age was 84.0 (± 3.56) years, and 51.6% were male. In-hospital mortality was 33.9%. The median time spent in the ICU was 3 [interquartile range (IQR), 2-8] days, the median time spent in hospital was 14 (IQR, 8-24) days and 9% of hospitalizations ended by the patients death involved intensive care. A surgical procedure was included in 43% of hospitalizations. Medical and surgical diagnosis-related group hospitalizations were characterized by significant differences in volume, mortality, ICU days and costs. CONCLUSIONS There was marked clinical heterogeneity in the population of elderly patients hospitalized in the ICU. These data provide baseline information and prompt further studies comparing intensive care utilization across age groups, between countries and over time.

Mixed method versus full top-down microcosting for organ recovery cost assessment in a French hospital group

BackgroundThe costing method used can change the results of economic evaluations. Choosing the appropriate method to assess the cost of organ recovery is an issue of considerable interest to health economists, hospitals, financial managers and policy makers in most developed countries.ObjectivesThe main objective of this study was to compare a mixed method, combining top-down microcosting and bottom-up microcosting versus full top-down microcosting to assess the cost of organ recovery in a French hospital group. The secondary objective was to describe the cost of kidney, liver and pancreas recovery from French databases using the mixed method.MethodsThe resources consumed for each donor were identified and valued using the proposed mixed method and compared to the full top-down microcosting approach. Data on kidney, liver and pancreas recovery were collected from a medico-administrative French database for the years 2010 and 2011. Related cost data were recovered from the hospital cost accounting system database for 2010 and 2011. Statistical significance was evaluated at P < 0.05.ResultsAll the median costs for organ recovery differ significantly between the two costing methods (non-parametric test method; P < 0.01). Using the mixed method, the median cost for recovering kidneys was found to be €5155, liver recovery was €2528 and pancreas recovery was €1911. Using the full top-down microcosting method, median costs were found to be 21–36% lower than with the mixed method.ConclusionThe mixed method proposed appears to be a trade-off between feasibility and accuracy for the identification and valuation of cost components when calculating the cost of organ recovery in comparison to the full top-down microcosting approach.

Organ recovery cost assessment in the French healthcare system from 2007 to 2014

Background Organ recovery costs should be assessed to allow efficient and sustainable integration of these costs into national healthcare budgets and policies. These costs are of considerable interest to health economists, hospitals, financial managers and policy makers in most developed countries. This study assessed organ recovery costs from 2007 to 2014 in the French healthcare system based on the national hospital discharge database and a national cost study. The secondary objective was to describe the variability in the population of deceased organ donors during this period. Methods All stays for organ recovery in French hospitals between January 2007 and December 2014 were quantified from discharge abstracts and valued using a national cost study. Five cost evaluations were conducted to explore all aspects of organ recovery activities. A sensitivity analysis was conducted to test the methodological choice. Trends regarding organ recovery practices were assessed by monitoring indicators. Results The analysis included 12 629 brain death donors, with 28 482 organs recovered. The mean cost of a hospital stay was €7469 (SD = €10, 894). The mean costs of separate kidney, liver, pancreas, intestine, heart, lung and heart-lung block recovery regardless of the organs recovered were €1432 (SD = €1342), €502 (SD = €782), €354 (SD = €475), €362 (SD = €1559), €542 (SD = €955), €977 (SD = €1196) and €737 (SD = €637), respectively. Despite a marginal increase in donors, the number of organs recovered increased primarily due to improved practices. Conclusion Although cost management is the main challenge for successful organ recovery, other aspects such as organization modalities should be considered to improve organ availability.

National cost study versus hospital cost accounting for organ recovery cost assessment in a French hospital group

BackgroundThe choice of cost data sources is crucial, because it influences the results of cost studies, decisions of hospital managers and ultimately national directives of policy makers. The main objective of this study was to compare a hospital cost accounting system in a French hospital group and the national cost study (ENC) considering the cost of organ recovery procedures. The secondary objective was to compare these approaches to the weighting method used in the ENC to assess organ recovery costs.MethodsThe resources consumed during the hospital stay and organ recovery procedure were identified and quantified retrospectively from hospital discharge abstracts and the national discharge abstract database. Identified items were valued using hospital cost accounting, followed by 2010–2011 ENC data, and then weighted using 2010–2011 ENC data. A Kruskal–Wallis test was used to determine whether at least two of the cost databases provided different results. Then, a Mann–Whitney test was used to compare the three cost databases.ResultsThe costs assessed using hospital cost accounting differed significantly from those obtained using the ENC data (Mann–Whitney; P-value < 0.001). In the ENC, the mean costs for hospital stays and organ recovery procedures were determined to be €4961 (SD €7295) and €862 (SD €887), respectively, versus €12,074 (SD €6956) and €4311 (SD €1738) for the hospital cost accounting assessment. The use of a weighted methodology reduced the differences observed between these two data sources.ConclusionsReaders, hospital managers and decision makers must know the strengths and weaknesses of each database to interpret the results in an informed context.

Impact of thyroid surgery volume and pathologic detection on risk of thyroid cancer: A geographical analysis in the Rhône-Alpes region of France

To investigate the impact of the volume of thyroid surgery and pathologic detection on the risk of thyroid cancer.