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Biomedical subjects

E Minvielle

Publications and source records attributed to E Minvielle.

9 recordsLinked to original sources
PubMed2006

[Quality criteria in medicine: which limits?].

This article aims to develop a critical appraisal of the criteria's development in medicine. The COMPAQH (Coordination for Measuring Performance and Assuring Quality in Hospitals) project (Ministry of Health/ High Authority of Health/ National Institute of Medical Research) helps to support this analysis. This project based on the test of 42 Quality indicators (QI) gives findings not only about the manner to build criteria, but also to interpret and diffuse results among physicians and hospital managers. Criteria must be elaborated in a pragmatic way. They must be in compliance with practice guidelines supported by scientific evidences. The associated risk is to create and develop a normative medicine. Collaboration with professional societies may be useful in preventing this risk.

France↗
PubMed2005

[Developing quality indicators in hospitals: the COMPAQH project].

BACKGROUND: To select a set of quality indicators (QI) in order to test them in a panel of 36 French hospitals METHODS: The COMPAQH (COordination for Measuring Performance and Assuring Quality in Hospitals) project is coordinated by the French National Institute for Medical Research and supported by the French Ministry of Health and the French National Evaluation and Accreditation Agency. This project has four objectives: (1) to select a set of QI -2003- (2) to implement them in 2004-2005 in a volunteer panel of hospitals (3) to compare the hospitals anonymously (4) to explore quality management implications. QI were selected with a four-step process: (1) Establishment of a list of national priorities for Quality Improvement in relation with the Ministry of Health. (2) setting up a potential list of QI regarding these priorities. The COMPAQH staff determined a preliminary set of 81 QI, based on data in the literature and evidence about the scientific soundness of quality measures and the effectiveness of methods for improving quality. (3) Evaluation of the preliminary list. Each QI was presented in a pamphlet describing its operational definition, rationale, methodology, workload and responsibility of data collection The hospital panel (representatives) ranked the 81 QI with a validated evaluation tool which contained four dimensions: Importance, Scientific acceptability, Feasibility, and Usability. (4) Development of a consensus on a final selection. Based on a structured voting process (Delphi method, two rounds), the hospital panel selected a comprehensive set of 42 QI among the 81. RESULTS: (1) Eight national priorities were defined: pain management, continuity of care, management of nutritional disorders, Iatrogenic risks (including nosocomial infections), patient satisfaction, follow-up of practice guidelines, management of human resources, accessibility. (2) A set of 42 QI were selected: a set of 6 core QI and 7 to 18 specific QI according to the hospital type. CONCLUSION: Such a set of QI provides a foundation for developing a quality measurement system in French hospitals. It requires a pragmatic view for implementing them and a coherence between the different objectives of use (internal and external use).

Accreditation↗
PubMed2000

Carcase characteristics of a heavy Japanese quail line under introgression with the roux gene.

1. The roux plumage sex-linked recessive gene may be used for early sexing of Japanese quail in crossbreeding production systems with wild-type and roux lines. However, associated effects of the gene on carcase and meat composition need to be assessed. 2. Quail carcases from pure Line K males and females (100% K), a heavy meat line which was used as the recipient line for the introgression of the roux gene, and from same-age roux or wild-type females from the second generation of introgression (75% K) were dissected. The effects of sex, line and plumage colour on carcase components and on protein and lipid contents of various tissues were estimated. 3. Expected sex differences in carcase weights were obtained, with marginally higher values for females. However, weights of parts and carcase yield (ratio of empty carcase weight without head, neck and feet over live body weight) were similar for both sexes in pure Line K which had a 68% carcase yield. Lipid contents in leg meat were higher in males (3.1%) than in females (2.7%). 4. The roux gene did not seem to have any major impact on carcase parts or composition. However, in roux birds, leg skin was marginally higher in lipids and pectoralis major lower in proteins than in wild-type ones.

Animals↗
PubMed1997

Beyond quality management methods: meeting the challenges of health care reform.

Over the last 20 years, the increasing complexity and technical intensiveness of health care in French hospitals have increased the level of uncertainty in the process of care. This paper argues that beyond quality management approaches, the most important issue in health care management is the need to implement new organizational methods in response to the dynamic changes that are transforming the care process. Uncertainty, complexity and speed can all be managed by standardizing operating procedures, but when quality management is applied to a complex system such as health care, a different approach is needed. One alternative to standardization can be found in new theories of organization that emphasize the flexibility of an organization, i.e. its capacity to adapt to uncertainty. Building on empirical work, this paper integrates these different theoretical perspectives and tries to provide insight into the kind of quality management methods that will allow hospitals to deal with the new constraints being placed on the process of care.

France↗
PubMed1995

[Managing of an innovation in health care: the case of polyvalent intravenous immunoglobulins at the Assistance-Publique-Hôpitaux de Paris].

Managing new innovations in medicine is a particularly timely subject. There is an abundant history concerning over expectations resulting from the development of new treatments or diagnostic procedures, some shown to be less effective than promised, others even found to be dangerous. A new aspect to the question is the importance of economic pressures which require rational investment decisions when diffusing innovating technologies. In 1991, the Commission for the evaluation and diffusion of innovating technologies (CEDIT) at the University Hospitals of Paris (Assistance Publique-Hôpitaux de Paris) developed a programme aimed at better managing the distribution and use of polyvalent intravenous immunoglobulins (IgIV), a new promising therapeutic tool with both a high cost and a certain number of risks. The programme was designed to assist prescribers in elaborating better therapeutic strategies and to help hospital managers rationalize expenditures for IgIV. The results of this experience are presented here together with certain conclusions concerning the way management decisions can be applied to the diffusion of an innovation in health care.

Diffusion of Innovation↗
PubMed1994

[Prospective Payment Information Systems and epidemiology: a difficult link to establish].

This paper reviews the epidemiologic limitations to take into account when using data produced within the frame of the French Prospective Payment System for planning or medical evaluation purposes. Problems in describing medical data include completeness, reliability, granularity (precision) and sequencing. Referral bias hamper morbidity data collected at the institutional level. Differences in the case-mix may be due to the characteristics of the reference population but also to available equipment and variations in medical practice.

Bias↗
PubMed1991

[Coding problems in medical information in the framework of the medicalization of the hospital information system].

The authors review the difficulties presented by the description of medical data, on the basis of the french experience with the programme to medicalize the hospital information system. They explain the different steps in preparing a hospital discharge abstract, and the difficulties presented by each one. They particularly stress the phase of hierarchization in choosing the principal diagnosis. They propose some solutions to improve data quality and an approach based on medical practice patterns.

Data Collection↗