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Y Matillon

Publications and source records attributed to Y Matillon.

At least 19 recordsLinked to original sources
PubMed2005

[Defining and assessing competence of healthcare professionals. A survey of 148 organizations].

INTRODUCTION: To study how competence is described and perceived by organizations of healthcare professionals in France and propose approaches toward implementing a policy to monitor and assess competence throughout medical professionals' careers. METHODS: After a literature search, we sent 160 letters to organizations representing 16 healthcare professions (listed in the French healthcare code) describing our objectives and proposing interviews. Semi-structured interviews (45-90 minutes) were conducted. The principle questions asked were: What is your organization's definition of competence? What are the principal elements that define competence in healthcare activities? How can a system for assessing competence be implemented? Which methods for such a system are most appropriate, based on experience in other countries? Who are the players in the field of competence? How can organizations participate in monitoring competence? RESULTS: 265 people representing 148 French organizations were interviewed. Analysis of the interviews showed that the principal points mentioned included: need for recognition; lack of training on new developments; need to anticipate changes; need for better health security in the healthcare system. There was a general consensus on the basic elements of competence, the responsibility of public institutions and professional organizations, and the need to work together. DISCUSSION: We suggest that competence in health care should be defined as follows: "professional competence is based on an initial diploma, participation in effective continuing medical education, a minimum amount of professional activity, and a regular peer review process". Healthcare professionals in France would like to have a better system that allows them to exchange more information on the principal issues in health care.

Clinical Competence↗
PubMed2002

[The accreditation procedure: An external recognition of quality in public and private health centres in France. ].

Since early 1990, the structures and financing of various health systems have been reformed. For the first time, some western Europe countries have admitted that quality insurance within the health system can become a governmental responsibility and, as in the past, simply the responsibility of the professionals and/or the health service administrators. During the last decade of the XXth century, pressure has gradually been increased for governments to become more involved in health system quality. This focus on quality was linked to human safety. In this historical perspective, the emergence of AIDS and the difficulty to control this epidemic, and the consequences of contamination by injection needles have probably played a part in this collective awareness. In this context, quality has become a major concern in Europe.

Accreditation↗
PubMed2001

Evaluation of 60 continuous quality improvement projects in French hospitals.

OBJECTIVE: To evaluate the feasibility of implementing continuous quality improvement (CQI) projects in French health care organizations. DESIGN: The French Ministry of Health issued two calls for CQI projects (in 1995 and 1996). ANAES was commissioned to monitor and evaluate the projects, and to provide advice. SETTING: ANAES in collaboration with French public hospitals. STUDY PARTICIPANTS: A jury selected 64 projects from 483 submissions. The first series of projects related to safety issues (e.g. blood transfusions), the second related chiefly to patient management. INTERVENTIONS: ANAES instructed project leaders in process analysis (modified four-step FOCUS-PDCA model), convened regular meetings between leaders and performed on-site visits. MAIN OUTCOME MEASUREMENTS: Objective outcomes: goal achievement, extension of projects to other topics and departments, allocation of resources. Subjective outcomes: changes in attitudes. Statistics were obtained from two questionnaires completed by project leaders. RESULTS: Four projects were discontinued; 82% (49 out of 60) met more than half their objectives. The CQI method was adopted by other departments in 65% and 50% (1st and 2nd series respectively) of cases. Hospital management often chose to provide continued support (81%/88%), offer training (59%/80%), create a CQI unit (62%/73%), and allocate a budget (61%/65%). A positive impact on staff attitudes was noted in over 75% of projects. CONCLUSION: ANAES' co-ordinated initiative to acquaint a hard core of French public hospitals with CQI proved successful. Identification of the factors for success and of potential hurdles helped pave the way for the national hospital accreditation procedure currently underway.

Attitude of Health Personnel↗
PubMed2000

Unjustified variations in patient management for acute myocardial infarction in the Rhône-Alpes region of France. PRIMA Group.

OBJECTIVES: To examine determinants of use of cardiac procedures after acute myocardial infarction and identify variation factors. METHODS: Observational prospective cohort study of 2,519 patients in 48 centers with a two-level logistic-regression analysis. RESULTS: Elderly patients were less likely to undergo pre- and inhospital thrombolysis (odds ratios, 0.71 and 0.64; 95% CI, 0.62-0.81 and 0.58-0.69, respectively). The elderly, females, and patients with heart failure on admission were less likely to undergo noninvasive tests (0.74, 0.62, and 0.51; 95% CI, 0.67-0.81, 0.46-0.83, and 0.38-0.68, respectively) and coronary angiography (0.38, 0.53, and 0.67; 95% CI, 0.34-0.42, 0.38-0.74, and 0.52-0.86, respectively) but not revascularization. Hospital factors were more difficult to interpret. CONCLUSIONS: Elderly, women, and heart failure patients underwent fewer cardiac procedures than lower-risk patients. Physicians should change their attitude toward these groups and use advanced procedures, bearing in mind the patients' needs rather than good procedural outcomes.

Age Factors↗
PubMed2000

[Introduction].

Explore the source record for details and available documents.

Diabetes Mellitus, Type 2↗
PubMed1998

Study of the variations of the cesarean sections rate in the Rhône-Alpes region (France): effect of women and maternity service characteristics.

OBJECTIVE: To analyze the variations of the rate of prophylactic cesarean sections and cesarean sections during labor according to the women's and maternity services' characteristics. STUDY DESIGN: The study population was a sample of 8470 women having delivered in one of the 86 maternity services of the Rhône-Alpes region (France) in 1990. The women's characteristics were risk factors for pregnancy or delivery. The maternity services' characteristics included those describing the service structure and the mode of recruitment. For the statistical analysis we used a two-level logistic model. RESULTS: After taking into account the women's characteristics, there remained a variation between the maternity services. This variation was in part explained by the type of recruitment of the maternity service. When the proportion of women with a previous cesarean section or a dystocia increased in the maternity service the cesarean sections rate decreased in women presenting similar characteristics. CONCLUSION: Thus, the maternity services which receive many "at risk" women tend to have higher cesarean section rates than the others. However, in comparison with women presenting similar characteristics, these same maternity services tend to perform fewer cesarean sections.

Cesarean Section↗
PubMed1998

Including practice data to improve evidence-based guidelines. Example of guidelines on the management of thyroid nodules.

Although clinical guidelines are based on the best evidence available, their proliferation has often failed to change actual practice. One of the many explanations suggested is that there is a gap between the expectations of the targeted professionals and the recommendations in the guidelines. In this study, we attempted to take into account the state of current practice and the physicians' priorities. Using the example of guidelines on the management of thyroid nodules, three different surveys have been conducted: (1) an analysis of physicians' expectations and practice through a postal questionnaire to define appropriate questions; (2) a survey of the professionals' expert opinions, and (3) a prospective study of the use of these guidelines in the management of 253 patients. The results of these surveys have modified the development of the guidelines, and helped us to adapt the content of the guidelines to match physicians' practices more closely.

Evidence-Based Medicine↗
PubMed1998

[Evaluation of information for renal insufficiency patients before dialysis].

The aim of this audit was to assess the quality of information given to patients before dialysis and to improve the use of this information on the acceptability of the treatment. Methods were those used in medical audit: retrospective data collection in a sample of patients, comparison to a set of standards given by professionals and recommendations disseminated in the group of professionals. Results showed that patients received a partial information on the various techniques used in dialysis. More complete information is needed. Recommendations consisted in a specialised team giving a detailed information on the disease and the techniques used in dialysis, with a psychological assistance. After implementation of this team, re-assessment showed a consistent benefit of structured information and entailed the necessity to improve the process of information delivery by general practitioners and specialists.

Adult↗
PubMed1998

[The impact of the data collection method on the medico-economic classification of admissions for myocardial infarction at the public hospitals in Lyon].

The aim of the PMSI (Programme de Médicalisation du Système d'Information) is to describe the activity of hospitals for budget allocation. To control the quality of this information, the authors carried out a study comparing the classification in homogenous disease groups (HDG) obtained from the PMSI with that obtained from the epidemiological data base of the PRIMA trial for patients admitted to the Civil Hospitals of Lyon for myocardial infarction between September 1st 1993 and January 31st 1995. Six hundred and fifty standardised hospital summaries were reconstituted form PRIMA data and grouped using the GENRSA 3 software. Five hundred and forty-one of these hospital stays were found in the PMSI data base and grouped. The concordance not due to chance between the two classifications was then assessed by the global kappa coefficient. It was less than the 40% threshold under which concordance not due to chance is considered to be unlikely. The discordances were essentially due to the presence of an associated diagnosis classifying the hospital stay in the HDG corresponding to complicated myocardial infarction. The presence of a classifying associated diagnosis was observed significantly more often in the PRIMA than in the PMSI data base. This results in an underestimation of the hospital activity and could have important repercussions in terms of budget allocation.

Budgets↗
PubMed1997

Cost-effectiveness of screening blood donors for hepatitis C and non-A, non-B, non-C hepatitis. The EATHIS Eco Research Group. European Acute Transfusion Hepatitis Interferon Study.

The current approach to screening for hepatitis C and non-A, non-B, non-C hepatitis in French blood transfusion centers involves a combination of a transaminase assay and tests for antibodies to hepatitis B core antigen (anti-HBc) and antibodies to hepatitis C virus (anti-HCV). A decision-analysis model was used to assess the cost-effectiveness ratio of this approach compared to the former approach, which included only transaminase and anti-HBc screening. Cost data were collected by a questionnaire sent to 26 centers throughout France. The average costs of diagnostic kits, equipment, staff, and administration were calculated. Estimates of prevalence and sensitivity values came from the medical literature. The cost-effectiveness ratio was expressed in French francs per infected donor detected. A sensitivity analysis of the variables in the model was performed to estimate the validity of the cost-effectiveness ratio. For 100,000 donations the incremental cost of the current approach reached FrF 2,566,111 (about US $500,000), with a marginal effectiveness of 180 donations detected. The sensitivity analysis showed the effect of prevalence on the incremental cost-effectiveness ratio. Transfusion centers may change their screening approach in areas of high or low prevalence of hepatitis C in France.

Blood Donors↗
PubMed1997

The French clinical guidelines and medical references programme: development of 48 guidelines for private practice over a period of 18 months.

The French medical profession and health insurance organizations have jointly committed themselves to a concept termed the 'medical regulation' of care. They decided to promote the quality of health care, judging that an approach based on quality was the best option for reducing the increase in health costs. The Clinical Guidelines and Medical References programme was entrusted to ANDEM (Agence Nationale pour le Développement de L'Evaluation Médicale). Fifty working groups (669 experts) and 50 reading groups (1643 experts) met from June 1994 to November 1995 to produce guidelines. Learned societies were involved to propose experts. Hospital practitioners, doctors who specialized in the topic in question and those who did not had equal representation in the groups. The method consisted of a review of the literature to determine the level of scientific evidence. ANDEM's Scientific Council suggested modifications to the groups and agreed to disseminate 48 of the 50 texts. Careful observation of the operation of the groups identified factors that can positively influence the nature of the discussions and help avoid conflict: an abundance of high-quality literature, an understanding of clinical research methodology, the existence of guidelines from different institutions or different countries tending towards the same conclusions, good initial work carried out by the chairperson and the project manager, a limit to the number of questions asked of the group, the chairperson having good people skills and meeting-management skills, and an absence of professional and financial consequences for the participants. Good management of working groups is an additional factor in ensuring success. The regulatory medical references programme has led to changes of behaviour within the medical profession.

Consensus Statements as Topic↗
PubMed1997

[Use of a logistic regression model at two levels in the analysis of medical practice variations: the prophylactic cesarean].

We show the use of a hierarchical logistic model to study the variations of the prophylactic cesarean section rate between the maternity hospitals of the Rhône-Alpes region. These variations are analyzed according to the women characteristics at first level, and the maternity hospital characteristics at second level. We present the two-level hierarchical logistic model and the method of estimation of the fixed and random parameters. Then, we compare and discuss the results obtained with those of the usual logistic model. The usual logistic model underestimates the standard error of the regression parameters. In our example however, the results obtained with the hierarchical model do not modify the conclusions concerning the effect of the women characteristics. All the women characteristics increase significantly the probability for a woman to have a prophylactic cesarean section. Nevertheless, the hierarchical model reveals the effect of the maternity hospital characteristics and shows that the maternity hospitals which receive many "at risk" women tend to perform fewer prophylactic cesarean sections than the others, in women with the same characteristics. It permits to estimate the residual variance of second level linked to the unobserved characteristics of the maternity hospitals. It permits to show that the effect of the main characteristics of the women (previous cesarean section, dystocia, chronic fetal distress) vary between maternity hospitals.

Bias↗