[Preventable readmissions of "community-acquired pneumonia": Usefulness and reliability of an indicator of the quality of care of patients' care pathways]. / Les réadmissions évitables des « pneumopathies communautaires ¼ : utilité et fiabilité d'un indicateur de la qualité du parcours de soins du patient.

UNLABELLED: Unlike Anglo-Saxon countries, the rate of preventable readmissions is not a national quality indicator in France. In the context of the European research project Performance Assessment Tool for quality improvement in Hospitals (PATH), this pilot study provides a tool for health professionals to more easily identify preventable readmissions in order to analyze their causes. The objective of this work was to show the reliability of this tool. METHODS: We compared the rate of preventable readmissions occurring within 30 days, for a given disease, collected by analyzing medical reports (the gold standard rate of this study) to the rates of preventable readmissions occurring within 30 days, measured from algorithms using data from the French Programme of Medicalization of Information Systems (PMSI). The data were derived from PMSI data of the Lariboisiere-Fernand-Widal Hospital, a university hospital in Paris. RESULTS: The community-acquired pneumonia gold standard rate of preventable readmissions occurring within 30 days was 6.3 %. Five algorithmic tools were used and measured rates between 2.9 % and 7.9 %. The positive likelihood ratios of these tools range from 8 to 308. CONCLUSION: This work presents a tool aimed at the health professionals that takes into account the diversity and complexity of the causes of avoidable readmissions, resulting from the quality of medical practice, the variability of the organization of hospital pathways and the links with ambulatory care.

[Patients members to a network's representations: prospects for the improvement of care]. / Les représentations de patients adhérents à un réseau de santé: perspectives d'amélioration de leur prise en charge.

OBJECTIVE: Identify the representations of patients regarding their disease, their accession and the positive and resistance factors of their participation in the network to understand how the network could improve their care. METHOD: Qualitative survey. We conducted twenty interviews, using open-ended questionnaires, with diabetic type 2 patients, registered for over a year in the healthcare Codiab network in the department of Morbihan. RESULTS: The relationship with their diabetes was built in connection with their stories, their family history, their socio-economic conditions. These dimensions strongly affect the perception they may have of their care. Their accession to the network, whether they are "participants" or "non" is mostly passive, perceived as a "prescription" which responds primarily to a need identified by a professional of care. The network may appear as an alternative to attending physician instead of an asset in connection with him. CONCLUSION: It would be necessary to establish a consulting educational diagnosis before the patients enter in the network in order to better identify their needs and expectations to improve the response of the network. It would then be a matter of ensuring a personalized therapeutic educational journey adapted over time to the patient's lifestyle. Finally, it would seem necessary to reposition in the network, physicians, local actors, which are essential to a relationship of care guided by care structured by networks.