[Evaluation of clinical practice, medical computerized database and improvement of antibiotic therapy for acute community-acquired pneumonia]. / Evaluation des pratiques professionnelles, tableau de bord et bon usage de l'antibiothérapie au cours des pneumonies aiguës communautaires.

UNLABELLED: The evaluation of clinical practice includes three successive phases: demonstration of suboptimal clinical practice, proposals for improvement, and assessment of effective changes. We present a medical computerized database used for this evaluation. PATIENT AND METHODS: Our database includes 24 parameters for all hospitalized patients among which diagnosis and antibiotherapy. The first assessment phase indicated an unjustified heterogeneous antibiotherapy for community-acquired pneumonia (CAP). The second phase was the drafting of our own consensus for CAP treatment, aiming at reducing the use of fluoroquinolones and third generation cephalosporin. The computerized database was used in the third phase to check observance of our consensus. RESULTS: Two hundred and fifty patients were hospitalized for CAP before the consensus, from October to January 2005, 2006, and 2007, compared to 113 patients from October 2008 to March 2009. The rate of adequate prescriptions improved from the first period to the second one: 58% versus 69%, p=0.045. The inadequate use of fluoroquinolones and third generation cephalosporins was more frequent during the first period, compared to the second one: 49% versus 38%, p=0.048. The mean hospital stay was longer before applying our consensus: 9+/-5 days versus 7+/-4 days, p=0.009. Evolution was unfavorable in 15/250 cases (6%) and 3/113 cases (<1%), respectively. CONCLUSION: A medical database allows for a rapid implementation of two out of three phases of clinical evaluation, through the appropriation of a new consensus, with a reduction of antibiotic misuse without impact on infectious morbidity and mortality.

[Computerized management of a medical department, disease-related group management, clinical research and evaluations]. / Gestion de services, tarification à l'activité, recherche clinique et évaluation des pratiques professionnelles: un même outil informatique.

The current French hospital reform is based on the disease-related group (DRG) approach and the constitution of bigger units pooling several departments of different specialties. This reform needed an efficient assessment of various medical activities. We report our experience of a medical table of our hospital activities used for 27 months. This medical table was made with a basic software integrating 24 parameters. The original concept was the translation of the specific final diagnosis for DRG defined by the site of infection. To create this medical table, we first simplified the conclusions of the patient's chart using a consensual and systematic plan. The number of patients per DRG and their evolution were therefore specifically determined. The medical table helped us in the daily management of our department, to identify the area of recruitment, the potential for heterogeneous care, allowing the implementation of protocols and their applications. Moreover, the table quantified morbidity and mortality, indicating our need for cooperation with other departments. All this data used medical-lexical terms, allowing other than economic analyses, even if this table identifies hospitalization-related costs, namely duration of hospital-stay, nosocomial infections and iatrogenic events. Finally, our table supports medical research and evaluation of practice. Our future goals are to introduce this table in several infectious-diseases units, and create specific tables for the main RDG, including economic parameters.