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Les données de routine des séjours d’hospitalisation pour évaluer la sécurité des patients : études de la qualité des données et perspectives de validation d’indicateurs de la sécurité des patients

Abstract : Assessing safety among hospitalized patients is a major issue for health services. The development of indicators to measure adverse events related to health care (HAE) is a crucial step, for which the main challenge lies on the performance of the data used for this approach. Based on the limitations of the measurement in terms of reproducibility and on the high cost of studies conducted using medical records audit, the development of Patient Safety Indicators (PSI) by the Agency for Healthcare Research and Quality (AHRQ) in the United States, using codes from the clinically modified 9th revision of the International Classification of Diseases (ICD) shows interesting prospects. Our work addressed five key issues related to the development of these indicators: nosological definition; feasibility and validity of codes based algorithms; quality of medical diagnoses coding using ICD codes, comparability across countries; and possibility of establishing a benchmark to compare these indicators. Some questions remain, and we suggest several research pathways regarding possible improvements of PSI based on a better definition of PSI algorithms and the use of other data sources to validate PSI (i.e., registry data). Thus, the use of adjustment models including the Charlson index, the average number of diagnoses coded and a variable of the positive predictive value should be considered to control the case-mix variations and differences of quality of coding for comparisons between hospitals or countries.
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Submitted on : Tuesday, April 24, 2012 - 2:37:30 PM
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Jean-Marie Januel. Les données de routine des séjours d’hospitalisation pour évaluer la sécurité des patients : études de la qualité des données et perspectives de validation d’indicateurs de la sécurité des patients. Santé publique et épidémiologie. Université Claude Bernard - Lyon I, 2011. Français. ⟨NNT : 2011LYO10355⟩. ⟨tel-00690802⟩

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