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Méthodologies d’évaluation de l’optimalité des soins : exemples des délais diagnostiques et des infections bactériennes sévères de l’enfant

Abstract : The aim of this thesis was to product new knowledge about the methodology on how to assess the optimality of care with the examples of time to diagnosis and serious bacterial infection (SBI). In two systematic reviews, we found that the key methodological points potentially related to risks of bias or threats to transportability were rarely reported in the primary studies and rarely evaluated by authors of systematic reviews. Then, we developed and internationally validated a reporting guideline to help scientists to better take into consideration these critical methodological points. In a population-based confidential inquiry, we found that: (i) care was suboptimal in 76% of the initial management of children who died from SBI, (ii) delayed first medical contact, undervaluation of severity or delayed antibiotic administration were detected in the management of 20%, 20% and 24% of children admitted to intensive care for a SBI, respectively, (iii) the total number of suboptimal cares delivered during the management was independently associated with death, and (iv) suboptimal cares were more frequent in children younger than one year old and if the care was delivered by a non specialist physician. Minimizing the risks of bias both in the selection process of the study population and in the assessment of the optimality of care, and taking into account confounding factors such as the intrinsic severity of the disease are keys elements to ensure a reliable evaluation of optimality of care in order to produce effective corrective clinical messages.
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Submitted on : Monday, August 28, 2017 - 4:25:39 PM
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  • HAL Id : tel-01578101, version 1

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Elise Launay. Méthodologies d’évaluation de l’optimalité des soins : exemples des délais diagnostiques et des infections bactériennes sévères de l’enfant. Santé publique et épidémiologie. Université Sorbonne Paris Cité, 2015. Français. ⟨NNT : 2015USPCB134⟩. ⟨tel-01578101⟩

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