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Summary: The incidence of hip fracture, death and the estimated incidence of major osteoporotic fracture in France were used to determine the lifetime and 10-year probability of fracture and incorporated into a probability model ( FRAX® ) calibrated to the French population. Introduction: Fracture probabilities in the French population have not been determined. Our aim was to determine the incidence of hip fracture in France and the estimated 10-year probabilities of hip and major osteoporotic fractures. Methods: The study population included adults over 50 years living in France in 2004. Incident hip fracture cases were identified from the French PMSI database. Incidence of the other major osteoporotic fractures was imputed from the relationship between hip fracture incidence and other major fracture in Sweden. These data were used to calculate population-based fracture probabilities according to age and BMD using cutoff values for femoral neck T-scores from the NHANES III data in Caucasian women. The probability model ( FRAX® ) calibrated to the French population was used to compute individual fracture probabilities according to specific clinical risk factors. Results: We identified 15,434 men and 51,469 women with an incident hip fracture. The remaining lifetime probability of hip fracture at 50 years was approximately 10 and 30% respectively. With a femoral neck T-score of −2 SD, one in two women and one in five men would sustain a major osteoporotic fracture in their lifetime. The 10-year probability of other major osteoporotic fractures increased with declining T-score and increasing age. Low body mass index and other clinical risk factors had an independent effect on fracture probability whether or not BMD was included in the FRAX® model. Conclusion: This analysis provides detailed estimation on the risk of fracture in the French population and may help to define therapeutic guidelines.

Objective: To identify factors predicting patient satisfaction 2 years after total knee arthroplasty (TKA) for osteoarthritis. Methods: Prospective multicenter study of patients followed up for 2 years after TKA for osteoarthritis. We evaluated pain and function (Lequesne index and WOMAC) at baseline and after 2 years. After 2 years, the patients rated their satisfaction as a percentage, with values greater than 50% defining good satisfaction. Factors associated with good satisfaction were identified by univariate analyses followed by multivariate analysis. Results: Of 299 patients, 264 completed the study (26 were lost to follow-up, six died, and three refused the 2-year evaluation), including 237 (89.8%) with satisfaction scores greater than 50%. Highly significant improvements were found after 2 years versus baseline in the Lequesne index (7.9 vs. 14.5, P < 0.0001) and WOMAC index (26.3 vs. 51.3, P < 0.0001). There were 26 (9.8%) complications. Factors significantly associated with good satisfaction in the multivariate model were absence of complications (P = 0.004), body mass index less than 27 kg/m 2 (P = 0.015), high radiological joint narrowing score (P = 0.038), age greater or equal to 70 years (P = 0.038), and absence of depression at the 2-year evaluation (P = 0.002). Conclusion: We report the first prospective multicenter study done in France to assess pain and function in a large number of patients treated with TKA for osteoarthritis. Our results indicate a high success rate. We identified three factors that predict patient satisfaction and can be assessed before surgery (age greater than 70 years, absence of obesity, and severe joint space narrowing). © 2010 Published by Elsevier Masson SAS on behalf of the Societe Francaise de Rhumatologie.

Objective: To describe the different falls typology and to investigate whether different falls profiles and faller profiles could be identified among a cohort of community-dwelling women aged 75 years and older. Design : Prospective cohort study. Participants : Women aged 75 years and older were enrolled in five French centers after a random selection from electoral lists and included in the EPIDOS study. Measurements: During a 4 year follow-up, women were contacted by telephone every 4 months to investigate the occurrence of falls. To minimize the memory bias, the specific questionnaire on falls was completed only if the fall took place in the week preceding the contact. A multiple correspondence analysis followed by clustering was carried out to identify the typology of falls. Results: 727 women described at least one fall. A full description of 662 falls was obtained during the follow-up period. In the multiple correspondence analysis the main discriminant item was outside versus inside falls. Moreover, four clusters were showed: outside falls linked to lack of attention (28% of women), outside falls related to exogenous/environmental factors (16%), inside falls associated with frailty (44%) and in height falls (11%). We also found that each type of falls was correlated with particular health or functional status (i.e.;dependence, motion difficulty, weakness, use of walking aid,...). Conclusion: From frailty to hyperactivity there are different falls and fallers profiles. Assessing such fall profiles could be helpful to develop new dedicated fall prevention programs in the elderly. Language: en

We estimated the excess hospital expenditure attributable to osteoporotic hip fracture (HF) within a population of 6,019 patients. Post-fracture excess of hospital days was 23.1, including 22.7 days in rehabilitation care. HF might result from a patient's pre-fracture poor health status rather than predispose to a worsening of such pre-existing conditions.Hip fracture represents a large burden on hospital services. It is unclear whether the post-fracture expenditure is linked to a worsening of pre-fracture comorbid conditions. We estimated the excess hospital expenditure attributable to osteoporotic HF following the initial hospitalization for acute care (index stay).We identified 6,019 patients (or = 50 years) who experienced HF in 2005 and compared their hospitalizations 1 year before and 1 year after the index stay. Excess expenditure was estimated by subtracting the utilization of hospital days or costs (Euros 2005) before the index stay from those after the index stay. Factors associated with hospitalization during the pre-fracture and post-fracture years were identified using multivariate logistic regressions.Beside the index stay, post-fracture excess of hospital days was 23.1 (95% Confidence Interval (CI) [21.8-24.3]), including 22.7 days (95% CI [21.7-23.7]) in rehabilitation care and 0.3 days (95% CI [0-0.9]) in acute care. Estimated excess cost per patient waseuro5,986 (95% CI [5,638-6,335]) after the index stay, includingeuro5,673 (95% CI [5,419-5,928]) in rehabilitation care. Male and elderly patients were at higher risk to be hospitalized in acute care during the year preceding and succeeding HF.Osteoporotic HF represents a pronounced excess expenditure in hospital, which is mostly linked to rehabilitation care. Considering that utilization of inpatient acute care was quite similar before and after the index stay, HF might result from a patient's pre-fracture poor health status, rather than predispose to a worsening of such pre-existing conditions.

Retrospective cohort design.To compare socio-demographic, impairment characteristics and utilization (physician and emergency department (ED) visits) for non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury 1 year post inpatient rehabilitation.Ontario, Canada.Inpatient stays (2003-2006) were identified from the National Rehabilitation Registry System. Exclusions were: in-hospital mortality; discharge after 31 March 2006; death within 1 year after discharge. Multivariate logistic regression analyses were used to determine factors predicting high utilization.NTSCI cases (n=1002) were greater than TSCI (n=560). NTSCIs were older (mean=61.6, s.d.=15.8) with more co-morbidities, paraplegic (39.5%) and female (P0.001). NTSCI had higher FIM admission and discharge scores but lower change scores. Mean number of physician visits for NTSCI and TSCI were 31.2 (median=24) and 29.7 (median=22), with no significant differences in mean specialist visits (NTSCI 16.5: TSCI 17.0). Factors predicting 30 or more physician visits included age 60 years or above (OR=1.5; 95% CI=1.2-1.9), urban living (OR=1.59; 95% CI=1.12-2.22) and lowest quartile (18-88) discharge FIM (OR=1.8; 95% CI=1.4-2.3). Charlson score of 3 or more (OR=2.1; 95% CI=1.3-3.2), urban living (OR=1.92; 95% CI=1.3-2.86) and lowest quartile discharge FIM (OR=1.5; 95% CI=1.2-2.0) were associated with 20 or more specialist visits. Factors for high ED use were: rurality (OR=1.5; 95% CI=1.1-2.1), low income (OR=1.4; 95% CI=1.1-1.9) and low (18-88) discharge FIM (OR=1.7; 95% CI=1.3-2.2).Both demonstrated significant health care utilization requiring attention to health care needs; particularly for those living in rural settings, with low income and/or low functional ability.

International audience; OBJECTIVE: To estimate breast cancer incidence in the general population using a method that corrects for lack of sensitivity and specificity in the identification of incident breast cancer in inpatient claims data. STUDY DESIGN AND SETTINGS: Two-phase study: phase 1 to identify incident cases in claims data, and phase 2 to estimate sensitivity and specificity in a subset of the population. Two algorithms (1: principal diagnosis; 2: principal diagnosis+specific surgery procedures) were used to identify incident cases in claims of women aged 20 years or older, living in a French district covered by a cancer registry. Sensitivity and specificity were estimated in one district and used to correct incident cases identified. RESULTS: The sensitivity and specificity for algorithms 1 and 2 were 69.0% and 99.89%, and 64.4% and 99.93%, respectively. In contrast to specificity, the sensitivity for both algorithms was lower for women younger than 40 years and older than 65 years. Cases reported by cancer registries were closer to cases identified with algorithm 2 (-3.2% to +20.1%) and to corrected numbers with algorithm 1 (-1% to +15%). CONCLUSION: To obtain reliable estimates of breast cancer incidence in the general population, sensitivity and specificity, which reflect medical and coding practice variations, are necessary.

Retrospective cohort study. To describe the physician utilization patterns (family physicians (FP), specialist and emergency department (ED) visits) of adults with traumatic spinal cord injury (SCI) 1 year after the initial injury. Ontario, Canada. A total of 559 individuals with a traumatic SCI were identified. Five administrative databases were linked to examine health-care utilization in acute care, inpatient rehabilitation, chronic care rehabilitation, outpatient physician visits and ED visits. Factors predicting frequent physician, specialist and ED use were identified. The mean number of physician visits for traumatic SCI patients during the first year after their injury onset was 31.7 (median 26). FPs had the greatest number of visits (mean 11.6, median 7) followed by physiatrists (mean 6.1, median 2). Factors predicting 50 or more physician visits included age 70 or above (OR=3.6, 95% CI=2.0–6.5), direct discharge to chronic care (OR=3.6, 95% CI=1.0–13.1) and in-hospital complication (OR=2.34, 95% CI=1.3–4.3). Age 70 or less (OR=0.19, 95% CI=0.0–0.9) and direct discharge to chronic care were associated with 50 or more specialist visits. Only rurality predicted two or more visits to the ED. Individuals with traumatic SCI show significant physician utilization, especially among their FPs and physiatrists. Although the factors predicting higher physician and specialist utilization may reflect individuals with the most severe impairment, comorbid conditions or lack of social support, the model for higher ED visits may point to limited accessibility to/availability of primary care services for SCI patients in rural regions.

International audience; One approach to estimate cancer incidence in the French D?rtements is to quantify the relationship between data in cancer registries and data obtained from the PMSI (Programme de M?calisation des Syst?s d'Information M?cale). This relationship may then be used in D?rtements without registries to infer the incidence from local PMSI data. We present here some methodological solutions to apply this approach. Data on invasive breast cancer for 2002 were obtained from 12 D?rtemental registries. The number of hospital stays was obtained from the National PMSI using two different algorithms based on the main diagnosis only (Algorithm 1) or on that diagnosis associated to a mention of "resection" (Algorithm 2). Considering registry data as gold standard, a calibration approach was used to model the ratio of the number of hospital stays to the number of incident cases. In D?rtements with registries, validation of the predictions was done through cross-validation. In D?rtements without registries, validation was done through a study of homogeneity of the mean number of hospital stays per patient. Cross-validation showed that the estimates predicted by the model were true with data extracted by Algorithm 1 but not by Algorithm 2. However, with Algorithm 1, there was an important heterogeneity between French D?rtements as to the mean number of hospital stays per patient, which had an important impact on the estimations. In the near future, the method will allow using medico-administrative data (after calibration with registry data) to estimate D?rtemental incidence of selected cancers.

There was 75% variation in the trend in hip fracture incidence with age in women aged 50 to 85 in France. In southwest France, the women are at higher risk of hip fracture at younger ages. This finding should be taken into account when examining risk factors. Few studies have analysed the geographical variations in the relationship between age and hip fracture incidence. Our goal was to assess these variations among women under 85 within the same country. The study population included women aged 50 to 85 who were living in France in 2004. Hip fracture cases were identified in the French Diagnosis Related Groups (DRG)-like database using the diagnosis code for closed hip fractures and procedural codes for treatment. The Moran index and a spatial model using latitude and longitude were used to assess the geographical heterogeneities of cumulative incidence risk (CIR) and age effect. A total of 29,218 hip fracture cases were identified. A south-to-north CIR gradient ranging from 7 to 16% was observed. The variation in the number of years until double hip fracture incidence was 75% (i.e. 1.49 to 2.57 years). In the south, and more markedly in southwest France, the women are at higher risk of hip fracture at a younger age. The risk of fracture may be different between women of the same age. This may be hidden in a comparison of standardised ratios. This finding should be considered when examining risk factors and implementing public health interventions.

To assess the prescription patterns of anti-osteoporosis medications, three cross-sectional analyses were performed between 2004 and 2006. Women aged 50 and older were identified from the health insurance claims database of the Rhone-Alpes area. HRT prescriptions decreased while bisphosphonates and raloxifene prescriptions increased, respectively, in different age groups. The objective of this study was to assess the prescription patterns of hormone replacement therapy (HRT) and anti-osteoporosis medications (AOM) in post-menopausal French women since the WHI and the revision of the French clinical practice guidelines in 2004. Three cross-sectional analyses were performed between 2004 and 2006. Women aged 50 and older who had at least one claim for a prescription for HRT, bisphosphonates or raloxifene were identified from health insurance claims database of the Rhone-Alpes area. A 39% decrease in the number of women who had HRT was observed (67,241 to 41,024). Twenty-one percent and 18% increases were observed, respectively, for bisphosphonates (39,192 to 47,395) and raloxifene (10,263 to 12,060). HRT and raloxifene were mainly prescribed to women aged 55 to 64 (58% and 39%, respectively), bisphosphonates to women aged 65 to 84 (70%). Ninety-eight percent of women had HRT prescribed by a gynaecologist or a general practitioner (GP). Most AOM were prescribed by a GP; 13% of women had AOM prescribed by a rheumatologist. Prescriptions for HRT in post-menopausal French women have significantly decreased while bisphosphonates and raloxifene prescriptions have increased, respectively, in different age groups but to a lesser extent than the HRT decrease.

Resume Objectif Evaluer l'intensite douloureuse et l'importance du handicap chez des patients presentant une gonarthrose juste avant la mise en place d'une prothese totale de genou (PTG). Methodes Deux cent quatre-vingt-dix-neuf patients porteurs de gonarthrose ont ete inclus dans 12 centres d'orthopedie a Lyon (France) la veille de leur intervention pour PTG. Les principales donnees collectees etaient : la douleur (echelle visuelle analogique [EVA]), la fonction (indice de Lequesne et Western Ontario McMaster Universities Osteoarthritis Index [Womac] en EVA). Resultats Deux cent sept femmes et 92 hommes ont ete inclus, moyenne d'âge : 73 ans. L'EVA moyenne de la douleur a la marche etait de 55,8 mm (24) [SD]. L'indice de Lequesne (mediane/rang) etait de 14,5/6–23. L'indice moyen de Womac etait de 51,3 mm (19) [SD]. Les patients presentant un indice de Lequesne inferieur a 12 etaient plus frequemment âges [> 70 ans OR : 2,85 (1,25–5)], de sexe masculin [OR : 2,5 (1,3–5)], avec un indice de masse corporelle (IMC) plus faible [IMC Conclusion Cette etude est une des premieres etudes multicentriques en France a etudier le score de Lequesne et de Womac avant la chirurgie. Les patients sont operes a des niveaux de handicap et de douleur eleves, avec peu de disparite. Cependant, certains facteurs comme l'âge, le sexe, la pratique d'un sport et l'IMC semblent avoir une influence sur le niveau de douleur et de handicap et interviennent probablement dans la decision chirurgicale.

Hip fractures are the most devastating result of osteoporosis and are common worldwide. Based on an exponential increase in incidence with age, many studies in the 1990s forecasted an epidemic of hip fracture in women in the next 15 years which is not currently being observed. Despite the ageing of the populations, accurate description of hip fracture incidence in women aged 85 or older are scarce.All women aged 60 to 95, living in the Rhône-Alpes area of France, who were admitted to hospitals during 2001-2004 for treatment of hip fracture were selected from the French claims databases. An exponential model was tested to describe the increase in hip fracture incidence in women aged 60-84 and 60-95. The first model was used to predict annual hip fracture incidence in women aged 85-95 in the Rhône-Alpes area, in France and in Europe.An exponential model was adequate to describe the increase in incidence in women aged 60-84. Assuming an exponential increase in incidence in women aged 85-95, the predicted number of cases was overestimated by 70% in the Rhône-Alpes. In France and in Europe, the excess number of incident cases is believed to be respectively 16,000 and 85,965 a year.The age-specific incidence estimates an average risk although the individual risks are heterogeneous throughout the population. The slower increase in incidence after age 85 might not be related to a decreasing individual risk with age but rather might indicate that women at higher risk have already experienced hip fracture or have died. After age 85, women who are still at risk may represent a population with a lower risk of hip fracture. Models adapted to the elderly population should be developed to improve the accuracy of predictions and optimise the health care system.

Backgrounds Since 2001, the French national case mix program is allowed by law to use an enciphering algorithm named “FOIN” to produce a unique anonymous identifier in order to crosslink, within and across hospitals, discharge abstracts from a given patient. This algorithm “thrashes” the person's health insurance number, date of birth and gender. Before using information produced by the case mix program, either for case mix payment or for epidemiology research or for assessing care approaches, the quality of linkage must be evaluated. Methods Foin error flags were first assessed in the 2002 Rhone-Alpes regional case mix database. Second, for the two university hospitals of Lyon and Saint-Etienne, double identifiers (two or more Foin identifiers for the same patient) and collisions (a single Foin identifier for at least two patients) were compared with others identifiers: administrative identifier and an anonymous identifier produced by Anonymat® software from name, forename and date of birth. Third, Foin error flags are crossed with Foin double identifier or collision mistakes. Results First, among 1 668 971 hospital discharge abstracts from the regional case mix database, 206 710 (12.4%) had at least one Foin error flag. The most frequent error flag (93 026 [5.5%] stays) was due to the lack of the three identifying variables. The greatest number for error flags concerned the stays of newborns (38.5%) and those of public hospitals (17.3%). Second, Foin created a few double identifiers: 1.2% among 137 236 patients from university hospital of Lyon and 0.3% among 39 512 patients from university hospital of Saint-Etienne. The collisions concerned 7776 (5.7%) patients from Lyon and 460 (1.2%) from Saint-Etienne. The identifier produced by Anonymat performed better than the one produced by Foin: 99.6% from the two university hospitals. Third, less than 3% of stays without Foin error flag nevertheless had mistakes on Foin when compared with others identifiers. Conclusion The overall assessment is not in favour of a quality threshold using the Foin identifier on a routine basis except in some areas and if certain activities like neonatology are excluded. There are several ways to improve the linkage of health data.

Position du probleme La mesure de l’incidence d’une pathologie est basee sur les donnees collectees par les registres ad hoc. Les donnees medico-administratives du secteur hospitalier peuvent constituer une source d’information pour les registres, en particulier de cancers. Le cancer thyroidien a ete l’objet de cette etude. L’objectif etait d’evaluer les donnees du Programme de medicalisation du systeme d’information (PMSI) comme source d’information du registre rhone-alpin des cancers thyroidiens et d’estimer les performances du PMSI pour l’estimation de l’incidence de ce cancer. Methodes Les patients atteints de cancers thyroidiens incidents en 2002 ont ete identifies dans la base PMSI de la region Rhone-Alpes a partir d’un algorithme fonde sur les codes GHM de thyroidectomie et sur le code diagnostic principal ou associe de cancer thyroidien. Ils ont ete croises avec ceux du registre en fonction du sexe, de l’âge, du code postal de residence, du mois de sortie complete par la duree de sejour versus la date de diagnostic. Apres determination du pourcentage de cas du PMSI identifies par le registre et celui de cas du registre identifies dans le PMSI, une methode de capture-recapture a permis d’estimer le nombre total de cas dans la region ainsi que la sensibilite de la combinaison des deux sources. Resultats Dans le PMSI, 667 patients ont ete identifies alors que 677 patients figuraient dans le registre ; 95,2 % des patients identifies dans le PMSI etaient presents dans le registre et 82,2 % des patients du registre ont ete identifies dans le PMSI. Soixante pour cent des cas absents du PMSI etaient des micro-cancers. En ne considerant que les cancers supra-centimetriques, 92 % des cas du registre etaient identifies dans le PMSI. La proportion de vrais cas presents dans la base PMSI et manquant au registre etait de 2 % de la totalite des cas. D’apres la methode de capture-recapture, 711 ont ete identifies en combinant les deux sources d’information, ce qui a conduit a une sensibilite 99,2 %. Conclusion Les donnees du PMSI peuvent contribuer au controle de l’exhaustivite des registres a la condition de verifier la date et la nature du diagnostic et d’automatiser la procedure de croisement. L’apport minime de cas au registre est a mettre en balance avec le travail necessaire a leur identification. L’aptitude du PMSI pour l’identification des cas incidents de cancers thyroidiens est acceptable, bien qu’entachee d’erreurs. La signification des variations de l’incidence determinee a partir des bases du PMSI necessite d’etre documentee en regard des donnees obtenues a partir des registres.

Position du probleme Les bases de donnees medico-administratives du secteur hospitalier de court sejour disponibles au niveau national englobent la majorite des patients cancereux au debut de leur maladie. L’objectif est de determiner la possibilite de denombrer a partir de ces donnees les patientes atteintes de cancer du sein incident en utilisant des methodes d’identification. Deux methodes d’identification a partir de ces donnees ont ete evaluees dans trois services specialises d’un Centre Hospitalo-Universitaire. Methodes La premiere methode d’identification permettait de selectionner les femmes ayant eu au moins un sejour avec cancer du sein en diagnostic principal. La deuxieme, plus restrictive, selectionnait les femmes ayant au moins un sejour avec cancer du sein en diagnostic principal et un acte chirurgical specifique du traitement curatif du cancer du sein. Ces deux methodes ont ete appliquees aux 4 588 femmes d’au moins 20 ans hospitalisees en 2000 dans trois services specialises des Hospices Civils de Lyon. Afin de les classer en deux groupes : cancer du sein incident ou absence de cancer du sein incident, 150 femmes ont ete tirees au sort dans chacun des groupes ainsi constitues et leurs dossiers medicaux ont ete utilises comme reference. Resultats La sensibilite et la specificite assorties de leur intervalle de credibilite etaient respectivement 99,4 % (84-99,9) et 91,7 % (90,3-93,3) pour la premiere methode ; 93,8 % (76,2-98,7) et 97,3 % (96,1-98) pour la deuxieme methode. Parmi les femmes identifiees a tort avec un cancer du sein incident en 2000, 75,4 % (43/57) avaient un cancer du sein non incident dans l’annee avec la premiere methode et 96 % (24/25) avec la deuxieme methode. Pour ces patientes identifiees a tort avec un cancer du sein incident, des erreurs de codage du diagnostic principal ont ete retrouvees dans 24,6 % (14/57) des cas avec la premiere methode et dans 4 % (1/25) des cas avec la deuxieme methode. Leur correction a conduit a des sensibilite et specificite de 99,2 % (86,5-99,9) et 92,9 % (91,4-94,6) pour la premiere methode et de 94,2 % (76,5-98,7) et 97,3 % (96,2-98,1) pour la deuxieme methode. Conclusions La deuxieme methode utilisant des actes de chirurgie apparait plus specifique avec une perte en sensibilite qui reste faible. Les conditions d’utilisation de methodes d’identification pour estimer le nombre de cancer incident reste a preciser.

Background: Claims databases that include standardized medical and administrative information routinely collected on patients are becoming increasingly prevalent in many industrialized countries. Some of them have a national scope and are an efficient source of information on large heterogeneous patient populations. These databases can help to describe cancer incidence in the absence of national cancer registries. A literature review was performed to describe the use of these databases to identify incident cancer cases.

Study design: Cohort study. Objectives: To provide recent estimates of the incidence of traumatic spinal cord injury (SCI) in adults living in Ontario.Setting:Ontario, Canada. Methods: The study included all men and women aged 18 years and older living in Ontario. The two primary data sources used for this study were the census data provided by Statistics Canada and the hospital Discharge Abstract Database (DAD) provided by the Canadian Institute for Health Information. Incidence was estimated for the fiscal years 2003/04-2006/07, and examined by age, gender, mechanism and seasonality of injury, the level of injury, the presence of comorbidity and in-hospital mortality. Results: The incident cases had a mean age of 51.3 years (s.d. 20.1). The majority of the cases was male (74.1%) and had a cervical SCI caused by falls (49.5%). The age-adjusted incidence rate was stable over the 4-year study period, from 24.2 per million (95% CI: 21.2-27.6) in 2003 to 23.1 per million (95% CI: 20.2-26.3) in 2006. Conclusion: Despite worldwide trends that have indicated motor vehicle collisions (MVCs) as the leading cause of injury, falls emerged as the leading cause of traumatic SCI in this study. This finding, and the fact that the number of fall-induced injuries increased steadily with age, may indicate that there is growing concern for the consequences of falls in the elderly. Further work is needed to understand this trend in age and gender and the causes of falls to develop effective fall prevention strategies. Language: en

In the United States, the Agency for Healthcare Research and Quality (AHRQ) has developed 20 Patient Safety Indicators (PSIs) to measure the occurrence of hospital adverse events from medico-administrative data coded according to the ninth revision of the international classification of disease (ICD-9-CM). The adaptation of these PSIs to the WHO version of ICD-10 was carried out by an international consortium.Two independent teams transcoded ICD-9-CM diagnosis codes proposed by the AHRQ into ICD-10-WHO. Using a Delphi process, experts from six countries evaluated each code independently, stating whether it was "included", "excluded" or "uncertain". During a two-day meeting, the experts then discussed the codes that had not obtained a consensus, and the additional codes proposed.Fifteen PSIs were adapted. Among the 2569 proposed diagnosis codes, 1775 were unanimously adopted straightaway. The 794 remaining codes and 2541 additional codes were discussed. Three documents were prepared: (1) a list of ICD-10-WHO codes for the 15 adapted PSIs; (2) recommendations to the AHRQ for the improvement of the nosological frame and the coding of PSI with ICD-9-CM; (3) recommendations to the WHO to improve ICD-10.This work allows international comparisons of PSIs among the countries using ICD-10. Nevertheless, these PSIs must still be evaluated further before being broadly used.

This is a cohort study with 1-year follow-up.The aim of this study was to examine 1-year rehospitalization rates following spinal cord injury (SCI) onset and health system factors affecting rehospitalization.All persons who had an acute care hospitalization for traumatic SCI in Ontario between 1 April 2003 and 31 March 2006 were identified according to International Classification of Diseases, Tenth Revision codes and followed for 1 year following acute care discharge through record linkage of administrative databases. Index cases with an SCI admission the year before 2003 as well as persons who died within 1 year after the index hospitalization were excluded from the analysis. Factors associated with 1-year rehospitalization were assessed using multivariate logistic regression analyses and included age, sex, rurality, length of stay, comorbidity, level of injury, discharge disposition, in-hospital complication, physician visits and specialist visits measure and etiology of injury.A total of 559 individuals met the inclusion criteria and 27.5% (n=154) were rehospitalized 1 year after initial acute care discharge. Factors significantly associated with 1-year rehospitalization were length of stay, rural residence, 50+ outpatient physician visits and 50+ specialists visits following the index admission. The main causes of rehospitalization were musculoskeletal, respiratory, gastrointestinal and urological disorders.This study presents recent data on rehospitalization and yet rehospitalization rates continue to remain high. Our findings have significant implications for healthcare policy and planning in Ontario, Canada with respect to the management of SCI to achieve optimal health outcomes, in particular in rural areas.

To evaluate, in daily clinical practice, the efficacy and tolerability of a single intra-articular injection of non-animal-stabilized hyaluronic acid (NASHA) in patients treated for symptomatic hip OA (HOA). Standardized follow-up (FU). Patients: forty patients suffering from HOA treated by a single intra-articular injection of NASHA in the painful hip under fluoroscopy. Evaluation: patient global assessment (PGA) and walking pain (WP) on a 100 mm visual analogue scale, WOMAC index, Lequesne index at each visit. Statistics: last observation carried forward. Treatment efficacy was assessed using OMERACT-OARSI response criteria, minimal clinically important improvement (MCII), patient acceptable symptom state (PASS) obtained from PGA, WOMAC and WP. Predictive factors of efficacy were also studied. Efficacy evaluation: 34 patients were assessable (mean FU 159 days). All clinical variables (WP, PGA, WOMAC, Lequesne index) decreased significantly between baseline and last evaluation. Twenty-two patients (71%) were classified OMERACT-OARSI responders, 25 subjects (75.8%) were classified PASS+, and 19 (61.3%) fulfilled criteria for MCII. Out of clinical and radiological variables only Lequesne index (p = 0.04) and WOMAC (p = 0.04) at baseline were found to be predictive of treatment efficacy. Safety evaluation: the treatment was well tolerated. There were no severe adverse events related to the treatment or to the procedure. However 15 of the 28 assessable patients experienced transient increase of pain in the target hip during the first week after injection. Viscosupplementation of the hip with NASHA is easily feasible in daily clinical practice, safe and well tolerated despite a frequent increase of pain the days following injection. Prospective controlled trials are needed to confirm these data and to evaluate both safety and efficacy of a second course of treatment.

International audience; OBJECTIVE: As in many countries, cancer registries cover only part of the population in France. Incidence/mortality ratio observed in registries is usually extrapolated to produce national estimates of cancer incidence. District-level estimates are not currently available. For cancer sites such as thyroid, the incidence/mortality ratio widely varies between districts, and alternative indicators must be explored. This study aims to produce national and district-level estimations of thyroid cancer incidence in France, using the ratio between incidence and hospital-based incidence. METHODS: Analyses concerned population living in France and aged over 20, for the period 1998-2000. For each sex, number of incident cases were analysed according to number of surgery admissions for thyroid cancer (Poisson model) in the districts covered by a registry. Age was included in the model as fixed effect and district as random effect. The model's ability to predict incidence was tested through cross-validation. The model was then extrapolated to produce national incidence estimations, and for women, district-level estimations. RESULTS: The national estimations of incidence rate age-standardised on the world population were 3.1 [95% prediction interval: 2.8-3.4] for men and 10.6 [9.8-11.4] for women, corresponding respectively to 1,148 [1,042-1,264] and 4,104 [3,817-4,413] annual new cases. For women, district-level incidence rates presented wide geographical variations, ranging broadly from 5 to 20 per 100,000. These estimations were quite imprecise, but their imprecision was smaller than the extent of geographical disparities. CONCLUSION: National incidence estimations obtained are relatively precise. District-level estimations in women are imprecise and should be treated carefully. They are informative though regarding the extent of geographical disparities. The approach can be useful to improve national incidence estimates and to produce district-level estimates for cancer sites presenting a high variability of the incidence/mortality ratio.

Incidence measures are essentially based on the data collected by cancer registries. Hospital claims databases from care units (PMSI) can be used as a source of information for registries because they contain standard records of most cancer patients. Regarding thyroid cancer, we have evaluated the PMSI as a source of information for the Rhône-Alpes thyroid cancer registry and usefulness of PMSI as a tool for surveillance of thyroid cancer incidence.Patients with incident thyroid cancer in 2002 were identified in the claims data of the Rhône-Alpes region using an algorithm based on DRG codes of thyroidectomy and on diagnosis codes of thyroid cancer in a principal or secondary position. The patients identified were compared to those in thyroid cancer registry of the Rhône-Alpes region regarding sex, age, ZIP code of residence, month of discharge and length of stay versus the diagnosis date. When the percentage of cases of claims data identified in the cancer registry and the percentage of cases of the cancer registry identified in claims data were obtained, the capture-recapture method was applied to estimate the number of missing cases and the total number of incident thyroid cancers in the region.667 patients were identified in claims data while the cancer registry included 677 patients. 95.2% of patients identified in claims data were in the cancer registry and 82.3% of patients in the cancer registry were identified in claims data. Cases lacking in claims data mostly corresponded to micro-cancers which represented 41% of cases in the cancer registry. Regarding cancer above 1 cm, 92% of the cancer registry cases were identified in claims data. Sensitivity of combining information from cancer registry and claims data was 99.2%. Cases lacking in cancer registry, present in claims data base and considered as true cases after obtaining pathological confirmation represented 2% of the whole thyroid cancer population.Claims data obtained from anonymous regional or national bases can be helpful for checking the completeness of thyroid cancer registries and to provide a small amount of unknown cases. They can be considered an acceptable tool for surveillance of thyroid cancer incidence. The significance of the variations in incidence that could be observed from claims data remains to be evaluated in comparison with comparable data obtained from registries.

Objective To evaluate pain and disability at the time of knee replacement surgery for osteoarthritis. Methods In this multicenter cross-sectional study, 299 patients at 12 orthopedic surgery centers in Lyon, France were evaluated on the day before knee replacement surgery. Pain severity was assessed on a visual analog scale (VAS) and function using the Lequesne index and the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Results There were 207 women and 92 men with a mean age of 73 years. Mean (±SD) VAS pain score upon walking was 55.8 ± 24 mm. Compared to patients with very severe disability (Lequesne index > 12), those with mild-to-severe disability (Lequesne index ≤ 12) were more likely to be older than 70 years (odds ratio [OR], 2.85; 95% confidence interval [95%CI], 1.25–5) and male (OR, 2.5; 95%CI, 1.3–5); they were less likely to have a body mass index > 27 kg/m 2 (OR, 2.2; 95%CI, 1.3–3.3) and to engage in sporting activities (OR, 3.3; 95%CI, 1.4–10). Conclusion Patients about to undergo knee replacement surgery had high levels of pain and disability, with little variation across centers. Nevertheless, the severity of pain and disability may depend in part on age, gender, body mass index, and sporting activities, which probably influence the decision to perform knee replacement surgery.

Summary Objective: In French national claims databases, claims are currently anonymous i.e. not linked to individual patients. In order to improve our estimate of the medical activity related to cancer in one French region, a statistical method was developed to use claims data to assess the number of cancer patients hospitalized in acute care. Methods: This method used the medical and administrative information available in the claims (i.e. age, primary site, length of stay) to predict an average number of stays per patient, followed by a number of patients. It was based on a two-phase study design using an internal dataset which contained personal identifiers to estimate the model parameters. Results: The predicted number of acute care patients hospitalized in one or several health care centers in one French region was 38,109 with a 95% predictive interval (37,990; 38,228) for the first six months of 2002. A prediction error of 24% was found. Conclusion: We provide a good estimate of the morbidity in acute care hospitals using claims data that is not linked to individual patients. This estimate reflects the medical activity and can be used to anticipate acute care needs.

Since 2001, the French national case mix program is allowed by law to use an enciphering algorithm named "FOIN" to produce a unique anonymous identifier in order to crosslink, within and across hospitals, discharge abstracts from a given patient. This algorithm "thrashes" the person's health insurance number, date of birth and gender. Before using information produced by the case mix program, either for case mix payment or for epidemiology research or for assessing care approaches, the quality of linkage must be evaluated.Foin error flags were first assessed in the 2002 Rhône-Alpes regional case mix database. Second, for the two university hospitals of Lyon and Saint-Etienne, double identifiers (two or more Foin identifiers for the same patient) and collisions (a single Foin identifier for at least two patients) were compared with others identifiers: administrative identifier and an anonymous identifier produced by Anonymat software from name, forename and date of birth. Third, Foin error flags are crossed with Foin double identifier or collision mistakes.First, among 1,668,971 hospital discharge abstracts from the regional case mix database, 206,710 (12.4%) had at least one Foin error flag. The most frequent error flag (93026 [5.5%] stays) was due to the lack of the three identifying variables. The greatest number for error flags concerned the stays of newborns (38.5%) and those of public hospitals (17.3%). Second, Foin created a few double identifiers: 1.2% among 137,236 patients from university hospital of Lyon and 0.3% among 39512 patients from university hospital of Saint-Etienne. The collisions concerned 7776 (5.7%) patients from Lyon and 460 (1.2%) from Saint-Etienne. The identifier produced by Anonymat performed better than the one produced by Foin: 99.6% from the two university hospitals. Third, less than 3% of stays without Foin error flag nevertheless had mistakes on Foin when compared with others identifiers.The overall assessment is not in favour of a quality threshold using the Foin identifier on a routine basis except in some areas and if certain activities like neonatology are excluded. There are several ways to improve the linkage of health data.

Hospital claims databases from acute care units are available nationwide and contain most patients at the beginning of their cancer. The goal is to define the ability of these databases to provide a number of incident breast cancer cases using identification methods. Two identification methods were assessed in three specialized sections of a teaching hospital.The first method identified women who had at least one stay with a principal diagnosis of breast cancer. The second, which is more restrictive, identified women who had at least one stay with a principal diagnosis of breast cancer and a breast cancer-specific surgical treatment code. Both methods were applied to 4588 women 20 Years of age or older hospitalized in three specialized sections of the Hospices Civils de Lyon in 2000. To categorize these women in two groups, incident breast cancer cases or non-incident breast cancer cases, 150 women were randomized in each of two groups, one for incident breast cancer cases and one for non-incident breast cancer cases. Their medical records were used as references.Sensitivity, specificity and their credibility intervals were respectively 99.4% (84-99.9) and 91.7% (90.3-93.3) for the first method and 93.8% (76.2-98.7) and 97.3% (96.1-98) for the second. Among women wrongly identified with an incident breast cancer in 2000, 75.4% (43/57) had a breast cancer that was not incident that Year with the first method, compared to 96% (24/25) with the second. Among these women wrongly identified with an incident breast cancer, coding errors of the principal diagnosis were found for 24.6% (14/57) of patients with the first method and for 4% (1/25) with the second. Their correction led to 99.2% (86.5-99.9) sensitivity and 92.9% (91.4-94.6) specificity for the first method and to 94.2% (76.5-98.7) sensitivity and 97.3% (96.2-98.1) specificity for the second.The second method using cancer-specific surgical codes appeared more specific with a slight loss in sensitivity. The use of identification methods to assess the number of incident cancer cases still have to be defined.

Summary Objective: In a two-phase study design, the characteristics of an external data set were studied for precision and bias of the number of incident or prevalent cases of a disease obtained from claims databases. Methods: In the study population (first phase), incident or prevalent cases were counted whereas external data (second phase) provided sensitivity and specificity estimates to count cases in a claims database. Influence of potential differences in sensitivity and specificity between the two phases were evaluated. This was illustrated for 50-90% sensitivity and 99-99.99% specificity ranges. Results and Conclusions: The impact of differences in sensitivity and specificity depends on the odds of disease in the study population. We provide advice on the choice of adequate data sets to correct claims database estimates.

Estimations of the number of hospitalized incident cancer cases show biases when claims databases are used. This is due to false reports of incident cancer because of a lack of specificity, and because of unrecorded cancers resulting from a lack of sensitivity. We present a statistical method to provide corrected estimations. This method is based on a two-phase study design using an external data set for sensitivity and specificity estimates. Inaccuracy of the corrected number of hospitalized incident cancer cases was assessed by a credibility interval determined by a Bayesian approach using a Monte Carlo method. Based on the population hospitalized in a large group of French University hospitals, 334 women were identified in the French claims database as having potential incident cases of breast cancer in 1997. According to our method, the corrected number was 565 (550-580). In absence of hospital-based cancer registries, our approach provides estimates and credibility intervals, and has many potential applications in defining hospital policies with its applicability to other diseases.

Resume Objectif Definir les facteurs predictifs de satisfaction deux ans apres la mise en place d’une prothese totale de genou dans la gonarthrose. Methode Etude prospective multicentrique de 299 patients operes d‘une prothese totale de genou pour gonarthrose et suivis deux ans. A l’inclusion et a deux ans, les principales donnees collectees etaient la douleur, la fonction (indice de Lequesne et WOMAC) et la satisfaction a deux ans (definie par une satisfaction superieure strictement a 50 % par le patient). Resultats Deux cent soixante-quatre patients ont termine l’etude (26 perdus de vue, six deces, trois refus). Deux cent trente-sept patients (89,8 %) se jugent satisfaits. Les indices de Lequesne et WOMAC sont tres significativement ameliores (Indice de Lequesne avant chirurgie : 14,5, a deux ans, 7,9 [ p p p = 0,004), un indice de masse corporelle inferieur a 27 ( p = 0,015), un score de pincement radiologique eleve ( p = 0,038), âge egal ou superieur a 70 ans ( p = 0,038) et l’absence de depression lors de l’evaluation a deux ans ( p = 0,002). Conclusion Cette etude est la premiere etude prospective francaise multicentrique etudiant le suivi douloureux et fonctionnel d’un grand nombre de patients operes d’une prothese totale de genou dans la gonarthrose. Elle montre les bons resultats de ces protheses dans la gonarthrose. Elle permet aussi de mettre en evidence des facteurs predictifs de satisfaction, identifiables avant la chirurgie (âge > 70 ans, absence d’obesite, pincement radiologique important).