Search

Asylum seekers face multiple language, cultural and administrative barriers that could result in the inappropriate implementation of COVID-19 measures. This study aimed to explore their knowledge and attitudes to recommendations about COVID-19. We conducted a cross-sectional survey among asylum seekers living in the canton of Vaud, Switzerland. We used logistic regressions to analyze associations between knowledge about health recommendations, the experience of the pandemic and belief to rumors, and participant sociodemographic characteristics. In total, 242 people participated in the survey, with 63% of men (n = 150) and a median age of 30 years old (IQR 23–40). Low knowledge was associated with linguistic barriers (aOR 0.36, 95% CI 0.14–0.94, p = 0.028) and living in a community center (aOR 0.43, 95% CI 0.22–0.85, p = 0.014). Rejected asylum seekers were more likely to believe COVID-19 rumors (aOR 2.81, 95% CI 1.24–6.36, p = 0.013). This survey underlines the importance of tailoring health recommendations and interventions to reach asylum seekers, particularly those living in community centers or facing language barriers.

Rapidly growing health-related data have the potential to improve health and healthcare, as well as to make health systems more efficient and focused on patients' needs. Their efficient and secure management represents major technological, organizational and societal challenges. Currently too compartmentalized and insufficiently accessible, these data are often in the hands of private providers and their collection does not necessarily guarantee data security and privacy protection. Professionals as well as some private for-profit companies are on the lookout for this new digital "gold". It is therefore urgent to define a democratic and legal framework for the governance, collection and use of health data in the highly decentralized and fragmented Swiss context.Les données de santé, dont le volume croît rapidement, ont le potentiel d’améliorer la santé et les soins, de rendre les systèmes de santé plus efficients et centrés sur les besoins des patients. Leur gestion efficace et sécurisée représente des défis technologiques, organisationnels et sociétaux majeurs. Actuellement, trop cloisonnées et insuffisamment accessibles, ces données sont souvent en main de prestataires privés et leur collecte ne garantit pas forcément l’ensemble des éléments de sécurité des données et de protection de la vie privée. Les professionnels, comme certaines entreprises privées à but lucratif, sont à l’affût de ce nouvel « or » numérique. Il apparaît donc urgent de définir un cadre démocratique et légal autour de la gouvernance, de la collecte et de l’utilisation des données de santé dans le contexte suisse fortement décentralisé et fragmenté.

UNSTRUCTURED Purpose: One-third of older inpatients experience adverse-drug events (ADEs), which increase their mortality and morbidity, and health care use and costs. In particular, antithrombotic drugs are among the most at-risk medications in this population. Reporting systems have been implemented at national, regional, and provider levels to monitor ADEs and design prevention strategies. Because of their well-known limitations, automated detection technologies based on electronic medical records (EMR) are currently being developed to detect routinely or predict ADEs. Aim: This study aims to develop and validate an automated detection tool for the monitoring of antithrombotic-related ADEs using EMRs from four large Swiss hospitals. We aim to assess cumulative incidences of hemorrhages and thromboses in older inpatients associated with the prescription of antithrombotic drugs, identify triggering factors, and propose improvements for clinical practice. Method: This collaborative and interdisciplinary project is a multicenter, cross-sectional study based on 2015-2016 EMR data from four large hospitals in Switzerland: Lausanne, Geneva, and Zürich University hospitals, and Baden Cantonal hospital. We have included older inpatients aged ≥65 years who stayed at one of the four hospitals during 2015 or 2016, received at least one antithrombotic drug during their stay, and signed or were not opposed to a general consent for participation in research. First, expert clinical pharmacists have selected a list of relevant antithrombotic drugs along with their side effects and risk and confounding factors. Second, administrative, clinical, prescription, and laboratory data available in the form of free texts and structured data have been extracted from study participants’ EMRs. Third, several automated rule-based and machine learning-based algorithms are currently being developed, allowing to identify hemorrhage and thromboembolic events and their triggering factors from extracted information. Finally, we plan to validate the developed detection tools (one per ADE type) through manual medical record review. Performance metrics for assessing internal validity will comprise the area under the receiver operating curve (AUC), F1-Score, sensitivity, specificity, and positive and negative predictive values. Relevance/Application: The project will allow the introduction of measures to improve safety in the prescribing of antithrombotic drugs, which today remains among the drugs most involved in adverse drug events. The findings will be implemented in clinical practice by means of indicators of adverse events for risk management, and training for healthcare professionals; the tools and methodologies developed will be disseminated for new research in this field. Conclusion: The increased performance of natural language processing as an important complement to structured data will bring existing tools to another level of efficiency in the detection of ADEs. Currently, such systems are not available in Switzerland and nor can “ready-made” systems from other countries be adapted since they are language dependent.

ObjectivesTo quantitatively assess the early impact of the COVID-19 pandemic on in-person outpatient care utilisation worldwide, as well as across categories of services, types of care and medical specialties.DesignRapid review.MethodA search of MEDLINE and Embase was conducted to identify studies published from 1 January 2020 to 12 February 2021, which quantitatively reported the impact of the COVID-19 pandemic on the amount of outpatient care services delivered (in-person visits, diagnostic/screening procedures and treatments). There was no restriction on the type of medical care (emergency/primary/specialty care) or target population (adult/paediatric). All articles presenting primary data from studies reporting on outpatient care utilisation were included. Studies describing conditions requiring hospitalisation or limited to telehealth services were excluded.ResultsA total of 517 articles reporting 1011 outpatient care utilisation measures in 49 countries worldwide were eligible for inclusion. Of those, 93% focused on the first semester of 2020 (January to June). The reported results showed an almost universal decline in in-person outpatient care utilisation, with a 56% overall median relative decrease. Heterogeneity across countries was high, with median decreases ranging from 10% to 91%. Diagnostic and screening procedures (−63%), as well as in-person visits (−56%), were more affected than treatments (−36%). Emergency care showed a smaller relative decline (−49%) than primary (−60%) and specialty care (−58%).ConclusionsThe provision of in-person outpatient care services has been strongly impacted by the COVID-19 pandemic, but heterogeneously across countries. The long-term population health consequences of the disruption of outpatient care service delivery remain currently unknown and need to be studied.PROSPERO registration numberCRD42021237366.

Background: Sepsis is a leading cause of morbidity and mortality. Prompt recognition and management are critical to improved outcomes. In 2019, the Lausanne University Hospital (LUH) launched a quality of care project aiming to improve sepsis management. As part of this effort, we aimed to assess sepsis awareness among nurses and physicians of the LUH and among the local paramedics. Methods: We conducted a survey on nurses and physicians at our institution and local paramedics between January and October 2020 representing over 1,000 professionals distributed over all hospital departments. The survey assessed professionals’ knowledge of sepsis epidemiology, definition, recognition and initial evaluation (nurses and paramedics) or sepsis epidemiology, diagnosis, and management (physicians). Pediatrics and the neonatal unit were excluded. Results: A total of 1,116 of 1,216 contacted persons among the 4417 targeted population participated and completed the survey (participation rate 91.8%). This included 619 of 2,463 (25.1%) of hospital nurses, 348 of 1,664 (20.9 %) of physicians and 149 of 290 (51.4%) of canton paramedics. Our nurse and physician sample was slightly imbalanced for sex and age. Thirteen percent of participants (28.4% of physicians, 5.9% of nurses, 6.8% of paramedics) correctly identified the Sepsis-3 consensus definition. Similarly, 48.6% of physicians and 10.0% of nurses identified the SOFA (sequential organ failure assessment) score as a sepsis defining score for infected patients. Furthermore, 24% of participants identified the Quick Sepsis-related Organ Failure Assessment (qSOFA) score as a predictor of increased mortality; 6% identified correctly the components of the score. For a patient with suspected sepsis, 96.1%, 91.6% and 75.8% of physicians respectively identified blood cultures, broad-spectrum antibiotics and fluid resuscitation as required interventions; 76.4% and 18.2% of physicians requested these initial measures within 1 and 3 hours, respectively. For physicians, recent training correlated with awareness regarding definitions, SOFA score and qSOFA score use and components: ORs (95%CI) 2.2 (1.4-3.6), 4.3 (2.7-6.7), 3.4 (2.2-5.2), and 2.6 (1.5-4.6), respectively).Conclusions: We identify a deficit of awareness among physicians, nurses and paramedics at LUH correlating with a lack of sepsis-specific training. Enhanced sepsis-specific educational efforts could significantly improve early identification and treatment of affected patients.

BACKGROUND Although the trend of progressing morbidity is widely recognized, there are numerous challenges when studying multimorbidity and patient complexity. For multimorbid or complex patients, prone to fragmented care and high health care use, novel estimation approaches need to be developed. OBJECTIVE This study aims to investigate the patient multimorbidity and complexity of Swiss residents aged ≥50 years using clustering methodology in claims data. METHODS We adopted a clustering methodology based on random forests and used 34 pharmacy-based cost groups as the only input feature for the procedure. To detect clusters, we applied hierarchical density-based spatial clustering of applications with noise. The reasonable hyperparameters were chosen based on various metrics embedded in the algorithms (out-of-bag misclassification error, normalized stress, and cluster persistence) and the clinical relevance of the obtained clusters. RESULTS Based on cluster analysis output for 18,732 individuals, we identified an outlier group and 7 clusters: individuals without diseases, patients with only hypertension-related diseases, patients with only mental diseases, complex high-cost high-need patients, slightly complex patients with inexpensive low-severity pharmacy-based cost groups, patients with 1 costly disease, and older high-risk patients. CONCLUSIONS Our study demonstrated that cluster analysis based on pharmacy-based cost group information from claims-based data is feasible and highlights clinically relevant clusters. Such an approach allows expanding the understanding of multimorbidity beyond simple disease counts and can identify the population profiles with increased health care use and costs. This study may foster the development of integrated and coordinated care, which is high on the agenda in policy making, care planning, and delivery.

ObjectivesTo assess the differences in the management and prognosis of acute coronary syndrome in men and women who were admitted to hospital for acute coronary syndrome.DesignCross sectional study.SettingDischarge data from Swiss hospitals linked at the hospital and patient levels.Participants224 249 adults (18 years and older) were admitted to hospital for acute coronary syndrome between 1 January 2009 and 31 December 2017 in any Swiss hospital, of which 72 947 (32.5%) were women. People who were discharged against medical advice were excluded.ResultsWomen admitted to hospital with acute coronary syndrome were older than their male counterparts (mean age 74.9 years (standard deviation 12.4)v67.0 years (13.2)). Irrespective of acute coronary syndrome type, women were less likely to undergo diagnostic procedures, such as coronary angiography (adjusted odds ratio 0.79 (95% confidence interval 0.77 to 0.82) for non-ST-segment elevation myocardial infarctionv0.87 (0.84 to 0.91) for ST-segment elevation myocardial infarction)) and ventriculography (0.84 (0.82 to 0.87)v0.90 (0.87 to 0.91)). Women were also less likely to receive treatments, such as percutaneous coronary intervention (0.67 (0.65 to 0.69)v0.76 (0.73 to 0.78)) and coronary artery bypass graft (0.57 (0.53 to 0.61)v0.79 (0.72 to 0.87)). Women had a poorer prognosis than men, with a higher likelihood of healthcare related complications (1.10 (1.06 to 1.15)v1.14 (1.09 to 1.21)) and of a longer hospital stay (1.24 (1.20 to 1.27)v1.24 (1.20 to 1.29)). In non-adjusted models, the likelihood of death in hospital was higher among women (odds ratio 1.30 (95% confidence interval 1.24 to 1.37) for non-ST-segment elevation myocardial infarctionv1.75 (1.66 to 1.85) for ST-segment elevation myocardial infarction), but the association was reversed for ST-segment elevation myocardial infarction (adjusted odds ratio 0.87 (0.82 to 0.92)) or was non-significant for non-ST-segment elevation myocardial infarction (1.00 (0.94 to 1.06)) after adjustment for confounding variables. The main effect modifier was age: younger women were more likely to die than men of the same age and older women were less likely to die than men of the same age. For example, women who were younger than 50 years had a 38% increased likelihood of dying compared with men of the same age range (adjusted odds ratio 1.38 (1.04 to 1.83)).ConclusionsSex inequalities were reported in the management of heart disease in this population of patients from a high income country with good healthcare coverage. These differences affect mortality and morbidity, especially in younger women. Efforts are needed to overcome these inequalities, including educational programmes aimed at healthcare professionals.

La disponibilite croissante des donnees generees par les prestataires de soins de sante ainsi que par la surveillance de l’incidence des maladies et des indicateurs de l’evolution des maladies a transforme le caractere de la recherche en sante. Les donnees de sante collectees en

The Swiss Monitoring of Adverse Drug Events (SwissMADE) project is part of the SNSF-funded Smarter Health Care initiative, which aims at improving health services for the public. Its goal is to use text mining on electronic patient reports to automatically detect adverse drug events automatically in hospitalised elderly patients who received anti-thrombotic drugs. The project is the first of its kind in Switzerland: the data is provided by four hospitals from both the German- and French-speaking part of Switzerland, all of which had not previously released electronic patient records for research, making extraction and anonymisation of records one of the major challenges of the project.

Background This study aims to describe the epidemiology of COVID-19 patients in a Swiss university hospital. Methods This retrospective observational study included all adult patients hospitalized with a laboratory confirmed SARS-CoV-2 infection from March 1 to March 25, 2020. We extracted data from electronic health records. The primary outcome was the need to mechanical ventilation at day 14. We used multivariate logistic regression to identify risk factors for mechanical ventilation. Follow-up was of at least 14 days. Results 145 patients were included in the multivariate model, of whom 36 (24.8%) needed mechanical ventilation at 14 days. The median time from symptoms onset to mechanical ventilation was 9·5 days (IQR 7.00, 12.75). Multivariable regression showed increased odds of mechanical ventilation with age (OR 1.09 per year, 95% CI 1.03–1.16, p = 0.002), in males (OR 6.99, 95% CI 1.68–29.03, p = 0.007), in patients who presented with a qSOFA score ≥2 (OR 7.24, 95% CI 1.64–32.03, p = 0.009), with bilateral infiltrate (OR 18.92, 3.94–98.23, p Conclusions This study gives some insight in the epidemiology and clinical course of patients admitted in a European tertiary hospital with SARS-CoV-2 infection. Age, male sex, high qSOFA score, CRP of 40 mg/l or greater and a bilateral radiological infiltrate could help clinicians identify patients at high risk for mechanical ventilation.

Introduction Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Therefore, cumulative incidence of postpartum hemorrhage and severe postpartum hemorrhage are commonly monitored within and compared across maternity hospitals or countries for obstetrical safety improvement. These indicators are usually based on hospital discharge data though their accuracy is seldom assessed. We aimed to measure postpartum hemorrhage and severe postpartum hemorrhage using electronic health records and hospital discharge data separately and compare the detection accuracy of these methods to manual chart review, and to examine the temporal trends in cumulative incidence of these potentially avoidable adverse outcomes. Materials and methods We analyzed routinely collected data of 7904 singleton deliveries from a large Swiss university hospital for a three year period (2014–2016). We identified postpartum hemorrhage and severe postpartum hemorrhage in electronic health records by text mining discharge letters and operative reports and calculating drop in hemoglobin from laboratory tests. Diagnostic and procedure codes were used to identify cases in hospital discharge data. A sample of 334 charts was reviewed manually to provide a reference-standard and evaluate the accuracy of the other detection methods. Results Sensitivities of detection algorithms based on electronic health records and hospital discharge data were 95.2% (95% CI: 92.6% 97.8%) and 38.2% (33.3% to 43.0%), respectively for postpartum hemorrhage, and 87.5% (85.2% to 89.8%) and 36.2% (26.3% to 46.1%) for severe postpartum hemorrhage. Postpartum hemorrhage cumulative incidence based on electronic health records decreased from 15.6% (13.1% to 18.2%) to 8.5% (6.7% to 10.5%) from the beginning of 2014 to the end of 2016, with an average of 12.5% (11.8% to 13.3%). The cumulative incidence of severe postpartum hemorrhage remained at approximately 4% (3.5% to 4.4%). Hospital discharge data-based algorithms provided significantly underestimated incidences. Conclusions Hospital discharge data is not accurate enough to assess the incidence of postpartum hemorrhage at hospital or national level. Instead, automated algorithms based on structured and textual data from electronic health records should be considered, as they provide accurate and timely estimates for monitoring and improvement in obstetrical safety. Furthermore, they have the potential to better code for postpartum hemorrhage thus improving hospital reimbursement.

Introduction The International Methodology Consortium for Coded Health Information (IMeCCHI) is a collaboration of health services researchers who promote methodological advances in coded health information. The IMeCCHI-DATANETWORK initiative focuses on developing a multi-purpose distributed data infrastructure and common data model (CDM) to enable cross-border data sharing and international comparisons. Methods IMeCCHI consortium partners from six different countries – Canada, Denmark, Italy, New Zealand, South Korea, and Switzerland – used a questionnaire to describe their original databases which differ in size, structure, content and coding systems. To standardize these data, they agreed on a CDM and mapped their population-based databases to meet the CDM specifications. At the end of this process, local data had a more homogenous content and structure, which made them syntactically and semantically interoperable. Data transformation was performed using a common data management software called TheMatrix. Results The CDM encompasses four tables of structured data (person characteristics, hospitalizations, outpatient prescription medication and death), linked at the individual level through a person identifier. It can be used to answer research questions across countries using locally converted databases, which facilitates study replication in a distributed fashion. As a proof-of-concept study, an initial research question was addressed using an agreed protocol. Local data were transformed in csv files in the CDM structure and TheMatrix was tested to transform the standardized data from each partner into local analytical datasets. This allowed results to be shared between countries, whilst maintaining local control over each region’s data. Conclusion The IMeCCHI-DATANETWORK, a model of a distributed data network, demonstrated that it is feasible to analyze international data using standardized analytical methods that enable independent analyses by regions, without relocating datasets thereby protecting local confidentiality obligations. The distributed data infrastructure can produce results that can be generalized to several countries, while facilitating cross-border data sharing and international comparisons. Keywords Common data model, international comparison, cross-border data sharing, interoperability, observational data

ObjectiveThis study aimed to examine the prevalence and determinants of benzodiazepine prescription among older adults in Switzerland, and analyse association with hospitalisation and costs.DesignRetrospective analysis of claims data.SettingThe study was conducted in nine cantons in Switzerland.ParticipantsOlder adults aged 65 years and older enrolled with a large Swiss health insurance company participated in the study.Primary and secondary outcome measuresThe primary outcome was prevalence of benzodiazepine prescription. The secondary outcomes were (1) determinants of any benzodiazepine prescription; (2) the association between any prescription and the probability of hospitalisation for trauma and (3) the association between any prescription and total healthcare expenditures.ResultsOverall, 69 005 individuals were included in the study. Approximately 20% of participants had at least one benzodiazepine prescription in 2017. Prescription prevalence increased with age (65–69: 15.9%; 70–74: 18.4%; 75–80: 22.5%; >80: 25.8%) and was higher in women (25.1%) compared with men (14.6%). Enrollees with the highest deductible of Swiss Francs (CHF) 2500 were 70% less likely to receive a prescription than enrollees with the lowest deductible of CHF 300 (adjusted OR=0.29, 95% CI 0.24 to 0.35).Individuals with at least one prescription had a higher probability of hospitalisation for trauma (OR=1.31, 95% CI 1. 20 to 1.1.44), and 70% higher health care expenditures (β=0.72, 95% CI 0. 67 to 0.77). Enrollees in canton Valais were three times more likely to receive a prescription compared to enrollees from canton Aargau (OR=2.84, 95% 2.51 to 3.21).ConclusionsThe proportion of older adults with at least one benzodiazepine prescription is high, as found in the data of one large Swiss health insurance company. These enrollees are more likely to be hospitalised for trauma and have higher healthcare expenditures. Important differences in prescription prevalence across cantons were observed, suggesting potential overuse. Further research is needed to understand the drivers of variation, prescription patterns across providers, and trends over time.

Summary: Background: Most claims-based frailty instruments have been designed for group stratification of older populations according to the risk of adverse health outcomes and not frailty itself. We aimed to develop and validate a tool based on one-year hospital discharge data for stratification on Fried's frailty phenotype (FP). Methods: We used a three-stage development/validation approach. First, we created a clinical knowledge-driven electronic frailty score (eFS) calculated as the number of deficient organs/systems among 18 critical ones identified from the International Statistical Classification of Diseases and Related Problems, 10th Revision (ICD-10) diagnoses coded in the year before FP assessment. Second, for eFS development and internal validation, we linked individual records from the Lc65+ cohort database to inpatient discharge data from Lausanne University Hospital (CHUV) for the period 2004-2015. The development/internal validation sample included community-dwelling, non-institutionalised residents of Lausanne (Switzerland) recruited in the Lc65+ cohort in three waves (2004, 2009, and 2014), aged 65-70 years at enrolment, and hospitalised at the CHUV at least once in the year preceding the FP assessment. Using this sample, we selected the best performing model for predicting the dichotomised FP, with the eFS or ICD-10-based variables as predictors. Third, we conducted an external validation using 2016 Swiss nationwide hospital discharge data and compared the performance of the eFS model in predicting 13 adverse outcomes to three models relying on well-designed and validated claims-based scores (Claims-based Frailty Index, Hospital Frailty Risk Score, Dr Foster Global Frailty Score). Findings: In the development/internal validation sample (n = 469), 14·3% of participants (n = 67) were frail. Among 34 models tested, the best-subsets logistic regression model with four predictors (age and sex at FP assessment, time since last hospital discharge, eFS) performed best in predicting the dichotomised FP (area under the curve=0·71; F1 score=0·39) and one-year adverse health outcomes. On the external validation sample (n = 54,815; 153 acute care hospitals), the eFS model demonstrated a similar performance to the three other claims-based scoring models. According to the eFS model, the external validation sample showed an estimated prevalence of 56·8% (n = 31,135) of frail older inpatients at admission. Interpretation: The eFS model is an inexpensive, transportable and valid tool allowing reliable group stratification and individual prioritisation for comprehensive frailty assessment and may be applied to both hospitalised and community-dwelling older adults. Funding: The study received no external funding.

IntroductionPostpartum hemorrhage (PPH) remains a major cause of morbidity and mortality worldwide. Geo-temporal comparisons of in-hospital PPH incidence remain a challenge due to differences in definition, data quality and the absence of accurate, validated indicators. Objectives and ApproachTo compare the incidence of PPH using different definitions to assess the need for a validated indicator. Singleton births from 2014-2016 at Lausanne University Hospital, Switzerland, were included. PPH was defined based on 1) clinical diagnosis using International Classification of Diseases (ICD-10-GM) PPH diagnostic codes, 2) volume of blood loss ≥500ml for vaginal births and ≥1000ml for cesareans 3) peripartum Hb change >2g/dl in vaginal births and ≥4g/dl in cesareans and 4) fulfillment of criteria from definition one, two or three. Data were extracted from hospital discharge data and linked with electronic health records. ResultsThere were 2529, 2660 and 2715 singleton births in 2014, 2015 and 2016, respectively, 28.8% were cesareans. Peripartum change in Hb was available for 17% of births. The incidence (95% CI) of PPH in 2014, 2015 and 2016 was, respectively: 1)6.0% (5.1, 7.0), 6.3% (5.4, 7.3) and 7.9% (6.9, 9.0) based on diagnostic codes; 2)7.9% (6.8, 9.0), 7.1% (6.2, 8.2) and 7.2% (6.3, 8.3) based on blood loss volumes; 3)2.4% (1.8, 3.1), 2.7% (2.1, 3.4) and 3.5% (2.9, 4.3) based on change in Hb; 4)11.3% (10.1, 12.6), 10.4% (9.3, 11.6) and 11.0% (9.9, 12.3) based on the combined definition. Differences in PPH incidence by year between definitions one and four, two and four and three and four were all statistically significant (McNemar p-values Conclusion/ImplicationsIncidence varied widely according to definition and data availability, not to mention data quality. Our results highlight the need for a validated PPH indicator to enable monitoring. Future prospects include the validation of a diagnostic code based PPH indicator aided by text mining in electronic health records.

IntroductionFrailty is strongly associated with adverse health outcomes and health care costs in elders. However, we have almost no idea of the prevalence of frail older inpatients in Swiss hospitals. Hospital discharge data could contribute to predicting frailty in these patients, and eventually improving SwissDRGs system or casemix-adjustment. Objectives and ApproachThe HFrailty project aimed to develop a predictive model of Fried’s Frailty Phenotype (FFP) based on hospital discharge data. We linked Lausanne University Hospital (CHUV) discharge data to clinical data from the Lausanne cohort study (Lc65+) over the period 2004-2015. The Lc65+ is a longitudinal population-based cohort comprising three random samples of approximately 1500 Lausanne residents aged 65 to 70, born respectively before, during and after World War II. With stepwise and lasso penalized logistic regression, random forest and neural networks, we identified the best-performing model for predicting FFP using CHUV’s data recorded within 12 months prior to frailty assessments. ResultsAmong Lc65+ participants, 1649 were assessed for frailty and hospitalized at least once during the follow-up period, resulting in 3499 FFP assessments of which 544 were preceded by at least one hospitalization within 12 months. In total, 45.7% of the participants were men and 9.4% were frail (FFP score ≥ 3). As expected, prevalence of frailty increased with age from 4.1% in the 66-70 age group, to 5.3% and 10.5% in the 71-75 and 76-80 groups, respectively. Logistic regression with lasso penalty was finally the best model regarding both performance and complexity. It had an area under receiver operating curve of 0.67 to predict FFP based on detailed diagnosis and procedure codes. Conclusion/ImplicationsHospital discharge data may be used to identify frail and non-frail individuals and estimate their prevalence in the Swiss non-institutionalized population. Our predictive model showed limited performance and could be improved. We are currently testing groups of diagnosis and procedure codes, as predictors, instead of detailed ones.

Background Results of associations between process and mortality indicators, both used for the external assessment of hospital care quality or public reporting, differ strongly across studies. However, most of those studies were conducted in North America or United Kingdom. Providing new evidence based on French data could fuel the international debate on quality of care indicators and help inform French policy-makers. The objective of our study was to explore whether optimal care delivery in French hospitals as assessed by their Hospital Process Indicators (HPIs) is associated with low Hospital Standardized Mortality Ratios (HSMRs). Methods The French National Authority for Health (HAS) routinely collects for each hospital located in France, a set of mandatory HPIs. Five HPIs were selected among the process indicators collected by the HAS in 2009. They were measured using random samples of 60 to 80 medical records from inpatients admitted between January 1st, 2009 and December 31, 2009 in respect with some selection criteria. HSMRs were estimated at 30, 60 and 90 days post-admission (dpa) using administrative health data extracted from the national health insurance information system (SNIIR-AM) which covers 77% of the French population. Associations between HPIs and HSMRs were assessed by Poisson regression models corrected for measurement errors with a simulation-extrapolation (SIMEX) method. Results Most associations studied were not statistically significant. Only two process indicators were found associated with HSMRs. Completeness and quality of anesthetic records was negatively associated with 30 dpa HSMR (0.72 [0.52–0.99]). Early detection of nutritional disorders was negatively associated with all HSMRs: 30 dpa HSMR (0.71 [0.54–0.95]), 60 dpa HSMR (0.51 [0.39–0.67]) and 90 dpa HSMR (0.52 [0.40–0.68]). Conclusion In absence of gold standard of quality of care measurement, the limited number of associations suggested to drive in-depth improvements in order to better determine associations between process and mortality indicators. A smart utilization of both process and outcomes indicators is mandatory to capture aspects of the hospital quality of care complexity. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2534-3) contains supplementary material, which is available to authorized users.

ObjectivesThe International Methodology Consortium for Coded Health Information (IMECCHI), an international collaboration of health services researchers, launched the IMECCHI-DATANETWORK initiative in October 2015. Its main objective is to enable replication of observational studies across countries through a distributed data infrastructure. ApproachIn a distributed data infrastructure, individual raw data are not shared. Instead, data are converted locally using a common data model (CDM) and loaded into a common software for data processing and analysis. Whenever a study protocol is agreed upon and ethically approved, an ad hoc procedure is programmed - using that software - including the data processing steps needed to create the analytical dataset from the CDM: record linkage, case selection, sampling, matching, etc. The procedure is then shared and locally run by each partner to generate an analytical dataset of integrated data. Analytical datasets may then be shared and pooled for statistical analyses. ResultsSix partners of the IMECCHI collaboration, located in countries across 4 continents (Canada, Denmark, Italy, New Zealand, South Korea, and Switzerland), currently participate in the initiative. They first conducted a survey to describe the origin, content, completeness and main attributes of each table in their original databases. Based on the results of the survey, a CDM was created, encompassing 4 tables of coded or structured data to be linked at the individual level using a common personal identifier: (1) characteristics of the subjects with dates of birth and death; (2) hospital discharge summaries with diagnosis and procedure codes, and admission, discharge and procedure dates; (3) drug dispensing information with date of dispensing, drug name, duration of the amount of active principle according to the Defined Daily Dose of the World Health Organization; (4) causes of death. In each table, additional attributes describe the coding systems in which the other attributes are coded. Using such specific attributes facilitates interoperability across multiple coding systems. The open source Java-based software, TheMatrix, which operates on flat csv files using a domain-specific programming language, was chosen to embed the ad hoc procedure. ConclusionWithin the IMECCHI-DATANETWORK initiative, databases from various countries will be locally converted in a CDM which will facilitate study replication in a distributed fashion while granting interoperability across coding systems. Through such international data networks, data are empowered for creating results which are generalizable to multiple countries. Cross-border data sharing and international comparisons are also facilitated.

Objectives The International Methodology Consortium for Coded Health Information (IMECCHI), an international collaboration of health services researchers, launched the IMECCHI-DATANETWORK initiative in October 2015. Its main objective is to enable replication of observational studies across countries through a distributed data infrastructure. Approach In a distributed data infrastructure, individual raw data are not shared. Instead, data are converted locally using a common data model (CDM) and loaded into a common software for data processing and analysis. Whenever a study protocol is agreed upon and ethically approved, an ad hoc procedure is programmed - using that software - including the data processing steps needed to create the analytical dataset from the CDM: record linkage, case selection, sampling, matching, etc. The procedure is then shared and locally run by each partner to generate an analytical dataset of integrated data. Analytical datasets may then be shared and pooled for statistical analyses. Results Six partners of the IMECCHI collaboration, located in countries across 4 continents (Canada, Denmark, Italy, New Zealand, South Korea, and Switzerland), currently participate in the initiative. They first conducted a survey to describe the origin, content, completeness and main attributes of each table in their original databases. Based on the results of the survey, a CDM was created, encompassing 4 tables of coded or structured data to be linked at the individual level using a common personal identifier: (1) characteristics of the subjects with dates of birth and death; (2) hospital discharge summaries with diagnosis and procedure codes, and admission, discharge and procedure dates; (3) drug dispensing information with date of dispensing, drug name, duration of the amount of active principle according to the Defined Daily Dose of the World Health Organization; (4) causes of death. In each table, additional attributes describe the coding systems in which the other attributes are coded. Using such specific attributes facilitates interoperability across multiple coding systems. The open source Java-based software, TheMatrix, which operates on flat csv files using a domain-specific programming language, was chosen to embed the ad hoc procedure. Conclusion Within the IMECCHI-DATANETWORK initiative, databases from various countries will be locally converted in a CDM which will facilitate study replication in a distributed fashion while granting interoperability across coding systems. Through such international data networks, data are empowered for creating results which are generalizable to multiple countries. Cross-border data sharing and international comparisons are also facilitated.

Inclusion and exclusion criteria for HPI. (DOCX 16 kb)

Description of the SIMEX method [47–50]. (DOCX 48 kb)

Objectif : la prescription medicamenteuse en soins primaires serait responsable d’effets indesirables chez 25 % des patients avec des consequences graves dans 13 % des cas. Notre objectif a ete d’elaborer une brochure interactive permettant d’informer et d’impliquer le patient en vue de prevenir les effets indesirables medicamenteux.Methodes : le processus de production et d’evaluation de la brochure a necessite plusieurs etapes : une revue de la litterature medicale internationale, une enquete Delphi, une evaluation de la lisibilite du texte, une etude qualitative de terrain, un travail linguistique, un travail d’infographie. Pour l’enquete Delphi 27 experts (patients, medecins generalistes, praticiens de sante publique, cardiologues, geriatres, psychologue, economiste, pharmaciens, infirmiere, ethicien) ont ete sollicites. Pour l’etude qualitative de terrain, un echantillon heterogene de sept medecins, treize patients et deux aidants a ete constitue.Resultats : une brochure interactive comprenant des items d’information sur le benefice et les risques des antihypertenseurs et un plan de soins a remplir par le patient suivi d’une fiche de signalement d’effets indesirables medicamenteux a ete elaboree. Suite a l’etude de terrain, les phrases ambigues et les termes medicaux peu comprehensibles ont ete reformules. Le temps necessaire pour presenter la brochure ainsi que sa facilite d’emploi etaient des criteres majeurs d’acceptabilite pour les soignants. Pour les patients il etait necessaire de mettre en evidence un benefice attendu pour susciter leur interet vis-a-vis de la brochure.Conclusion : le processus de developpement utilise a permis d’elaborer une brochure comprehensible et acceptable en soins primaires pour prevenir les effets indesirables des antihypertenseurs et leur gravite.

Outcome indicators are routinely used to compare hospitals with respect to quality of care. Indicators might be based on observed proportions of adverse events (binary outcomes) or observed averages of e.g. lengths or costs of hospital stays (continuous outcomes). These observed values are compared with expected ones in an average hospital, which might be estimated from a reference sample and should be appropriately adjusted for the case mix of patients. One possibility to achieve a reliable adjustment is to stratify the patients according to their risks, where each patient belongs to one and only one stratum. Control limits calculated under the null hypothesis of an average hospital, allowing to decide whether a discrepancy between an observed and an expected value might be explained by chance or not, are then plotted around the indicator, such that hospitals falling above those control limits are detected as being statistically worse than an average hospital. Calculation of valid control limits is however not always obvious. In this article, we propose a simple and unified framework to calculate such control limits when adjustment is based on stratification, where we allow to distinguish and disentangle the variability explained by stratification and the variability due to chance, where we take into account the uncertainty about the estimation of the expected values, and where it is possible not only to detect those hospitals which are statistically worse, but also those which are statistically much worse than an average hospital. The method applies both to binary and continuous outcomes and is illustrated on Swiss hospital discharge data.

Background Permanent recurrent laryngeal nerve palsy and hypoparathyroidism are 2 major complications after thyroid operation. Assuming that the rate of immediate complications can predict the permanent complication rate, some authors consider these complications as a valid metric for assessing the performance of individual surgeons. This study aimed to determine the correlation between rates of immediate and permanent complications after thyroidectomy at the surgeon level. Methods We conducted a prospective, cross-sectional study in 5 academic hospitals between April 2008 and December 2009. The correlation between the rates of immediate and permanent complications for each of the 22 participating surgeons was calculated using the Pearson correlation test (r). Results The study period included 3,605 patients. There was a fairly good correlation between rates of immediate and permanent recurrent laryngeal nerve palsy (r = 0.70, P = .004), but no correlation was found for immediate and permanent hypoparathyroidism (r = 0.18, P = .427). Conclusion The immediate hypoparathyroidism rate does not reflect the permanent hypoparathyroidism rate. Consequently, immediate hypoparathyroidism should not be used to assess the quality of thyroidectomy or to monitor the performance of surgeons.

BACKGROUND In-hospital mortality is widely used to judge the quality of hospital care, but is biased by discharge patterns. Fixed-timeframe indicators have thus been recommended. However, the 30-day postadmission indicator may underestimate hospital-wide mortality, as patients dying in hospital >30 days after admission are considered as survivors. OBJECTIVES To identify the most relevant timeframes and to assess the contribution of cause-of-death data. METHODS The 2009 French hospital discharge database was linked to vital status records and to the causes of death register for 11.5 million hospital stays by beneficiaries of French general health insurance. Correlations and agreements between the 30-day hospital standardized mortality ratio (HSMR) and the in-hospital, 60-, 90-, 180-, and 365-day postadmission HSMRs were estimated. RESULTS A total of 7.8%, 1.5%, and 0.5% of patients who died during their hospital stay were considered as survivors by the 30-, 60-, and 90-day HSMRs, respectively. The 30-day HSMR correlated strongly with the 60-day HSMR (Pearson coefficient=0.92), and their agreement on outlier status was excellent (κ coefficient=0.80). The association remained substantial at 90 days, but weakened at 180 days and even more so at 365 days. Regardless of the timeframe, exclusion of deaths likely due to independent causes barely modified the indicators. CONCLUSIONS This nationwide study shows that 60- and 90-day HSMRs encompass in-hospital deaths better than the 30-day HSMR, while capturing the same interhospital variations. They should thus be preferred. The contribution of cause-of-death data to hospital-wide indicators seems negligible.

La societe hypermoderne entraine, par son exces permanent, une surconsommation medicale. Cette surconsommation trouve des explications diverses, genere des pathologies et des difficultes du systeme de sante variees. Cependant de nouveaux liens sociaux se developpent, ils permettront peut-etre d’eviter une acceleration d’une medecine a deux vitesses.

Antihypertensive drugs are thought to be responsible for adverse drug events in 25% of patients, with severe consequences in 13% of cases. The purpose of this study was to develop an interactive booklet designed to inform and involve patients with a view to preventing adverse drug events.The development of the booklet involved several stages, including a literature review, a Delphi survey, a readability assessment, a qualitative study in primary care, a revision process, and graphic design work. 27 experts (patients, general practitioners, public health practitioners, cardiologists, geriatricians, psychologists, economists, pharmacists, nurses and ethicists) participated in the Delphi survey, while the qualitative study was based on a sample that included 7 doctors, 13 patients and 2 healthcare assistants.We developed an interactive booklet containing information items on the benefits and risks of antihypertensive drugs, a care plan to be completed by the patient, and a form for reporting adverse drug events. Ambiguous sentences and incomprehensible medical terms were rephrased. The time required to present the booklet and ease of use were key acceptability criteria for caregivers. Among the patients, the study found that interest in the booklet required clear evidence of an expected benefit.An understandable and acceptable interactive booklet was developed using a systematic process to prevent severe adverse drug events in primary care.

Objectives Accreditation in France relies on a mandatory 4-year cycle of self-assessment and a peer review of 82 standards, among which 14 focus priority standards (FPS). Hospitals are also required to measure yearly quality indicators (QIs—5 in 2010). On advice given by the accreditation committee of HAS (Haute Autorite en Sante), based on surveyors proposals and relying mostly on compliance to standards, accreditation decisions are taken by the board of HAS. Accreditation is still perceived by hospitals as a burdensome process and a simplification would be welcomed. The hypothesis was that a more limited number of criteria might give sufficient amount of information on hospitals overall quality level, appraised today by accreditation decisions. Design The accuracy of predictions of accreditation decisions given by a model, Partial Least Square-2 Discriminant Analysis (PLS2-DA), using only the results of FPS and QIs was measured. Accreditation decisions (full accreditation (A), recommendations or reservation (B), remit decision or non-accreditation (C)), results of FPS and QIs were considered qualitative variables. Stability was assessed by leave one out cross validation (LOOCV). Setting and participants All French 489 acute care organisations (ACO) accredited between June 2010 and January 2012 were considered, 304 of them having a rehabilitation care sector (RCS). Results Accuracy of prediction of accreditation decisions was good (89% of ACOs and 91% of ACO-RCS well classified). Stability of results appeared satisfactory when using LOOCV (87% of ACOs and 89% of ACO-RCS well classified). Identification of worse hospitals was correct (90% of ACOs and 97% of ACO-RCS predicted C were actually C). Conclusions Using PLS2-DA with a limited number of criteria (QIs and FPS) provides an accurate prediction of accreditation decisions, especially for underperforming hospitals. This could support accreditation committees which give advices on accreditation decisions, and allow fast-track handling of ‘safe’ reports.

Background Common low back pain represents a major public health problem in terms of its direct cost to health care and its socio-economic repercussions. Ten percent of individuals who suffer from low back pain evolve toward a chronic case and as such are responsible for 75 to 80% of the direct cost of low back pain. It is therefore imperative to highlight the predictive factors of low back pain chronification in order to lighten the economic burden of low back pain-related invalidity. Despite being particularly affected by low back pain, Hospices Civils de Lyon (HCL) personnel have never been offered a specific, tailor-made treatment plan. The PRESLO study (with PRESLO referring to Secondary Low Back Pain Prevention, or in French, PREvention Secondaire de la LOmbalgie), proposed by HCL occupational health services and the Centre Médico-Chirurgical et de Réadaptation des Massues – Croix Rouge Française, is a randomized trial that aims to evaluate the feasibility and efficiency of a global secondary low back pain prevention program for the low back pain sufferers among HCL hospital personnel, a population at risk for recurrence and chronification. This program, which is based on the concept of physical retraining, employs a multidisciplinary approach uniting physical activity, cognitive education about low back pain and lumbopelvic morphotype analysis. No study targeting populations at risk for low back pain chronification has as yet evaluated the efficiency of lighter secondary prevention programs. Methods/Design This study is a two-arm parallel randomized controlled trial proposed to all low back pain sufferers among HCL workers, included between October 2008 and July 2011 and followed over two years. The personnel following their usual treatment (control group) and those following the global prevention program in addition to their usual treatment (intervention group) are compared in terms of low back pain recurrence and the impairments measured at the beginning and the end of the study. The global prevention program is composed of a two-hour information session about low back pain and pain pathways, followed by five weekly 90-min exercise sessions with one physiotherapist per group of eight to ten personnel. A booklet for home use with patient-managed exercise instructions and information (The Back Book) is given to each participant at the end of the program. An X-ray assessment of the entire spinal column of each participant (in both the control and intervention groups) is performed at the onset of the study in order to analyze sagittal spinopelvic balance as well as lombopelvic morphotype. Discussion The results of this study, which is innovative and unique in France, will be available in 2014 and will make it possible to draw conclusions regarding the program’s impact on the risk of recurrence and chronification of low back pain. Trial registration http://www.clinicaltrials.gov # NCT00782925

Cet article a pour ambition de proposer un modele multidimensionnel coherent de la performance hospitaliere. En effet, le secteur hospitalier doit repondre a une performance globale et multidimensionnelle (qualite et securite des soins, utilisation optimale des ressources, productivite, satisfaction du patient, etc.). En France, aucun modele integrant les differentes dimensions de la performance hospitaliere n’a pour l’instant ete instaure alors que l’hopital public est au centre d’enjeux essentiels pour son avenir. Pour construire ce modele, nous nous appuierons d’une part sur une comparaison des systemes hospitaliers de trois pays anglo-saxons et d’autre part, sur une revue des cadres conceptuels et des objectifs qui sous-tendent la mesure de la performance en sciences de gestion, appliquee aux etablissements hospitaliers. Ces recherches permettront de mettre en evidence non seulement l’importance des criteres budgetaires desires par l’Etat mais egalement la satisfaction et la confiance des usagers ainsi que la motivation et l’adhesion du personnel professionnels de sante aux objectifs recherches.

Background: The emergency department has been identified as an area within the health care sector with the highest reports of violence. The best way to control violence is to prevent it before it becomes an issue. Ideally, to prevent violent episodes we should eliminate all triggers of frustration and violence. Our study aims to assess the impact of a quality improvement multi-faceted program aiming at preventing incivility and violence against healthcare professionals working at the ophthalmological emergency department of a teaching hospital. Methods/Design: This study is a single-center prospective, controlled time-series study with an alternate-month design. The prevention program is based on the successive implementation of five complementary interventions: a) an organizational approach with a standardized triage algorithm and patient waiting number screen, b) an environmental approach with clear signage of the premises, c) an educational approach with informational videos for patients and accompanying persons in waiting rooms, d) a human approach with a mediator in waiting rooms and e) a security approach with surveillance cameras linked to the hospital security. The primary outcome is the rate of incivility or violence by patients, or those accompanying them against healthcare staff. All patients admitted to the ophthalmological emergency department, and those accompanying them, will be enrolled. In all, 45,260 patients will be included in over a 24-month period. The unit analysis will be the patient admitted to the emergency department. Data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and patients will not be blinded. Discussion: The strengths of this study include the active solicitation of event reporting, that this is a prospective study and that the study enables assessment of each of the interventions that make up the program. The challenge lies in identifying effective interventions, adapting them to the context of care in an emergency department, and thoroughly assessing their efficacy with a high level of proof. The study has been registered as a cRCT at clinicaltrials.gov (identifier: NCT02015884).