Rev Epidemiol Sante
-
Rev Epidemiol Sante · Dec 2002
Comparative Study[Quality of medical database to valorize the DRG model by ISA cost indicators].
The use of the French version of the DRG model is focused on cost allocation, based on the case-mix system and the use a weight called ISA (Synthetic Index of Activity) for each DRG. However, this administrative database is becoming more and more used by both researchers and health policy makers for health planning and benchmarking. In France, data abstraction and coding of medical records is done by physicians. The objective of this study was to determine the accuracy of a database of the discharge summaries used for DRGs and to compare consequences of inappropriate coding on budget estimation and risk adjustment. ⋯ Discharge summaries used in the French DRGs system consistently underestimate the presence of comorbid conditions, which has direct implications for policy-makers comparing performance between hospital units. Both clinical practitioners and policy makers should be aware of this bias when assessing patient's quality of care or performing health planning through discharge summaries.
-
Rev Epidemiol Sante · Dec 2002
Comparative Study[Macro-economic calculation of spending versus micro-economic follow-up of costs of breast cancer].
In the healthcare field, the ability to make economic forecasts requires knowledge of the costs of caring for major diseases. In the case of a semi-chronic condition like cancer, this cost covers all the episodes of care associated with a patient. An evaluation of a macro-economic method of calculating costs for treating non-metastatic cancer, covering all hospital episodes, is proposed. This method is based entirely on the use of annual hospital activity databases, linked to data concerning the incidence of cancer. It allows us to obtain the global cost of care for a neoplasm of a particular site, without the need to reconstruct the whole care pathway of the patients. ⋯ This method may be extended to all types of neoplasms. This method cannot be used instead of follow-up studies, for cost-efficacy or cost-severity analysis, but may be interesting beyond economic forecasts, in the field of payment per pathology.
-
Rev Epidemiol Sante · Oct 2002
[The contribution of multilevel models in contextual analysis in the field of social epidemiology: a review of literature].
Using contextual factors beyond individual factors, contextual analysis allows a more accurate identification of at-risk populations, which could be useful when planning health programs. Multilevel models, widely used in British and North-American social epidemiology research but less frequently in France, are particularly suitable to analyse contextual data, because they take into account their hierarchical structure. This paper addresses methodological issues in the utilization of multilevel models, and reports some results which illustrate their potentials compared to those of more conventional statistical methods. ⋯ Multilevel models can also help examine whether the between-group variations affect all the members of the groups, or only specific sub-groups. Finally, they can estimate how much of this complex between-group variability is explained by the contextual factors included in the model. The overall conclusion is that multilevel statistical methods should be used in social epidemiology studies dealing with individual and contextual data, to produce results that are both richer and more consistent.
-
Rev Epidemiol Sante · Apr 2002
[The precautionary principle applied to lung cancer risk caused by residential radon].
Residential radon seems to represent a major health hazard. The studies, which investigate the pulmonary risk of cancer caused by radon, are of different nature and their results are divergent. Thus, there persist scientific uncertainties concerning the real size of this risk. ⋯ Precautionary principle is based on the debated hypothesis of no threshold linear relation between radon exposition and health consequences. This relation has been established on professional and residential exposures. The implementation of this epidemiological model shows the "residential radon" risk as the second cause of pulmonary cancer and responsible of about 10% of these specific cancers.