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Gérard, Olivier. "LORH : outil pour la planification du parcours patient dans le milieu hospitalier". Electronic Thesis or Diss., Amiens, 2022. http://www.theses.fr/2022AMIE0060.
Pełny tekst źródłaIn this thesis, we studied a problem of patient care planning, proposed by the Evolucare Technologies company. The company aims to provide a software capable of producing schedules that respect the various constraints and meet the needs of patients and care teams. The LORH project is Evolucare's answer to this issue. We studied the problem and proposed several resolution methods. This NP-hard problem is close to the Resource Constraint Project Scheduling Problem (RCPSP), a well-known problem in the literature. We first formally described the problem and developed the objective function. Our first approach is a 0-1 linear programming model incorporating all variables and constraints of our problem. The initial solutions required for other resolution methods were obtained with a randomized construction algorithm named LORH_RCA. Our second approach LORH_ALNS is a local search based on Adaptive Large Neighborhood Search (ALNS) using a set of moves specifically designed for this problem. We then proposed a genetic algorithm LORH_GA with crossover and mutation operators designed for our problem. The last method named LORH_GADM is also a genetic algorithm with solution diversity management in order to reduce the early convergence to local optimums. We evaluated these approaches on a set of instances generated from problems reported by Evolucare. The linear programming model implemented under CPLEX allowed us to obtain optimal solutions on some instances. We then obtained with LORH_ALNS additional optimal solutions and better upper bounds for all our instance families. These results were successively improved by LORH_GA and LORH_GADM with a gain of 16.42% between LORH_ALNS and LORH_GADM. We also evaluated LORH_ALNS, LORH_GA and LORH_GADM on the RCPSP literature instances and obtained an average difference of 5.4% with the optimal solutions with LORH_GA and LORH_GADM
Jaffré, Marc-Olivier. "Connaissance et optimisation de la prise en charge des patients : la science des réseaux appliquée aux parcours de soins". Thesis, Compiègne, 2018. http://www.theses.fr/2018COMP2445/document.
Pełny tekst źródłaIn France, the streamlining of means assigned hospitals result in concentration of resources ana growing complexily of heallhcare facilities. Piloting and planning (them turn out to be all the more difficult, thus leading of optimjzation problems. The use of massive data produced by these systems in association with network science an alternative approach for analyzing and improving decision-making support jn healthcare. Method : Various preexisting optimisation are first highblighted based on observations in operating theaters chosen as experirnentai sites. An analysis of merger of two hospitlas also follows as an example of an optimization method by massification. These two steps make it possible to defend an alternative approach that combines the use of big data science of networks data visualization techniques. Two sets of patient data in orthopedic surgery in the ex-Midi-Pyrénées region in France are used to create a network of all sequences of care. The whole is displayed in a visual environment developed in JavaScript allowing a dynamic mining of the graph. Results: Visualizing healthcare sequences in the form of nodes and links graphs has been sel out. The graphs provide an additional perception of' the redundancies of he healthcare pathways. The dynamic character of the graphs also allows their direct rnining. The initial visual approach is supplernented by a series of objcctive measures from the science of networks. Conciusion: Healthcare facilities produce massive data valuable for their analysis and optimization. Data visualizalion together with a framework such as network science gives prelimiaary encouraging indicators uncovering redondant healthcare pathway patterns. Furthev experimentations with various and larger sets of data is required to validate and strengthen these observations and methods
Cazin, Léo. "Regrouper pour mieux gouverner ? : Le cas des hôpitaux publics français". Thesis, Paris Sciences et Lettres (ComUE), 2017. http://www.theses.fr/2017PSLEM013/document.
Pełny tekst źródłaAs in most of developed countries, French public hospitals are facing several challenges: shortage of medical resources, development of new care practices, as well as recurrent reforms introducing new financing or governance rules. The fragmented organization of the hospital network, which is made up of nearly a thousand public institutions, makes it difficult to implement a large-scale transformation that would meet these multiple constraints.In such a context, the latest healthcare law (2016) now requires all public hospitals in France to join a Territorial Hospital Group (THG). THGs come after a series of instruments that aimed at reorganizing the territorial hospital organisation, with mixed results up to now. This new reform has aroused many questions regarding its objectives and implementation conditions. Indeed, it contrasts with the strong state-control trend that had prevailed so far, by giving local actors a large amount of autonomy.The thesis is based on the analysis of this reform through a multiple case study. The main ambition of this work is to question the inclusion of the THG law in a new public action paradigm.Despite its apparently relatively vague objectives, I show that this reform is a real break in public action, as it aims at initiating local exploration dynamics around new territorial organizations. This approach corresponds to a new governmentality regime, providing actors with specific objects of government, such as care pathways, capable of triggering collective learning through the creation of exploration partnerships. However, due to remaining inconsistencies in the government’s action, the trajectories of these THGs appear to be very heterogeneous. Therefore, I suggest several recommendations for the management of these exploration dynamics, as well as for consistent public action engineering, in order to carry out such new orientations
Duflos, Claire. "Les parcours de soins des insuffisants cardiaques : de leur mesure à leur utilisation". Thesis, Montpellier, 2018. http://www.theses.fr/2018MONTT065/document.
Pełny tekst źródłaHeart failure is a frequent and serious chronic pathology, whose evolution is peppered with decompensations that usually require hospitalization. Despite clear scientific recommendations (treatment of etiology and co-morbidities, early symptomatic treatment of decompensations, specific treatment for cases with decreased ejection fraction), the organization of the health system does not promote optimal delivery of recommended care. The literature reports that the delivery of care, as well as the content of delivered care, vary widely from one environment to another, with an impact on the risk of rehospitalization. Therefore, improving the quality of care needs to describe the delivery modalities and the content of care, that is to say, the care pathway. The methods of describing these pathways are rare and non-consensual. The aim of this thesis is to propose methods for describing care pathways, with the aim of offering support for clinical and public health decision-making. Two studies are carried out on two very different bases: an ambulatory and hospital medico-administrative database on a regional scale, and a monocentric clinical hospital database. These two studies highlight, using a hierarchical ascending classification on principal components, easily interpretable groups of patients. In particular, they each show two groups whose clinical characteristics are similar, but whose management is very different; a low level of care is associated with an poor prognosis. The methodology used in these studies is discussed in light of the literature, and the opportunities offered by the findings in terms of research, clinical practice, and public health are explored
Franck, Thomas. "Modélisation, analyse et pilotage des parcours des personnes âgées en soins aigus et sur le long terme". Thesis, Lyon, 2018. http://www.theses.fr/2018LYSEM014.
Pełny tekst źródłaThe growing number of dependent elderly people is one of the major issues in France for the coming years. The elderly healthcare pathway is complex because many factors can disrupt the various decision-making. Indeed, dependence, chronic diseases or even the social environment are to be taken into account during a hospitalization or placement over the long term. The care path of the elderly is divided into two parts: (i) acute hospitalization and (ii) long-term care. We first studied the problems related to acute hospitalization with case studies in collaboration with the University Hospital of Saint-Etienne. The first topic concerns the organization of geriatric services, we use discrete event simulation to evaluate the relevancy of an integrated configuration (Acute Care and Rehabilitative Care are the same service). In the same way we evaluate the setting up of a hotline allowing a direct contact between community doctors and the Geriatric Hospital, the goal is to avoid the systematic use of the Emergency Department. We then study long-term care pathways by modeling the states of health of the elderly according to three criteria (degree of dependence, degree of chronic pathologies and degree of social isolation). A Markov chain is used to represent transitions between states. A simulation model is used to determine the size of a territory. Finally, we are interested in optimize patient flows in residential long-term care facilities (EHPAD, USLD) with a stochastic optimization model
Hamana, Sabri. "Modélisation et simulation des flux d'informations Ville-Hôpital et évaluation de leur impact sur le parcours de soins". Thesis, Lyon, 2017. https://tel.archives-ouvertes.fr/tel-02873368.
Pełny tekst źródłaThe French health policy which aim to improve health system by the modernization of health information systems has created a latent need, that of measurement of the impact of information systems on the value creation within healthcare institutions, hence the need of tools and methods for carrying out this evaluation work.The aim of this thesis is to propose a framework for the modelling, analysis and cost evaluation of territorial health-care information systems. For this purpose, we propose a new class of timed Petri nets, called THIS nets (Territorial Health-care Information Systems), which formally describes patient care-pathways, relevant information flows and their interactions. THIS nets are then used for verification of the health information systems and evaluation of their performances such as cycle time distribution and probability of information availability at some target time. A real example of cancer patient health-care information system is used to illustrate the usefulness of the proposed approach. We show that advanced information system allows earlier start of the medical consultations and thus a more efficient care pathway. A case study is proposed through a cost-effectiveness analysis on Electronic Health Record (EHR) implementation versus the patient's paper file in the context of cancer visits. Results show that the adoption of the developed HIS strictly dominated (i.e., was both less costly and more effective) the use of a low HIS with the patient's paper file. Such positive impact was demonstrated on the long term through a service quality analysis using the provided THIS net
Vuagnat, Albert. "Peut-on utiliser les données du programme de médicalisation du système d'information pour décrire les parcours de soins?" Thesis, Bourgogne Franche-Comté, 2020. http://www.theses.fr/2020UBFCI013.
Pełny tekst źródłaThe French medical information system program (PMSI) defines the item and format all hospitals and clinics in France have to use for claim data: diagnoses, medical procedures, patient, structure and stay characteristics, this for any hospital stay. These medical records abstracts are linked by means of a salted SHA-1 hash of social security number, date of birth and gender. Hash is generated by an unique software, used by all hospitals and clinics, that also calculates a delay in days since, for privacy reasons, no dates of hospital admission are mentioned in the abstracts. The data are gathered in a national database. This collection of linked abstracts designed for funding, could also be used to describe medical history and hospital outcome. The aim of the present work is to assess the quality of the linkage information and its potential contribution to medical knowledge. The first step was to assess quality of linkage information. This was found appropriate and consistent as a result of uniform generating process that relied on well know and standardized information. The second step was to shape the database in order to derive hospital outcome. Finally, this was used in to settings, readmission after surgery, one-year follow-up after non-fatal self-harm. To conclude this national linked claim database appears as suited for hospital outcome measurement. Access to the database has to comply with regulation defined by the committee on informatics and civil rights (CNIL)
Maunoury, Franck. "Évaluation médico-économique de la réforme de l'Assurance maladie du 13 août 2004 : application au parcours de soins coordonnés de patients chroniques traités par corticostéroïdes inhalés". Phd thesis, Université Claude Bernard - Lyon I, 2009. http://tel.archives-ouvertes.fr/tel-00679327.
Pełny tekst źródłaMaunoury, Franck. "Évaluation médico-économique de la réforme de l’Assurance maladie du 13 août 2004 : application au parcours de soins coordonnés de patients chroniques traités par corticostéroïdes inhalés". Thesis, Lyon 1, 2009. http://www.theses.fr/2009LYO10193/document.
Pełny tekst źródłaThe objective of this thesis is to conceptualize, starting from the exploitation of the refunding data of cares from the Sickness insurance, the various trajectories of cares recourses introduced by chronic diseases as asthma, and to study their determinants by analysing the profile and the subsequent behavior of the general practitioner. The study of the relation between the prescriptive behavior and the trajectory of cares is carried out by different multivariate analyses. The other objective is to evaluate, from a pharmacoeconomic point of view, the impact of the general practitioner characteristics on the various trajectories of cares followed by the patients with chronic diseases. The characteristics likely to identify a typology of practitioners correspond to the variables influencing the prescriptive behavior (age, sex, duration of exercise, type of exercise, etc). The principal question of the thesis is that of the regulating effect of the economic incentive, rested on the coordinated care pathway (reform of the Sickness insurance, August 2004), on the trajectories of cares, really observed by the chronic patients. The corollaries are: Does the no-reimbursement of some medical acts, not considered in the coordinated care pathway, have a significant impact on the empirical recourse of the patient? Does the profile of the general practitioner have an effect on the respect or not of the allowed trajectory of cares classified by the French reform? Which are the principal determinants of disregarding this referential trajectory, by notably analysing the “practitioner - patient” characteristics?
Ferrera, Bibas Félicia. "La création collective de sens peut-elle favoriser la fabrique d'un dispositif d'action organisée ? : cas du parcours de la personne âgée". Electronic Thesis or Diss., Aix-Marseille, 2015. http://www.theses.fr/2015AIXM1098.
Pełny tekst źródłaWe are trying to understand and experiment with the creation of a collective action program that is coordinated around approved health care pathways. This program is called CareHolder, and is based in an area not far from a large city in the Provence-Alpes-Côte d’Azur region. It distinguishes itself for its governance, tools, activities, and for its key players marked by their diversity, without any predefined organizational links and without a higher authority requiring them to work together. By relying on the perspectives of sensemaking and sensegiving (Weick), we have stated the hypothesis that the collective sensemaking process is at the root of a social structure organized ex-nihilo. We shall analyze this process on two analytical levels: 1) the unfolding of the collective sensemaking process as the development of a social process based on giving sense to a collective healthcare program (Therapeutic Patient Education), and 2) the role of the sensegiver in its capacity to support the “CareHolder”. The Therapeutic Patient Education is here envisaged both as a therapeutic tool and as a managerial tool. We have analyzed the emergence and the implementation of the CareHolder over several years. Our main results have highlighted the three skills of the sensegiver during the collective sensemaking process: 1) bringing the players together, 2) promoting equivocality to encourage and clarify an outlook, and 3) being able to anchor what emerges from the relations by relying on ritualistic elements and enabling the players to ‘settle into’ this new collective working environment with the patient. We propose empirical recommendations and future research paths
De, oliveira Hugo. "Modélisation prédictive des parcours de soins à l'aide de techniques de process mining et de deep learning". Thesis, Lyon, 2020. http://www.theses.fr/2020LYSEM021.
Pełny tekst źródłaInitially created for a reimbursement purpose, non-clinical claim databases are exhaustive Electronic Health Records (EHRs) which are particularly valuable for evidence-based studies. The objective of this work is to develop predictive methods for patient pathways data, which leverage the complexity of non-clinical claims data and produce explainable results. Our first contribution focuses on the modeling of event logs extracted from such databases. New process models and an adapted process discovery algorithm are introduced, with the objective of accurately model characteristic transitions and time hidden in non-clinical claims data. The second contribution is a preprocessing solution to handle one complexity of such data, which is the representation of medical events by multiple codes belonging to different standard coding systems, organized in hierarchical structures. The proposed method uses auto-encoders and clustering in an adequate latent space to automatically produce relevant and explainable labels. From these contributions, an optimization-based predictive method is introduced, which uses a process model to perform binary classification from event logs and highlight distinctive patterns as a global explanation. A second predictive method is also proposed, which uses images to represent patient pathways and a modified Variational Auto-Encoders (VAE) to predict. This method globally explains predictions by showing an image of identified predictive factors which can be both frequent and infrequent
Cardoso, Sonia Filomena. "Apports de la modélisation ontologique pour l’analyse des ruptures de parcours de soins dans la Sclérose Latérale Amyotrophique". Thesis, Sorbonne université, 2019. http://www.theses.fr/2019SORUS587.
Pełny tekst źródłaPatients with ALS require multidisciplinary support during their course. Pathology causes many disabilities and disabilities. This complex management can lead to situations of course failure through absence, cessation or difficulties of management, however the causes of these breaks are not known. The city hospital coordination network SLA Île-de-France has a textual coordination base, on which the needs and demands of patients are described throughout their journey. To this end, we propose to analyze this basis in order to extract knowledge and describe the patient pathways. For this we use a semantic annotation tool that uses as a resource an ontology of the domain that we have created OntoParon. OntoParon is a modular ontology composed of a medical module, a socio-environmental module, a coordination module, a core module and a consolidation module. These ontological modules make it possible to take into account the dimensions involved in patients' journeys. Defined concepts, reporting on important themes such as the exhaustion of the caregiver or even the presence of social problems were created to detect the difficulties encountered. The annotation of 931 patient files has shown that not all patients have the same needs or the same demands, some themes are expressed differently depending on the age, the pathology or the lifestyle of the patients
Fave, Levert Sophie. "Parcours de soins des patients atteints de maladie rénale chronique : place et éthique des réseaux de santé ?" Thesis, Lyon 1, 2013. http://www.theses.fr/2013LYO10081/document.
Pełny tekst źródłaChronic diseases necessarily imply partnership between patients and medical team. The health care system is directed towards secondary prevention and the preservation of quality of life. Chronic kidney disease is a public health priority by its prevalence, diabetes and cardiovascular comorbidities, specific care as dialysis or transplantation, economics and impact on patients’ way of life. Guidelines encourage early therapeutic care plan. Renal care networks aim at raising awareness of kidney disease detection, coordinate and promote multidisciplinary follow-up and connections between hospitals and ambulatory care. This work analyses the role of renal care networks in France. A survey on access to care and care plan running supports shows a strong heterogeneity in their organisation and management. While international literature describes the positive effect of such supported care management on evolution of renal function and quality of life, using renal care networks by professionals and patients remains uncertain. The study suggests promoting supporting patients in care management and globalizing practices through training, multidisciplinary approach and pedagogic attitude. Every plan of life has to integrate all morbidities in a same coordinated and evaluated care plan
Vialard, Lucie. "Accès aux soins et parcours thérapeutiques du cancer du sein : l’exemple de la région Ile-de-France". Thesis, Paris 10, 2019. http://www.theses.fr/2019PA100130.
Pełny tekst źródłaBreast cancer is the most frequent cancer for women in France. It has now been demonstrated that the risk factors for reporting and dying from this cancer, for participating in screening and prevention programs as well as for accessing quality care, depend on social characteristics. The existence of geographical disparities in incidence, screening participation and mortality has also been documented, depending on where women live. The objective of this research is to analyse the construction of inequalities in access to care during the period of the breast cancer healthcare pathway, in the vast urban area of the region of Paris (France). This is the first research in health geography to simultaneously question the roles of the individual characteristics of women (recorded in the anonymized databases of the French Health Insurance) and the urban dynamics specific to their residential environment, in the genesis of the inequality process in the treatment of breast cancer. The results highlight spatial disparities in the treatment sequences of women treated for invasive cancer. Other disparities also exist for access to surgical innovation, out-of-pocket expenses and delays in access to adjuvant treatment. Finally, our results show the existence of geographical inequalities in access to supportive care and quality of life during the healthcare pathway of breast cancer, when women reside far from the care centre and are cared for the entire healthcare pathway in this hospital
Gozlan, Guy. "Améliorer la coordination dans le champ sanitaire et médico-social pour limiter le risque de handicap psychique. Etude du cas Prépsy". Thesis, Versailles-St Quentin en Yvelines, 2015. http://www.theses.fr/2015VERS012S/document.
Pełny tekst źródłaImproving Global Health of young people with chronic disease requires the implementation of innovative medical and managerial strategies based on the coordination of care, integration of services and case management. This work studies the contributions of a new form of hybrid organization developed by Prepsy, serving users in complex situations, with schizophrenia suffering in the form of an intensive collaborative personalized support in the natural environment, to limit the bio-psycho-social impact and the risk of mental disability by maintaining the life course. It highlights the organizational and strategic conditions for success of this type of organization in order to refine the model to better suit the needs of the people concerned and their families
Giusti, Igor. "Changer d’angle de vue pour concevoir autrement l’action publique ? Le cas des déserts médicaux au prisme des parcours de soins". Thesis, Université Paris sciences et lettres, 2020. http://www.theses.fr/2020UPSLM054.
Pełny tekst źródłaThis dissertation deals with the concept of medical desert. Despite widespread use of the word by the media and political representatives, identifying medical deserts is far from easy for public authorities. Spotting inequalities in access to health services requires to identify users’ needs wherever they live. However, health needs are individualized. Besides, an individual does not fully know his needs. We must therefore understand how public authorities themselves appreciate this object and how they design actions accordingly to regulate care access. This is our purpose in this dissertation. We led an action research with the Regional Health Agency of Corsica in order to analyze how public actions are designed to regulate care access inequalities. We show in particular how the care pathway approach can highlight the diversity of inequalities in a medical desert thanks to a more global modeling of health needs. Fighting medical deserts is no longer limited to guaranteeing the presence of health professionals locally. It also relies on ensuring equality between citizens in the continuity of their care pathway. Yet, territories and individuals specificities suggest a strong heterogeneity between these pathways, which is difficult to manage at a national level. We then evaluate feasibility of a bottom-up innovative public action to reduce inequalities in care access. Through a slow, fragile and complex process, local actions can still address territorial specificities without ignoring a national regulatory and institutional framework. However, multiplying these proximity experiments requires new national-level criteria to select and rank projects. Hence, we recommend methods often used to manage the exploration of the unknown
Prodel, Martin. "Modélisation automatique et simulation de parcours de soins à partir de bases de données de santé". Thesis, Lyon, 2017. http://www.theses.fr/2017LYSEM009/document.
Pełny tekst źródłaDuring the last two decades, the amount of data collected in Information Systems has drastically increased. This large amount of data is highly valuable. This reality applies to health-care where the computerization is still an ongoing process. Existing methods from the fields of process mining, data mining and mathematical modeling cannot handle large-sized and variable event logs. Our goal is to develop an extensive methodology to turn health data from event logs into simulation models of clinical pathways. We first introduce a mathematical framework to discover optimal process models. Our approach shows the benefits of combining combinatorial optimization and process mining techniques. Then, we enrich the discovered model with additional data from the log. An innovative combination of a sequence alignment algorithm and of classical data mining techniques is used to analyse path choices within long-term clinical pathways. The approach is suitable for noisy and large logs. Finally, we propose an automatic procedure to convert static models of clinical pathways into dynamic simulation models. The resulting models perform sensitivity analyses to quantify the impact of determinant factors on several key performance indicators related to care processes. They are also used to evaluate what-if scenarios. The presented methodology was proven to be highly reusable on various medical fields and on any source of event logs. Using the national French database of all the hospital events from 2006 to 2015, an extensive case study on cardiovascular diseases is presented to show the efficiency of the proposed framework
Roux, Jonathan. "Parcours de soins des patients atteints de sclérose en plaques à partir des données médico-administratives en France". Thesis, Rennes 1, 2018. http://www.theses.fr/2018REN1B042/document.
Pełny tekst źródłaMultiple sclerosis (MS) is a chronic neurological disease starting in young adulthood and affecting about 100,000 persons in France. During the last two decades, therapeutic practices have evolved with the release of new substances, especially oral disease-modifying therapies (DMTs). Care pathways in MS involve both medical (general practitioners, neurologists) and paramedical (physiotherapists and nurses) health care professionals. However, no recommendation on care pathways in MS exists so far in France. Moreover, few data are available on care-seeking of persons with MS (PwMS) and the utilization of DMTs in France. The use of state sequence analysis (SSA) on data issued from the French National Health Data System (SNDS, i.e. databases from the French Health Insurance System) offers the opportunity to study care pathways. The main objective of this PhD thesis was to study the care pathways of PwMS in France using data from SNDS, in order to describe care-seeking and to create a typology of pathways. The secondary objectives were to study MS DMTs utilization in France (frequency and therapeutic sequences), and the feasibility to measure the level of motor disability in SNDS. Over the 2010-2015 study period, 112,745 PwMS were identified. Amongst them, 47.4% had at least one delivery of a MS-specific DMT. A typology was obtained allowing the identification of five clinically distinct groups of patients. In parallel, a parameter quantifying the level of motor disability in SNDS, which could be replicated in other studies, was defined. Thanks to the different analyses and raised methodological questions, key-elements allowing the use of SSA in health field, especially multichannel sequence analysis, were highlighted
Opatowski, Marion. "Résistance bactérienne aux antibiotiques, apport du système national des données de santé Hospitalisations with infections related to antimicrobial-resistant bacteria from the French nationwide hospital discharge database, 2016". Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPASR006.
Pełny tekst źródłaThe massive use of antibiotics in human and veterinary medicine has led to a significant increase of bacterial resistance to these drugs, making infections more difficult to treat. Antimicrobial resistance has become a major public health issue, which is why many action plan have been implemented at national and global scales. This thesis aims to analyze and measure the epidemiological and public health impacts of bacterial resistance to antibiotics based on the French national medico-administrative databases of health insurance (SNDS). First, an assessment of antimicrobial resistance in France was carried out. It was estimated that resistant bacteria caused 139 105 (95% CI 127 920–150 289) infections in 2016, resulting in a 12.3% (95% CI 11.3–13.2) resistance rate, and 2.52 hospitalizations for 1 000 patient-days. Then, risk factors for the acquisition resistant organisms were examined in the context of hospitalized urinary tract infections. A matched case-control analysis was conducted. This study point out the critical window of 3 months before the hospitalization of interest, the impact of broad-spectrum antibiotic consumption, urological procedures (of which prostate biopsy) and long intensive care unit stays on antibiotic resistance. Finally, the repercussion of antibiotic resistance were studied, by comparing the care pathways that follow bone and joint infections on prosthesis. A sequence analysis was conducted on a matched exposed-non exposed sample, and 6 typical care pathways were provided. Then, the use of a multinomial logistic regression allowed to compare the effect of resistance on care pathways
Ferrera, Bibas Félicia. "La création collective de sens peut-elle favoriser la fabrique d'un dispositif d'action organisée ? : cas du parcours de la personne âgée". Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM1098/document.
Pełny tekst źródłaWe are trying to understand and experiment with the creation of a collective action program that is coordinated around approved health care pathways. This program is called CareHolder, and is based in an area not far from a large city in the Provence-Alpes-Côte d’Azur region. It distinguishes itself for its governance, tools, activities, and for its key players marked by their diversity, without any predefined organizational links and without a higher authority requiring them to work together. By relying on the perspectives of sensemaking and sensegiving (Weick), we have stated the hypothesis that the collective sensemaking process is at the root of a social structure organized ex-nihilo. We shall analyze this process on two analytical levels: 1) the unfolding of the collective sensemaking process as the development of a social process based on giving sense to a collective healthcare program (Therapeutic Patient Education), and 2) the role of the sensegiver in its capacity to support the “CareHolder”. The Therapeutic Patient Education is here envisaged both as a therapeutic tool and as a managerial tool. We have analyzed the emergence and the implementation of the CareHolder over several years. Our main results have highlighted the three skills of the sensegiver during the collective sensemaking process: 1) bringing the players together, 2) promoting equivocality to encourage and clarify an outlook, and 3) being able to anchor what emerges from the relations by relying on ritualistic elements and enabling the players to ‘settle into’ this new collective working environment with the patient. We propose empirical recommendations and future research paths
Domingo, Hugues Renaud. "Valeur des soins et maladies chroniques : applicabilité du Time Driven Activity Based Costing (TDABC)". Thesis, Montpellier, 2018. http://www.theses.fr/2018MONTD034.
Pełny tekst źródłaThis thesis questions the applicability of the TDABC in the health sector in France with a context marked by changes in recent years: rising of chronic diseases, budget restrictions, reforms, questioning of the financing system (DRG) . By mobilizing the conceptual framework of the value of care, two action research projects are conducted respectively on hospital health mediation and the stroke care pathway. According to the criteria of simplicity and precision of costing methods, the literature suggests that TDABC is suitable for cross-sectoral approaches and the health sector. The results show the applicability of the TDABC and other contributions including the inclusion in the time equations of certain cost variations related to the diversity of care pathways and changes in treatment, a possible simplification by the Pareto law, a toolunderstandable by health professionals and stimulating dialogue, simulation of the "hidden costs" of the unavailability of resources and bottlenecks. However, several questions remain, nuancing the possibility of its generalization in the state and questioning the conceptual framework of the value, notably the estimation of the time and the non quantifiable as the value of the care
Heren, Le Bastard Claire. "Evaluation de la perception et de l’adaptation au handicap auditif ou visuel chez l’adulte : validation de questionnaires spécifiques et études cliniques". Thesis, Angers, 2021. http://www.theses.fr/2021ANGE0071.
Pełny tekst źródłaHandicap assessment makes it possible to identify specific needs and then to target adapted therapeutic recommendations (medical, technical, rehabilitation and psycho social). The specific work of this thesis aimed at the development of questionnaires to assess perception and adaptation to hearing and visual handicap in adults, the validation of these questionnaires and their clinical application: the QUEPAHAA (Questionnaire for the Assessment of Perception and Adaptation of Hearing Handicap in Adults) and the QUEPAHVA (Questionnaire for the Assessment of Perception and Adaptation of Visual Handicap in Adults). The statistical results have attested to their good psychometric qualities. Our study continued with their clinical application. The results showed the significant effects of a multidisciplinary care program on the perception and adaptation to sensory handicap.Then, we carried out the study of two individual cases. Clinical interviews and questionnaires showed improvement in handicap adaptation and mood following multidisciplinary care program. New interdisciplinary questionnaires, QUEPAHAA and QUEPAHVA cover a diagnostic, therapeutic and institutional interest. In addition to allowing a better understanding of people, these questionnaires can be integrated into professional practices, care protocols or clinical research
Imbaud, Claire. "Influence des technologies de santé dans les parcours de soins des personnes âgées : quel plateau médico-technique ? : éléments de réponse par l’analyse des données de santé". Thesis, Compiègne, 2017. http://www.theses.fr/2017COMP2380/document.
Pełny tekst źródłaThis work questions the answer to be given in terms of organization of the health technical offer and its fair distribution in the territories especially for the elderly patients with multimorbidities. It is based on the assumption that there is space for a concept of small multi-disciplinary outpatient health facilities, with a small health-technical platform, which would help to streamline and optimize care pathways. The method consisted on the one hand to study in Germany smaller community interdisciplinary health care center (the MVZ) in operation for a longer time than the the French multidisciplinary médical care centers. And on the other hand it analyzed the national heath data to reveal both the existence of comorbidités related groups and homogeneous care pathways related groups. The results are positive, both in network science analysis and in the automation of representations of complex care pathways. They made it possible to create representative patterns of groups, to characterize the consumption of care, in terms of medical devices and human resources, to quantify the cumulative distances traveled and the costs accumulated by patients according to their place of residence and the health institutions to which they are sent. We get addition elements for the definition and labeling of small community health centers, satellite of larger hospitals. This work represents a particularly useful step, both conceptual and practical, for complex health data studies of elderly
Clairet, Anne-Laure. "Gestion des risques médicamenteux dans des contextes spécifiques : typologie et épidémiologie". Thesis, Bourgogne Franche-Comté, 2019. http://www.theses.fr/2019UBFCE020.
Pełny tekst źródłaThe medical management of a patient is a multidisciplinary process consisting of several stages: prescription, dispensation, administration. Securing the medical management of a patient is essential to control the iatrogenic risk. In France, for all causes, nearly 6.2 serious adverse events occur per 1000 days of hospitalization (9.2 in surgery and 4.7 in medicine), or about one serious adverse event every five days in a hospital ward with 30 beds. Medication errors would be estimated at nearly 60,000 to 130,000 per year, nearly half of which would be preventable.Clinical pharmacy is a health discipline focused on the patient whose exercise aims to optimize the therapeutic management at each stage of the care pathway. For this, clinical pharmacy acts contribute to the security, relevance and efficiency of the use of health products.The objectives of this thesis are to describe the pharmacist's role in the prevention and management of medication errors through the example of two unique care pathways and the management of a patient in a particular care context:- the care pathway of the patient initiating oral anticancer treatment;- the path of care of the elderly subject:o the role of the hospital pharmacist in the care and continuity of the elderly patient's care during acute hospitalization in a geriatric ward;o the training of community pharmacists in the preparation of outpatient medication reports and feedback on their implementation;- the hospitalization of a patient in intensive care unit.This work allows the synthesis of 3 examples related to the complexity of the care of the patients within the care pathways or in particular care contexts:- Acute management of a patient with chronic illness in a medical resuscitation department;- Chronic management of a medical oncology patient during the initiation of oral anticancer treatment;- The hospital and outpatient care of a polyp old patient.Drug risks differ according the type of treatment. Thus, the main risk identified during a first prescription of an oral anticancer drug is the self-medication of the patient. In intensive care, the pharmacist must be expert in order to be able to answer certain problems not seen in other conventional wards. New missions are entrusted to community pharmacists, especially in the care of the elderly.Faced with these new missions of the pharmacist and in view of the expertise required of a pharmacist in specialized care services (oncology, Intensive care unit for example), it is necessary to evolve some university education
Cohen, Sarah. "Apport et utilisation des bases de données médico-administratives dans l’étude des problématiques émergentes chez les patients adultes atteints de cardiopathie congénitale Administrative health databases for addressing emerging issues in adults with CHD: a systematic review Accuracy of claim data in the identification and classification of adults with congenital heart diseases in electronic medical records Exposure to low-dose ionizing radiation from cardiac procedures and malignancy risk in adults with congenital heart disease". Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCB228.
Pełny tekst źródłaCongenital heart diseases (CHD) are the most common types of birth defects and affect approximately 1% of births. Ninety percent of children born with CHD reach now adulthood thanks to improvements of pediatric cardiology and cardiac surgery. These "survivors" are not definitively cured. They are prone to cardiac or extra cardiac complications and specific issues that justify an increase in consumption of healthcare. The need for population-based studies worldwide has led to secondary analyses of administrative medical databases (AMD). The objective of this thesis was to study the conditions of use of the AMD and their possible applications, specifically to understand the emerging issues of this new adult population with CHD (ACHD). The first part of this work was to systematically describe all the studies that had used AMD to specifically explore the issues of ACHD patients. This review showed the value of these databases in the field of ACHD: the large numbers of patients allows studying relatively rare diseases and the availability of comprehensive data over long periods of follow-up enables to study cardiac and extra cardiac complications even when the occurrence is delayed. In France, claim databases use the International Classification of Diseases, 10th revision (ICD-10), the reliability of which is still largely unknown in this context. The second part of this work was therefore to study the performances of ICD-10 to identify and classify ACHD patients in the data warehouse of the Georges Pompidou European Hospital which has a dedicated specialized ACHD Unit. The third part of this thesis reported a concrete example of the use of AMD. Based on the Quebec Congenital Heart Disease Database derived from Quebec’s AMD, our goal was to evaluate the association between exposure to ionizing radiation from cardiac procedures and the risk of cancer in ACHD. Indeed, the improvement in the life expectancy of patients with CHD and the increasing use of cardiac imaging modalities using ionizing radiations may have a carcinogenic effect in the long term. Although not designed for research purposes, this thesis showed that AMD are a particularly relevant tool for generating new knowledge about ACHD patients through the comprehensiveness of information, the possibility of extracting large samples of patients with a longitudinal follow-up over long periods of observation. The exploitation of electronic medical records through text mining methods could then be used to develop and validate algorithms to identify CHD patients in AMD. In France, although efforts have been made to create an effective multi-center collaborative program, there is currently no significant epidemiological data for all ACHDs. Secondary analysis of existing resources, such as the National Health Data System, would establish the national ACHD cohort and analyze their care pathway in order to guide healthcare resources allocation
Benabdejlil, Hajar. "Modélisation des processus de soins : vers une implantation de nouveaux services à valeur ajoutée". Thesis, Bordeaux, 2016. http://www.theses.fr/2016BORD0411/document.
Pełny tekst źródłaToday, the actors of public health face many challenges related to the ever-changing needs of an aging population and the increasing number of chronic diseases.These needs and the related cost, lead to rethink the care management and rationalize the patient healthcare pathways to make them more efficient.Our thesis work has the following main results.First a general introduction of the health system is presented, followed by an analysis of the evolution of the health system, its principles and its challenges. Next, we provided an overview of trends and organizational innovations in response to these challenges.Secondly, based on a bibliographic, we presented our definitions of pathways (healthcare, health, and life), their relative positioning and their influence on the challenges mentioned above.To model the pathways, we analyzed the concepts mentioned in the preceding definitions and we structured them into a meta-model. Then we used it to enrich an existing enterprise modeling language (GRAI Extended Actigram) and thus obtain a language totally suited to our needs.The latter was used to represent the heathcare processes of two examples of diseases, influenza A (H1N1) and COPD. In the frame of this presentation, methodological aspects were discussed (information resources, translation, etc.).Finally, on the basis of a state-of-the-art of the offered services by current computer platforms, we proposed a methodology for defining value-added services providing an improved access to information and improving the dynamics and efficiency of healthcare based on the modeled healthcare processes
Namaki, Araghi Sina. "A methodology for business process discovery and diagnosis based on indoor location data : Application to patient pathways improvement". Thesis, Ecole nationale des Mines d'Albi-Carmaux, 2019. http://www.theses.fr/2019EMAC0014.
Pełny tekst źródłaBusiness processes are everywhere and, as such, we must acknowledge them. Among all of them, hospital processes are of vital importance. Healthcare organizations invest huge amount of efforts into keeping these processes under control, as the allowed margin of error is so slight. This research work seeks to develop a methodology to endorse improvement of patient pathways inside healthcare organizations. It does so by using the indoor location data of patients. This methodology is called DIAG (Data state, Information state, Awareness, Governance). It is constructed of several different functions. The most important ones are as follows: (i) location data interpreting, (ii) automatic discovery of business process models, (iii) business process analyzing for evaluating the performance and quality of processes, and finally, (iv) automatic diagnosing of business processes. Along the former functions, the contribution of this thesis are: The DIAG methodology which, through four different states, extracts knowledge from location data; the DIAG meta-model which supports both the interpretation of location data (from raw data to usable information) and the alignment of the domain knowledge (which are used for the diagnosing methods); two process discovery algorithms which explore statistical stability in event logs, application of Statistical Process Control (SPC) for the “enhancement notation” of Process Mining; the ProDIST algorithm for measuring the distance between process models; two automatic process diagnosing methods to detect causes of structural deviations in individual cases and common processes. The state of the art in this dissertation endorses the necessity for proposing such solutions. A case study within this research work illustrates the applicability of the DIAG methodology and its mentioned functions and methods
Cantrelle, Christelle. "Le parcours de soin des greffés cardiaques en France : détermination des facteurs associés à leur accès à la greffe". Thesis, Université Paris-Saclay (ComUE), 2018. http://www.theses.fr/2018SACLS063/document.
Pełny tekst źródłaHeart transplantation (HTx) is the preferred option for medically refractory advanced heart failure. Due to the small number of available grafts, current allocation policy in France, as in many other countries, is based on the severity of the candidate’s heart disease. This Ph. D thesis was designed to determine candidate and center factors associated with access to heart transplantation in France and in-hospital care pathways one year before heart transplantation using appropriate methodologies and the national hospital database. We first analyzed 1-year mortality in patients listed for HTx in France from 2010 to 2013 using competing risk models in order to distinguish patient-related predictors and the influence of allocation policy. We then distinguished the proportions explained by candidate characteristics and center factors with the persistent between-center variability on 1-year access to transplantation (2010-2014). These disparities are mediated by the severity of the candidate’s heart disease, the allocation system and listing practices rather than by transplant activity. These findings provide a new contribution to improve the heart transplant allocation scoring system in France. The study based on the nationwide administrative database overcomes a major limitation of the national transplantation registry by shedding light on the healthcare pathway of heart transplanted recipients (2010-2015) during the year prior to transplantation. These findings will be useful to assess the medical benefits and criteria for registration on the heart transplant waiting list. This study will be continued by a detailed analysis of the healthcare consumption of these patients based on French national health insurance (SNDS) data
Benaim, Anne. "Vieillesse et fragilité : le parcours et le devenir des personnes âgées de 75 ans ou plus hospitalisées pour fracture du col du fémur à Strasbourg". Thesis, Strasbourg, 2015. http://www.theses.fr/2015STRAG020/document.
Pełny tekst źródłaIn a context of depressed health-conditions for elderly people, the levels of dependency are rising. It induces deep consequences for the entire health care organisation. For instance, the fractures of the femoral neck (FFN) represent a healthcare challenge regarding their strong impact on patients’ quality of life and on their morbity-mortality. We conducted a qualitative and quantitative study (Jan. 2012- Jan. 2013) within the main department of orthopedic surgery in Alsace in order to track the healthcare paths of 107 patients of 75 years-old or more. Our main conclusion is that patients are poorly involved in the decisions for their care. This is all the more harmful because the FFN is in fact dual. It is both a physical (higher assistance needed) and a symbolic (earlier dependency) breakage. Our interactionist study identifies areas for pragmatic actions in health-care, public policies and ethic that could contribute to absorb / reduce the pernicious effects of this pathology
Lamé, Guillaume. "Intégration entre services hospitaliers : management des opérations en cancérologie". Electronic Thesis or Diss., Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLC027.
Pełny tekst źródłaThis dissertation addresses the challenge of coordinating hospital services. We take an integrated view on care delivery and the various units involved in a care process, with a case study in outpatient chemotherapy process at Henri Mondor hospital, Créteil, France. We tackle three research questions :1. How should a change program in a multi-department setting be designed and managed?2. How can one improve outpatient chemotherapy delivery?3. Why do strategic plans look so disconcerting and disappointing in public academic medical centers, compared to otherindustrial organizations, when similar methods are applied?Our main research method is action-research. During reorganization projects, we adapt and combine methods from operational research and industrial engineering in order to integrate hospitals’ specificities. We propose and evaluate reorganisation methods focused on interdepartmental coordination, and we contribute to a better knowledge of the specific environment of hospitals, which is quite different from the contexts in which industrial engineering traditionally developed
Andrianasolo, Andry Herisoa. "Comportements en cas de fièvre ou de toux dans quatre districts de Madagascar : déterminants et implications pour l’accès à la santé". Thesis, Bourgogne Franche-Comté, 2017. http://www.theses.fr/2017UBFCH008/document.
Pełny tekst źródłaMalaria, tuberculosis and acute respiratory infections constitute a major public health issue in Madagascar, the first two of which are the subject of national control programs largely inspired and financed by international organizations. The diagnostic, therapeutic and preventive methods recommended officially in the conventional health system are standardized and are based on a solid corpus of scientific knowledge. Among other diseases, they are explicitly targeted by the universal sustainable development goals (SDG). To reach them, the United nations recommend the implementation of an universal health coverage (UHC). Madagascar has adopted the SDG and is committed to the implementation of a UHC. The acceptance and implementation of these disease management methods depend on logistical and organizational factors, but also on the beliefs and practices of individuals, families and social or professional groups. In practice, there are many obstacles in the way of effective access to health care for diseases targeted by SDG and UHC, including those already covered by vertical and internationally supported control programs. These works on malaria, tuberculosis and acute respiratory infections were carried out within the framework of this sociological thesis, using a qualitative methods (among 83 individuals) and quantitative methods (with about 26,000 people interviewed), by population surveys, on several fields in Madagascar, involving caregivers, cared population and institutional actors. The acceptance and implementation of these disease management methods depend on logistical and organizational factors, but also on the beliefs and practices of individuals, families and social or professional groups. In practice, there are many obstacles in the way of effective access to health care for diseases targeted by SDGs and UHC, including those already covered by vertical and internationally supported control programs. The representative elements of the studied zones of Madagascar presented in this thesis provide an insight that could be useful for the implementation of a CSU across the country. They also reveal the challenges, not just financial, that remain to be overcome
Nuemi, Tchathouang Gilles Eric. "Identification des profils de changement sur données longitudinales, illustrée par deux exemples : étude des trajectoires hopsitalières de prise en charge d'un cancer. Construction des profils évolutifs de qualité de vie lors d'un essai thérapeutique pour un cancer avancé". Thesis, Dijon, 2014. http://www.theses.fr/2014DIJOMU02/document.
Pełny tekst źródłaContext In healthcare domain, data mining for knowledge discovery represent a growing issue. Questions about the organisation of healthcare system and the study of the relation between treatment and quality of life (QoL) perceived could be addressed that way. The evolution of technologies provides us with efficient data mining tools and statistical packages containing advanced methods available for non-experts. We illustrate this approach through two issues: 1 / What organisation of healthcare system for cancer diseases management? 2 / Exploring in patients suffering from metastatic cancer, the relationship between health-related QoL perceived and treatment received as part of a clinical trial. Materials and methods Today we have large databases. Some are dedicated to gather together all hospital stays, as is the case for the national medico-administrative DRG-type database. Others are used to store information about QoL perceived by patients, routinely collected in clinical trials. The analysis of these data was carried out following three main steps: In the first step, data are prepared to be useable according to a defined concept of data analysis. For example, a classical database (patient-centered) was converted to a new database organised around a new defined entity which was different from the patient (eg. Care trajectory). Then in the second step, we applied data mining methods for knowledge discovery: we used the formal analysis of concepts method and unsupervised clustering techniques. And finally the results were presented in a graphical form. Results Concerning the question of the organisation of healthcare system, we constructed a typology of hospital care trajectories. We were able then to describe current practice in the management of cancers from the first cancer related surgical operation until one year of follow-up. In the case of breast cancer, we’ve described a typology of care on the basis of hospital costs over a one year follow up. Concerning the second question, we have also constructed a typology of QoL change patterns. This comprised three groups: Improvement, stability and degradation group.Conclusion The main interest of this work was to highlight new thoughts, which advances understanding and, contributing in appropriate solutions building
Humbert, Christophe. "Dépendance , innovation et coordination gérontologique : des dispositifs socio-techniques pour l’autonomie des personnes âgées ?" Thesis, Strasbourg, 2020. http://www.theses.fr/2020STRAG020.
Pełny tekst źródłaThis Phd work aims to question recent transformations in the field of support and care for the so-called "dependent" elderly. One of the central objectives of this thesis is to develop a definition of autonomy, as it is brought into play in innovative socio-technical devices used in gerontology. This research is based on the analysis of the deployment of an information system (IS) for gerontological coordination, in Alsace. Four consecutive years along, I followed the innovation trajectory of this IS, between 2015 and 2018. I mainly analyze its impact on “dependence trajectories” of ten elderly people, at different stages of deployment of the device
Romanens, Jean-Louis. "Permanences, mutations et renouveau du service public hospitalier". Thesis, Montpellier 1, 2014. http://www.theses.fr/2014MON10007/document.
Pełny tekst źródłaPermanencies, mutations and revival of hospital public utilities : The legislative corpus initiated on July, 21st, 2009, by the law reforming the hospital and relative to the patients, health and territories, put a new legal paradigm concerning the hospital public utilities. So we have questioned this concept, its constraints, its permanencies but also mutations and apparent revival. The concept of a public hospital service, may be the first public service created in our history, emerged from a slow maturation, based on that rule: ''serve the other one'', canonically appeared during the Orleans Council, 511. Since one thousand and five hundred years, it has often mutate but has kept this mental content, on which transplanted the hospital experiment. Two new mutations were developed during the last decade. In a formal legal break-off, distinguishing public services missions opened to any health actor, and the public utilities' guaranties of equality, continuity, mutability, the public utilities originating from hospital, leaving its organicity, built for itself a euro-compatibility. In return, mainly supported by the French hospital and its nine million hospitalizations a year, it shaped the concept of general economic interest service of the European Union. Through another mutation of its autonomous management, it has found the ethic of a new synergy between systemic medical quality and economic management grounded on activeness. However, it weighs on its future, other imperatives. On one hand, the cooperations between establishments require their elevation into a public utilities mission rank. And a management of the user's representatives and the various hospital staff must be integrated to the strategy. On the other hand, the heavy current stakes in public health, worsening the social deficits, paralyzed by the corporatism and sanitary powerlessness, would quickly require a personalized coverage in health routes of chronic diseases, and of populations in social dislocation. The rise of a territory health public utilities mission opened to any health actor whose legislation we propose, would contribute to the inter-professional coordination and the relevance of the health system. In continuation, we propose legislative and organizational modalities of creation of specific entities by the health establishments, in territories of exception agreed with the Regional Health Agency (Agence Régionale de Santé). It would be a matter of Inter professional hospital poles of health (PHIS) on ambulatory medicine of prevention, therapeutic education, organic care, mental care, reeducation and rehabilitation follow-up. Health centers included into health poles, they would allow restoring population accessibilities adapted to each territory, bettering the town-hospital relationship, and a research-teaching valuing the general medicine. In its society and for the citizen, the public hospital utilities have to stay the experiment of future
Lamé, Guillaume. "Intégration entre services hospitaliers : management des opérations en cancérologie". Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLC027/document.
Pełny tekst źródłaThis dissertation addresses the challenge of coordinating hospital services. We take an integrated view on care delivery and the various units involved in a care process, with a case study in outpatient chemotherapy process at Henri Mondor hospital, Créteil, France. We tackle three research questions :1. How should a change program in a multi-department setting be designed and managed?2. How can one improve outpatient chemotherapy delivery?3. Why do strategic plans look so disconcerting and disappointing in public academic medical centers, compared to otherindustrial organizations, when similar methods are applied?Our main research method is action-research. During reorganization projects, we adapt and combine methods from operational research and industrial engineering in order to integrate hospitals’ specificities. We propose and evaluate reorganisation methods focused on interdepartmental coordination, and we contribute to a better knowledge of the specific environment of hospitals, which is quite different from the contexts in which industrial engineering traditionally developed