Дисертації з теми "Évaluation médicale – France"
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Moty, Céline. "De la mesure à la maîtrise de la variabilité des pratiques médicales en France : illustration avec le dépistage de l'infection à cytomégalovirus chez la femme enceinte en France." Bordeaux 2, 2005. http://www.theses.fr/2005BOR21218.
Evaluation of medical practices has been done in France for 20 years, the variability of these practices is still an unsolved problem with causes and consequences that we document. The structures that realise these evaluations are multiple, with different methods and objectives. This diversity does not contribute to the visibility and coherence of the evaluation. Furthermore, measuring the variability of medical practices is not often followed by the implementation of actions making the practices converge and get them standardised. Indicators and information systems operational in routine for evaluation studies are lacking, as well as a clear definition of a standard, of an acceptable deviation, and of control method to follow-up, incite and correct. As an illustration, we present the variability in serological screening practices for cytomegalovirus infection in pregnant women and the actions set up to limit this variability
Doulans, Lydie. "L'aide médicale urgente dans l'Orne." Caen, 1993. http://www.theses.fr/1993CAEN3059.
Ponet, Philippe. "Contribution à l'étude du processus de démocratisation fonctionnelle : Autour des "affaires en responsabilité médicale"." Paris 1, 2009. http://www.theses.fr/2009PA010279.
Stalla, Bruno. "Les références médicales opposables en 1994 : aperçu de leur application dans le domaine de la prescription médicale de spécialités pharmaceutiques." Paris 5, 1996. http://www.theses.fr/1996PA05P001.
Baptiste, Vénonique. "Le statut de l'auto-évaluation dans la démarche de changement : l'accréditation hospitalière." Lyon 3, 2003. http://www.theses.fr/2003LYO33005.
Today, hospitals have to change. In this context, the French government has set up in 1996 a system of accreditation which relies mainly on a self-assessment. The objectives are to incite hospitals to enter into a continuous quality improvement process. The object of our research deals with the concept of self-assessment in connection with the one of change. Il aims to confront them on a theoretical and on a practical point of view. The first part deals with the concepts of evaluation and change. Il aims to define the concept of self-assessment, to point out the reflexivity between evaluation and change and to expose the stakes of self-assessment in terms of change. The second part presents and analyses the practical application of self-assessment and its consequences in terms of change. We conclude on the differences between self-assessment and its consequences in the theory and in a practical application
Fallacher, Marie-Hélène. "Etude qualitative des interventions héliportées du SMUR de Dordogne d'avril 1998 à janvier 1999 : utilisation d'outils d'évaluation simples." Bordeaux 2, 2000. http://www.theses.fr/2000BOR2M091.
Cervoise, Hélène. "Etude des admissions au service des urgences du centre hospitalier universitaire de Fort-de-France." Bordeaux 2, 1993. http://www.theses.fr/1993BOR2M077.
Benyahia, Nesrine. "Le droit de l'imagerie médicale et ses enjeux de santé publique : étude comparative France, Angleterre, Allemagne et Québec." Thesis, Sorbonne Paris Cité, 2017. http://www.theses.fr/2017USPCB173.
Medical imaging is a care activity at the crossroads of all medical specialties. It has become a primary care activity at the heart of the diagnosis and treatment of many pathologies in oncology, neurology and cardiology, for instance. Its essential role in the care path of the patient is the result of the important development of the technologies, but also of the clinical indications. The framing of medical imaging in the French healthcare system remains nevertheless unclear and bordered by legal and economic constraints. This legal and economic uncertainty is an obstacle to the effective access to medical imaging technology for patients through, in particular, an exacerbated control of equipment installations and a disorganized acts pricing procedure. Furthermore, the lack of medico-economic evaluations delays the implementation of innovations and even creates risks to the safety and quality of the imaging tests performed
Laurent, Jean-Jacques. "Etude critique de l'activité du SMUR de Bordeaux au moyen de l'indice de gravité simplifié ambulatoire (IGSA)." Bordeaux 2, 1995. http://www.theses.fr/1995BOR2M149.
Gilles, Marion. "Compter pour peser : la quantification de la "santé au travail" en entreprises : entre institutionnalisation et ambiguïtés conceptuelles." Paris, EHESS, 2013. http://www.theses.fr/2013EHES0096.
This research focuses on the process of quantification of health at work" and its effects. To that end, the thesis examines three quantification instruments, set up by occupational health physicians. It brings together the analysis of the genesis of the instruments, their uses and effects with the study of the actors who produced and managed them. The research, based on an important field research on the production of numbers and their appropriation, combines interviews, observations of the manufacturing of numbers and sessions of presentation of the quantitative data, analysis of archives and documents ("companies' documents" and the "grey literature" on the quantification instruments). Focussing on the "definitional struggles" about the categories proposed by physicians and "conflicting uses" around the numbers, the thesis demonstrates that their production is part of social relations that contribute to the redefinition of the goals initially assigned to instruments by their creators. Embedded in unfavourable power relations, physicians struggle to weigh on the institutionalisation of the categories they produced and disseminated and to control the uses of "their" numbers. Stepping aside from the public statistics usually studied in the sociology of quantification, this thesis enlightens the process of manufacturing, distributing and appropriation of numbers devoid of legitimate institutional support. It also contributes to the knowledge about the stakes and the debates surrounding the definition of "health at work" issues and how one should deal with these
Le, Fèvre-Brenot Valérie. "Principes de rationalisation de l'activité des transports sanitaires héliportés hospitaliers sur la région Aquitaine : évaluation économique en 1995." Bordeaux 2, 1997. http://www.theses.fr/1997BOR2M073.
Roullière-Le, Lidec Christine. "Evaluation économique des urgences cardiologiques : Exemple : le Syndrome Coronarien Aigu sus-ST." Paris 9, 2007. https://bu.dauphine.psl.eu/fileviewer/index.php?doc=2007PA090066.
Context : Diversity of medical treatments for patients suffering of ST Elevation Myocardial Infarction related to different approaches, and this, with no medico-economic’s evaluation during the prehospital’s phase. Objective: Medico economic study based on different alternatives of diagnosis/treatment for patient. Method: Cost efficiency study based on Fast Mi registery datas. Efficiency criteria used is re perfusion procedure, what ever its timemesurement Results: 26% from 1714 patients follow the efficient progression. Most critical patients follow circuits that are detrimental to therapeutically eligibility. Regional results are homogenous, despite differences linked to circuits. Conclusions: A better information to patients and to referees would limit dispersion of channels and improve diagnosis and therapy processes, in a regional strategy
Greco, Luca. "Interaction, contexte et cognition : les pratiques de description et de catégorisation de la douleur dans les appels au 15." Paris, EHESS, 2002. http://www.theses.fr/2002EHES0090.
The object of our study is constituted by practices of description and categorization of pain in calls to emergency assistance (15 , Samu 78). The aim of our research is to take in account discursive resources employed by participants (caller, patient, call-taker, doctor) in order to construct an experience : a pain. Therefore, we are interested in socio-cognitive aspects concerning verbalization of a sensorial data and in referential practices emerging in talk-in-interaction. In order to do that, we have studied sequential organization of emergency calls (part II) and categorization practices emerging by the actions of the participants to the interaction (part III). We have used a pluridisciplinary approach : Conversation Analysis, Ethnography and Situated Cognition
Pasquier, Laurent. "Enjeux sociétaux et de l'organisation des soins liés à la généralisation de l'accès aux tests génétiques en France : analyse des évolutions en cours et évaluation qualitative des pratiques auprès de médecins non-généticiens." Thesis, Normandie, 2020. http://www.theses.fr/2020NORMC418.
Genetic testing is widely accepted to be a common practice in many medical specialties. Nonetheless, it raises specific issues that impact the trajectory of people’s lives, not only in the short term, but in the long term as well, and shakes up notions of prevention, prediction, health and illness for patients and their families. These genetic tests raise questions central to the choices individuals and society must make when using them, such as respecting basic rights, handling results and uncertainty and balancing concerns for medical confidentiality with the rights of third parties. We need to consider how to help physicians deal with the rapid development of genomic medicine, for which most of them are not specifically trained. Analysing how these professionals integrate genetic testing into the patient-provider relationship is essential to paving the way for a better use of genomics by all.We used a multidisciplinary approach that brings together medical geneticists, legal experts, sociologists, ethicists and patient associations to conduct a discussion on the medical, ethical, sociological and legal stakes of widespread genetic testing. We also conducted a qualitative study made up of a series of semi-structured interviews in focus groups with 21 neurologists and endocrinologists about their genetic testing practices.Based on these discussions and the qualitative study, we recommend implementing regulations that promote a true policy supporting medical practices surrounding genetic testing by:1. Promoting research about the medical usefulness of genetic testing for patients and their families in face of the uncertainties related to test results, especially when it involves offering genetic testing to the general population.2. Orienting practices toward a systemic approach using a multidisciplinary team or network (including organ specialists and clinical and biologist geneticists) to provide resources for dealing with uncertainties in interpreting results or situations that require additional technical or clinical skills and, if necessary, to allow for joint consultations with both a geneticist and a non-geneticist medical specialist.3. Collecting additional quantitative data about these practices, including legal and economic data, and meeting with health professionals involved in genomic medicine to effect changes in the regulatory framework, which currently seems to be only partially suited to widespread genetic testing and medical practices. This groundwork seems essential to educating legislators before any changes are made during an upcoming revision of the French Bioethics Act.4. Promoting real patient autonomy and avoiding the recommendation of genetic testing in automated care management procedures. The simple fact of having a written consent cannot justify making genetic testing commonplace given the stakes associated with the results. Autonomy could be increased by providing prescribing physicians with continuing medical education sessions to make them aware of the issues and increasing public’s level of genetic literacy.All in all, this dialog between genetic medical/technical disciplines and human and social sciences seems relevant considering the many difficult social challenges. Such a dialog is likely to recommend appropriate support for each patient and family with regard to medical genetics
Gonzalez, Salazar Nancy. "Circulation des savoirs et des pratiques médicaux entre la France et le Rio de la Plata (1828 - 1886)." Thesis, Paris, EHESS, 2017. http://www.theses.fr/2017EHES0093.
As a key factor in the development of nations, medicine and its organization were at the center of the preoccupations of the political authorities who succeeded one another in Argentina and Uruguay as soon as these territories were conquered by Spain. Yet, once independence has been achieved, repeated economic crises and a chaotic political situation have meant that medicine on both sides of the Plata has struggled to awaken and consolidate. While in Uruguay the erection of a faculty of medicine was not possible until 1875, that of Buenos Aires, erected in 1821, functioned in an intermittent manner until 1852, because of the troubled political situation in the country with the Juan Manuel de Rosas's dictatorship. As a result, many Uruguayans and Argentines have gone to begin or perfect their medical training at the Faculty of Paris. At the same time, in spite of the political unrest and the economic instability of the region, many French doctors decided to establish themselves on the banks of the Plata in the first half of the 19th century.This work examines the links that physicians living on both sides of the Atlantic between 1828 and 1886 developed, maintained and strengthened over the course of the century. This dynamic circulation of knowledge and medical techniques, energetic and permanent, benefited the medicine on both sides of the Atlantic. More specifically, we approach these exchanges by an analysis of the management carried out by the medical corps of Montevideo and Buenos Aires of the epidemics of cholera and yellow fever when they broke out in these towns and of the knowledge that circulated in the area before and after their appearance. We also study the reception given by the members of the French and Rioplatense medical spheres to the speeches related to the crematist system and its establishment, a system that excited the European medical profession at the turn of the 1860s. We show that medicine on both sides of the Atlantic has been enriched by the contact and reciprocal exchanges that these doctors have maintained. Indeed, while Plata's medicine has to a large extent been awakened by the contribution of the French medical actors who brought their knowledge and know-how to the region, French medicine was in turn fueled by the stay of doctors of the Hexagon in the banks of the Plata. Regardless of the length of their stay in the region, the various explorations they have carried out and their direct confrontation with the local pathology have allowed French physicians to increase their knowledge and acquire a singular experience. This experience had a significant impact, not only in their daily practice, but also in the adoption of innovative practices essential to French medical progress in the last quarter of the 19th century
Factor esencial para el desarrollo de las naciones, la medicina y su organización se encontraron en el centro de las preocupaciones de las autoridades políticas del Río de la Plata (Argentina y Uruguay) desde el momento mismo de la conquista española. Sin embargo, una vez adquirida la Independencia, las crisis éconómicas y la inestabilidad política fueron permanentes en los dos países, En consecuencia, el despliegue y la consolidación de la medicina de parte y parte de la Plata se vieron fuertemente comprometidos. Mientras que en Uruguay la facultad de medicina fue creada apenas en 1875, la facultad de Buenos Aires, instalada desde 1821, funcionó de manera irregular hasta 1852, puesto que el régimen dictatorial de Juan Manuel de Rosas entorpeció la enseñanza y puso freno al movimiento científico establecido desde principios de siglo 19. Fue por eso que, con el objetivo de formarse o especializarse en la facultad de medicina de París, numerosos uruguayos y argentinos viajaron a Francia. Paralelamente, y a pesar de las múltiples agitaciones políticas y de la economía vacilante de la Plata, varios médicos franceses decidieron establecerse en la región desde la primera mitad del siglo. Este trabajo explora las relaciones establecidas y consolidadas con el paso del tiempo entre los médicos y estudiantes en medicina rioplatenses y franceses que viajaban entre el viejo continente y la Plata, y que dieron paso a la instauración de una circulación énergica y permanente de saberes, de prácticas y de técnicas médicas, que benefició tanto a la medicina rioplatense como a la medicina francesa. Dicha circulación es ejemplificada a través de la actuación concreta de los cuerpos médicos de Buenos Aires y Montevideo en los momentos en que el cólera y la fiebre amarilla irrumpieron en estas ciudades de forma epidémica, asi como también de la circulación de saberes que, sobre estas enfermedades exóticas, tuvo lugar en la región antes y después de su aparición en la Plata. Asimismo, se analiza la recepción de los discursos y la puesta en práctica de la cremación de cadáveres – sistema que provocó el entusiasmo del cuerpo médico europeo desde finales de los años 1860 – en las esferas médicas francesa y rioplatense. Se espera así recalcar que la medicina de parte y parte del Atlántico se vió enriquecida por el contacto y los intercambios científicos enfectuados entre los médicos franceses y rioplatenses. En efecto, si los médicos franceses, llevando sus conocimientos y su experiencia a la Plata, jugaron un rol clave y estimularon el desarrollo de la medicina rioplatense, la medicina francesa fue, a su turno, alimentada por la estadía de los médicos franceses en la región. En efecto, sin importar el tiempo pasado en la Plata, las múltiples exploraciones geográficas y la confrontación directa avec la patología local enriquecieron los conocimentos de esos médicos y les aportaron una experiencia singular cuyo impacto, altamente significativo en el ejercicio cotidiano de su profesión, repercutió igualmente en el desarrollo de la médicina nacional, estimulando la adopción de prácticas innovantes indispensables al progreso médico francés en el último cuarto del siglo 19
Pillant, Alain. "L'audit et l'évaluation des entreprises médicales." Paris 1, 1999. http://www.theses.fr/1999PA010054.
Chevillard, Guillaume. "Dynamiques territoriales et offre de soins : l’implantation des maisons de santé en France métropolitaine." Thesis, Paris 10, 2015. http://www.theses.fr/2015PA100109/document.
France faces an old and persistent problem, which is geographical imbalance of general practitioners. This uneven distribution grows at a steady pace due to less attractive areas. New urban and rural areas are emerging with limited access to primary health care, while existing ones grow even bigger. Since 2008, the liberal primary care team (PCT) are financially supported by the public authorities. They hope this structure will attract and retain general practitioner in the aforementioned areas.This study aims to explore how the space and the territory contribute to the localisation of PCT and how these structures affect spaces and territories. Localisation and impact of PCT are studied at different level, using quantitative and qualitative approaches. Spatial analysis of PCT is based on several tools such as SIG and typology in synergy with field investigation in two French regions. Effects of PCT on general practitioner density are studied on a national scale comparing the evolution of this density in space with PCT and similar space without PCT. The results are completed with field investigation
Mornet, Chantal. "Le patient-client à l'hopital : contribution à la formulation d'une métamorphose." Lyon 3, 2000. http://www.theses.fr/2000LYO33028.
Pichetti, Sylvain. "La concurrence par comparaison, applications en économie de la santé." Besançon, 2002. http://www.theses.fr/2002BESA0001.
Yardstick competition is a way of regulating several regional monopolies so as to induce a form of competition that weakens individual firms' monopolies of information and hence improves the terms of the trade-off between allocative, productive and distributional efficiency. This is done by making the reward to one firm depend on its performance relative to that of other firms. This promising mechanism is however rarely applied in economics. This phenomenon can be explained by the fact that it is difficult to compare firms whose environments are heterogeneous. The DEA method is very convenient to treat this problem. The important potential of the method as a way of comparison is illustrated by two original contributions centered on health economics. The first one aims at estimating the efficiency of hospitals in order to assign to each of them a budget target. The second one aims at estimating the efficiency of health expenses at the departmental level through the DEA method
Rabilloud, Muriel. "Méthodes d'évaluation des pratiques médicales au niveau d'une région : application à l'étude de la prise en charge hospitalière de la naissance dans la région Rhône-Alpes." Lyon 1, 1999. http://www.theses.fr/1999LYO10251.
Gillet, Hauquier Marie-Annick. "L'accident sanitaire : essai sur l'émergence d'une notion juridique." Lille 2, 2004. http://www.theses.fr/2004LIL20022.
After more than forty years of attempts to reform the law of medical liability, Act number 2002-303 of 4th March 2002 institutes a new patient law in its proposal of a reshaping of the health services as whole. If it is a question of the compensation for " foreseeable health risks " the legislator has at no stage incorporated its definition. And in fact is the term foreseeable " risk " not too restrictive in its scope ? Is it not more a question of unforeseeable medical accident ? Consequently should the refunding of medical expenses trouth the social security system be general or personal ? Beyond medical liability based on fault and compensation based on foreseeable risk, should the legislator not propose a scheme of prevention, of precautionary health measures even ? The present study has for its object the extraction of a definition of the notion of medical accident in its different guises with the aim of contributing to the filling in of the gaps in the law
Maes, Blandine. "Représentations professionnelles et accréditation : entre recherche de sens et contrôle." Toulouse 2, 2003. http://www.theses.fr/2003TOU20083.
Today, no passing through for health institutions development without quality. This concept appeared in the course of time in the health context with a legislation, norms more accurate and restricting, in ordre to comply with requirements of regulations stated by the various hospitals related reforms, especially the one of 1996 which obliges any health institution to proceed with an accreditation approach implementation. The objective of this work is to identify the representations of accreditation with its own principles (quality, quality approach) to different professional groups in health institutions (private, public, semi-public). The statistics analysis of 89 interviews and 175 questionnaires, enable us to comprehend the conmmitments nature on accreditation in function of the context of various health institutions, of social positions, of values and cultures of the groups they belong to. This idea means for somme professionals regulation's action, a technocratic procedure of control, for others, a process, a research of sense, a fundamental step in the continuing search to improve the quality of medical care
Guerrero, Isabelle. "Évaluation économique du protocole de traitement des fentes faciales." Montpellier 1, 1986. http://www.theses.fr/1986MON10053.
Cleft lip and palate treatment may be considered as a good which economic value depends on its ability to satisfy a need and on the efficency of the unit where it is produced : the hospital. From the research carried out at the regional hospital of montpellier on 166 children treated for cleft, it appears that the clinical production is adapted to the need for treatment. Nevertheless, the hospital as a whole does not seem to function in the best economic way. The results obtained do not confirm the case-mix analysis by which the cost by d. R. G. Should be used as the new basis of hospital tariffs
Pagès, Jacques. "Les métamorphoses de la gestion juridique des établissements du secteur sanitaire, social et médico-social." Paris 2, 2001. http://www.theses.fr/2001PA020052.
Monier, Isabelle. "Dépistage anténatal du retard de croissance intra-utérin en France : évaluation, déterminants et impact sur les issues périnatales." Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066660.
Fetal growth restriction (FGR) is a pregnancy complication that is responsible for significant perinatal mortality and morbidity. Screening for FGR is a key component of prenatal care. The objectives of this thesis were to evaluate the performance of prenatal screening for FGR, to identify the determinants of antenatal suspicion of FGR and to measure its impact on perinatal outcomes. For the first part of the thesis, we used data from the nationally representative French National Perinatal Survey of births (N=14,100 singleton pregnancies): 21.7% of infants with a low birthweight <10th percentile were suspected with FGR during pregnancy and half of infants suspected with FGR had a normal birthweight (false positives). The risk of indicated delivery was higher when FGR was suspected, regardless of the existence of low birthweight, suggesting possible iatrogenic effects. Outcomes were not different for suspected versus unsuspected low birthweight infants. In the second part of the thesis, we used data from the EPIPAGE 2 national cohort of children born before 32 weeks of GA in 2011 (N=3698 singleton non-anomalous infants). Active management for fetal indications in cases of suspected FGR was initiated at 26 weeks. Antenatal and postnatal assessments of FGR were discordant for 14% of infants. When assessments were discordant, birthweight was a better predictor of adverse neonatal outcome. Our results raise questions about the effectiveness of screening strategies for FGR in France. New strategies for the detection of FGR are needed as well as research to measure the impact of screening on medical decisions and health
Laveix, Cyril. "Centre d'Albret : cellule d'accueil pour démunis : évaluation du coût médicamenteux." Bordeaux 2, 1998. http://www.theses.fr/1998BOR2P051.
Maanaoui, Mehdi. "La greffe d'îlots pancréatiques chez le patient diabétique transplanté rénal." Electronic Thesis or Diss., Université de Lille (2022-....), 2023. https://pepite-depot.univ-lille.fr/ToutIDP/EDBSL/2023/2023ULILS071.pdf.
Pancreatic islet transplantation is an innovative cellular therapy for the management of diabetes in patients with type 1 diabetes. Currently, there are few studies that address the prognostic impact of islet transplantation in patients with type 1 diabetes who have received a kidney transplant or the determinants of transplantation success in this population. Furthermore, the definition of diabetes is evolving, with the dichotomy between type 1 and type 2 diabetes fading in favor of diabetes classifications based on the patient's clinical and biological phenotype. Pancreatic islet transplantation could potentially be expanded to other profiles of patients with diabetes and a kidney transplant, especially if there's evidence of insulin secretion deficiency. Thus, the objective of this thesis is to determine the role of pancreatic islet transplantation in patients with diabetes and a kidney transplant.In the first section, we present the results of a nationwide cohort study assessing the effect of pancreatic islet transplantation following kidney transplantation compared to insulin alone in patients with type 1 diabetes. Islet-after-kidney recipients were matched to control patients using a time-dependent propensity score. After matching, pancreatic islet transplantation is associated with a reduction in the combined risk of death and return to dialysis, as well as the isolated risk of death. This study emphasizes the importance of considering islet transplantation as a full-fledged therapeutic alternative, especially in regions where it is not reimbursed or available.The second section explores the determinants of islet loss of functionality, in particular the repercussions of alloimmunity. The results of a single-center study suggest that preformed DSA and early de novo DSA have little impact on islet transplantation outcomes, but late de novo DSA is temporally associated with impaired metabolic results. No cases of cross-sensitization between pancreatic islets and the underlying kidney in recipients were described, neither in the study nor in the literature.The last section focuses on evaluating the insulin profile in patients with type 2 diabetes and a kidney transplant, through the calculation of HOMA-2 scores, to extract the impact of insulin secretion. Analysis of a single-center retrospective cohort shows an association between insulin resistance evaluated by HOMA-2 and the risk of allograft loss, while insulin secretion was only associated with metabolic balance. However, given the relationship between metabolic balance and the likelihood of death and graft loss in kidney transplant patients with diabetes, pancreatic islet transplantation could be part of the therapeutic arsenal in a personalized medicine approach for these patients.In conclusion, this thesis advocates for personalized diabetes medicine in kidney transplant patients, promoting the integration of pancreatic islet transplantation as a key component in the therapeutic strategy for these individuals
Bidau-Batguzere, Karine. "Information et consentement en médecine générale appliquée à la gériatrie : enquête auprès de 242 généralistes." Bordeaux 2, 2000. http://www.theses.fr/2000BOR2M114.
Pagouape-Marchand, Patricia. "Une expérience de médecine générale en station de ski (Piau-Engaly)." Bordeaux 2, 1995. http://www.theses.fr/1995BOR2M095.
Ziani, Aouaz Amani. "L'impact de l'utilisation de la tarification à l'activité sur la qualité et l'accès aux soins à l'hôpital public en France." Paris 8, 2013. http://octaviana.fr/document/188336273#?c=0&m=0&s=0&cv=0.
A new payment system has been introduced in French hospitals. This system has been created in the United-States and is actually used in many countries across the world. The prospective payment system based on Diagnosis Related Groups is the name of this new payment concept. Similarities exist among patients of each DRG concerning the principal diagnosis and the means used to take care about patients. This payment system is suspected to have some effect on quality and access to care. A review of the international literature showed that some effects like shortening of length of stay, quicker and sicker syndrom and increasing number of transfer to the skilled nursing facilities have been noted by many empirical studies. In France, there is no empirical studies which have been conducted to demonstrate such effects, but the personal working in hospital like doctors and nurses experience constraints and increased workload since the new payment system have been introduced. The recent experience of the new payment system in France and the absence of empirical studies do not allow such conclusions
Badila, Kouendolo Diaz Patrice. "Indices d'amélioration dans les conditions de la vie quotidienne chez les déments vu par les soignants." Thesis, Lyon 2, 2015. http://www.theses.fr/2015LYO20146.
The Alzheimer's disease and the related pathologies, by evolving, generate a change of the the overall condition of the patient, and a general dependence. The patient, whose capacities of adaptation are affected by the disease risks, in all the stages of the disease, to react by behavior disorders. It is these disorders which lead him generally to enter specialized institution.The institution then has to take care of the physical and psychic dependence of the patient. She owes to set up a prevention of the complications of the disease. With among these the disturbing behavioral manifestations. It requires at the same time specially trained teams and establishments or units of care adapted to this specific management.This thesis tries to answer a simple question: on what base themselves, on a daily basis, the nursing to speak about "improvement" or about "worsening", without using of the evaluation with tests in standard condition?And these, by knowing that the standard conditions which are valid for the search, are artificial conditions which do not allow to characterize all the potentialities of the disease.The present work, made in a specialized unit, aims to decode what determines subjectively the assessment of the nursing from an analysis of their discourse within semi-directive discussions.This discourse was successively the object of an IT analysis by the software "Alceste", then a thematic analysis of contents, called: "manual".The results of these two analyses are mirrored with those of the "standard" tests (MMS; GDS; NPI/ES ZARIT). Tests which allowed to distinguish which patients, from a classic point of view, had been stable, but also had improved or deteriorated in six months.The second analysis allowed to highlight very explicitly that the dominant concerns of the nursing was about descriptive elements. That is on the tasks which they have to do materially.It seems that for the nursing the notion of improvement or worsening of the patient is, in summary, correlated to the workload it involves. Due, among others, to the annoying behavior and to the medical problems…We observe, furthermore, that the patient is a bit considered as a subject in which become identified. Psychological factors can be however envisaged by the nursing when it is a question of explaining certain disturbing behavior
Derros, Ellie. "L'hôpital malade de l'absentéisme santé : évaluation socio-économique des congés "maladie" non ordinaires chez les personnels non médicaux dans trois établissements publics d'Auvergne." Thesis, Clermont-Ferrand 1, 2012. http://www.theses.fr/2012CLF10395/document.
The present study focuses on the long absenteeism for health reason at non medicalhospital staff. Two types of non ordinary sick leave are aimed : the C.L.M. and C.L.D. (rulingson salary insurance). Those indeed constitute a challenge of management by thedisorganizations and the costs, mainly hidden, which they cause. They represent also a stakein social health, because of the morbidity they express.In order to characterize and measure them, this work takes as a starting point theorganizations socio-Economic approach (I.S.E.O.R., Lyon). We particularly try to carry out aplural diagnosis (social, organizational and financial). The ambition is threefold. It acts 1) tomake become aware of the scale of the damages (mirror effect for the direction); 2) tocontribute to the development of a theoretical and practical reference frame (widenedevaluation of the absences); 3) to contribute to the promotion of good and really presenteeim(human resources recommendations).The various investigations are done on three publicregional hospitals of voluntarily different size (C.H.U., C.H., H.L. – in the center of France).Each time the results let appear alarming profiles, operations, spending and lived. They giveevidence to a failure in organisational and managerial human resources. These negativereturns also attest an extension possibility of the socio-Economics’ analysis (to the extendedsickness absences in structures of care). They finally allows to identify some tracks ofintervention, sometimes transverse (proximity in the procedures), sometimes specific(peculiarities of the structure)
Brusq, Julie. "Innovation et communication organisationnelle dans le secteur associatif professionnel : exemples de démarches qualité dans les secteurs médico-social et psychiatrique." Thesis, Rennes 2, 2013. http://www.theses.fr/2013REN20024.
The highly sensitive domain of services delivery to persons is mostly under the command of powerful NGO’s managing institutions and professional services with high efficiency. Meanwhile, the state which is the main financial source of these institutions has initiated through regulations a movement of organizational modernization which leads to extremely controversial changes in interventions, in representations, in strategies of collective actions, among trades and professions as well as in organizational structures. This development, present in the regulation of April 24, 1996, for the health domain, and the law of January 2nd, 2002, for the medico-social domain, implies that the professional domain be able to formulate innovative solutions, especially with regard to the evaluation of professional actions, and to the on-going improvement of the quality of services. In a context of a global crisis concerning the ways of managing resources, organizational innovations are conceived according to an approach centering on work autonomy and follow-up. Problems of communication and organization overhaul, of professional discourses and stylistics, and other mini-cultural issues are analyzed through a method of participant-observation in order to understand professional mutations taking place since the law of January 2nd, 2002, and of the regulation of April 24th, 1996
Costin, Maria. "Qualité et modernisation du management hospitalier public, une comparaison Franco-Moldave des grands hôpitaux : Vers une réflexion stratégique de l'organisation hospitalière." Paris 13, 2008. http://www.theses.fr/2008PA131007.
Thanks to the new perspectives linked to the independence of 1991, the management of the health system is finally confronted to international norms. In spite of restricted means, the representatives for Moldovan health have to find modern methods of management, to ameliorate the quality of medical care. In France, the hospital reforms centered on the workmanship of the expenses of health and the modernization of the tools of management allowed to identify other problems such as: the quality and security of care, the rights of the patients and the content of the users. To better meet the needs of patients it is not enough to make important means available to the different medical services, but to bring about real efficiency for the patients. In this context, that amounts to bringing some change in the mode of administration of hospital business towards a culture of management where the research of performance becomes the rule. The improvement of the medical services passes through the modernization of the system of management. It is under conditions, that we are led to offer a managererial approach of 5 functions (organization of work, motivation, training, automatization and auto-evaluation) which structure the manager frame of hospitals, with regard to the complexity hospital activities. These 5 pillars will allow the managers to have a view of the tasks and priority missions to be fulfilled
Pomies, Frédéric. "Prise en charge de l'enfant et de l'adolescent asthmatique en médecine générale : enquête auprès de 51 médecins généralistes." Bordeaux 2, 2000. http://www.theses.fr/2000BOR2M012.
Zimban, Alain. "Evaluation de la couverture mammographique des femmes âgées de 50 à 72 ans dans le Libournais." Bordeaux 2, 2000. http://www.theses.fr/2000BOR2M082.
Coulm, Bénédicte. "Accoucher en France : prise en charge de la naissance en population générale." Thesis, Paris 11, 2013. http://www.theses.fr/2013PA11T085/document.
We assessed practices during delivery and the postpartum period in France, in a context where evidence based medicine plays a more and more important role in professional practice, where the closure of maternity units leads to a concentration of births in large public and specialized units, and where professionals want to meet the needs of women and some of their requests.We first described how maternity units’ characteristics contribute to explain variations in obstetrical intervention’s rates. We studied postpartum length-of-stay and support for women after discharge from maternity unit, and interventions performed during labor among low-risk women (inductions, cesareans, instrumental deliveries and episiotomy).In a second part we estimated the proportions of potentially avoidable cesarean deliveries and inductions without medical indications; we also investigated which factors were associated with these interventions.Obstetrical practices differed slightly depending on the size or the level of care of maternity units, except potentially avoidable cesareans, which were more frequent in small and low-specialized units, and postpartum length-of-stay, which were shorter in large and type 3 units. On the contrary, the private status of the unit strongly influenced the management of delivery: all studied interventions were more frequent in private units, sometimes in response to maternal requests (inductions without medical indications for example). Women’s medical characteristics had an impact on obstetric intervention rates; the associations were similar to those previously reported in other publications. However social characteristics had little influence on the content of care.The results provide an overall evaluation, useful for assessing perinatal public health policies. They raise questions about maternity unit organization and processes that lead to decisions to perform obstetrical interventions
Châtelet, Raphaël. "Veille sanitaire de défense : dimensions qualitative et quantitative dans l'analyse des processus, des acteurs-utilisateurs et des produits d'information." Thesis, Montpellier 3, 2017. http://www.theses.fr/2017MON30048.
The french armed forces can be exposed to biological and chemical risks within their work. The Medical Intelligence unit of the French armed forces Center of Epidemiology and Public Health has developed an information system in order to protect their health. Created to be used in usual or crisis situation, the system provides quickly decision-makers, experts, veterinary, pharmacist and army medical officer with useful information for decision making. The aim of our study is to offer an overall assessment, in particular to determine if it corresponds to the needs and practices for the users.These last years, a real technological revolution has occured, giving birth to numerous informational devices intended to help the users. Scientific studies to analyze the way the latter use them were then carried out.Resting on current theoretical foundations in information and communication sciences and on a methodology of mixed research associating quantitative and qualitative methods, we have analyzed the existing device and studied to what extent it becomes integrated into the information and communication practices of the staffs connected in the Military Health Service.This study allows to bring new knowledge on the french military practices, still largely unknown, and to propose an adaptable assessment grid to various documentary information systems
Linglin, Emilie. "Corps humain et assurances de personnes." Thesis, Paris 2, 2014. http://www.theses.fr/2014PA020026.
In that it is intimately linked to the person, the human body is a delicate entity which is the object of diverse protections. Amongst these figure personal insurances which, with their nature of precaution, play an important economic and social role that justifies easier access. This study aims to determine in which manner the specificity of the human body and the will to protect it affect the two principal aspects of contractual processes in insurance: the understanding and the coverage of risk factors. Indeed to determine a risk and to decide to cover it, the insurer must understand it. Concerning coverage of risks liable to affect the individual’s existence, his physical integrity or his health, pertinent information concerns the insurance candidate’s intimacy. In which way is it possible to reconcile the rights respecting private life, medical confidentiality, the protection of genetic data and the insurer’s need for information ? In addition, in order to respond to the ever increasing demands for protection of the human body, the combined actions of legislators and judges cause certain mutations in coverage of risk by the insurer that weigh on the person and it is necessary to study these modalities. Despite all the attention paid to the human body, the “soul” of personal insurance must not be sacrificed
Berger, Morgan. "L'accessibilité aux soins des hémophiles en Bretagne." Phd thesis, Université Rennes 2, 2012. http://tel.archives-ouvertes.fr/tel-00772541.
Wolff, Valérie. "La grande précarité au rythme de l’urgence : mobilisation du personnel autour du patient sans-abri dans un service hospitalier d’urgences." Thesis, Strasbourg, 2014. http://www.theses.fr/2014STRAG036.
For many homeless people, emergency hospital services open to all continuous represent a privileged channel of recourse in seeking care, assistance or accommodation. However, due to overcrowding in emergency events, health policies are moving towards a restriction of the welcome to the kernel serious pathologies. The example of patient precarious situation then pushes its climax tensions that occur in these services, torn between their skills to treat life- threatening emergency and traditional hospitality function "all-comers". A fieldwork conducted in a hospital emergency department, shows the diversity of personal forms of mobilization around homeless patients in their dimensions both moral and organizational
Dourgnon, Paul. "Evaluation des politiques publiques et inégalités sociales d'accès aux services de santé." Phd thesis, Université Paris Dauphine - Paris IX, 2013. http://tel.archives-ouvertes.fr/tel-00912417.
Lemonnier, Irawati. "Stratégies diagnostiques et qualité de vie en oncologie bronchopulmonaire - Programme d'évaluation de la TEP dans l'inter-région Grand-Est." Thesis, Nancy 1, 2011. http://www.theses.fr/2011NAN10001/document.
Background: The Positron Emission Tomography was installed in 2003 in the North-eastern region of France. Previous studies showed its diagnostic performance and its benefices in avoiding: surgical exploratory interventions proved to be unnecessary a posteriori (for example, thoracotomy or laparotomy with painful consequences), and certain complementary imaging tests or unnecessary functional explorations. Objectives : 1) to evaluate changes in diagnostic strategies of Solitary Pulmonary Nodule (SPN) and Non Small Cell Lung Cancer (NSCLC) induced by the implantation of PET in the Northeastern region of France ; 2) to mesure the impact of these changes on the health related quality of life (HRQoL) of patients with SPN and NSCLC; and 3) to study the prognostic role of the HRQoL on the survival of patients with NSCLC.Methodes: An observational, prospective, multi-center design was applied. Two cohorts « Before (2001 - 2002) - After (2004 - 2005) » the PET implantation in the regions were settled up. Data collected included: patients' socio-demographic and clinical characteristics, the diagnostic tests and then treatments that were carried out during 6 months after the end of the diagnostic process. Two HRQoL questionnaires (the generic questionnaire SF-36 and the cancer specific one QLQ-C30) were distributed at 3 and 6 months after the end of the diagnostic process.Results:1) The number of diagnostic tests of patients with SPN decreased significantly from a mean of 4 in the before-PET to 3 tests in the after-PET period. Meanwhile, there was not any difference of the frequency of invasive tests considered unnecessary aposteriori for patients with benign SPN (47% before-PET versus 49% after-PET period). One year after its installation, the PET was used in 11 % of diagnostic strategies. In 7.7% of cases it was used after the bronchoscopy. 2) A comparison of the QoL with that of the French general population revealed that patients with SPN, whatever the diagnosis, benign or malignant, had worse mean scores (-8 to -32 points, p<0.001) compared to the general population with similar age and sex. A difference of 24, 30 and 32 points were observed in the "physical functioning", "emotional role" and "physical role" (p<0.001). The scores of patients with benign nodule were higher than those of malignant, especially on "social functioning", "physical role", and "emotional role" (+10, +14 and +18 points respectively, p=0.02 to 0.04). 3) Good scores on "physical functioning" of SF-36 (HR=0.78; CI=0.68 - 0.90; p<0.001) as well as "role functioning" of QLQ-C30 (HR=0.53; CI=0.59 - 0.89; p=0.003) were related to a better survival. Higher symptoms of constipation (HR=1.18; CI=1.005-1.38; p=0.04) in QLQ-C30 were associated to a worse one. While being a woman was associated to a better survival (HR=0.55 ; CI=0,33 - 0,94 ; p=0,04), the stage III and IV of the NSCLC was related to a lower one (HR=1,72 ; CI=1,16 ? 2,57 ; p=0,007) .Conclusion: The diagnostic strategies of SPN changed after PET was available for medical practice. This study showed the negative impact of SPN to patients' HRQoL. It indicates the domains in which health practitioners could interfere in order to improve the management of these diseases, because this study confirmed previous studies in pulmonary oncology, that patients' QoL is related to the survival
Bosembo, Ilondjo Maurice. "Évaluation des besoins et des ressources hospitalières en Afrique centrale." Thèse, 2005. http://hdl.handle.net/1866/15310.