Précautions et limitations lors de l'utilisation de la mortalité intra-hospitalière comme indicateur de la qualité des soins

INTRODUCTION : La mortalité intra-hospitalière, utilisée comme indicateur de qualité aux USA et en Angleterre pour comparer les performances des hôpitaux est désormais également mesurable en Suisse, mais il parait important de relever les limitations et précautions liées à son utilisation. METHODES: Les données saisies en 2001 pour l'OFS par les hôpitaux valaisans servirent à établir les taux de mortalité globaux et par pathologie et à calculer les risques relatifs de mortalité propres à chaque hôpital, bruts et ajustés. RESULTATS: Les taux bruts de mortalité intra-hospitalière globale variaient de 1.25% à 1.80% selon les hôpitaux. Les taux par pathologie variaient peu, les différences ne reflétant que rarement des risques relatifs statistiquement significatifs après ajustement. DISCUSSION: Le taux de mortalité intra-hospitalière ne saurait être utilisé comme indicateur de qualité sans certaines précautions concernant notamment l'ajustement du "case-mix", l'exclusion de patients en soins palliatifs et l'examen des taux spécifiques par pathologie. [Auteurs] [Summary] INTRODUCTION: Inhospital mortality has been used as an outcome quality indicator in the USA and in England to compare and benchmark hospital performance. If is now also possible to measure this outcome indicator in Switzerland, but it is important to highlight limitations and precautions to its use. METHODS: We collected administrative data from acute care community hospitals in the Canton of Valais, Switzerland, for the year 2001. We assessed rates of global and disease specific inhospital mortality and calculated crude and adjusted relative risks of inhospital mortality, specific to each hospital. RESULTS: The crude rates of the global inhospital mortality varied from 1.25% to 1.80% between hospitals. The variation for disease specific mortality rates was low. After adjustment, differences between relative risks were almost never statistically significant. DISCUSSION: The use of inhospital mortality as an quality indicator, need to be done with cautions, in particular adjustment for the case-mix, exclusion of patients in palliative care and analysis of disease specific rates. [Authors]]]> Hospital Mortality ; Hospitals, Community ; Quality Indicators, Health Care oai:serval.unil.ch:BIB_41D2D7AFCA90 2023-07-29T01:23:17Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_41D2D7AFCA90 La vitesse, le type de véhicule et le sentiment d'impunité: une étude des excès de vitesse sur autoroute Johner, S. Kuhn, A. info:eu-repo/semantics/article article 2010 Revue interdisciplinaire de circulation routière, no. 2-3, pp. 15-19 fre oai:serval.unil.ch:BIB_41D2E0F9C11D 2023-07-29T01:23:17Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_41D2E0F9C11D Performances of the Rapid Polymyxin Acinetobacter and Pseudomonas Tests for Colistin Susceptibility Testing. info:doi:10.1089/mdr.2018.0153 info:eu-repo/semantics/altIdentifier/doi/10.1089/mdr.2018.0153 info:eu-repo/semantics/altIdentifier/pmid/30508392 Lescat, M. Poirel, L. Jayol, A. Nordmann, P. info:eu-repo/semantics/article article 2019-05 Microbial drug resistance, vol. 25, no. 4, pp. 520-523 info:eu-repo/semantics/altIdentifier/eissn/1931-8448 urn:issn:1076-6294 <![CDATA[Objectives: Owing to the emergence of colistin resistance in nonfermenting Gram negative bacteria, reliable and rapid techniques for testing colistin susceptibility are needed. We evaluated the performances of the Rapid Polymyxin Acinetobacter and Pseudomonas tests using a collection of Acinetobacter baumannii and Pseudomonas aeruginosa clinical isolates. Methods: Colistin susceptibility of A. baumannii and P. aeruginosa isolates (colistin susceptible and colistin resistant) was tested with the Rapid Polymyxin Acinetobacter and Pseudomonas tests and compared with the broth microdilution method. Results: The Rapid Polymyxin Acinetobacter and Pseudomonas tests were able to detect all colistin-resistant and all colistin-susceptible A. baumannii and P. aeruginosa isolates within 4 hours. Conclusion: The Rapid Polymyxin Acinetobacter and Pseudomonas tests are reliable techniques for detecting colistin resistance. Overall, both techniques allow an accurate and a rapid screening (&lt;4 hours) of colistin resistance in A. baumannii and P. aeruginosa