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Prost P, Duraes M, Georgescu V, Rebel L, Mercier G, Rathat G. Impact of Ovarian Cancer Surgery Volume on Overall and Progression-Free Survival: A Population-Based Retrospective National French Study. Ann Surg Oncol 2024; 31:3269-3279. [PMID: 38393461 DOI: 10.1245/s10434-024-15050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Data are limited on the relationship between ovarian cancer surgery volume and outcomes in France. METHODS For this retrospective, population-based study, patients with ovarian cancer that was diagnosed between January 1, 2012 and December 31, 2016 were identified from the French National Health Data System (SNDS). Hospitals were classified in function of their ovarian cancer surgery volume. Patient, tumor, hospital, and hospital stay characteristics also were evaluated. The hospital procedure volume effect on 5-year overall survival (OS) and recurrence-free survival (RFS) was determined with Cox-proportional hazards models. RESULTS This study included 8429 patients and 53.4% underwent cytoreductive surgery in hospitals with procedure volume < 20 cases/year. The 5-year OS rates were 63% and 60% in hospitals with procedure volume ≥ 20 and < 20 cases/year (p = 0.02). In multivariate analysis, OS and RFS were significantly increased when surgery was performed in hospitals doing ≥ 20 surgeries/year (vs. < 20) (hazard ratio HR = 1.18, 95% CI = 1.08-1.29 and HR = 1.10, 95% CI = 1.03-1.17). In the volume subgroup analysis, a difference was observed mainly between hospitals with < 10 surgeries/year and the other hospitals (HR = 1.27, 95% CI = 1.14-1.41 and HR = 1.14, 95% CI = 1.05-1.23). The patients' age and comorbidities, tumor stage, and hospital stay (duration, first cytoreduction surgery) were associated with OS. CONCLUSIONS Ovarian cancer surgery volume ≥ 20 cases/year was significantly associated with improved OS and RFS but only with a limited clinical benefit. The biggest differences in OS and RFS were observed between hospitals with procedure volume < 10 cases/year and all the other hospitals.
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Affiliation(s)
- Pauline Prost
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France.
| | - Martha Duraes
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Vera Georgescu
- Health Data Science Unit, Montpellier University Hospital and UMR IDESP, INSERM, Montpellier University, Montpellier, France
| | - Lucie Rebel
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Grégoire Mercier
- Health Data Science Unit, Montpellier University Hospital and UMR IDESP, INSERM, Montpellier University, Montpellier, France
| | - Gauthier Rathat
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
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Sommerauer C, Gallardo-Dodd CJ, Savva C, Hases L, Birgersson M, Indukuri R, Shen JX, Carravilla P, Geng K, Nørskov Søndergaard J, Ferrer-Aumatell C, Mercier G, Sezgin E, Korach-André M, Petersson C, Hagström H, Lauschke VM, Archer A, Williams C, Kutter C. Estrogen receptor activation remodels TEAD1 gene expression to alleviate hepatic steatosis. Mol Syst Biol 2024; 20:374-402. [PMID: 38459198 PMCID: PMC10987545 DOI: 10.1038/s44320-024-00024-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024] Open
Abstract
Sex-based differences in obesity-related hepatic malignancies suggest the protective roles of estrogen. Using a preclinical model, we dissected estrogen receptor (ER) isoform-driven molecular responses in high-fat diet (HFD)-induced liver diseases of male and female mice treated with or without an estrogen agonist by integrating liver multi-omics data. We found that selective ER activation recovers HFD-induced molecular and physiological liver phenotypes. HFD and systemic ER activation altered core liver pathways, beyond lipid metabolism, that are consistent between mice and primates. By including patient cohort data, we uncovered that ER-regulated enhancers govern central regulatory and metabolic genes with clinical significance in metabolic dysfunction-associated steatotic liver disease (MASLD) patients, including the transcription factor TEAD1. TEAD1 expression increased in MASLD patients, and its downregulation by short interfering RNA reduced intracellular lipid content. Subsequent TEAD small molecule inhibition improved steatosis in primary human hepatocyte spheroids by suppressing lipogenic pathways. Thus, TEAD1 emerged as a new therapeutic candidate whose inhibition ameliorates hepatic steatosis.
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Affiliation(s)
- Christian Sommerauer
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institute, Science for Life Laboratory, Solna, Sweden
| | - Carlos J Gallardo-Dodd
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institute, Science for Life Laboratory, Solna, Sweden
| | - Christina Savva
- Department of Medicine, Integrated Cardio Metabolic Center, Karolinska Institute, Huddinge, Sweden
| | - Linnea Hases
- Department of Protein Science, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden
| | - Madeleine Birgersson
- Department of Protein Science, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden
| | - Rajitha Indukuri
- Department of Protein Science, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden
| | - Joanne X Shen
- Department of Physiology and Pharmacology, Karolinska Institute, Solna, Sweden
| | - Pablo Carravilla
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institute, Science for Life Laboratory, Solna, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Science for Life Laboratory, Solna, Sweden
| | - Keyi Geng
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institute, Science for Life Laboratory, Solna, Sweden
| | - Jonas Nørskov Søndergaard
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institute, Science for Life Laboratory, Solna, Sweden
| | - Clàudia Ferrer-Aumatell
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institute, Science for Life Laboratory, Solna, Sweden
| | - Grégoire Mercier
- Department of Physiology and Pharmacology, Karolinska Institute, Solna, Sweden
| | - Erdinc Sezgin
- Department of Women's and Children's Health, Karolinska Institute, Science for Life Laboratory, Solna, Sweden
| | - Marion Korach-André
- Department of Medicine, Integrated Cardio Metabolic Center, Karolinska Institute, Huddinge, Sweden
| | - Carl Petersson
- Department of Drug Metabolism and Pharmacokinetics, The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Hannes Hagström
- Department of Medicine Huddinge, Karolinska Institute, Huddinge, Sweden
- Division of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital Huddinge, Huddinge, Sweden
| | - Volker M Lauschke
- Department of Physiology and Pharmacology, Karolinska Institute, Solna, Sweden
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - Amena Archer
- Department of Protein Science, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden
| | - Cecilia Williams
- Department of Protein Science, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden
| | - Claudia Kutter
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institute, Science for Life Laboratory, Solna, Sweden.
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Magaldi M, Nogue E, Molinari N, De Luca N, Dupuy AM, Leclercq F, Pasquie JL, Roubille C, Mercier G, Cristol JP, Roubille F. Predicting One-Year Mortality after Discharge Using Acute Heart Failure Score (AHFS). J Clin Med 2024; 13:2018. [PMID: 38610783 PMCID: PMC11012877 DOI: 10.3390/jcm13072018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Acute heart failure (AHF) represents a leading cause of unscheduled hospital stays, frequent rehospitalisations, and mortality worldwide. The aim of our study was to develop a bedside prognostic tool, a multivariable predictive risk score, that is useful in daily practice, thus providing an early prognostic evaluation at admission and an accurate risk stratification after discharge in patients with AHF. Methods: This study is a subanalysis of the STADE HF study, which is a single-centre, prospective, randomised controlled trial enrolling 123 patients admitted to hospital for AHF. Here, 117 patients were included in the analysis, due to data exhaustivity. Regression analysis was performed to determine predictive variables for one-year mortality and/or rehospitalisation after discharge. Results: During the first year after discharge, 23 patients died. After modellisation, the variables considered to be of prognostic relevance in terms of mortality were (1) non-ischaemic aetiology of HF, (2) elevated creatinine levels at admission, (3) moderate/severe mitral regurgitation, and (4) prior HF hospitalisation. We designed a linear model based on these four independent predictive variables, and it showed a good ability to score and predict patient mortality with an AUC of 0.84 (95%CI: 0.76-0.92), thus denoting a high discriminative ability. A risk score equation was developed. During the first year after discharge, we observed as well that 41 patients died or were rehospitalised; hence, while searching for a model that could predict worsening health conditions (i.e., death and/or rehospitalisation), only two predictive variables were identified: non-ischaemic HF aetiology and previous HF hospitalisation (also included in the one-year mortality model). This second modellisation showed a more discrete discriminative ability with an AUC of 0.67 (95% C.I. 0.59-0.77). Conclusions: The proposed risk score and model, based on readily available predictive variables, are promising and useful tools to assess, respectively, the one-year mortality risk and the one-year mortality and/or rehospitalisations in patients hospitalised for AHF and to assist clinicians in the management of patients with HF aiming at improving their prognosis.
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Affiliation(s)
- Mariarosaria Magaldi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (M.M.)
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
| | - Erika Nogue
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier University, 34090 Montpellier, France
| | - Nicolas Molinari
- Institute of Epidemiology and Public Health, INSERM, INRIA, CHU Montpellier, University of Montpellier, 34090 Montpellier, France
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (M.M.)
| | - Anne-Marie Dupuy
- Département de Biochimie et Hormonologie, Centre de Ressources Biologiques, CHU de Montpellier, 34295 Montpellier, France;
| | - Florence Leclercq
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
| | - Jean-Luc Pasquie
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
| | - Camille Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, CEDEX 5, 34090 Montpellier, France
- Department of Internal Medicine PhyMedExp CHU Montpellier, Montpellier University, 34090 Montpellier, France
| | - Grégoire Mercier
- Department of Statistics, Montpellier University Hospital, CEDEX 5, 34090 Montpellier, France;
| | - Jean-Paul Cristol
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, CEDEX 5, 34090 Montpellier, France
- Laboratory of Biochemistry, Montpellier University Hospital, CEDEX 5, 34090 Montpellier, France
| | - François Roubille
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, CEDEX 5, 34090 Montpellier, France
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Roubille F, Mercier G, Lancman G, Pasche H, Alami S, Delval C, Bessou A, Vadel J, Rey A, Duret S, Abraham E, Chatellier G, Durand Zaleski I. Weight telemonitoring of heart failure versus standard of care in a real-world setting: Results on mortality and hospitalizations in a 6-month nationwide matched cohort study. Eur J Heart Fail 2024. [PMID: 38450858 DOI: 10.1002/ejhf.3191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
AIMS Evaluating the benefit of telemonitoring in heart failure (HF) management in real-world settings is crucial for optimizing the healthcare pathway. The aim of this study was to assess the association between a 6-month application of the telemonitoring solution Chronic Care Connect™ (CCC) and mortality, HF hospitalizations, and associated costs compared with standard of care (SOC) in patients with a diagnosis of HF. METHODS AND RESULTS From February 2018 to March 2020, a retrospective cohort study was conducted using the largest healthcare insurance system claims database in France (Système National des Données de Santé) linked to the CCC telemonitoring database of adult patients with an ICD-10-coded diagnosis of HF. Patients from the telemonitoring group were matched with up to two patients from the SOC group based on their high-dimensional propensity score, without replacement, using the nearest-neighbour method. A total of 1358 telemonitored patients were matched to 2456 SOC patients. The cohorts consisted of high-risk patients with median times from last HF hospitalization to index date of 17.0 (interquartile range: 7.0-66.0) days for the telemonitoring group and 27.0 (15.0-70.0) days for the SOC group. After 6 months, telemonitoring was associated with mortality risk reduction (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.56-0.89), a higher risk of first HF hospitalization (HR 1.81, 95% CI 1.55-2.13), and higher HF healthcare costs (relative cost 1.38, 95% CI 1.26-1.51). Compared with the SOC group, the telemonitoring group experienced a shorter average length of overnight HF hospitalization and fewer emergency visits preceding HF hospitalizations. CONCLUSION The results of this nationwide cohort study highlight a valuable role for telemonitoring solutions such as CCC in the management of high-risk HF patients. However, for telemonitoring solutions based on weight and symptoms, consideration should be given to implement additional methods of assessment to recognize imminent worsening of HF, such as impedance changes, as a way to reduce mortality risk and the need for HF hospitalizations. Further studies are warranted to refine selection of patients who could benefit from a telemonitoring system and to confirm long-term benefits in high-risk and stable HF patients.
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Affiliation(s)
- François Roubille
- Cardiology Department, Hôpital Lapeyronie, PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, INI-CRT, Montpellier, France
| | - Grégoire Mercier
- Economic Evaluation Unit (URME), University Hospital of Montpellier, Montpellier, France
- IDESP, Université de Montpellier, INSERM, Montpellier, France
| | | | | | - Sarah Alami
- Air Liquide Santé International, Bagneux, France
| | | | | | | | | | | | | | - Gilles Chatellier
- Department of Statistics Informatics and Public Health, Université Paris-Cité, Paris, France
- Clinical Research Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Isabelle Durand Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France
- Santé Publique Hôpital Henri Mondor, Créteil, France
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Plat R, Vasile M, Roubille F, Mercier G. Relationships between the COVID-19 lockdown, socioeconomic factors and acute coronary syndrome hospitalisations in France. PLoS One 2023; 18:e0286700. [PMID: 37285371 DOI: 10.1371/journal.pone.0286700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Worldwide, the COVID-19 pandemic has been associated with an overall drop in acute coronary syndrome (ACS) hospitalizations. Additionally, there is a well-known association between ACS and socioeconomic status. This study aims to assess the COVID-19 effect on ACS admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity. MATERIALS AND METHODS In this retrospective study, we used the French hospital discharge database (PMSI) to estimate ACS admission rates in all public and private hospitals in 2019 and 2020. A negative binomial regression explored the nationwide change in ACS admissions during lockdown compared with 2019. A multivariate analysis explored the factors associated with the ACS admission incidence rate ratio (IRR, 2020 incidence rate/2019 incidence rate) variation at the county level. RESULTS We found a significant but geographically heterogeneous nationwide reduction in ACS admissions during lockdown (IRR 0·70 [0·64-0·76]). After adjustment for cumulative COVID-19 admissions and the ageing index, a higher share of people on short-term working arrangements during lockdown at the county level was associated with a lower IRR, while a higher share of individuals with a high school degree and a higher density of acute care beds were associated with a higher ratio. CONCLUSIONS During the first national lockdown, there was an overall decrease in ACS admissions. Local provision of inpatient care and socioeconomic determinants linked to occupation were independently associated with the variation in hospitalizations.
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Affiliation(s)
- Rodney Plat
- Data Science Unit, Montpellier University Hospital, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Maria Vasile
- Data Science Unit, Montpellier University Hospital, Montpellier, France
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Grégoire Mercier
- Data Science Unit, Montpellier University Hospital, Montpellier, France
- UMR UA11 IDESP CNRS, University of Montpellier, Montpellier, France
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Pujol JL, Mercier G, Vasile M, Serre I, Vernhet-Kovacsik H, Bommart S. Brief Report: A Multidisciplinary Initial Workup for Suspected Lung Cancer as Fast-Track Intervention to Histopathologic Diagnosis. JTO Clin Res Rep 2023; 4:100526. [PMID: 37333015 PMCID: PMC10275718 DOI: 10.1016/j.jtocrr.2023.100526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
Guidelines for optimal timing of lung cancer diagnosis and treatment have been implemented in many countries, but the effect of fast-track interventions on the shortening of time interval is still debatable. In this study, the delay from the first specialist visit to the histopathologic diagnosis was compared between two patient cohorts: before (n = 280) and after (n = 247) implementation of a fast-track multidisciplinary diagnosis program. The cumulative incidence function curves were compared, and hazard ratio was adjusted in the Cox model. The implementation allowed a statistically significant increase in the cumulative incidence of the lung cancer histopathologic diagnosis over time. Adjusted hazard ratio for patients accrued in the post-implementation cohort was 1.22 (1.03-1.45) (p = 0.023), corresponding to a reduction of this waiting period by 18%. In conclusion, a multidisciplinary approach of the diagnostic process implemented at the initial visit allows a significant reduction of the timeline until the histopathologic diagnosis of lung cancer.
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Affiliation(s)
- Jean-Louis Pujol
- Thoracic Oncology Unit, University Hospital of Montpellier, Montpellier, France
- Cancerology Resarch Institute of Montpellier (IRCM), National Institute for Health and Medical Research (INSERM) Unit-U1194, Montpellier, France
| | - Grégoire Mercier
- Data-Science Unit, University Hospital of Montpellier, Montpellier, France
- UMR UA11 Desbrest Institute of Epidemiology and Public Health (IDESP) French National Centre for Scientific Research (CNRS), University of Montpellier, Montpellier, France
| | - Maria Vasile
- Data-Science Unit, University Hospital of Montpellier, Montpellier, France
| | - Isabelle Serre
- Pathological Department, University Institute for Clinical Research, Montpellier, France
| | | | - Sébastien Bommart
- Department of Medical Imaging, University Hospital of Montpellier, Montpellier, France
- UMR 9214 French National Centre for Scientific Research (CNRS), National Institute for Health and Medical Research (INSERM) U1046, PhyMedExp University of Montpellier, Montpellier, France
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Gusmano MK, Weisz D, Mercier G, Vasile M, Rodwin VG. Access to outpatient care in Manhattan and Paris: A tale of real change in two world cities. Health Policy 2023; 132:104822. [PMID: 37068448 DOI: 10.1016/j.healthpol.2023.104822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023]
Abstract
France's system of universal health insurance (UHI) offers more equitable access to outpatient care than the patchwork system in the U.S., which does not have a UHI system. We investigate the degree to which the implementation of the Patient Protection and Affordable Care Act (ACA) has narrowed the gap in access to outpatient care between France and the U.S. To do so, we update a previous comparison of access to outpatient care in Manhattan and Paris as measured by age-adjusted rates of hospital discharge for avoidable hospital conditions (AHCs). We compare these rates immediately before and after the implementation of the ACA in 2014. We find that AHC rates in Manhattan declined by about 25% and are now lower than those in Paris. Despite evidence that access to outpatient care in Manhattan has improved, Manhattanites continue to experience greater residence-based neighborhood inequalities in AHC rates than Parisians. In Paris, there was a 3% increase in AHC rates and neighborhood-level inequalities increased significantly. Our analysis highlights the persistence of access barriers to outpatient care in Manhattan, particularly among racial and ethnic minorities, even following the expansion of health insurance coverage.
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Affiliation(s)
- Michael K Gusmano
- College of Health, Lehigh University, 124 South Morton Street, Room 150, Bethlehem, PA 18015, United States.
| | - Daniel Weisz
- International Longevity Center, Columbia University, New York, NY, United States
| | - Grégoire Mercier
- Equipe de Science des Données, Unité de Recherche Médico-Economique, DIM, CHU de Montpellier, Montpellier, France
| | - Maria Vasile
- Data Science Unit, Montpellier University Hospital, Montpellier, France
| | - Victor G Rodwin
- Robert Wagner School of Public Service, New York University, New York, NY, United States
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Alami S, Courouve L, Lancman G, Gomis P, Al-Hamoud G, Laurelli C, Pasche H, Chatellier G, Mercier G, Roubille F, Delval C, Durand-Zaleski I. Organisational Impact of a Remote Patient Monitoring System for Heart Failure Management: The Experience of 29 Cardiology Departments in France. Int J Environ Res Public Health 2023; 20:4366. [PMID: 36901372 PMCID: PMC10002348 DOI: 10.3390/ijerph20054366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Remote patient monitoring (RPM) for the management of patients with chronic heart failure (CHF) has been widely studied from clinical and health-economic points of view. In contrast, data on the organisational impact of this type of RPM are scarce. The objective of the present study of cardiology departments (CDs) in France was to describe the organisational impact of the Chronic Care ConnectTM (CCCTM) RPM system for CHF. An organisational impact map for health technology assessment was used to identify and define the criteria evaluated in the present survey, including the care process, equipment, infrastructure, training, skill transfers, and the stakeholders' abilities to implement the care process. In April 2021, an online questionnaire was sent to 31 French CDs that were using CCCTM for CHF management: 29 (94%) completed the questionnaire. The survey results showed that CDs progressively modified their organisational structures upon or shortly after the implementation of the RPM device. Twenty-four departments (83%) had created a dedicated team, sixteen (55%) had provided dedicated outpatient consultations for patients with an emergency alert, and twenty-five (86%) admitted patients directly (i.e., avoiding the need to attend the emergency department). The present survey is the first to have assessed the organisational impact of the implementation of the CCCTM RPM device for CHF management. The results highlighted the variety of organisational structures, which tended to structure with the use of the device.
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Affiliation(s)
- Sarah Alami
- ALSI, Air Liquide Santé International, 92220 Bagneux, France
| | | | - Guila Lancman
- ALSI, Air Liquide Santé International, 92220 Bagneux, France
| | | | | | | | - Hélène Pasche
- ALSI, Air Liquide Santé International, 92220 Bagneux, France
| | - Gilles Chatellier
- Department of Statistics Informatics and Public Health, Université Paris-Cité, 75006 Paris, France
- Clinical Research Unit, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Grégoire Mercier
- Economic Evaluation Unit (URME), University Hospital of Montpellier, 34295 Montpellier, France
- IDESP, Université de Montpellier, INSERM, 34000 Montpellier, France
| | - François Roubille
- Cardiology Department, Hôpital Lapeyronie, PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, INI-CRT, 34090 Montpellier, France
| | - Cécile Delval
- ALSI, Air Liquide Santé International, 92220 Bagneux, France
| | - Isabelle Durand-Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l’Hôtel Dieu, 75004 Paris, France
- Santé Publique Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny F, 94010 Créteil, France
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Mercier G, Georgescu V, Baehr C, Riedel C. Geographic variation in COVID-19 hospital admissions in France: a population-based study. Eur J Public Health 2022. [PMCID: PMC9594458 DOI: 10.1093/eurpub/ckac129.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The impact of various environmental, socio-economic, and epidemiological factors on COVID-19 transmission and severity is well-known. However, there is little evidence about the respective role of these factors at the population-level at a national scale. The objective was to identify the environmental and contextual factors that influenced the spread and the severity of COVID-19 at the French department level during the first national lockdown. We performed a national, population-based, retrospective analysis. The cumulative rate of patients admitted for COVID-19 to any public or private acute care hospital from March 31st, 2020 to May 25, 2020 was modelled at the ‘departement’ (hereafter county) level. We used spatial regression models to quantify the aggregated effect of population health status, air pollution, meteorological, and socioeconomic factors. 57,356 patients were admitted to an acute care facility for COVID-19 over the period of interest. At the county level, the age and sex-standardized rate of admission ranged from 0.07 to 3.24 admissions per 1,000 people. After adjustment on the pre-lockdown COVID-19 hospital admission rate, the standardized cumulative rate hospital admission for COVID-19 during the period of interest was significantly and positively associated with the prevalence of diabetes, with the prevalence of mental conditions, and with high cumulative exposure to atmospheric ozone values. It was significantly and negatively associated with high cumulative exposure to ultraviolet radiation. These results suggest that several population-based epidemiological and meteorological factors could have played a role in COVID-19 spread in France. They provide potentially useful insights to design and implement geographically differentiated public health policies.
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Affiliation(s)
- G Mercier
- Health Data Science Unit, Montpellier University Hospital , Montpellier, France
- UMR IDESP, Montpellier University , Montpellier, France
| | - V Georgescu
- Health Data Science Unit, Montpellier University Hospital , Montpellier, France
| | - C Baehr
- CNRM UMR 3589, Meteo France , Toulouse, France
| | - C Riedel
- Health Data Science Unit, Montpellier University Hospital , Montpellier, France
- Internal Medicine Department, Montpellier University Hospital , Montpellier, France
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Bernard L, Valsecchi V, Mura T, Aouinti S, Padern G, Ferreira R, Pastor J, Jorgensen C, Mercier G, Pers YM. Management of patients with rheumatoid arthritis by telemedicine: connected monitoring. A randomized controlled trial. Joint Bone Spine 2022; 89:105368. [PMID: 35248737 DOI: 10.1016/j.jbspin.2022.105368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a prevalent and disabling disease that is the source of significant direct and indirect costs. The current recommended therapeutic strategy is based on the rapid introduction of therapy with conventional Disease-Modifying Anti-Rheumatic Drugs (DMARDs) combined with regular disease monitoring by the rheumatologist. The onerous nature of such intense monitoring has motivated the development of new, less demanding strategies such as telemedicine. This study aimed to estimate the cost-effectiveness of the connected monitoring of RA patients initiating a new DMARD therapy versus conventional monitoring. METHODS An economic evaluation based on a randomized controlled trial of 89 patients was conducted. The patients in the intervention group (n=45) were monitored using a connected monitoring interface on a smartphone, while patients in the control group (n=44) were conventionally monitored. Health outcomes were measured as the gain in quality-adjusted life-years (QALYs), assessed using the EuroQol-5D questionnaire. Resource use and health outcomes were collected alongside the trial and at the six-month follow-up using application data and the related clinical case manager time, visits, hospitalisations, and transport records. These outcomes were valued using externally collected data on unit costs and QALY weights. RESULTS Compared to conventionally monitored patients, patients receiving connected monitoring had a slightly greater but not significant gain in the average QALY of 0.07. The economic analysis found that connected monitoring resulted in a significant cost reduction of 72€ (2927€ vs. 2999€, P<0.01). The incremental cost-utility ratio of the intervention was equal to -1,029€ per QALY (95% CI: -32,033; +24,625) with a 97.8% chance of being cost-effective at a threshold of 30,000€ per QALY gained. CONCLUSION Implementing EULAR recommendations for RA patients initiating a DMARD treatment using connected monitoring is more efficient and less expensive than conventional care. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT03005925).
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Affiliation(s)
- Laurene Bernard
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Verushka Valsecchi
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Thibault Mura
- Clinical Research and Epidemiology Unit (URCE), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Safa Aouinti
- Clinical Research and Epidemiology Unit (URCE), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Guillaume Padern
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Rosanna Ferreira
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Jenica Pastor
- Clinical Research and Medico economic Unit (URME), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Christian Jorgensen
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Grégoire Mercier
- Clinical Research and Medico economic Unit (URME), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Yves-Marie Pers
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France.
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Pathak A, Levy P, Roubille F, Chatellier G, Mercier G, Alami S, Lancman G, Pasche H, Laurelli C, Delval C, Ramirez‐Gil JF, Galinier M. Healthcare costs of a telemonitoring programme for heart failure: indirect deterministic data linkage analysis. ESC Heart Fail 2022; 9:3888-3897. [PMID: 35950267 PMCID: PMC9773639 DOI: 10.1002/ehf2.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/01/2022] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS We aim to evaluate the costs associated with healthcare resource consumption for chronic heart failure (HF) management in patients allocated to telemonitoring versus standard of care (SC). METHODS AND RESULTS OSICAT-ECO involved 745 patients from the OSICAT trial (NCT02068118) who were successfully linked to the French national healthcare database through an indirect deterministic data linkage approach. OSICAT compared a telemonitoring programme with SC follow-up in adults hospitalized for acute HF ≤ 12 months. Healthcare resource costs included those related to hospital and ambulatory expenditure for HF and were restricted to direct costs determined from the French health data system over 18 months of follow-up. Most of the total costs (69.4%) were due to hospitalization for HF decompensation, followed by ambulatory nursing fees (11.8%). During 18-month follow-up, total costs were 2% lower in the telemonitoring versus the SC group, due primarily to a 21% reduction in nurse fees. Among patients with NYHA class III/IV, a 15% reduction in total costs (€3131 decrease) was observed over 18-month follow-up in the telemonitoring versus the SC group, with the highest difference in hospital expenditure during the first 6 months, followed by a shift in costs from hospital to ambulatory at 12 months. CONCLUSIONS HF hospitalization and ambulatory nursing fees represented most of the costs related to HF. No benefit was observed for telemonitoring versus SC with regard to cost reductions over 18 months. Patients with severe HF showed a non-significant 15% reduction in costs, largely related to hospitalization for HF decompensation, nurse fees, and medical transport.
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Affiliation(s)
- Atul Pathak
- Department of Cardiovascular MedicinePrincess Grace HospitalMonacoPrincipality of Monaco
| | - Pierre Levy
- LEDa – LEGOS, Université Paris DauphinePSL Research UniversityParisFrance
| | - François Roubille
- Cardiology Department, INI‐CRT, CHU de Montpellier, PhyMedExpUniversité de Montpellier, INSERM, CNRSMontpellierFrance
| | - Gilles Chatellier
- Clinical Research Unit and CIC 1418 INSERMGeorge‐Pompidou European HospitalParisFrance
| | - Grégoire Mercier
- Economic Evaluation Unit (URME), University Hospital of MontpellierMontpellier UniversityMontpellierFrance,IDESPUniv Montpellier, INSERMMontpellierFrance
| | - Sarah Alami
- Air Liquide Santé InternationalBagneuxFrance
| | | | | | | | | | | | - Michel Galinier
- Cardiology DepartmentRangueil University HospitalToulouseFrance,Faculty of MedicineUniversity of Paul Sabatier‐Toulouse IIIToulouseFrance
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Plat R, Vasile M, Roubille F, Mercier G. Impact du confinement national sur les admissions pour syndrome coronarien aigu en France : une analyse spatiale des déterminants socio-économiques et d'offre de soins. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Huguet H, Padern G, Pers YM, Mercier G. Comorbidités et traitements médicamenteux des patients atteints de la maladie de Gaucher: analyse nationale à partir du Système national des données de santé. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Nicolet G, Quantin C, Duclos A, Chollet F, Cottenet J, Mercier G. Développement d'un modèle prédictif du risque de réhospitalisation non programmée à partir des données PMSI nationales. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Plat R, Vasile M, Quantin C, Arquizan C, Mercier G. The effects of the COVID-19 lockdown and socio-economic factors on stroke hospitalizations in France. Eur J Public Health 2021. [PMCID: PMC8574701 DOI: 10.1093/eurpub/ckab164.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Worldwide, the COVID-19 pandemic has been associated with a drop in overall stroke hospitalizations. Additionally, there is a well-known association between stroke and socioeconomic status. This study aims to assess the COVID-19 effect on stroke admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity. Methods In this retrospective nationwide study, we used data from the French hospital discharge database (PMSI) to estimate rates of admission for stroke to all public and private hospitals in 2019 and 2020. We used negative binomial regression to test for a nationwide change in stroke admissions during the first lockdown, compared to the same period in 2019 (from week 12 to week 19). We conducted a multivariate analysis to explore the factors associated with the stroke admission incidence rate ratio variation (2020 incidence rate/2019 incidence rate) at the county level. Results We found a significant nationwide reduction in stroke admissions during the first wave of COVID-19 (incidence rate ratio 0,91 [0,86 - 0.97]), with notable geographic variations. After adjustment on hospital bed capacity, cumulative in-hospital COVID-19 incidence, standardized death rate at age 65 and unemployment rate, a higher share of labourers at the county level was associated with a higher incidence rate ratio (p < 0.01). Conclusions During the first national lockdown, there has been an overall decrease in stroke admission rates. Socio-economic determinants such as low-skilled jobs were independently associated with an increase in the stroke admission incidence rate ratio, while we did not find any independent effect from the local COVID 19 burden and hospital capacities. Key messages The first national lockdown led to an overall decrease in stroke admissions in France. This decrease varied between counties according to socio-economic determinants.
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Affiliation(s)
- R Plat
- Data-Science Unit, Montpellier University Hospital, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - M Vasile
- Data-Science Unit, Montpellier University Hospital, Montpellier, France
| | - C Quantin
- Clinical Epidemiology, Clinical Trials Unit, Dijon University Hospital, Dijon, France
| | - C Arquizan
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - G Mercier
- Data-Science Unit, Montpellier University Hospital, Montpellier, France
- UMR UA11 IDESP CNRS, University of Montpellier, Montpellier, France
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Decarriere G, Pastor J, Demoulin D, Mouterde G, Lukas C, Combe B, Mercier G, Morel J, Daien C. OP0214 IMPACT OF A MULTI-MORBIDITY SCREENING AND PREVENTION PROGRAM IN CHRONIC INFLAMMATORY RHEUMATIC DISEASES ON THE ONE-YEAR HOSPITALIZATION RATE BASED ON AN ANALYSIS OF THE FRENCH NATIONAL HEALTH DATABASE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:A screening program for multimorbidities started in 2014 at the Montpellier University Hospital for primary prevention in patients with chronic inflammatory rheumatic diseases (IRD).Objectives:The objective of this work was to assess the impact of this program on morbidity by comparing the hospitalization rate of those patients in the year following the screening to the one of patients with IRD who did not benefit from this program.Methods:Patients with IRD who benefit from the screening program in 2015, 2016 and 2017 were identified in the French national health database PMSI and matched to 3 controls living in the same area on age, sex, type of IRD, use of intravenous (IV) biologic (b) DMARDs and index date. The exclusion criteria were subjects in secondary prevention identified as history of myocardial infarction in the previous 5 years or use of antiplatelet therapy. The primary outcome was the rate of all-cause hospitalization in the following year. The secondary endpoints were hospitalizations for another reason than IRD (“non-IRD”) including those for cardiovascular [CV] events and major fractures. Hospitalization rates were compared between the two groups in the year after screening (or index date) and also between the year preceding screening and the year after for each group. Univariate and multivariate odds ratios (CI95%) were calculated, taking into account the medical history (hypertension, diabetes, heart failure, CV disease, COPD, major fractures in the 5 years preceding the index date) and hospitalizations in the previous year.Results:486 patients were identified and matched with 1458 controls. 67.08% had rheumatoid arthritis and 21.81% spondyloarthritis; 7% of them had IV bDMARDs. Unscreened patients had more hypertension (19% vs 10.1%), diabetes (9% vs 4.9%), heart failure (2.3% vs 0.4%) and “non-IRD” hospitalizations (78.5% vs 72.2%) in the 5 years preceding the index date. In the year following the index date, the percentages of “all causes” and “non-IRD” hospitalizations were significantly higher in non-screened than in screened patients (n = 1944, 64.8% versus 51%, Chi2 test, p <0.001; and 47.1% versus 37.9%, p <0.001 respectively). 17 (1.17%) cardiovascular events occurred in non-screened versus 2 (0.41%) in screened patients (n = 1944, Chi2 test, p = 0.14). There was no difference in the occurrence of CV events or major fractures between the 2 groups. In multivariate analysis, screening was associated with a 49% (0.51 [0.41-0.64]) reduction in “all causes” hospitalization and a 27% (0, 73 [0.58-0.91]) decrease in “non-IRD” hospitalization, with no difference for CV or fracture cardiological events. The risk factors associated with “non-IRD” hospitalization were: history of “non-IRD” hospitalization in the previous year (2.26 [1.63-3.13]), IV bDMARDs (1.69 [1, 14-2.53]) and age> 70 years (1.44 [1.02-2.03] vs <50 years). Hospitalization in the previous year for “all causes” or “non-IRD” was associated with rehospitalization in the following year in the non-screened group (p <0.001), but not in the screened group (p = 0.750 and p = 0.066 respectively).Conclusion:Our screening and prevention program was associated with a reduction in hospitalizations in the following year and a decrease in the risk of re-hospitalization compared to unscreened patients with IRD. This suggests a positive impact of performing systematic screening for multi-morbidities in IRD patients.Acknowledgements:We thank Pfizer for their financial supportDisclosure of Interests:guillaume decarriere: None declared, Jenica PASTOR: None declared, David DEMOULIN: None declared, Gael Mouterde Speakers bureau: Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Grant/research support from: Pfizer, Cédric Lukas Speakers bureau: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Consultant of: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Grant/research support from: Pfizer, Novartis and Roche-Chugai, Bernard Combe Speakers bureau: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Consultant of: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Grant/research support from: Novartis, Pfizer, and Roche-Chugai, Grégoire Mercier: None declared, Jacques Morel Speakers bureau: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Consultant of: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Grant/research support from: Novartis, Pfizer, and Roche-Chugai, Claire Daien Speakers bureau: Pfizer, Roche-Chugai, Fresenius, BMS, MSD, Lilly, Novartis, Galapagos, Consultant of: Abivax, Abbbvie, BMS, Roche-Chugai, Grant/research support from: Pfizer, roche-chugai, fresenius, MSD
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Robert P, Albrengues C, Fabre R, Derreumaux A, Pancrazi MP, Luporsi I, Dubois B, Epelbaum S, Mercier G, Foulon P, Bremond F, Manera V. Efficacy of serious exergames in improving neuropsychiatric symptoms in neurocognitive disorders: Results of the X-TORP cluster randomized trial. Alzheimers Dement (N Y) 2021; 7:e12149. [PMID: 34013018 PMCID: PMC8112479 DOI: 10.1002/trc2.12149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/24/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy of a serious exergame in improving the neuropsychiatric symptoms of patients with neurocognitive disorders. METHODS X-Torp is a serious exergame combining motor and cognitive activities. Ninety-one subjects (mean age = 81.7 years, mean Mini-Mental State Examination = 18.3) were recruited in 16 centers. Centers were randomized into intervention and control centers. Subjects underwent assessment for cognitive and behavioral symptoms at baseline (BL), the end of the intervention (W12), and 12 weeks after the end of the intervention (W24). RESULTS The comparison of neuropsychiatric symptoms between BL and W12 and W24 showed that subjects of the intervention group improved in apathy between BL and W12. Mixed analysis (time BL, W12, W24 x group) indicated a significant increase in apathy and neuropsychiatric symptoms in the control subjects. DISCUSSION The use of X-Torp improved neuropsychiatric symptoms, particularly apathy. Future studies should more consistently use behavioral and neuropsychiatric symptoms as outcome measures.
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Affiliation(s)
- Philippe Robert
- CoBTeK LabUniversité Côte d'AzurNiceFrance
- Centre mémoire CMRRCentre Hospitalier Universitaire de NiceNiceFrance
- Association Innovation AlzheimerNiceFrance
| | - Claire Albrengues
- Centre mémoire CMRRCentre Hospitalier Universitaire de NiceNiceFrance
| | - Roxane Fabre
- Département de Santé PubliqueCentre Hospitalier Universitaire de NiceNiceFrance
| | - Alexandre Derreumaux
- CoBTeK LabUniversité Côte d'AzurNiceFrance
- Centre mémoire CMRRCentre Hospitalier Universitaire de NiceNiceFrance
| | | | | | - Bruno Dubois
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) SalpetrièreParisFrance
| | - Stéphane Epelbaum
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) SalpetrièreParisFrance
| | - Grégoire Mercier
- UMR CEPELUniversité de MontpellierMontpellierFrance
- DIM, CHU de MontpellierHôpital La ColombiereMontpellierFrance
| | - Pierre Foulon
- Company GENIOUS Healthcare—Mindmaze GroupLausanneSwitzerland
| | | | - Valeria Manera
- CoBTeK LabUniversité Côte d'AzurNiceFrance
- Association Innovation AlzheimerNiceFrance
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Pers YM, Valsecchi V, Mura T, Aouinti S, Filippi N, Marouen S, Letaief H, Le Blay P, Autuori M, Fournet D, Mercier G, Ferreira R, Jorgensen C. A randomized prospective open-label controlled trial comparing the performance of a connected monitoring interface versus physical routine monitoring in patients with rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:1659-1668. [PMID: 33020846 DOI: 10.1093/rheumatology/keaa462] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES In RA, telemedicine may allow tight control of disease activity while reducing hospital visits. We developed a smartphone application connected with a physician's interface to monitor RA patients. We aimed to assess the performance of this e-Health solution in comparison with routine practice in the management of patients with RA. METHODS A six-month pragmatic, randomized, controlled, prospective, clinical trial was conducted in RA patients with high to moderate disease activity starting a new DMARD therapy. Two groups were established: 'connected monitoring' and 'conventional monitoring'. The primary outcome was the number of physical visits between baseline and six months. Secondary outcomes included adherence, satisfaction, changes in clinical, functional and health status scores (Short-Form 12). RESULTS Of the 94 randomized patients, 89 completed study: 44 in the 'conventional monitoring' arm and 45 in the 'connected monitoring' arm. The total number of physical visits between required baseline and six-month visits was significantly lower in the 'connected monitoring' group [0.42 (0.58) vs 1.93 (0.55); P <0.05]. No differences between groups were observed in the clinical and functional scores. A better quality of life for Short-Form 12 subscores (Role-Physical and Role-Emotional) were found in the 'connected monitoring' group. CONCLUSION Our results suggest that connected monitoring reduces the number of physical visits while maintaining a tight control of disease activity and improving quality of life in patients with RA starting a new treatment. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT03005925.
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Affiliation(s)
- Yves-Marie Pers
- IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, Montpellier, France
| | - Verushka Valsecchi
- IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, Montpellier, France
| | - Thibault Mura
- Clinical Research and Epidemiology Unit (URCE), Montpellier, France
| | - Safa Aouinti
- Clinical Research and Epidemiology Unit (URCE), Montpellier, France
| | - Nathalie Filippi
- IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, Montpellier, France
| | - Sarah Marouen
- IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, Montpellier, France
| | - Hind Letaief
- IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, Montpellier, France
| | - Pierre Le Blay
- IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, Montpellier, France
| | - Michel Autuori
- IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, Montpellier, France
| | - Dominique Fournet
- IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, Montpellier, France
| | - Grégoire Mercier
- Economic Evaluation Unit (URME), CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Rosanna Ferreira
- IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, Montpellier, France
| | - Christian Jorgensen
- IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, Montpellier, France
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Duflos C, Labarre JP, Ologeanu R, Robin M, Cayla G, Galinier M, Georger F, Petroni T, Alarcon C, Aguilhon S, Delonca C, Battistella P, Agullo A, Leclercq F, Pasquie JL, Papinaud L, Mercier G, Ricci JE, Roubille F. PRADOC: a trial on the efficiency of a transition care management plan for hospitalized patients with heart failure in France. ESC Heart Fail 2020; 8:1649-1655. [PMID: 33369195 PMCID: PMC8006694 DOI: 10.1002/ehf2.13086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/30/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
Aims Transition care programmes are designed to improve coordination of care between hospital and home. For heart failure patients, meta‐analyses show a high efficacy but with moderate evidence level. Moreover, difficulties for implementation of such programmes limit their extrapolation. Methods and results We designed a mixed‐method study to assess the implementation of the PRADO‐IC, a nationwide transition programme that aims to be offered to every patient with heart failure in France. This programme consists essentially in an administrative assistance to schedule follow‐up visits and in a nurse follow‐up during 2 to 6 months and aims to reduce the annual heart failure readmission rate by 30%. This study assessed three quantitative aims: the cost to avoid a readmission for heart failure within 1 year (primary aim, intended sample size 404 patients), clinical care pathways, and system economic outcomes; and two qualitative aims: perceived problems and benefits of the PRADO‐IC. All analyses will be gathered at the end of study for a joint interpretation. Strengths of this study design are the randomized controlled design, the population included in six centres with low motivation bias, the primary efficiency analysis, the secondary efficacy analyses on care pathway and clinical outcomes, and the joint qualitative analysis. Limits are the heterogeneity of centres and of intervention in a control group and parallel development of other new therapeutic interventions in this field. Conclusions The results of this study may help decision‐makers to support an administratively managed transition programme.
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Affiliation(s)
- Claire Duflos
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France.,CEPEL, Univ Montpellier, CNRS, Montpellier, France
| | | | - Roxana Ologeanu
- Montpellier Research Management, Univ Montpellier, Montpellier, France
| | - Marie Robin
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, 34295, France
| | - Guillaume Cayla
- Department of Cardiology, Nimes University Hospital, Montpellier University, Nimes, France
| | - Michel Galinier
- Fédération des Services de Cardiologie, CHU Toulouse-Rangueil, Toulouse, France
| | | | - Thibaut Petroni
- Cardiology, Clinique du Pont de Chaume ELSAN, Montauban, France
| | - Clément Alarcon
- Department of Cardiology, Alès-Cévennes Hospital, Alès cedex, France
| | - Sylvain Aguilhon
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, 34295, France
| | - Christine Delonca
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, 34295, France
| | - Pascal Battistella
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, 34295, France
| | - Audrey Agullo
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, 34295, France
| | - Florence Leclercq
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, 34295, France
| | - Jean-Luc Pasquie
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, 34295, France.,PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Laurence Papinaud
- Direction Régional du Service Médical Languedoc-Roussillon, CNAM, Paris, France
| | - Grégoire Mercier
- CEPEL, Univ Montpellier, CNRS, Montpellier, France.,Public Health Department, Montpellier University Hospital, Montpellier Cedex 5, France
| | - Jean-Etienne Ricci
- Department of Cardiology, Nimes University Hospital, Montpellier University, Nimes, France
| | - François Roubille
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, 34295, France.,PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
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Mercier G, Arquizan C, Roubille F. Understanding the effects of COVID-19 on health care and systems. Lancet Public Health 2020; 5:e524. [PMID: 33007210 PMCID: PMC7524439 DOI: 10.1016/s2468-2667(20)30213-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Grégoire Mercier
- Public Health Department, Montpellier University Hospital, 34295 Montpellier cedex 5, France; CEPEL, Université de Montpellier, INSERM, Centre national de la recherche scientifique, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Montpellier University Hospital, 34295 Montpellier cedex 5, France
| | - François Roubille
- Department of Cardiology, Montpellier University Hospital, 34295 Montpellier cedex 5, France; PhyMedExp, Université de Montpellier, INSERM, Centre national de la recherche scientifique, Montpellier, France.
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Duflos C, Troude P, Strainchamps D, Ségouin C, Logeart D, Mercier G. Hospitalization for acute heart failure: the in-hospital care pathway predicts one-year readmission. Sci Rep 2020; 10:10644. [PMID: 32606326 PMCID: PMC7327074 DOI: 10.1038/s41598-020-66788-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 05/06/2020] [Indexed: 11/18/2022] Open
Abstract
In patients with heart failure, some organizational and modifiable factors could be prognostic factors. We aimed to assess the association between the in-hospital care pathways during hospitalization for acute heart failure and the risk of readmission. This retrospective study included all elderly patients who were hospitalized for acute heart failure at the Universitary Hospital Lariboisière (Paris) during 2013. We collected the wards attended, length of stay, admission and discharge types, diagnostic procedures, and heart failure discharge treatment. The clinical factors were the specific medical conditions, left ventricular ejection fraction, type of heart failure syndrome, sex, smoking status, and age. Consistent groups of in-hospital care pathways were built using an ascending hierarchical clustering method based on a primary components analysis. The association between the groups and the risk of readmission at 1 month and 1 year (for heart failure or for any cause) were measured via a count data model that was adjusted for clinical factors. This study included 223 patients. Associations between the in-hospital care pathway and the 1 year-readmission status were studied in 207 patients. Five consistent groups were defined: 3 described expected in-hospital care pathways in intensive care units, cardiology and gerontology wards, 1 described deceased patients, and 1 described chaotic pathways. The chaotic pathway strongly increased the risk (p = 0.0054) of 1 year readmission for acute heart failure. The chaotic in-hospital care pathway, occurring in specialized wards, was associated with the risk of readmission. This could promote specific quality improvement actions in these wards. Follow-up research projects should aim to describe the processes causing the generation of chaotic pathways and their consequences.
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Affiliation(s)
- Claire Duflos
- Department of Medical Information, CHU, University of Montpellier, Montpellier, France.
- PhyMedExp, U1046, INSERM, Montpellier, France.
| | - Pénélope Troude
- Public Health Department, Universitary Hospital Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, Paris, France
| | - David Strainchamps
- Department of Medical Information, CHU, University of Montpellier, Montpellier, France
| | - Christophe Ségouin
- Public Health Department, Universitary Hospital Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, Paris, France
| | - Damien Logeart
- Cardiology Department, Universitary Hospital Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, Paris, France
| | - Grégoire Mercier
- Department of Medical Information, CHU, University of Montpellier, Montpellier, France
- CEPEL, University of Montpellier, Montpellier, France
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22
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Huet F, Prieur C, Schurtz G, Gerbaud E, Manzo-Silberman S, Vanzetto G, Elbaz M, Tea V, Mercier G, Lattuca B, Duflos C, Roubille F. Acute cardiovascular diseases may be less likely to be considered because of the COVID-19 pandemic-our duty is first to alert, then to analyse more deeply: Response to a letter entitled "Severity of cardiovascular diseases during the COVID-19 pandemic" from T. Imamura. Arch Cardiovasc Dis 2020; 113:486-487. [PMID: 32616390 PMCID: PMC7301107 DOI: 10.1016/j.acvd.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Fabien Huet
- Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, France
| | - Cyril Prieur
- Department of Cardiology, Hôpital Cardiologique Louis-Pradel, 69500 Bron, France
| | - Guillaume Schurtz
- Department of Cardiology, Institut Coeur Poumons, Hôpital Cardiologique, 59000 Lille, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier-Arnozan, 33600 Pessac, France
| | | | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Meyer Elbaz
- Department of Cardiology, Hôpital Rangueil, 31400 Toulouse, France
| | - Victoria Tea
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Grégoire Mercier
- CEPEL, Université de Montpellier, CNRS, 34090 Montpellier, France; Medico-Economic Research Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - Benoît Lattuca
- Department of Cardiology, CHU de Nîmes, 30029 Nîmes, France
| | - Claire Duflos
- CEPEL, Université de Montpellier, CNRS, 34090 Montpellier, France; Clinical Research and Epidemiology Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - François Roubille
- Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, France.
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Pers YM, Valsecchi V, Mura T, Aouinti S, Filippi N, Marouen S, Letaief H, Le Blay P, Autuori M, Fournet D, Mercier G, Ferreira Lopez R, Jorgensen C. FRI0651-HPR A RANDOMIZED PROSPECTIVE OPEN-LABEL CONTROLLED TRIAL COMPARING THE PERFORMANCE OF A CONNECTED MONITORING INTERFACE IN PATIENTS WITH RHEUMATOID ARTHRITIS VERSUS PHYSICAL ROUTINE MONITORING. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Telemedicine has found wider application in chronic diseases for encouraging tight home-monitoring in order to improve patients’ outcome (Smolen et al. 2017).In previous studies, a high feasibility and high patient-satisfaction rate was found as well as the evidence for a superior or equal effectiveness of telemedicine compared to the standard face-to-face approach, however the results were weakened by some methodological biases and wide heterogeneity of interventions, thus preventing to draw definitive conclusions (Piga et al. 2017; Najm, Gossec, et al. 2019).Objectives:In rheumatoid arthritis (RA), telemedicine may allow a tight control of disease activity while reducing hospital visits. We developed a smartphone application connected with a physician’s interface to monitor RA patients. We aimed to assess the performance of this e-Health solution in comparison with routine practice in the management of patients with RA.Methods:A 6-month pragmatic, randomized, controlled, prospective, clinical trial was conducted in RA patients with high to moderate disease activity starting a new Disease Modifying Anti-Rheumatic Drug (DMARD) therapy. Two groups were established: “connected monitoring” and “conventional monitoring”. The primary outcome was the number of physical visits between baseline and 6 months. Secondary outcomes included adherence, satisfaction, changes in clinical, functional, and health status scores (SF-12).Results:Of the 94 randomized patients, 89 completed study: 44 in the “conventional monitoring” arm and 45 in the “connected monitoring” arm. The total number of physical visits between baseline and 6 month was significantly lower in the “connected monitoring” group (0.42 ± 0.58 versus 1.93 ± 0.55; p<0.05). No differences between groups were observed in the clinical and functional scores. A better quality of life for SF-12 subscores (Role-Physical, Social-Functioning and Role-Emotional) were found in the “connected monitoring” group.Conclusion:According to our results, a connected monitoring reduces the number of physical visits while maintaining a tight control of disease activity and improving quality of life in patients with RA starting a new treatment.References:[1] Najm, Aurelie, Laure Gossec, Catherine Weill, David Benoist, Francis Berenbaum, and Elena Nikiphorou. 2019. “Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review.”JMIR MHealth and UHealth7 (11): e14730.https://doi.org/10.2196/14730.[2] Piga, Matteo, Ignazio Cangemi, Alessandro Mathieu, and Alberto Cauli. 2017. “Telemedicine for Patients with Rheumatic Diseases: Systematic Review and Proposal for Research Agenda.”Seminars in Arthritis and Rheumatism47 (1): 121–28.https://doi.org/10.1016/j.semarthrit.2017.03.014.[3] Smolen, Josef S, Robert Landewe, Johannes Bijlsma, Gerd Burmester, Katerina Chatzidionysiou, Maxime Dougados, Jackie Nam, et al. 2017. “EULAR Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2016 Update.”Annals of the Rheumatic Diseases76 (6): 960–77.https://doi.org/10.1136/annrheumdis-2016-210715.Disclosure of Interests:None declared
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Huet F, Prieur C, Schurtz G, Gerbaud E, Manzo-Silberman S, Vanzetto G, Elbaz M, Tea V, Mercier G, Lattuca B, Duflos C, Roubille F. One train may hide another: Acute cardiovascular diseases could be neglected because of the COVID-19 pandemic. Arch Cardiovasc Dis 2020; 113:303-307. [PMID: 32362433 PMCID: PMC7186196 DOI: 10.1016/j.acvd.2020.04.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 01/23/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) is likely to have significant implications for the cardiovascular care of patients. In most countries, containment has already started (on 17 March 2020 in France), and self-quarantine and social distancing are reducing viral contamination and saving lives. However, these considerations may only be the tip of the iceberg; most resources are dedicated to the struggle against COVID-19, and this unprecedented situation may compromise the management of patients admitted with cardiovascular conditions. Aim We aimed to assess the effect of COVID-19 containment measures on cardiovascular admissions in France. Methods We asked nine major cardiology centres to give us an overview of admissions to their nine intensive cardiac care units for acute myocardial infarction or acute heart failure, before and after containment measures. Results Before containment (02–16 March 2020), the nine participating intensive cardiac care units admitted 4.8 ± 1.6 patients per day, versus 2.6 ± 1.5 after containment (17–22 March 2020) (rank-sum test P = 0.0006). Conclusions We confirm here, for the first time, a dramatic drop in the number of cardiovascular admissions after the establishment of containment. Many hypotheses might explain this phenomenon, but we feel it is time raise the alarm about the risk for patients presenting with acute cardiovascular disease, who may suffer from lack of attention, leading to severe consequences (an increase in the number of ambulatory myocardial infarctions, mechanical complications of myocardial infarction leading to an increase in the number of cardiac arrests, unexplained deaths, heart failure, etc.). Similar consequences can be feared for all acute situations, beyond the cardiovascular disease setting.
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Affiliation(s)
- Fabien Huet
- Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier, France
| | - Cyril Prieur
- Department of Cardiology, Hôpital Cardiologique Louis Pradel, 69500 Bron, France
| | - Guillaume Schurtz
- Department of Cardiology, Institut Coeur Poumons, Hôpital Cardiologique, 59000 Lille, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, 33600 Pessac, France
| | | | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Meyer Elbaz
- Department of Cardiology, Hôpital Rangueil, 31400 Toulouse, France
| | - Victoria Tea
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Grégoire Mercier
- CEPEL, Université de Montpellier, CNRS, 34090 Montpellier, France; Medico-Economic Research Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - Benoît Lattuca
- Department of Cardiology, CHU de Nimes, 30029 Nimes, France
| | - Claire Duflos
- CEPEL, Université de Montpellier, CNRS, 34090 Montpellier, France; Clinical Research and Epidemiology Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - François Roubille
- Department of Cardiology, Hôpital Universitaire de Montpellier, 34295 Montpellier, France; PhyMedExp, Université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier, France.
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Huet F, Nicoleau J, Dupuy AM, Curinier C, Breuker C, Castet-Nicolas A, Lotierzo M, Kalmanovich E, Zerkowski L, Akodad M, Adda J, Agullo A, Leclercq F, Pasquie JL, Battistella P, Roubille C, Fesler P, Mercier G, Bourel G, Cristol JP, Roubille F. STADE-HF (sST2 As a help for management of HF): a pilot study. ESC Heart Fail 2020; 7:774-778. [PMID: 32168423 PMCID: PMC7160465 DOI: 10.1002/ehf2.12663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/21/2020] [Accepted: 02/06/2020] [Indexed: 11/29/2022] Open
Abstract
Aims Biomarkers are not recommended until now to guide the management of patients with heart failure (HF). Soluble suppression of tumorigenicity 2 (sST2) appears as a promising biomarker. The current study considered pre‐discharged sST2 values as a guide for medical management in patients admitted for acute HF decompensation, in an attempt to reduce hospital readmission. Methods and results STADE‐HF was a blinded prospective randomized controlled trial and included 123 patients admitted for acute HF. They were randomized into the usual treatment group (unknown sST2 level) or the interventional treatment group, for whom sST2 level was known and used on Day 4 of hospitalization to guide the treatment. The primary endpoint was the readmission rate for any cause at 1 month. It occurred in 10 patients (19%) in the usual group and 18 (32%) in the sST2 group without statistical difference (P = 0.11). Post hoc analysis in the whole group shows that the mean duration of hospitalization was lower in patients with low sST2 (<37 ng/mL) at admission vs. high sST2 (8.5 ± 9.5 vs. 14.8 ± 14.9 days, respectively, P = 0.003). In addition, a decrease in sST2 greater than 18% is significantly associated with a lower readmission rate. Conclusions Soluble suppression of tumorigenicity 2‐guided therapy over a short period of time does not reduce readmissions. However, sST2 was clearly associated with duration of hospitalization, and the decrease in sST2 was associated with decreased rehospitalizations. Long‐term outcome using sST2‐guided therapy deserves further investigations.
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Affiliation(s)
- Fabien Huet
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
| | - Jean Nicoleau
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Anne-Marie Dupuy
- Laboratory of Biochemistry, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Corentin Curinier
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Cyril Breuker
- Department of Pharmacy, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Audrey Castet-Nicolas
- Department of Pharmacy, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Manuela Lotierzo
- Laboratory of Biochemistry, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Eran Kalmanovich
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Laetitia Zerkowski
- Department of Internal Medicine, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Mariama Akodad
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
| | - Jérôme Adda
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
| | - Audrey Agullo
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Florence Leclercq
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Jean-Luc Pasquie
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
| | - Pascal Battistella
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Camille Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France.,Department of Internal Medicine, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Pierre Fesler
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France.,Department of Internal Medicine, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Grégoire Mercier
- Department of Statistics, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Guillaume Bourel
- Department of Statistics, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Jean-Paul Cristol
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France.,Laboratory of Biochemistry, Montpellier University Hospital, Montpellier, cedex 5, France
| | - François Roubille
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
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Calais C, Mercier G, Meusy A, Le Collen L, Kahn SR, Quéré I, Galanaud JP. Pulmonary embolism home treatment: What GP want? Thromb Res 2020; 187:180-185. [DOI: 10.1016/j.thromres.2020.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/23/2019] [Accepted: 01/14/2020] [Indexed: 11/27/2022]
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Nicoleau J, Huet F, Dupuy A, Curinier C, Breuker C, Castet-Nicolas A, Lotierzo M, Kalmanovich E, Zerkowski L, Akodad M, Adda J, Battistella P, Roubille C, Fesler P, Mercier G, Chapet N, Bourel G, Cristol J, Roubille F. STADE-HF: A Titration based on sST2 is safe but failed to decrease readmissions in patients admitted for acute heart failure. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Téot L, Geri C, Lano J, Cabrol M, Linet C, Mercier G. Complex Wound Healing Outcomes for Outpatients Receiving Care via Telemedicine, Home Health, or Wound Clinic: A Randomized Controlled Trial. INT J LOW EXTR WOUND 2019; 19:197-204. [DOI: 10.1177/1534734619894485] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Use of telemedicine has expanded rapidly in recent years, yet there are few comparative studies to determine its effectiveness in wound care. To provide experimental data in the field of telemedicine with regard to wound care, a pilot project named “Domoplaies” was publicly funded in France in 2011. A randomized, controlled trial was performed to measure the outcomes of patients with complex wounds who received home wound care from a local clinician guided by an off-site wound care expert via telemedicine, versus patients who received in-home or wound clinic visits with wound care professionals. The publicly funded network of nurses and physicians highly experienced in wound healing was used to provide wound care recommendations via telemedicine for the study. The healing rate at 6 months was slightly better for patients who received wound care via telemedicine (61/89; 68.5%) versus wound care professional at home (38/59; 64.4%) versus wound care clinic (22/35; 62.9%), but the difference was not significant ( P = .860833). The average time to healing for the 121/183 wounds that healed within 6 months was 66.8 ± 32.8 days for the telemedicine group, 69.3 ± 26.7 for the wound care professional at home group, and 55.8 ± 25.0 days for the wound care clinic group. Transportation costs for the telemedicine and home health care groups were significantly lower than the wound clinic group, and death rate was similar between all the 3 groups ( P < .01). Telemedicine performed by wound healing clinicians working in a network setting offered a safe option to remotely manage comorbid, complex wound care patients with reduced mobility.
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Affiliation(s)
- Luc Téot
- Montpellier University Hospital, Montpellier, France
| | - Chloé Geri
- Hospital Home Wound Care Network, Montpellier, France
| | - Julie Lano
- Hospital Home Wound Care Network, Montpellier, France
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Mercier G, Rodwin V, Quantin C, Chernew M, Gusmano M. The risk of emergency department visits in adults living in rural France. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Individuals living in rural areas have poorer health outcomes due to complex causal pathways related to socio-economic status, health behaviors and lower use of primary care. Emergency department visits without inpatient admission (hereafter ED visits) are an indirect measure of access to primary care.
Objective
To analyze the determinants of ED visits among French adults living in rural areas.
Methods
We analyze survey data from the CONSTANCES cohort study, a representative sample of French adults aged 18-69 years. These data on individuals’ demographics, self-reported and physician-reported clinical indicators, and individual socio-economic status, are linked to France’s claims database (SNIIRAM). We analyze the risk of having at least one ED visit, in 2016, using a multivariate logistic regression model.
Results
Among 12,834 adults included in the study, 1,412 (11%) had at least one ED visit in 2016. After adjustment, the ED visit risk was associated negatively with female gender (OR = 0.87; p < 0.01), age (OR = 0.97; p < 0.01), secondary education (OR = 0.85; p = 0.03), higher use of GPs (OR = 0.99; p = 0.02); and positively associated with the number of comorbidities (OR = 1.1; p < 0.01), poorer self-reported health status (OR = 1.01; p = 0.02), a higher self-reported depression score (OR = 1.01; p = 0.02), and acute care inpatient admissions (OR = 2.4; p < 0.01).
Conclusions
These results suggest that, among adults living in rural France, those with a lower educational level are at higher risk of ED visits.
Policy implications: To reduce health disparities among rural and urban areas, policymakers and primary care professionals should focus on targeted outreach strategies to identify high-needs individuals.
Key messages
The risk of emergency department visit varies significantly among adult living in rural France. Among adults living in rural France, those with a lower educational level are at higher risk of ED visit.
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Affiliation(s)
- G Mercier
- DIM, CHU de Montpellier, Montpellier, France
- CEPEL, UM/CNRS, Montpellier, France
- Health Care Policy Department, Harvard Medical School, Boston, USA
| | - Victor Rodwin
- Wagner School of Public Service, New York University, New York, USA
| | | | - Michael Chernew
- Health Care Policy Department, Harvard Medical School, Boston, USA
| | - Michael Gusmano
- Institute for Health, Health Care Policy and Aging, Rutgers University, New Brunswick, USA
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30
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Mercier G, Quantin C, McWilliams M. Individual Versus Area Level Social Risk Measurement in the General French Population. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ongoing health policy changes include a move towards alternative delivery and payment models. In addition, the emphasis is put on social determinants as part of performance measurement and payment calibration. Most payers and policy makers rely on area-level socio-economic data, which can lead to sub-optimal. However, little is known about the agreement between individual and area-level variables. The objective was to assess the agreement between individual and area-level social risk variables in the general French population.
Methods
We used data from the CONSTANCES general-purpose cohort, a randomly selected representative sample of French adults aged 18-69 years. Data collected include socioeconomic and demographic characteristics, behaviors, and health data. We assessed the correlation or agreement between individual and area-level variables for 4 dimensions: household annual pretax income, secondary education completion, occupational group (workers), and unemployment.
Results
115,263 individuals were included in the study, 53% female and aged 48 years on average. The median annual household income was 42,000 Euros (USD 50,400), 73% had completed secondary education, 7% were unemployed, and 9.3% were workers. The correlation between income measured at the individual and area level was positive but moderate (Rho=0.20; p < 0.01). Individuals having completed secondary education had a higher area-level median completion rate compared to those having a lower education level (48% versus 41%; p < 0.01). Unemployed individuals had a slightly higher area-level median unemployment rate compared to employed ones (11% versus 10%; p < 0.01). Lastly, workers had a higher area-level median probability to be a worker rate compared to other individuals ones (25% versus 18%; p < 0.01).
Conclusions
In the general French population, area-level socio-economic variables are poor proxies for individual-level social risk.
Key messages
Area-level socio-economic data is a poor proxy for individual data. Researchers and policy makers should move towards individual data.
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Affiliation(s)
- G Mercier
- CHU de Montpellier, Montpellier, France
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31
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Ngo T, Georgescu V, Gervet C, Laurent A, Libourel T, Mercier G. Machine learning application to the reduction of ambulatory care sensitive admissions (ACSA). Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Reducing Ambulatory Care Sensitive Admissions (ACSA) not only enhances patients’ quality of life but could also save substantial costs. ACSA are avoidable admissions for chronic conditions that are associated with socio-economic status, health status, utilization and readiness of primary care service as well as environmental factors. Undoubtedly, health authorities are highly interested in enhancing the health care services in order to reduce the number of ACSA. The objective is to identify the geographic areas where the primary care workforce should be increased in order to maximize the decrease in ACSA.
Methods
Using ambulatory care and inpatient claims data as well as contextual variables, we apply support vector machine regression (SVR) to select the geographic areas (fr. Bassins de vie - BVs) and the number of to-be-added primary care nurses that maximize the ACSA reduction. We also take into account the constraints related to budget and the equality of health care access. Particularly, there are three possible constraints: (1) the total number of nurses can be added in the whole region; (2) the maximum number of the nurses can be added at each area; (3) the maximum density of nurses (numbers of the nurses per 10,000 habitants) can be reached at each area. The results are visualized using spatial maps.
Preliminary results
In 2014, 27,000 ACSA occurred in the Occitanie, France region. For a specific set of constraints values, the model identified 16 BVs (out of 201) where the addition of 30 nurses could lead to the maximum ACSA reduction in number which is 17.
Conclusions
In the French Occitanie region, our SVR model was able to target a small number of geographic areas to maximize the impact of increased primary care workforce on ACSA. Our approach is applied to a single region, and it can be applied to other regions or extended at the national level as well as to other countries.
Key messages
A decision support tool to help health authorities in locating primary health care resources for the maximum reduction of ambulatory care sensitive admissions. An application of machine learning in primary care services.
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Affiliation(s)
- T Ngo
- Economic Evaluation Unit, University Hospital of Montpellier, Montpellier, France
- LIRMM, University of Montpellier, Montpellier, France
| | - V Georgescu
- Economic Evaluation Unit, University Hospital of Montpellier, Montpellier, France
| | - C Gervet
- Espace-Dev, University of Montpellier, Montpellier, France
| | - A Laurent
- LIRMM, University of Montpellier, Montpellier, France
| | - T Libourel
- Espace-Dev, University of Montpellier, Montpellier, France
| | - G Mercier
- Economic Evaluation Unit, University Hospital of Montpellier, Montpellier, France
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32
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Bousquet J, Illario M, Farrell J, Batey N, Carriazo AM, Malva J, Hajjam J, Colgan E, Guldemond N, Perälä-Heape M, Onorato GL, Bedbrook A, Leonardini L, Stroetman V, Birov S, Abreu C, Abrunhosa A, Agrimi A, Alalääkkölä T, Allegretti N, Alonso-Trujillo F, Álvarez-Benito M, Angioli S, Apóstolo J, Armitage G, Arnavielhe S, Baena-ParejoI M, Bamidis PD, Balenović A, Barbolini M, Baroni I, Blain H, Bernard PL, Bersani M, Berti E, Bogatyrchuk L, Bourret R, Brehm J, Brussino L, Buhr D, Bultje D, Cabeza E, Cano A, De Capitani C, Carantoña E, Cardoso A, Coll Clavero JI, Combe B, Conforti D, Coppola L, Corti F, Coscioni E, Costa E, Crooks G, Cunha A, Daien C, Dantas, Darpón Sierra J, Davoli M, Dedeu Baraldes A, De Luca V, De Nardi L, Di Ciano M, Dozet A, Ekinci B, Erve S, Espinoza Almendro JM, Fait A, Fensli R, Fernandez Nocelo S, Gálvez-Daza P, Gámez-Payá J, García Sáez M, Garcia Sanchez I, Gemicioğlu B, Goetzke W, Goossens E, Geurdens M, Gütter Z, Hansen H, Hartman S, Hegendörfer G, Heikka H, Henderson D, Héran D, Hirvonen S, Iaccarino G, Jansson N, Kallasvaara H, Kalyoncu F, Kirchmayer U, Kokko JA, Korpelainen J, Kostka T, Kuna P, Lajarín Ortega T, Lama CM, Laune D, Lauri D, Ledroit V, Levato G, Lewis L, Liotta G, Lundgren L, Lupiañez-Villanueva F, Mc Garry P, Maggio M, Manuel de Keenoy E, Martinez C, Martínez-Domene M, Martínez-Lozano Aranaga B, Massimilliano M, Maurizio A, Mayora O, Melle C, Mendez-Zorilla A, Mengon H, Mercier G, Mercier J, Meyer I, Millet Pi-Figueras A, Mitsias P, Molloy DW, Monti R, Moro ML, Muranko H, Nalin M, Nobili A, Noguès M, O’Caoimh R, Pais S, Papini D, Parkkila P, Pattichis C, Pavlickova A, Peiponen A, Pereira S, Pépin JL, Piera Jiménez J, Portheine P, Potel L, Pozzi AC, Quiñonez P, Ramirez Lauritsen X, Ramos MJ, Rännäli-Kontturi A, Risino A, Robalo-Cordeiro C, Rolla G, Roller R, Romano M, Romano V, Ruiz-Fernández J, Saccavini C, Sachinopoulou A, Sánchez Rubio MJ, Santos L, Scalvini S, Scopetani E, Smedberg D, Solana-Lara R, Sołtysik B, Sorlini M, Stericker S, Stramba Badiale M, Taillieu I, Tervahauta M, Teixeira A, Tikanmäki H, Todo-Bom A, Tooley A, Tuulonen A, Tziraki C, Ussai S, Van der Veen S, Venchiarutti A, Verdoy-Berastegi D, Verissimo M, Visconti L, Vollenbroek-Hutten M, Weinzerl K, Wozniak L, Yorgancıoğlu A, Zavagli V, Zurkuhlen AJ. The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing. Transl Med UniSa 2019; 19:66-81. [PMID: 31360670 PMCID: PMC6581486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs.
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Affiliation(s)
- J Bousquet
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France,VIMA, INSERM U 1168, VIMA : Ageing and chronic diseases. Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France, Euforea, Brussels, Belgium, and Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany
| | - M Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET) Naples, Italy
| | - J Farrell
- LANUA International Healthcare Consultancy, Down, UK
| | - N Batey
- EIPonAHA Reference Site Collaborative network, Head of EU & International Funding, Health and Social Services Group, Welsh Government, Cardiff, UK
| | - AM Carriazo
- Regional Ministry of Health of Andalusia, Seville, Spain
| | - J Malva
- Institute of Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra; Coimbra, and Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - J Hajjam
- CENTICH Mutualité Française Anjou Mayenne, Angers, France
| | - E Colgan
- Department of Health, Social Services and Public Safety, Northern Ireland Belfast, UK
| | - N Guldemond
- Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, The Netherlands
| | | | - GL Onorato
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | - A Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | - L Leonardini
- Veneto Region, Mattone Internazionale Program, Italy
| | - V Stroetman
- Empirica Communication and Technology Research, Bonn, Germany
| | - S Birov
- Empirica Communication and Technology Research, Bonn, Germany
| | - C Abreu
- Nursing School of Coimbra, Ageing@Coimbra, Coimbra, Portugal
| | - A Abrunhosa
- Comissão de Coordenação e Desenvolvimento Regional do Centro (CCDRC), Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - A Agrimi
- Aprulia Region - Research, Innovation and Capacity Building department, Bari – Italy
| | | | | | - F Alonso-Trujillo
- Agency for Social Services and Dependency of Andalusia, Seville, Spain
| | | | - S Angioli
- Campania Councillor for European Funds, Euromediterranean Basin and Youth Policies, Naples, Italy
| | - J Apóstolo
- Nursing School of Coimbra, Ageing@Coimbra, Coimbra, Portugal
| | - G Armitage
- Newcastle University, Operations Director, National Innovation Centre for Ageing, New Castle, UK
| | | | | | - PD Bamidis
- Medical Education Informatics; Lab of Medical Physics; Medical School; Aristotle University of Thessaloniki, Greece
| | - A Balenović
- Health Care Center Zagreb, City of Zagreb, AHA Reference site, Zagreb, Croatia
| | - M Barbolini
- Regione Emilia Romagna - Agenzia Sanitaria e Sociale, Regional Health and Social Agency Emilia-Romagna, Reference Site of the European Innovation Partnership on Healthy and Active Ageing, Bologna, Italy, and EU Commission Senior Public Health Expert
| | | | - H Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France,EUROMOV. EA 2991, Euromov, University of Montpellier, France
| | - PL Bernard
- Sport Faculty, University of Montpellier, France
| | - M Bersani
- Head Unit Plans and Projects; DG Welfare – Region of Lombardy, Milano (Italy)
| | - E Berti
- Regional Health and Social Agency Emilia-Romagna, Bologna, Italy
| | - L Bogatyrchuk
- The medical improving center “Elbrus”, Zhytomir, Ukraine
| | - R Bourret
- Centre Hospitalier Valenciennes, France
| | - J Brehm
- Health region CologneBonn, Köln, Germany
| | - L Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - D Buhr
- University of Tuebingen / Steinbeis Transfercenter for Social and Technological Innovation, Tuebingen, Germany
| | - D Bultje
- Healthy Ageing Network Northern Netherlands, Groningen, The Netherlands
| | - E Cabeza
- Cap de Servei de Promoció de la Salut, Direcció General de Salut Pública i Participació, Palma de Mallorca, Spain
| | - A Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Spain,INCLIVA, Valencia, Spain
| | - C De Capitani
- Lombardy Cluster Technologies for Living Environments, Lecco (LC), Italy
| | - E Carantoña
- Consejería de Presidencia y Participación Ciudadana, Oviedo, Spain
| | - A Cardoso
- Nursing School of Coimbra, Ageing@Coimbra, Coimbra, Portugal
| | - JI Coll Clavero
- Innovation and new technologies, Hospital de Barbastro Servicio Aragones de Salud Aragon, Spain
| | - B Combe
- Department of Rheumotology, University Hospital, Montpellier, France
| | - D Conforti
- Autonomous Province of Trento, Health and Social Solidarity Department & TrentinoSalute4.0, Trento, Italy
| | - L Coppola
- Head Unit Health Promotion and Screening; DG Welfare – Region of Lombardy, Milan, Italy
| | - F Corti
- FIMMG, Federazione Italiana Medici di Medicina Generale, Milan, Italy
| | - E Coscioni
- Department of Heart Surgery, San Giovanni di Dio e Ruggi d’Aragona Hospital, Salerno, Italy
| | - E Costa
- UCIBIO, REQUIMTE, Faculty of Pharmacy of University of Porto, Porto4ageing Reference Site, University of Porto, PORTO, Portugal
| | - G Crooks
- Scottish Centre for Telehealth and Telecare, NHS 24, Glasgow, UK
| | - A Cunha
- Instituto Pedro Nunes, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - C Daien
- Department of Rheumotology, University Hospital, Montpellier, France
| | - Dantas
- Cáritas Diocesana de Coimbra, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | | | - M Davoli
- Department of Epidemiology, ASL Roma 1, Lazio Regional Health Service, Roma, Italy
| | - A Dedeu Baraldes
- Agency for Health Quality & Assessment of Catalonia of the Ministry of Health of Catalonia – AquAs, Barcelona, Spain
| | - V De Luca
- R&D Unit, Federico II University Hospital, Naples, Italy
| | - L De Nardi
- Health Information System International Projects, Lombardia Informatica SpA, Milano, Italy
| | - M Di Ciano
- InnovaPuglia - Inhouse ICT company of Regione Puglia and Reference Site Puglia WI-FI Management, Bari, Italy
| | - A Dozet
- Health economist, Region Skåne, Sweden
| | - B Ekinci
- Head Chronic Disease Department, Ministry of Health, Ankara, Turkey
| | - S Erve
- CENTICH Mutualité Française Anjou Mayenne, Angers, France
| | | | - A Fait
- Health and Social Care Directorate, ATS Città Metropolitana (Health and Social Care Agency), Milano, Italy
| | - R Fensli
- Centre of eHealth and Health Care Technology, University of Agder, Faculty of Engineering and Science, Grimstad, Norway
| | - S Fernandez Nocelo
- Galician Health Knowledge Agency (ACIS), Regional Ministry of Public Health of Galicia
| | - P Gálvez-Daza
- Regional Ministry of Equality and Social Policies of Andalusia, Seville, Spain
| | | | - M García Sáez
- Agency for Social Services and Dependency of Andalusia, Seville, Spain
| | | | - B Gemicioğlu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - W Goetzke
- Health region CologneBonn, Köln, Germany
| | - E Goossens
- Center for Gastrology, School of Gastrologic Sciences and Primary Food Care, Leuven, Belgium
| | - M Geurdens
- Center of Expertise in Primary Food Care, Center for Research and Innovation in Care (CRIC), Antwerp, Belgium
| | - Z Gütter
- University Hospital Olomouc - NTMC, National eHealth Centre, Olomouc, Czech Republic
| | - H Hansen
- EU Consultant & Project Manager, South Denmark European Office, Brussels, Belgium
| | - S Hartman
- Department of Social Services and Health Care, Business Development, HELSINGIN KAUPUNKI, City of Helsinki, Finland
| | | | | | - D Henderson
- Head of European Engagement, NHS 24, Glasgow, UK
| | | | | | - G Iaccarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - N Jansson
- Network Ecosystem, BusinessOulu, Oulu, Finland
| | - H Kallasvaara
- Helsinki-Uusimaa Regional Council, Helsinki, Finland
| | - F Kalyoncu
- Hacettepe University, School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Ankara, Turkey
| | - U Kirchmayer
- Department of Epidemiology, ASL Roma 1, Lazio Regional Health Service, Roma, Italy
| | - JA Kokko
- Department of Healthcare and Social Welfare, Technology Specialist, Oulu, Finland
| | - J Korpelainen
- Oulu University Hospital OYS, Hospital District, Oulu, Finland
| | - T Kostka
- Department of Geriatrics, Medical University of Lodz, Healthy Ageing Research Centre (HARC), Lodz, Poland
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - T Lajarín Ortega
- Committee of Representatives of People with disabilities and their Families, Region de Murcia, Spain
| | - CM Lama
- Regional Ministry of Health of Andalusia, Seville, Spain
| | | | | | - V Ledroit
- Alsace Lorraine Champagne Ardenne, Bureau Europe Grand Est, Bruxelles, Belgique
| | - G Levato
- SIFMED, Scuola Italiana Di Formazione E Ricerca In Medicina Di Famiglia, Milan, Italy
| | - L Lewis
- Head of Research and Development, International Foundation for Integrated Care and EIP on AHA B3 Action Group Chair, Wolfson College, Oxford, UK
| | - G Liotta
- Biomedicine and Prevention Department, University of Rome Tor Vergata, Rome, Italy
| | - L Lundgren
- Development Department, Region Norrbotten, Sweden
| | | | - P Mc Garry
- Greater Manchester Ageing Hub, Greater Manchester Combined Authority, Manchester, UK
| | - M Maggio
- Department of Medicine and Surgery - Geriatric Clinic Unit Department of Medicine Geriatric Rehabilitation, University Hospital of Parma, Italy
| | - E Manuel de Keenoy
- Kronikgune, International Centre of Excellence in Chronicity Research, Barakaldo, Bizkaia, Spain
| | - C Martinez
- Costa Cálida Cares-Senior Tourism and Services, Region de Murcia, Spain
| | - M Martínez-Domene
- Regional Ministry of Equality and Social Policies of Andalusia, Seville, Spain
| | | | - M Massimilliano
- Financial Range for Innovation, Research, International care and health sector; Friuli Venezia Giulia Autonomous Region, Central Directorate for Health, Social Health Integration, Social Policies and Family, Trieste, Italy
| | - A Maurizio
- Plans and Projects Unit, DG Welfare – Region of Lombardy, Italy
| | - O Mayora
- Bruno Kessler Foundation, eHealth Unit and TrentinoSalute4.0, Trento, Italy
| | - C Melle
- Care Management Unit, Hausach, Gesundes Kinzigtal GmbH, Kizingtal, Germany
| | | | - H Mengon
- Autonomous Province of Trento, Health and Social Solidarity Department & TrentinoSalute4.0, Trento, Italy
| | - G Mercier
- Unité Médico-Economie, Département de l’Information Médicale, University Hospital, Montpellier, France
| | - J Mercier
- Department of Physiology, CHRU, University Montpellier, PhyMedExp, INSERM U1046, CNRS UMR 9214, France
| | - I Meyer
- Care Management Unit, Hausach, Gesundes Kinzigtal GmbH, Kizingtal, Germany
| | | | - P Mitsias
- Department of Neurology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - DW Molloy
- Centre for Gerontology and Rehabilitation, School of Medicine, UCC @ St Finbarr’s Hospital, Cork, Ireland
| | - R Monti
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - ML Moro
- Regional Health and Social Agency Emilia-Romagna, Bologna, Italy
| | - H Muranko
- GEWI Institute, Regional Innovation Partnership on Active and Healthy Ageing, Köln, Germany
| | | | - A Nobili
- Mario Negri Institute for Pharmacological Research, IRCCS; Clinical Pharmacology, Geriatrics, Internal Medicine, Milano, Italy
| | | | - R O’Caoimh
- Centre for Gerontology and Rehabilitation, School of Medicine, UCC @ St Finbarr’s Hospital, Cork, Ireland,Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - S Pais
- Center for Biomedical Research-CBMR, Department of Biomedical Sciences and Medicine, International Center on Ageing-CENIE, University of Algarve, Portugal
| | - D Papini
- Regional Health and Social Agency Emilia-Romagna, Bologna, Italy
| | - P Parkkila
- Oulu University Hospital OYS, Hospital District, Oulu, Finland
| | - C Pattichis
- Dept of Computer Science, University of Cyprus, Cyprus, Greece
| | - A Pavlickova
- European Service Development Manager, NHS 24, Glasgow, UK
| | - A Peiponen
- Social services and health care division, Hospital, rehabilitation and care services, Southern service district, City of Helsinki, FINLAND
| | - S Pereira
- University of Porto and Porto4Ageing Reference Site, Porto, Portugal
| | - JL Pépin
- Université Grenoble Alpes, Laboratoire HP2, Grenoble, INSERM, U1042 and CHU de Grenoble, France
| | - J Piera Jiménez
- Information and R&D Officer, Badalona Serveis Assistencials, Badalona, Spain
| | - P Portheine
- Coöperatie Slimmer Leven, Eindhoven, The Netherlands
| | - L Potel
- International Affairs & Public Procurement of Innovation, Hospital Procurement Network, Paris, France
| | - AC Pozzi
- IML, Lombardy Medical Initiative, Bergamo, Italy
| | - P Quiñonez
- Agency for Social Services and Dependency of Andalusia, Seville, Spain,Regional Ministry of Equality and Social Policies of Andalusia, Seville, Spain
| | | | - MJ Ramos
- UCIBIO, REQUIMTE, Faculty of Sciences of University of Porto and Porto4Ageing Reference Site, Porto, Portugal
| | | | - A Risino
- Health Innovation Manchester, Manchester, UK
| | - C Robalo-Cordeiro
- Faculty of Medicine, University of Coimbra, Portugal, Ageing@Coimbra EIP-AHA Reference Site
| | - G Rolla
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - R Roller
- Medical University of Graz, Department of Internal Medicine, Graz, Austria
| | | | - V Romano
- IRES - Institute for Economic and Social Research - Piedmont, Torino, Italy
| | | | - C Saccavini
- Arsenàl.IT, Veneto’s Research Centre for eHealth Innovation, Venice, Italy
| | - A Sachinopoulou
- Oulu University, Center of Health and Technology, Oulu, Finland
| | - MJ Sánchez Rubio
- Regional Ministry of Equality and Social Policies of Andalusia, Seville, Spain
| | - L Santos
- Odem dos Farmacêuticos, Secção Regional do Centro, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - S Scalvini
- Cardiology Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane, Brescia, Italy
| | - E Scopetani
- Tuscany Region, Directorate Citizenship rights and social cohesion, Firenze, Italy
| | - D Smedberg
- RISE Research Institutes of Sweden, Division Safety and Transport - Measurement Science and Technology, Lund, Sweden
| | - R Solana-Lara
- Regional Ministry of Health of Andalusia, Seville, Spain
| | - B Sołtysik
- Department of Geriatrics, Medical University of Lodz, Healthy Ageing Research Centre (HARC), Lodz, Poland
| | - M Sorlini
- International Affairs & Public Procurement of Innovation, Hospital Procurement Network, Paris, France
| | - S Stericker
- Head of Programmes, Yorkshire & Humber Academic Health Science Network, Wakefield, UK
| | - M Stramba Badiale
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - I Taillieu
- Coördinator Zorgeconomie, Fabrieken voor de Toekomst, Brugge, Belgium
| | | | - A Teixeira
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Ageing@Coimbra EIP-AHA Reference Site, Portugal
| | - H Tikanmäki
- Life Science Industries and Company Networks, BusinessOulu, Oulu, Finland
| | - A Todo-Bom
- Faculty of Medicine, University of Coimbra, Portugal, Ageing@Coimbra EIP-AHA Reference Site
| | - A Tooley
- University of Porto and Porto4Ageing Reference Site, Porto, Portugal
| | - A Tuulonen
- Tays Eye Centre, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - C Tziraki
- Research and Evaluation Department, Municipality of Jérusalem, Israël,Medicine and Health Care Science, Allilegi Community Based Organization for AD and Active Healthy Aging, Heraklion, Crete, Heraklion-Crete Reference Site Region, Greece
| | - S Ussai
- DG Welfare, Lombardy Region, Italy
| | - S Van der Veen
- Department of Med Hum, Amsterdam University Medical Centers, VU University, NL
| | - A Venchiarutti
- Friuli Venezia Giulia Autonomous Region, Central Directorate for Health, Social Health Integration, Social Policies and Family, Trieste, Italy
| | - D Verdoy-Berastegi
- Kronikgune, International Centre of Excellence in Chronicity Research, Barakaldo, Bizkaia, Spain
| | - M Verissimo
- Faculty of Medicine, University of Coimbra, Portugal, Ageing@Coimbra EIP-AHA Reference Site
| | - L Visconti
- LifeTechValley, Life Sciences Incubator BioVille, Diepenbeek, Belgium
| | - M Vollenbroek-Hutten
- University of Twente, Biomedical systems and signal group/telemedicine, Twente, The Netherlands
| | - K Weinzerl
- Human.technology Styria GmbH, Graz, Austria
| | - L Wozniak
- Research and International Relations, Department of Structural Biology, Medical University of Lodz, Lodz, Poland
| | - A Yorgancıoğlu
- Celal Bayar University, School of Medicine, Department of Pulmonology, Manisa, Turkey
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Mercier G, Duflos C, Riondel A, Delmas C, Manzo-Silberman S, Leurent G, Elbaz M, Bonnefoy-Cudraz E, Henry P, Roubille F. Admissions to intensive cardiac care units in France in 2014: A cross-sectional, nationwide population-based study. Medicine (Baltimore) 2018; 97:e12677. [PMID: 30290655 PMCID: PMC6200530 DOI: 10.1097/md.0000000000012677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Geographic variation in admission to the intensive cardiac care unit (ICCU) might question about the efficiency and the equity of the healthcare system. The aim was to explain geographic variation in the rate of admission to ICCU for coronary artery disease (CAD) or heart failure (HF) in France.We conducted a retrospective study based on the French national hospital discharge database. All inpatient stays for CAD or HF with an admission to an ICCU in 2014 were included. We estimated population-based age and sex-standardized ICCU admission rates at the department level. We separately modeled the department-level admission rates for HF and CAD using generalized linear models.In all, 61,010 stays for CAD and 27,828 stays for HF had at least 1 ICCU admission. The ICCU admission rates were explained by the admission rate for CAD, by the diabetes prevalence, by the proportion of the population >75 years, and by the drive time to the ICCU.This work sheds light on the finding of substantial geographic variation in the ICCU admission rates for CAD and HF in France. This variation is explained by both the age and the health status of the population and also by the drive time to the closest ICCU for HF. Moreover, ICCU admission for HF might be more prone to unwarranted variations due to medical practice patterns.
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Affiliation(s)
- Grégoire Mercier
- Economic Evaluation Unit, University Hospital of Montpellier
- CEPEL, UMR CNRS Université de Montpellier, Montpellier
| | - Claire Duflos
- Economic Evaluation Unit, University Hospital of Montpellier
| | - Adeline Riondel
- Economic Evaluation Unit, University Hospital of Montpellier
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology department, University Hospital of Rangueil, Toulouse
| | - Stéphane Manzo-Silberman
- Department of cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris
| | - Guillaume Leurent
- CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Cardiology department, University Hospital of Rangueil, Toulouse
| | | | - Patrick Henry
- Department of cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris
| | - François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex, France
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Zabawa C, Cottenet J, Zeller M, Mercier G, Rodwin VG, Cottin Y, Quantin C. Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: Impact of postdischarge ambulatory care. Medicine (Baltimore) 2018; 97:e11085. [PMID: 29901621 PMCID: PMC6023939 DOI: 10.1097/md.0000000000011085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Rehospitalization after acute myocardial infarction (AMI) is common in elderly patients. It increases morbimortality and health care expenditures. The association between ambulatory care after discharge for AMI and rehospitalization has never been studied in France. We analyzed the impact of ambulatory care on rehospitalization of elderly patients (≥65 years) within 30 days after hospital discharge.We conducted a nationwide population-based study of elderly patients hospitalized with a main diagnosis of AMI in France between 2011 and 2013. We excluded patients hospitalized for AMI in the previous year and those who died during the index hospitalization or within 30 days after discharge. The primary outcome was the first all-cause 30-day rehospitalization in an acute care hospital. Individual and neighborhood-level variables were compared among rehospitalized and nonrehospitalized patients. Determinants of 30-day rehospitalization were identified using logistic regression models.Among the 624 eligible patients, 137 (22.0%) were rehospitalized within 30 days after discharge. In multivariate analyses, chronic kidney failure (odds ratio [OR] 1.88; 95% confidence interval [CI], 1.01-3.53) was an independent predictor of 30-day rehospitalization. We found no association among deprivation and spatial accessibility measures and 30-day rehospitalization. The purchase of lipid-lowering drugs prescription within 7 days after discharge was associated with a reduced risk of 30-day rehospitalization (OR 0.53; 95% CI, 0.36-0.79).This study highlights the role of coordination among hospital and primary care physicians in post-AMI discharge and follow-up among elderly patients. Specifically, targeted interventions to reduce 30-day rehospitalizations should focus on patients with comorbidities and use of prescription drugs after hospital discharge.
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Affiliation(s)
- Claire Zabawa
- Department of General Medicine, UFR Sciences de Santé
- Biostatistics and Bioinformatics, University Hospital
| | | | - Marianne Zeller
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, UFR Sciences de Santé, Bourgogne Franche-Comté University, Dijon
| | - Grégoire Mercier
- Economic Evaluation Unit, University Hospital, Montpellier, France
| | - Victor G. Rodwin
- Robert F. Wagner School of Public Service, New York University, New York, NY
| | - Yves Cottin
- Department of Cardiology, University Hospital
| | - Catherine Quantin
- Biostatistics and Bioinformatics, University Hospital
- INSERM, CIC 1432
- Clinical Epidemiology/Clinical Trials Unit, University Hospital, Clinical Investigation Center, Dijon
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, INSERM, UVSQ, Institut Pasteur, Paris-Saclay University, Paris, France
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Abstract
The hospital costing process implies access to various sources of data. Whether a micro-costing or a gross-costing approach is used, the choice of the methodology is based on a compromise between the cost of data collection, data accuracy, and data transferability. This work describes the data sources available in France and the access modalities that are used, as well as the main advantages and shortcomings of: (1) the local unit costs, (2) the hospital analytical accounting, (3) the Angers database, (4) the National Health Cost Studies, (5) the INTER CHR/U databases, (6) the Program for Medicalizing Information Systems, and (7) the public health insurance databases.
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Affiliation(s)
- G Mercier
- Unité de recherche médico-économique, département d'information médicale, UMR 5112 CNRS-université de Montpellier, CHU de Montpellier, 34000 Montpellier, France.
| | - N Costa
- Inserm UMR 1027, unité d'évaluation médico-économique (UEME), CHU de Toulouse, 31059 Toulouse cedex 9, France.
| | - C Dutot
- Département d'information médicale, CHU de Montpellier, 34090 Montpellier, France.
| | - V-P Riche
- Cellule innovation, direction de la recherche, CHU de Nantes, 44000 Nantes, France.
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Bourel G, Duteil E, Mercier G, Roubille F. Prise en charge de l’insuffisance cardiaque : impact d’une organisation innovante sur les réhospitalisations et les coûts, Montpellier, France. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Curinier C, Solecki K, Dupuy AM, Breuker C, Lotierzo M, Zerkowski L, Kalmanovich E, Akodad M, Adda J, Battistella P, Castet-Nicolas A, Kuster N, Marques S, Soltani S, Chettouh M, Verchere A, Belloc C, Roubille C, Fesler P, Mercier G, Cristol JP, Audurier Y, Roubille F. Evaluation of the sST2-guided optimization of medical treatments of patients admitted for heart failure, to prevent readmission: Study protocol for a randomized controlled trial. Contemp Clin Trials 2018; 66:45-50. [PMID: 29414143 DOI: 10.1016/j.cct.2018.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Corentin Curinier
- Cardiology Department, University Hospital of Montpellier, Montpellier, France.
| | - Kamila Solecki
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Anne-Marie Dupuy
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France
| | - Cyril Breuker
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France; Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; Economic evaluation unit at Montpellier teaching hospital, University of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Manuela Lotierzo
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France
| | - Laetitia Zerkowski
- Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France
| | - Eran Kalmanovich
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Mariama Akodad
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Jérôme Adda
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Pascal Battistella
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | | | - Nils Kuster
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France
| | - Sandra Marques
- Cardiology Department, University Hospital of Montpellier, Montpellier, France; Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France; Pharmacy Department, University Hospital of Montpellier, Montpellier, France; Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; Economic evaluation unit at Montpellier teaching hospital, University of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Sonia Soltani
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Marine Chettouh
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Anne Verchere
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Claire Belloc
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Camille Roubille
- Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Pierre Fesler
- Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Grégoire Mercier
- Economic evaluation unit at Montpellier teaching hospital, University of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Yohan Audurier
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
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Lehmann M, Mercier G, Aubas P. Poids moyen des séjours MCO de 2009 à 2016, rattrapage des évolutions tarifaires par les évolutions de classement. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Duflos C, Kanouni T, Cartron G, Mercier G. pports de l’analyse contextuelle des données non structurées des dossiers médicaux dans une étude rétrospective de parcours de soins en hémato-oncologie à Montpellier, France. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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40
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Georgescu V, Bourel G, Mercier G. Prise en charge de la polyarthrite rhumatoïde en France : données en vie réelle issues de l’échantillon généraliste des bénéficiaires. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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41
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Quantin C, Le Goaster C, Mercier G, Seguret F. [Editorial]. Rev Epidemiol Sante Publique 2018; 66 Suppl 1:S3-S4. [PMID: 29439888 DOI: 10.1016/j.respe.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C Quantin
- Service de biostatistique et d'information médicale, centre hospitalier universitaire, boulevard Jeanne d'Arc BP 77908, 21079 Dijon cedex, France.
| | - C Le Goaster
- Mission scientifique et internationale, santé publique, France
| | - G Mercier
- Responsable unité de recherche médico-economique, DIM-CHU de Montpellier, France
| | - F Seguret
- Unité d'évaluation et d'études epidémiologiques sur les bases nationales d'activité hospitalière, département d'information médicale-CHU Montpellier, France
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Emery G, Le Fur C, Epis-de-Fleurian AA, Josseran A, Blin O, Debroucker F, Demarcq O, Detournay B, Favrel-Feuillade F, Finas R, Malbezin M, Mercier G, Mismetti P, Oget-Gendre C. Care pathway, towards the establishment of tailored funding: Reasons and criteria for success. Therapie 2018; 73:33-40. [DOI: 10.1016/j.therap.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 12/01/2022]
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Chanques G, Conseil M, Roger C, Constantin JM, Prades A, Carr J, Muller L, Jung B, Belafia F, Cissé M, Delay JM, de Jong A, Lefrant JY, Futier E, Mercier G, Molinari N, Jaber S, Chanques G, Conseil M, Prades A, Carr J, Jung B, Belafia F, Cissé M, Delay JM, De Jong A, Verzilli D, Clavieras N, Jaber S, Mercier G, Molinari N, Mathieu E, Bertet H, Roger C, Muller L, Lefrant JY, Boutin C, Constantin JM, Futier E, Cayot S, Perbet S, Jabaudon M. Immediate interruption of sedation compared with usual sedation care in critically ill postoperative patients (SOS-Ventilation): a randomised, parallel-group clinical trial. The Lancet Respiratory Medicine 2017; 5:795-805. [DOI: 10.1016/s2213-2600(17)30304-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/25/2022]
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Lasocki S, Puy H, Mercier G, Lehmann S. Impact of iron deficiency diagnosis using hepcidin mass spectrometry dosage methods on hospital stay and costs after a prolonged ICU stay: Study protocol for a multicentre, randomised, single-blinded medico-economic trial. Anaesth Crit Care Pain Med 2017; 36:391-396. [PMID: 28919067 DOI: 10.1016/j.accpm.2017.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Iron deficiency (ID) is frequent but difficult to diagnose in critically ill patients. ID may be responsible for prolonged post-ICU hospital stays, since it results in fatigue, muscle weakness and anaemia. Hepcidin, the key iron metabolism hormone, may be a good marker of ID in these patients. The aim of this study is to determine whether using mass spectrometry hepcidin determination to diagnose (and treat) ID after prolonged ICU stays may reduce patients' subsequent hospital stays and costs in comparison with conventional (ferritin) methods. METHODS This is a randomised, controlled, single-blinded, multicentre medico-economic study. Hepcidin quantification will be performed in anaemic (WHO criteria) critically ill adults about to be discharged, after a stay ≥5days. In the intervention arm (hepcidin) results will be given to the ICU-physicians, and not in the control arm. ID Treatment will be recommended in intervention arm: IV iron when hepcidin is <20μg/L; IV iron+erythropoietin when hepcidin is between 20-41μg/L; in the control arm: IV iron when ferritin <300μg/L and Transferrin saturation <20%. The primary endpoint will be the number of days spent in hospital 90 days after ICU discharge and the direct hospital costs. Secondary endpoints will be anaemia and iron deficiency on D15, fatigue and the proportion of patients alive and at home on D30 and D90. DISCUSSION The results of this study will show whether diagnosing iron deficiency using MS hepcidin determination methods is liable to reduce patients' post-ICU hospital stay and costs, as well as their anaemia and fatigue.
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Affiliation(s)
- Sigismond Lasocki
- Département anesthésie réanimation, Institut MITOVASC, CNRS UMR 6214, Inserm U1083, Université d'Angers, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - Hervé Puy
- Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France; Inserm U1149, centre de recherche sur l'inflammation, France; Laboratory of excellence, GR-Ex, Paris, France; Hôpital Louis-Mourier, centre français des porphyries, AP-HP, Colombes, France
| | | | - Sylvain Lehmann
- Laboratoire de biochimie - protéomique clinique, CRB de Montpellier, CHU de Montpellier, Montpellier, France
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Ghorbel L, Coudert L, Gilbert Y, Mercier G, Blais JF. Determination of critical operational conditions favoring sulfide production from domestic wastewater treated by a sulfur-utilizing denitrification process. J Environ Manage 2017; 198:16-23. [PMID: 28441553 DOI: 10.1016/j.jenvman.2017.04.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 04/05/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to determine the critical operational conditions leading to the generation of sulfide in a domestic wastewater treated by a sulfur-utilizing denitrification process. The influence of various important parameters on the reduction of the sulfates present in denitrified domestic wastewaters to sulfide was studied. Experiments were carried out in batch mode with denitrified domestic wastewaters containing various amounts of both organic matter and sulfates. Preliminary results showed that aqueous sulfide was generated for DOC and sulfate contents higher than 56 mg/L and 371 mg/L, respectively, while DOC and sulfate contents of 77 mg/L and 412 mg/L, respectively, were required to allow the release of gaseous H2S. Good correlations were also observed between gaseous sulfide production and the values of ORP and DOC, while the amounts of dissolved sulfide produced seemed to be correlated with the ORP values and the concentration of sulfates. Additional experiments were conducted using a Box-Behnken methodology to determine if the production of aqueous or gaseous sulfide can be predicted depending on the DOC (from 50 to 90 mg/L) and sulfate contents (from 160 to 380 mg/L) at various temperatures ranging from 5 to 25 °C. The highest sulfide generation (H2S(g) = 84.8 ppm and H2S(aq) = 2.42 mg/L) occurred at 25 °C with DOC and sulfate concentrations starting from 90 mg/L and 270 mg/L, respectively, indicating that the production of sulfides from denitrified domestic wastewaters required conditions not likely to occur at the effluent of a sulfur-based denitrification unit following secondary treatment.
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Affiliation(s)
- L Ghorbel
- Institut national de la recherche scientifique (Centre Eau, Terre et Environnement), Université du Québec, 490 rue de la Couronne, Québec, Qc, G1K 9A9, Canada.
| | - L Coudert
- Institut national de la recherche scientifique (Centre Eau, Terre et Environnement), Université du Québec, 490 rue de la Couronne, Québec, Qc, G1K 9A9, Canada.
| | - Y Gilbert
- PREMIER TECH, 1 Avenue Premier Campus, Rivière-du-Loup, Qc, G5R 6C1, Canada.
| | - G Mercier
- Institut national de la recherche scientifique (Centre Eau, Terre et Environnement), Université du Québec, 490 rue de la Couronne, Québec, Qc, G1K 9A9, Canada.
| | - J F Blais
- Institut national de la recherche scientifique (Centre Eau, Terre et Environnement), Université du Québec, 490 rue de la Couronne, Québec, Qc, G1K 9A9, Canada.
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Roubille F, Mercier G, Delmas C, Manzo-Silberman S, Elbaz M, Riondel A, Henry P. P2725Description of acute cardiac care in 2014: A French nation-wide database on 277,845 admissions in 270 ICCUs. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F. Roubille
- University Hospital of Montpellier, Montpellier, France
| | - G. Mercier
- University Hospital of Montpellier, Montpellier, France
| | - C. Delmas
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | | | - M. Elbaz
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - A. Riondel
- University Hospital of Montpellier, Montpellier, France
| | - P. Henry
- Hospital Lariboisiere, Paris, France
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Bousquet J, Bourret R, Camuzat T, Augé P, Bringer J, Noguès M, Jonquet O, de la Coussaye JE, Ankri J, Cesari M, Guérin O, Vellas B, Blain H, Arnavielhe S, Avignon A, Combe B, Canovas G, Daien C, Dray G, Dupeyron A, Jeandel C, Laffont I, Laune D, Marion C, Pastor E, Pélissier JY, Galan B, Reynes J, Reuzeau JC, Bedbrook A, Granier S, Adnet PA, Amouyal M, Alomène B, Bernard PL, Berr C, Caimmi D, Claret PG, Costa DJ, Cristol JP, Fesler P, Hève D, Millot-Keurinck J, Morquin D, Ninot G, Picot MC, Raffort N, Roubille F, Sultan A, Touchon J, Attalin V, Azevedo C, Badin M, Bakhti K, Bardy B, Battesti MP, Bobia X, Boegner C, Boichot S, Bonnin HY, Bouly S, Boubakri C, Bourrain JL, Bourrel G, Bouix V, Bruguière V, Cade S, Camu W, Carre V, Cavalli G, Cayla G, Chiron R, Coignard P, Coroian F, Costa P, Cottalorda J, Coulet B, Coupet AL, Courrouy-Michel MC, Courtet P, Cros V, Cuisinier F, Danko M, Dauenhauer P, Dauzat M, David M, Davy JM, Delignières D, Demoly P, Desplan J, Dujols P, Dupeyron G, Engberink O, Enjalbert M, Fattal C, Fernandes J, Fouletier M, Fraisse P, Gabrion P, Gellerat-Rogier M, Gelis A, Genis C, Giraudeau N, Goucham AY, Gouzi F, Gressard F, Gris JC, Guillot B, Guiraud D, Handweiler V, Hayot M, Hérisson C, Heroum C, Hoa D, Jacquemin S, Jaber S, Jakovenko D, Jorgensen C, Kouyoudjian P, Lamoureux R, Landreau L, Lapierre M, Larrey D, Laurent C, Léglise MS, Lemaitre JM, Le Quellec A, Leclercq F, Lehmann S, Lognos B, Lussert CM, Makinson A, Mandrick K, Mares P, Martin-Gousset P, Matheron A, Mathieu G, Meissonnier M, Mercier G, Messner P, Meunier C, Mondain M, Morales R, Morel J, Mottet D, Nérin P, Nicolas P, Nouvel F, Paccard D, Pandraud G, Pasdelou MP, Pasquié JL, Patte K, Perrey S, Pers YM, Portejoie F, Pujol JLE, Quantin X, Quéré I, Ramdani S, Ribstein J, Rédini-Martinez I, Richard S, Ritchie K, Riso JP, Rivier F, Robine JM, Rolland C, Royère E, Sablot D, Savy JL, Schifano L, Senesse P, Sicard R, Stephan Y, Strubel D, Tallon G, Tanfin M, Tassery H, Tavares I, Torre K, Tribout V, Uziel A, Van de Perre P, Venail F, Vergne-Richard C, Vergotte G, Vian L, Vialla F, Viart F, Villain M, Viollet E, Ychou M, Mercier J. MACVIA-LR (Fighting Chronic Diseases for Active and Healthy Ageing in Languedoc-Roussillon): A Success Story of the European Innovation Partnership on Active and Healthy Ageing. J Frailty Aging 2017; 5:233-241. [PMID: 27883170 DOI: 10.14283/jfa.2016.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.
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Affiliation(s)
- J Bousquet
- Professor Jean Bousquet, CHRU, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France, Tel +33 611 42 88 47,
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Roubille F, Mercier G, Delmas C, Manzo-Silberman S, Leurent G, Elbaz M, Riondel A, Bonnefoy-Cudraz E, Henry P. Data on nation-wide activity in intensive cardiac care units in France in 2014. Data Brief 2017; 13:166-170. [PMID: 28603762 PMCID: PMC5451179 DOI: 10.1016/j.dib.2017.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 11/25/2022] Open
Abstract
We present data in relation to the article entitled “Description of acute cardiac care in 2014: A French nation-wide database on 277,845 admissions in 270 ICCUs”.(10.1016/j.ijcard.2017.04.002) (Roubille et al., 2017) [1]: the main characteristics of the pathologies managed in the intensive cardiac care units (ICCUs), the details on the interventions performed and the main differences between centers following the size of the centers and a figure presenting the monthly variations of admissions in the ICCUs in France in a total of 277,845 patients in 270 centers admitted at least one time in the ICCUs in 2014 (exhaustive data).
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Affiliation(s)
- François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France
| | - Grégoire Mercier
- Economic Evaluation Unit at Montpellier Teaching Hospital, University of Montpellier, Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, Toulouse, France
| | - Stéphane Manzo-Silberman
- Department of Cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Guillaume Leurent
- CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, Toulouse, France
| | - Adeline Riondel
- Economic Evaluation Unit at Montpellier Teaching Hospital, University of Montpellier, Montpellier, France
| | | | - Patrick Henry
- Department of Cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris, France
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Duflos C, Molinari N, Solecki K, Roubille F, Mercier G. Construction of a mortality score in French heart failure outpatients: Model comparisons. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Roubille F, Mercier G, Delmas C, Manzo-Silberman S, Leurent G, Elbaz M, Riondel A, Bonnefoy-Cudraz E, Henry P. Description of acute cardiac care in 2014: A French nation-wide database on 277,845 admissions in 270 ICCUs. Int J Cardiol 2017; 240:433-437. [PMID: 28400122 DOI: 10.1016/j.ijcard.2017.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/10/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Intensive Cardiac Care Unit (ICCU) has greatly evolved for decades: it no longer includes only patients with coronary artery disease (CAD). The clinical characteristics and pathological profiles of patients have markedly changed. Detailed data on the topic are critically lacking. METHODS We present here a French nation-wide administrative database with an exhaustive description of patients admitted to ICCU throughout a whole year (2014). RESULTS A total of 277,845 patients in 270 centers were admitted to ICCUs at least once in 2014 (exhaustive data). Median age was 71years (IQR: 59-81) and the patients were primarily male (63%). Mean ICCU stay was 2.0days (1.0-4.0). CAD patients (49.0%) represented the major group admitted, followed by patients with arrhythmias (15.2%) and heart failure (HF) (10.0%). Patients admitted with acute CAD were significantly younger (mean age 67.4 y), had better outcomes (mortality 4.0%), and shorter hospital stays (mean stay 6.7 d). Patients with HF were significantly older (mean age 75.2 y), with longer hospital stays (mean stay 12.0 d), and poorer outcomes (mortality 10.5%). CONCLUSION We present here the largest contemporary administrative database on patients admitted to ICCUs in a developed country. CAD (mainly acute coronary syndromes) remains the primary cause of admission but the population is, by far, more complex than generally considered.
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Affiliation(s)
- François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France.
| | - Grégoire Mercier
- Economic Evaluation Unit at Montpellier Teaching Hospital, University of Montpellier, Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, Toulouse, France
| | - Stéphane Manzo-Silberman
- Department of Cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Guillaume Leurent
- CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, Toulouse, France
| | - Adeline Riondel
- Economic Evaluation Unit at Montpellier Teaching Hospital, University of Montpellier, Montpellier, France
| | | | - Patrick Henry
- Department of Cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris, France
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