Dissertations / Theses: 'Health administrative database'

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Ladouceur, Martin. "Bayesian estimation of the prevalence of osteoarthritis in the Québec elderly population from an administrative database." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=81351.

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Osteoarthritis (OA) is the most prevalent form of arthritis. It is a disabling condition that mostly affects the elderly with huge costs to society. Estimating the prevalence of OA is important for planning health services, for creating programs aimed to prevent OA disability and for assisting patients living with these disabilities. Several authors have attempted to estimate the prevalence of OA using data obtained from self-report questionnaires or administrative databases. Self-report questionnaires are prone to recall bias and estimates from administrative databases have relied solely on diagnostic codes, that can sometimes be inaccurate. If data from three presumed conditionally independent tests are used to estimate the prevalence, then the problem is identifiable, meaning that all parameters can be estimated without imposing constraints on the parameter space. When data from the three conditionally independent diagnostic tests were considered, the estimated prevalence of OA was 14.8% (95% CI: 14.5-15.1). A moderate degree of variation in this prevalence estimate was found across different models carrying different assumptions. The Bayesian latent class methodology used is advantageous in accounting for the different estimates that may arise from different sets of modelling assumptions. As the validity of the results rely on various assumptions, all of which are difficult to verify, final conclusions depend on which assumptions are thought most likely to be true, and the degree of robustness of estimates across different models.

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Potvin, Kenneth A. "Use of an administrative database to develop and test a model to predict the allocation of clinical pharmacy human resources." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0021/MQ57158.pdf.

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Walden, Judith Gail. "Using Administrative Healthcare Records to Identify Determinants of Amputee Residuum Outcomes." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3264.

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In the United States, the number of major limb amputees is predicted to exceed several million in the coming decades. For those amputees using a prosthesis, their quality of life (QoL) is often modulated by residuum limb problems resultant from its use. Multiple factors preclude quality evidence-based medicine (EBM) research in the field of prosthetics, leading to greater health risk from prosthetic prescription ambiguity. Positive social change is integral to good QoL; studies support administrative healthcare (AHc) as useful to support such, especially in the absence of EBM. This study utilized Veterans Healthcare Administration (VHA) AHc data to discriminate determinants of residual limb skin problem severity (RLSPS), relative to the artificial limb configuration (ALC) used through a retrospective, longitudinal study of a cohort of U.S.Veteran dysvascular amputees. The dataset was derived from multiple archival VHA AHc databases from which 279 Cohort members were identified who underwent amputation surgery during the fiscal year (FY) 2007 were dispensed a prosthesis, and had clinical records through FY 2011. ICD-9-CM and HCPCS codes were used to identify categories of RLSPS and ALC, respectively, with generalized estimating equations modeling to identify likelihood associations of parameters. Derivation of the study cohort dataset was encumbered by data integrity issues and coding system limitations; significant associations were detected for RLSPS with chronic obstructive pulmonary disease, substance use disorder, and major depressive disorder, regardless of the ALC dispensed. The findings support the utility of an amputee-prosthesis AHc database to drive product, policy, and medical decisions toward an improved QoL for this vulnerable population.

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Hasselback, Paul. "Native mortality in Canada: An epidemiological study using computerized record linkage of native administrative files with the Canada mortality database and two sources of routinely collected mortality statistics." Thesis, University of Ottawa (Canada), 1990. http://hdl.handle.net/10393/5619.

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Natives in Canada suffer from high rates of morbidity and mortality in comparison to the Canadian population. Investigation of this inequity has been hampered by a lack of valid health statistics on native populations. This thesis assesses native mortality through a study of three potential sources of native mortality statistics using routinely collected data. Objectives were to: (1) Measure mortality indicators using a computerized record linkage of government Indian administrative records with the Canada Mortality Database. (2) Compare native mortality indicators based on the linked files, on-reserve deaths, and Medical Services Branch native client files. (3) Relate mortality amongst natives with respect to the Canadian population. (4) Determine if there is a contribution of "rural" living to native mortality. The record linkage includes deaths recorded with DIAND as occurring in 1981. The average annual mortality rate for the two other native files and comparison populations are derived from 1979-1983 records. (Abstract shortened by UMI.)

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Scheer, Darren. "Respiratory Infections and Risk for Development of Narcolepsy: Analysis of the Truven Health MarketScan Database (2008 to 2010) with Additional Assessment of Incidence and Prevalence." Scholar Commons, 2019. https://scholarcommons.usf.edu/etd/7927.

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Background and Significance: Narcolepsy is a chronic neurological disorder. These patients experience various psychiatric and physical comorbid diseases and mortality at an increased rate compared to the general population. Additionally, patients with narcolepsy experience approximately a doubling of various annual healthcare related facility visits, transactions, and costs comparatively. Narcolepsy with cataplexy is generally believed to be more prevalent than narcolepsy without cataplexy. However, incidence and prevalence estimates of narcolepsy (with or without cataplexy) vary widely with few large epidemiological studies conducted worldwide and none in the U.S evaluating these proportions in both children and adults utilizing a large health care claims database. One of the main mechanisms underlying narcolepsy, the destruction of hypocretin neurons, is not clear. Two of the more noted hypotheses for this pathology are autoimmune and infection based triggers in allele carrier patients. These have been highlighted since narcolepsy diagnoses increased following the late 2000s influenza vaccinations, especially across Europe. Specific influenza and streptococcal infections have also been considered. Large U.S. healthcare claims database investigations of the association between specific infections and development of narcolepsy were not found in the published scientific literature. Our goals were to enhance the knowledge regarding the epidemiology and possible infection triggers of narcolepsy. The information gained may aid in the overall understanding of the condition, the possible vulnerable populations, and lead to hypotheses regarding which subpopulations research should be focused upon and those triggers that may be avoided or reduced in exposure. Methods: The Truven Health MarketScan Commercial Dissertation Database (THMCDD) was used to estimate prevalence and incidence of narcolepsy, with and without cataplexy, by age groups, gender, and region among patients under age 66 with continuous enrollment for years 2008-2010. THMCDD contains health claims information for over 18 million people. Prevalence was expressed as cases/100,000 persons. Average annual incidence (using varying criteria for latency between the diagnostic tests, polysomnograph coupled with MSLT, and the diagnosis) was expressed as new cases/100,000 persons/year. Subsequently, we conducted a case-control study to assess the differences in respiratory infections between patients with incident narcolepsy diagnosis and controls. Continuously enrolled patients under age 66 were included. Cases of narcolepsy occurring from July 1, 2009 through December 31, 2010 were included based on two diagnosis criteria (using varying criteria for latency between diagnosis and the diagnostic tests). Non-narcolepsy controls were frequency matched on look-back time by assigning an index date equal to a case diagnosis date. Occurrence of prior respiratory infections was compared between cases and controls based on narcolepsy criteria and four different time periods pre-index date. Infections were grouped into 9 types based on pathogen and clinical manifestation. Results: From 2008 through 2010, there were 8,444,517 continuously enrolled patients and 6,703 diagnosed with narcolepsy (prevalence overall:79.4/100,000; without cataplexy:65.4/100,000; with cataplexy: 14.0/100,000). Based on the 3 definitions of incidence, overall average annual incidence was 7.67, 7.13, and 4.87/100,000 persons/year. Incidence for narcolepsy without cataplexy was generally several times higher than narcolepsy with cataplexy. Prevalence and incidence were approximately 50% greater for females compared to males across most age groups. Prevalence was highest among the 21-30 age group, with incidence highest among enrollees in their early 20s and late teens. Regionally, the North Central U.S. had the highest prevalence and incidence, while the West was the lowest. For the case-control study, Adjusted odds ratio (aOR) increases were statistically significant for Group 5 (acute respiratory infections), Group 8 (other pneumonias, bronchopneumonia, etc.) and Group 9 (influenzas) across various time periods pre-index date and for both narcolepsy criteria. Overall, the most significant aORs were for acute respiratory infections during the 3 to 15 months pre-index date for both narcolepsy diagnosis criteria (aOR=1.73, 95% 1.52 to 1.98 and aOR=1.83, 95% CI 1.57 to 2.19). The aORs for acute respiratory infections were approximately 50% greater among females than males. Conclusion: We observed higher prevalence and incidence of narcolepsy compared to most previous studies. Females were associated with approximately 50% increased proportions compared to males. We also found that the greatest prevalence and incidence of narcolepsy occurred in patients in their early 20s, and those residing in the North Central region of the U.S. Perhaps most striking was the observation of much greater proportions of narcolepsy without cataplexy compared to narcolepsy with cataplexy. In the case-control assessment, we found increased occurrences of acute respiratory infections, pneumonias, and influenza prior to incident narcolepsy diagnosis, compared to controls. Generally, these rates appeared higher for females than males and occurred for both narcolepsy diagnosis criteria. Additionally, these associations were observed in the infection assessment periods 3 to 15 months and 6 to 18 months prior to incident narcolepsy diagnosis. Increased awareness and early notification among healthcare providers for signs and symptoms of narcolepsy is critical in helping this population of patients manage this burdensome condition. Also, the identification of potential narcolepsy triggers by certain infections may aid in the understanding of the disease. These findings may have implications in the understanding of mechanisms and causation of other acute onset neurological disorders. Our observations of consistently increased risk of incident narcolepsy related to recent previous viral respiratory infections and the inconsistent results for bacterial infections require additional study to confirm these findings.

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Macdonald, Kristian I. "Development and Validation of an Administrative Data Algorithm to Identify Adults who have Endoscopic Sinus Surgery for Chronic Rhinosinusitis." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/35148.

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Objective: 1) Systematic review on the accuracy of Chronic Rhinosinusitis (CRS) identification in administrative databases; 2) Develop an administrative data algorithm to identify CRS patients who have endoscopic sinus surgery (ESS). Methods: A chart review was performed for all ESS surgical encounters at The Ottawa Hospital from 2011-12. Cases were defined as encounters in which ESS for performed for Otolaryngologist-diagnosed CRS. An algorithm to identify patients who underwent ESS for CRS was developed using diagnostic and procedural codes within health administrative data. This algorithm was internally validated. Results: Only three studies meeting inclusion criteria were identified in the systematic review and showed inaccurate CRS identification. The final algorithm using administrative and chart review data found that encounters having at least one CRS diagnostic code and one ESS procedural code had excellent accuracy for identifying ESS: sensitivity 96.0% sensitivity, specificity 100%, and positive predictive value 95.4%. Internal validation showed similar accuracy. Conclusion: Most published AD studies examining CRS do not consider the accuracy of case identification. We identified a simple algorithm based on administrative database codes accurately identified ESS-CRS encounters.

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Blomqvist, Paul. "On the use of administrative databases in health care analyses /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-2855-X.

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Kudjawu, Yao Cyril. "Délais d’accès au traitement des patients atteints de cancers en France et impact des inégalités sociales de santé : étude à partir des bases de données médico-administratives." Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS023/document.

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Contexte : Le délai d’accès au traitement pour cancer est un aspect important de la qualité des soins. Compte tenu de l’augmentation du nombre de cancers, les établissements de soins seront amenés à traiter un nombre élevé de patients atteints de cancers. Notre objectif était d’étudier le délai d’accès au traitement après le diagnostic de cancer chez les patients atteints de cancers du côlon (CC), du rectum-anus (RC) ou du poumon (CP) ainsi que les facteurs associés et l’impact des inégalités sociales.Méthode : A l’aide de codes diagnostiques de la classification internationale des maladies et de codes de la classification commune des actes médicaux, nous avons sélectionné dans la base du programme de médicalisation des systèmes d’information de nouveaux patients diagnostiqués pour CC, RC et CP en 2009-2010 et traités. Les informations sur ces patients ont été croisées avec celles des bénéficiaires d’affection longue durée pour ces cancers et avec celles de l’indice de désavantage social.Résultats : Nous avons inclus 15 694, 6 623 et 14 596 patients atteints et traités respectivement pour CC, CR et CP. Les délais médians entre l’endoscopie et l’accès à : 1) la chirurgie chez les patients avec un parcours chirurgical pour CC, CR et CP étaient respectivement de 22 (Q25 = 14; Q75 = 34), 97 (Q25 = 34; Q75 = 141), et 44 (Q25 = 26; Q75 = 82) jours ; 2) la chimiothérapie chez les patients avec un parcours non-chirurgical pour CC, CR et CP étaient respectivement de 36 (Q25 = 21; Q75 = 59), 40 (Q25 = 27; Q75 = 59) et 33 (Q25 = 22; Q75 = 49) jours; 3) la radiothérapie chez les patients avec un parcours non-chirurgical chez les patients avec CR et CP étaient respectivement de 53 (Q25 = 39; Q75 = 78) et 88 (Q25 = 46; Q75 = 162) jours; 4) au premier traitement, quel que soit le parcours, était de 23 (Q25 = 14; Q75 = 35), 43 (Q25 = 27; Q75 = 74) et 34 (Q25 = 22; Q75 = 50) jours respectivement pour CC, CR et CP. Le délai d’accès au premier traitement variait selon les régions. Il était long dans la plupart des régions du nord et dans les départements d’Outre-mer, court dans les régions d’Île-de-France, du sud, de l’est et parfois de l’ouest pour les trois cancers. En analyse multiniveau, l’âge et le statut de l’établissement du premier traitement étaient significativement associés au délai d’accès au premier traitement pour CC. Ces facteurs, y compris l’indice de désavantage social étaient significativement associés au délai d’accès au premier traitement pour le CR et le CP. Le délai d’accès au premier traitement augmentait avec l’âge. Il était plus élevé dans les hôpitaux publics comparés aux hôpitaux privés et faible chez les patients des communes les moins défavorisées comparés aux patients des communes les plus défavorisées. Conclusion : A notre connaissance, cette étude est la première à décrire les délais d’accès au traitement après endoscopie chez les patients atteints de cancer à partir des bases médico-administratives en France. Les résultats, qui compléteront ceux issus des données registres de cancers et des réseaux régionaux de cancérologie, pourront être utiles aux décideurs politiques dans la mise en place de recommandations de prise en charge des cancers
Background: timeliness of cancer treatment is an important aspect of health quality. Care centers are expected to treat a growing number of patients with cancer. Our objectives were to examine treatment times from diagnosis to first-course therapy for patients with colon (CC), rectum-anus (RC), and lung (LC) cancers and assess factors associated with time to-treatment and the impact of deprivation index.Methods: using the international classification of diseases and medical procedures codes, from national hospital discharge database which has been crossed with long term illness data and French deprivation Index information, we selected patients newly diagnosed for CC, RC or LC in 2009-2010 who had undergone treatment.Results: We included 15,694, 6,623 and 14,596 patients diagnosed and treated for CC, RC and LC respectively. Median times from endoscopy to: 1) surgery in patients with a surgical treatment pathway for CC, RC, and LC were 22 (Q25 = 14; Q75 = 34), 97 (Q25 = 34; Q75 = 141), and 44 (Q25 = 26; Q75 = 82) days, respectively; 2) to chemotherapy for patients with a non-surgical treatment pathway, for CC, RC, and LC were 36 (Q25 = 21; Q75 = 59), 40 (Q25 = 27; Q75 = 59), and 33 (Q25 = 22; Q75 = 49) days respectively; 3) to radiotherapy in RC and LC patients were 53 (Q25 = 39; Q75 = 78) and 88 (Q25 = 46; Q75 = 162) days respectively; 4) to first treatment, irrespective of pathway and treatment combination for CC, RC and LC were 23 (Q25 = 14; Q75 = 35), 43 (Q25 = 27; Q75 = 74), and 34 (Q25 = 22; Q75 = 50) days respectively.Time to first treatment vary across regions. It was longer in most northern regions and in overseas districts and shorter in Île-de-France, southern, eastern and sometimes in western regions for the three cancers. In multilevel analysis, Age and status of the first care center were significantly associated to time to first treatment in CC patients. Similar factors, including Deprivation index, were significantly associated to time to first treatment in RC and LC patients. The time to first treatment increased with age. It was higher in public hospitals compared to private hospitals and low in patients with low deprivation index compared to patients with high deprivation index. Conclusion: To our knowledge, this is the first study based on medico-administrative database describing time to first treatment after endoscopy in patients suffering from cancers in France. The results, which will complement those from cancer registry data and regional networks of cancerology, could inform decision-making policies on the implementation of guidelines on timeframes for cancer treatment access

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Ng, Ryan. "Assessment of systemic lupus erythematosus diagnoses within Quebec's health administrative databases." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=107884.

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Background: Systemic lupus erythematosus (SLE) is a chronic, relatively uncommon autoimmune disease that has a relapsing-remitting course, with clinical manifestations in various organ systems (cutaneous, renal, and other). To control disease, immunosuppressive drugs are often required. Health administrative databases are useful for studying SLE because of their wide population coverage, and could potentially be used to study SLE incidence, prevalence, clinical manifestations, and medication use. However, because the diagnoses in these administrative databases are not necessarily clinically confirmed, SLE case ascertainment is a methodological challenge. First, some of the methodological issues were examined in this thesis. Second, clinical manifestations and the association between early antimalarial drug use and future renal manifestations were examined in a cohort of SLE patients. Methods: The initial SLE case definition was a previously-used algorithm that identified subjects as having SLE if they met one of the following criteria: one SLE hospital discharge code, one rheumatologist SLE claim and/or two SLE non-rheumatologist claims at least eight weeks apart but within two years. Alternative algorithms were formed by modifying one or more of the initial algorithm's parameters. Incidence and prevalence estimates were determined using each alternative algorithm and compared to the initial estimates. The effect of using different data period lengths for detecting patients was also examined. Kaplan-Meier (K-M) analyses were performed to assess documentation of clinical SLE manifestations and use of selected immunosuppressant medications, within an incident SLE cohort identified by the initial algorithm (described above). The observation interval began four years prior to SLE diagnosis and continued up to eight years after SLE diagnosis. Cox proportional hazards regression analyses were used to examine the association between early antimalarial drug use and renal manifestations. Results: With the initial algorithm, the 1998 yearly incidence was 6.0 cases per 100,000 (95% confidence interval (CI), 5.5–6.6). When parameters from the initial algorithm were changed, the 1998 incidence varied to between 4.4 and 7.4/100,000. The prevalence also changed from 65.5/100,000 (95% CI: 63.7–67.4) with the initial algorithm, to between 47.8–79.1/100,000 with the alternate algorithms. When the length of the data period changed from fifteen years to five years, the 2001 yearly incidence was overestimated by 38.3% (5.7/100,000 initially and 7.9/100,000 with only five years of data) and the prevalence was underestimated by 29.9% (the new estimate being 46.0/100,000, 95% CI: 44.4–47.5).Over-all, 66.2% (95%CI: 63.4–68.9%) of incident patients (within the SLE cohort assembled using the initial algorithm) had evidence of at least one SLE manifestation within the period under examination. The most common manifestation was cutaneous involvement, present in 30.0%. Within the sub-cohort of incident SLE patients covered by RAMQ drug insurance, 87.2% (95% CI: 84.2–90.3%) had received at least one of the medications under study, by the end of the study interval. No association was found between early antimalarial drug use and subsequent renal manifestations.Conclusion: Varying the case definition and data period can change incidence and prevalence estimates considerably, so all features, including the time period in which the data spans, should be selected carefully and explicitly stated. The majority of incident SLE patients had evidence of SLE manifestations or used medications which would provide possible confirmation of SLE case status. This additional information can be used in future health services administrative database research to understand SLE, and help compensate for the databases' lack of clinical confirming data.
Contexte : Le lupus érythémateux disséminé (LED) est une maladie auto-immune chronique relativement peu commune. L'évolution de cette maladie est décrite en phases de poussées et de rémissions et ses manifestations cliniques touchent plusieurs organes. L'utilisation de médicaments immunosuppresseurs est souvent nécessaire pour contrôler le LED. Les banques de données administratives du domaine de la santé s'avèrent utiles pour étudier le LED, car elles pourraient être utilisées pour étudier l'incidence, la prévalence et les manifestations cliniques. Toutefois, comme les diagnostics présents dans ces bases de données administratives n'ont pas nécessairement de confirmation clinique, la détermination des cas de LED représente un défi d'ordre méthodologique et certains de ces problèmes méthodologiques font l'objet de la présente thèse.Méthodologie : L'algorithme initial de définition de cas de LED a déjà été utilisé pour identifier des sujets atteints de LED s'ils répondaient aux critères suivants : un code de congé d'hôpital de LED, une réclamation d'un rhumatologue pour le LED et/ou deux réclamations par un médecin autre qu'un rhumatologue pour le LED séparées d'au moins huit semaines, mais dans un intervalle de deux ans. D'autres algorithmes ont été créés en modifiant un paramètre ou plus de l'algorithme initial. Des estimations d'incidence et de prévalence ont été obtenues grâce à chaque algorithme créé et ces valeurs ont été comparées aux estimations initiales. L'effet de l'utilisation de périodes de données de différentes longueurs sur la détection des patients a également été examiné. Des analyses Kaplan-Meier (K-M) ont été faites pour évaluer la documentation des manifestations cliniques du LED et l'utilisation de médicaments immunosuppresseurs spécifiques au sein d'une cohorte incidente de patients atteints de LED identifiés par l'algorithme initial (décrit plus haut). L'intervalle d'observation a débuté quatre ans avant le diagnostic de LED et s'est poursuivi jusqu'à huit ans après le diagnostic. Des analyses utilisant le modèle de régression à risques proportionnels de Cox ont servi à examiner l'association entre l'utilisation précoce d'antipaludiques et les manifestations rénales. Résultats : Avec l'algorithme initial, l'incidence annuelle de LED en 1998 était de 6,0 cas pour 100 000 habitants (95 % d'intervalle de confiance (CI), 5,5-6,6). En changeant les paramètres de l'algorithme initial, l'incidence en 1998 a varié entre 4,4 et 7,4 pour 100 000. La prévalence a passé de 65,5 pour 100 000 (95 % CI : 63,7–67,4) avec l'algorithme initial à entre 47,8–79,1 pour 100 000 avec les autres algorithmes. En modifiant la longueur des périodes de données de quinze à cinq ans, l'incidence annuelle en 2001 était surestimée par 38,3 %.Dans l'ensemble, 66,2 % (95 % CI : 63,4–68,9 %) des patients incidents au sein de la cohorte de patients atteints de LED assemblée grâce à l'algorithme initial montraient au moins une manifestation de LED au cours de la période évaluée. Au sein d'une sous-cohorte de patients incidents atteints de LED couverts par la RAMQ, 87,2 % (95 % CI : 84,2–90,3 %) ont reçu au moins un médicament à l'étude avant la fin de l'intervalle étudié. Aucune association n'a été trouvée entre l'utilisation précoce d'antipaludiques et les manifestations rénales subséquentes. Conclusion : La variation de la définition de cas et de la période de données peut modifier considérablement les estimations d'incidence et de prévalence. Ainsi, tous les paramètres, y compris la période de temps pour laquelle les données sont recueillies, devraient être choisis avec précaution. La majorité des patients incidents atteints de LED montrent des manifestations de LED qui pourraient offrir une confirmation potentielle des cas de LED. Ces informations supplémentaires pourront être utilisées pour des études futures sur les bases de données des services de soins de santé afin de mieux comprendre le LED.

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Cohen, Sarah. "Apport et utilisation des bases de données médico-administratives dans l’étude des problématiques émergentes chez les patients adultes atteints de cardiopathie congénitale Administrative health databases for addressing emerging issues in adults with CHD: a systematic review Accuracy of claim data in the identification and classification of adults with congenital heart diseases in electronic medical records Exposure to low-dose ionizing radiation from cardiac procedures and malignancy risk in adults with congenital heart disease." Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCB228.

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Les cardiopathies congénitales (CC) sont les plus fréquentes des malformations congénitales et concernent près de 1% des naissances. Grâce aux progrès considérables de la cardiologie pédiatrique et de la chirurgie cardiaque, 90% des enfants nés avec une CC atteignent désormais l'âge adulte. Mais ces « survivants » ne sont pas guéris. Un certain nombre de complications, cardiaques et extracardiaques, attendues ou non, et de problématiques spécifiques émergent, justifiant une consommation de soins grandissante. Le besoin d’études en population a motivé l’analyse secondaire de données médico-administratives dans diverses régions du globe. L’objectif de cette thèse était d’étudier les conditions d’utilisation des bases de données médico-administratives (BDMA) et leurs applications possibles pour mieux comprendre les enjeux émergents de cette population nouvelle d’adultes avec CC (ACC). La première partie de ce travail a été de décrire de manière systématique toutes les études ayant utilisé des BDMA pour explorer spécifiquement les problématiques des patients ACC. Cette revue a montré l’intérêt de ces bases de données dans le domaine des ACC, les effectifs importants permettant d’étudier des maladies relativement rares et la disponibilité de données exhaustives sur de longues périodes d’observation autorisant l’étude de certaines complications cardiaques ou extracardiaques de survenue parfois différée chez ces patients. En France, les bases de données administratives de remboursement utilisent la Classification internationale des Maladies, dixième révision (CIM-10) dont la fiabilité pour repérer les ACC et les pathologies qui leur sont associées est inconnue dans ce contexte. La deuxième partie de ce travail avait donc pour objectif d’étudier la performance de la CIM-10 pour identifier et classer des patients ACC au sein de l’entrepôt de données de l’hôpital Européen Georges Pompidou disposant d'une unité dédiée aux ACC. La troisième partie de cette thèse rapporte un exemple concret de l’utilisation des BDMA. A partir des données de la Québec Congenital Heart Disease Database issue des BDMA du Québec, notre objectif était d’évaluer l’association entre l’exposition aux rayonnements ionisants provenant de procédures cardiaques et la survenue de cancer chez les ACC. En effet, l’amélioration de l’espérance de vie des patients avec CC et l’augmentation du recours aux modalités d’imagerie cardiaque irradiante, font craindre un effet carcinogène potentiel à long terme. Bien qu’elles n’aient pas été conçues à des fins de recherche, ce travail de thèse montre que les BDMA sont un outil particulièrement pertinent pour générer de nouvelles connaissances sur les patients ACC de par l’exhaustivité des informations disponibles, la possibilité de produire de grands échantillons et de permettre un suivi longitudinal sur de longues périodes d'observation. L’exploitation des dossiers médicaux électroniques par des méthodes de fouilles de texte pourrait alors permettre de développer et valider des algorithmes pour identifier les cas de CC dans les BDMA. En France, bien que des efforts aient été déployés pour créer un programme de collaboration multicentrique efficace, il n’existe à l’heure actuelle aucune donnée épidémiologique d’envergure concernant l’ensemble des ACC. L’analyse secondaire de ressources existantes, telles que le Système National des Données de Santé, permettrait d’établir la cohorte nationale d’ACC et d’analyser leur parcours de soins afin d’orienter au mieux l’allocation des ressources
Congenital heart diseases (CHD) are the most common types of birth defects and affect approximately 1% of births. Ninety percent of children born with CHD reach now adulthood thanks to improvements of pediatric cardiology and cardiac surgery. These "survivors" are not definitively cured. They are prone to cardiac or extra cardiac complications and specific issues that justify an increase in consumption of healthcare. The need for population-based studies worldwide has led to secondary analyses of administrative medical databases (AMD). The objective of this thesis was to study the conditions of use of the AMD and their possible applications, specifically to understand the emerging issues of this new adult population with CHD (ACHD). The first part of this work was to systematically describe all the studies that had used AMD to specifically explore the issues of ACHD patients. This review showed the value of these databases in the field of ACHD: the large numbers of patients allows studying relatively rare diseases and the availability of comprehensive data over long periods of follow-up enables to study cardiac and extra cardiac complications even when the occurrence is delayed. In France, claim databases use the International Classification of Diseases, 10th revision (ICD-10), the reliability of which is still largely unknown in this context. The second part of this work was therefore to study the performances of ICD-10 to identify and classify ACHD patients in the data warehouse of the Georges Pompidou European Hospital which has a dedicated specialized ACHD Unit. The third part of this thesis reported a concrete example of the use of AMD. Based on the Quebec Congenital Heart Disease Database derived from Quebec’s AMD, our goal was to evaluate the association between exposure to ionizing radiation from cardiac procedures and the risk of cancer in ACHD. Indeed, the improvement in the life expectancy of patients with CHD and the increasing use of cardiac imaging modalities using ionizing radiations may have a carcinogenic effect in the long term. Although not designed for research purposes, this thesis showed that AMD are a particularly relevant tool for generating new knowledge about ACHD patients through the comprehensiveness of information, the possibility of extracting large samples of patients with a longitudinal follow-up over long periods of observation. The exploitation of electronic medical records through text mining methods could then be used to develop and validate algorithms to identify CHD patients in AMD. In France, although efforts have been made to create an effective multi-center collaborative program, there is currently no significant epidemiological data for all ACHDs. Secondary analysis of existing resources, such as the National Health Data System, would establish the national ACHD cohort and analyze their care pathway in order to guide healthcare resources allocation

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Kolakowsky-Hayner, Stephanie A. "Vocational Rehabilitation of Clients with Brain Injury: An Investigation of Racial Disparity within The Rehabilitation Services Administration (RSA) 911 Database." VCU Scholars Compass, 2007. https://scholarscompass.vcu.edu/etd/5958.

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Finding and maintaining employment is an ongoing problem for persons with disabilities, especially those with brain injuries. State vocational rehabilitation agencies are the primary authority responsible for providing employment-related services for individuals with disabilities throughout the United States. Little effort has been committed to identifying disparities in health and rehabilitation services provided to Americans with disabilities, particularly those with brain injuries. The purpose of this investigation was to utilize Aday and Andersen's Framework for the Study of Access to examine racial disparity within the Rehabilitation Services Administration 911 Database, and thus the vocational rehabilitation system, among clients with brain injury. Upon review of the descriptive ﬁndings, Whites and Asian or Paciﬁc Islanders were more likely to be accepted for rehabilitation than Blacks and American Indians or Alaskan Natives. Acceptance rates for males and females were similar. Clients, who received their primary source of support from “other” sources at the time of application, were least likely to be accepted for vocational rehabilitation. Hispanics appeared to have lower acceptance rates than non-Hispanics. Persons with greater than a high school education were more likely to be accepted for rehabilitation than persons with less education who had completed schooling through the regular education system. Exhaustive CHAID ﬁndings suggest that racial disparity in rehabilitation acceptance rates is not a clear cut issue. Each of the racial groups was more likely to be accepted for rehabilitation under different circumstances. Consequently, a deﬁnitive broadcast statement about racial disparity within the Federal Rehabilitation System cannot be made. With regard to reason for closure, although the Chi-square analyses for the current investigation were signiﬁcant, the degree of association was extremely modest. There did not appear to be a practical difference between White and non-White clients with regard to reason for closure. Future research, and practice and policy implications are discussed.

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Black, Cody. "The Health System Costs of Potentially Inappropriate Prescribing in Ontario: A Population-based Study." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38417.

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Potentially Inappropriate Prescribing (PIP) is common in Canada yet little is known about its health system costs or which PIPs have the greatest cost impact. This thesis examined the health system costs from hospitalizations, emergency department (ED) visits and medications from all PIP, and for distinct PIP. PIPs were identified in a cohort of older adults in Ontario using a subset of the STOPP/START criteria applicable to health administrative databases, and all analyses were conducted by comparing participants with and without PIP. In study one, the costs from hospitalization, ED visits and newly prescribed medications were identified using population attributable fractions. PIP was identified as responsible for a sizeable portion of all three cost categories, with hospitalization and ED visits costs most highly impacted. Study two compared the incremental costs due to PIP among four distinct PIP criteria selected based on differing frequency and crude costs to validate the use of such characteristics for priority-setting. The crude healthcare costs, as well as the cost of the drug causing the PIP and the frequency of the PIP were identified as likely key characteristics of high-impact PIP. Combined, these studies provide evidence on the overall burden of PIP, while also identifying likely characteristics of high-impact PIP. They suggest interventions at the health system level may be needed to address medication appropriateness and provide information which may be helpful to decision-makers when identifying which PIPs should be targeted for intervention, given no health system level interventions for PIP are currently in place.

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Stevens, Kim D. "Reducing Errors with Blood Administration Transfusion Systems." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7340.

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The intention of implementing technology into healthcare practices is to reduce opportunity for errors in the delivery of providing health care. However, errors still occur, and many times are preventable. Configurations of health information technology systems should match clinical workflows to promote usage as intended. The purpose of this quality improvement project was to evaluate the impact of revised system configurations and use of a blood product transfusion system for the administration of blood products after one year of implementation. The method of heuristic evaluation is a usability engineering method for finding problems in a user interface design with the input of a small workgroup of subject matter experts. The project site had experienced reported incidents of blood product administration error as well as problems with systems communication since the implementation of the blood transfusion system. There were 31 nurse clinical educator staff users of the system who completed a survey evaluation of their perceptions of the blood transfusion system before and after configuration changes. The findings revealed that the mean quality and productivity score after the system configuration occurred was significantly higher than the mean score prior to the system configuration change, t (30) = -7.93, p < .001. The correlation between the one survey was also statistically significant, r = .46, p = .009. This project supports positive social change by reducing the potential for error for system users in the process of the blood administration process through heuristic evaluation through the implementation of changes to the technological system.

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Mason, Patricia Lynn. "Diffusion of Electronic Health Records in Rural Primary Care Clinics." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/466.

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By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants' experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs under the American Recovery and Reinvestment Act, Health Information Technology for Economic and Clinical Health, and the Patient Protection and Affordable Care Act legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants: (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of transformation at rural medical practices. The implications for positive social change include the potential implementation of EHRs particularly in physician practices in rural communities, which could provide cost-efficient health care services for those communities and a more sustainable future at primary care practices.

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Harper, Sherhonda Yvette. "Public Health Providers' Perceptions of Electronic Health Records in a Disaster." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4634.

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The introduction of federal initiatives and incentives regarding health information technology fostered a movement towards the adoption of electronic health records (EHR). Implementation of EHRs sparked discussions among healthcare providers, patients, and others about the benefits or challenges of the move from the traditional paper method to the electronic version in healthcare settings. A knowledge gap in research involving the usefulness of EHRs and their impact to the delivery of care in other settings exists. The purpose of this qualitative study was to explore public health providers' perceptions of the meaningful use of EHRs in a disaster setting. Study participants were public health providers from Louisiana recruited via criterion sampling and snowball sampling. A qualitative, phenomenological design was used to gain understanding of the public health providers' experiences with and perceptions of EHRs in a disaster setting. Data were collected from 7 public health providers using in-depth interviews and reflective journal notes. The data were analyzed for patterns and themes using the hermeneutic circle method. The study findings indicate that individuals want to be involved in designing their system and adjusting workflow in the workplace setting. The majority of participants concluded that EHR systems are beneficial in the disaster setting, but there were no impacts to improving health outcomes. The findings provide policymakers, public health departments, healthcare providers, emergency managers, and communities needed information on the potential impact of EHRs in the disaster setting on improving safe and effective care.

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Weagraff, Joseph B. "Health Care Leaders' Experiences of Electronic Medical Record Adoption and Use." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3216.

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Adoption of electronic medical record (EMR) technology systems of meaningful use has been slow despite the mandate by the U.S. government. The purpose of this single case study was to explore strategies used by health care leaders to implement EMR technology systems of meaningful use to take advantage of federal incentive payments. Diffusion of innovation theory provided the conceptual framework for the study. Semistructured interviews were conducted with 6 health care leaders from a military installation in the Southeast United States. Data were analyzed using software, coding, and inductive analyses. The 3 prominent themes were patient, provider, and champion. Alerts from an EMR technology system can increase providers' awareness and improve patient safety. Providers' involvement in every phase of an EMR system's implementation can improve the adoption rate. Champions play a critical role in successful adoption and implementation of EMR systems. Results of this study may assist health care leaders in implementing EMR systems to take advantage of federal incentive payments. Implications for positive social change include enhanced delivery of safe, high-quality health care.

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Tannan, Ritu. "Acceptance and Usage of Electronic Health Record Systems in Small Medical Practices." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1028.

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One of the objectives of the U.S. government has been the development of a nationwide health information infrastructure, including adoption and use of an electronic health records (EHR) system. However, a 2008 survey conducted by the National Center for Health Statistics indicated a 41.5% usage of the EHR system by physicians in office-based practices. The purpose of this study was to explore opinions and beliefs on the barriers to the diffusion of an ERH system using Q-methodology. Specifically, the research questions examined the subjectivity in the patterns of perspectives at the preadoption stage of the nonusers and at the postadoption stage of the users of an EHR system to facilitate effective diffusion. Data were collected by self-referred rank ordering of opinions on such barriers and facilitators. The results suggested that the postadoption barriers of time, change in work processes, and organizational factors were critical. Although the time barrier was common, barriers of organizational culture and change in work processes differed among typologies of perspectives at the postadoption stage. Preadoption barriers of finance, organizational culture, time, technology, and autonomy were critical. The typologies of perspectives diverged on critical barriers at the preadoptive stage. A customized solution of an in-house system and training is recommended for perspectives dealing with technical and organizational concerns and a web-based system for perspectives concerned with barriers of finance, technology, and organization. The social impact of tailoring solutions to personal viewpoints would result in the increased sharing of quality medical information for meaningful decision making.

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Drill, Valerie Gerene. "A Multisite Hospital's Transition to an Interoperable Electronic Health Records System." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3293.

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The health care industry is transforming into an industry that requires health information technology, yet many health care organizations are reluctant to implement new technology. The purpose of this case study was to explore strategies that led to a successful transition from an older electronic health record (EHR) system to a compliant EHR system at a multisite hospital system (MHS). The study included face-to-face and phone interviews with 12 managers who worked on the transition of an MHS's EHR system in the Pacific Northwest region of the United States. The technology acceptance model was used to frame the study. Audio recordings with these managers were transcribed and analyzed along with interview notes and publicly available documents to identify themes regarding strategies used by managers to successfully upgrade to a compliant EHR system at an MHS. Three major themes emerged: hybrid implementation strategy, training strategy, and social pressure strategy. Results may be used to facilitate the adoption of information technology systems in any industry. Results may directly benefit other MHSs by facilitating successful EHR system transitions. Implications for social change include improved care coordination, reductions in duplicated medical procedures, and more timely and relevant tests for patients through the full use of EHRs.

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Ngunyu, Daniel Kanyi. "Strategies for Applying Electronic Health Records to Achieve Cost Saving Benefits." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5236.

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The American Recovery and Reinvestment Act (ARRA) of 2009 authorized the distribution of about $30 billion incentive funds to accelerate electronic health record (EHR) applications to improve the quality of care, safety, privacy, care coordination, and patients' involvement in healthcare. EHR use has the potential of saving $731 in costs for hospitals per patient admission; however, most hospitals are not applying EHR to reach the level at which cost savings are possible. The purpose of this single case study was to explore strategies that IT leaders in hospitals can use to apply EHR to achieve the cost saving benefits. The participants were IT leaders and EHR super users at a large hospital in Texas with successful experience in applying EHR. Information systems success model formed the conceptual framework for the study. I conducted face-to-face interviews and analyzed organizational documents. I used qualitative textual data analysis method to identify themes. Five themes emerged from this study, which are ensuring information quality, ensuring system quality, assuring service quality, promoting usability, and maximizing net benefits of the EHR system. The findings of this study included four strategies to apply EHR; these strategies include engaging training staff, documenting accurately and in a timely manner, protecting patient data, and enforcing organizational best practice policies to maximize reimbursement and cost savings. The findings of this study could contribute to positive social change for the communities because EHR successful application includes lower cost for hospitals that may lead to the provision of affordable care to more low-income patients.

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Touat, Mehdi Benjamin. "Coût de l’antibiorésistance en France : évaluation à partir des bases de données médico-administratives." Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPASV005.

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La résistance aux antibiotiques est considérée comme une menace majeure pour la santé publique mondiale. Le traitement des infections à germe résistant est plus difficile et conduit à des modifications de l’organisation des soins avec une augmentation des durées de séjour, de la morbidité et de la mortalité. L’évaluation du poids économique de la résistance aux antibiotiques pourrait éclairer les décideurs sur les priorités d’action à mener en termes de prévention, de recherche et de prise en charge. L’objectif général de cette thèse est d’évaluer l’impact économique de la résistance aux antibiotiques à partir des données du Système National des Données de Santé (SNDS). L’utilisation du SNDS permet d’identifier de façon exhaustive les patients hospitalisés atteints d’une infection bactérienne, suivis ou non par les professionnels libéraux ou en structure adaptée. Le suivi des séjours hospitaliers avec les consultations en médecine de ville rend possible la reconstitution des parcours de soins et les coûts qui y sont associés. La population étudiée concerne l’ensemble des patients hospitalisés présentant une infection bactérienne aiguë (regroupé en 13 sites infectieux). Dans un premier travail, nous nous sommes intéressés au coût hospitalier, du point de vue du payeur. Une étude cas-témoins appariés a permis d’estimer un surcoût hospitalier attribuable à la résistance de 110 millions € en 2015 et une extrapolation conduit à un surcoût de 290 millions €. Dans un second temps, nous nous sommes concentrés sur les conséquences à 12 mois d’une hospitalisation à germe résistant aux travers de quatre études : (1) Pour les patients ayant eu une infection à germe résistant, une analyse de séquence a permis d’identifier cinq parcours hospitaliers types. Les parcours hospitaliers les plus longs étaient observés suite à une infection ostéo-articulaire et une mortalité élevée concernait principalement les infections du cœur et du médiastin ou des voies respiratoires basses ; (2) La dépense ambulatoire étudiée par une approche de double différence, a montré que la surconsommation attribuable à la résistance aux antibiotiques était faible et limitée au premier mois qui suit une hospitalisation ; (3) La consommation de ressources hospitalières mesurée par la durée d’hospitalisations (en jours) attribuable à l’antibiorésistance est augmentée pour deux secteurs : en séjours hospitaliers en soins de courte durée pour infection et en hospitalisation à domicile ; (4) le surcoût hospitalier attribuable à la résistance aux antibiotiques l’année qui suit l’hospitalisation initiale a été estimé à 618 € [IC95% 419 ; 817] par patient. À travers 5 indicateurs économiques, cette thèse a mise en évidence que l’antibiorésistance provoque un coût substantiel pour l’assurance maladie
Antimicrobial resistance (AMR) is a major threat to global public health, makes infections more difficult to treat, and potentially jeopardizes medical progress and innovation. AMR is also associated with higher morbidity and mortality. Assessing the economic burden of AMR could highlight priorities in prevention, research and management for decision-makers. The main objective of this Ph.D. dissertation is to assess the economic impact of AMR in France based on data from the National Health Data System (SNDS) database. SNDS contains patient-level medical data and inpatient and outpatient care costs reimbursed by national health insurance. We thus used SNDS to analyse care pathways and associated costs among a population that included all hospitalized patients with acute bacterial infection (classified into 13 infectious sites). First, we investigated the hospital cost from the payer's perspective. Through a matched case-control design, we estimated an additional hospital cost of €110 million caused by AMR in 2015, with an extrapolation showing that the overall cost could reach €290 million. Second, we focused on the effects at 12 months of hospitalization with AMR. In this context, four studies were developed. (1) For patients with resistant infections, a sequence analysis identified five distinct hospital pathways. Longest hospital stays were observed for bone and joint infections, whereas patients with heart and mediastinum infections or lower respiratory tract infections had higher mortality rates. (2) Ambulatory expenditure was studied using a difference-in-difference approach and we showed a low overconsumption due to AMR, limited to the first month following hospitalization. (3) Hospital resource consumption measured by duration of hospitalization due to AMR was increased in acute care hospital stays for infection and in hospitalization at home. (4) Additional hospital cost due to antibiotic resistance during the year following initial hospitalization was estimated at €618 [IC95% 419; 817] per patient. In conclusion, using five economic criteria this Ph.D dissertation has shown that AMR bears a substantial cost burden on the French public health insurance system

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Williams, Gary L. "Exploring Management Practices of the Health Care System for Contractors." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4952.

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Researchers have found that military members serving in war experienced changes in physical and mental health. Military members' healthcare is managed by the Department of Defense. The problem was that management practices of the system for providing long-term healthcare for employees of a contracting company working in foreign combat zones is either minimal or nonexistent. The purpose of this case study was to explore ways that contractor managers and government managers can work together to provide healthcare for those contract employees who will be deployed with the U.S. military. The primary research question was to determine what managers of contractors could do to improve the management practices to support their personnel who will serve in hostile environments. To analyze data, content analysis was used. Two theories were used in the conceptual framework for this case study, Bandura's self-efficacy theory and Kolb's experiential learning theory. Ten American contractor managers and 10 government managers were interviewed regarding the information they provided to their contract employees. One major finding identified was that contractor managers and government managers had little understanding about the disparity of information, services, and assistance available to contractors before participating in this study. Additional findings were that all managers understood they play a key role in the modification, development, and mitigation of any healthcare management systems for contractors in the future. Regarding social change, the contractor managers and government managers can use the findings to improve how the U.S. government and contractor management teams provide short term as well as long-term healthcare management system for future contractor personnel who serve in combat zones thus benefiting both contractors and their families.

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Enders, Dirk [Verfasser], Iris [Akademischer Betreuer] [Gutachter] Pigeot-Kübler, and Til [Gutachter] Stürmer. "Designs and analytical strategies to control for unmeasured confounding in studies based on administrative health care databases / Dirk Enders ; Gutachter: Iris Pigeot-Kübler, Til Stürmer ; Betreuer: Iris Pigeot-Kübler." Bremen : Staats- und Universitätsbibliothek Bremen, 2017. http://d-nb.info/1137608528/34.

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Price, Todd. "Patient Satisfaction Management in Office Visits and Telehealth in Health Care Technology." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5032.

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Telehealth and remote medical treatments have begun to be more commonly used in healthcare systems. Researchers have theorized that providers' abilities to treat patients are not directly tied to the proximity of the patient to the doctor, but by the identification and treatment of the patient's symptoms. Although the treatment and cure rates are being established within individual health systems and professional medical associations, empirical research is lacking regarding patient satisfaction with this remote treatment situation. The purpose of this quantitative study was to address this gap by examining satisfaction ratings of patients between virtual provider visits and face-to-face provider visits. The Clinician & Group Survey developed by the Consumer Assessment of Health Care Providers and Systems (CAHPS), through the United States government department, Agency for Health Care Research and Quality, measured patient satisfaction. Data from health care patients in the United States (N=8854) were randomly selected from the CAHPS data set containing 457,418 encounters. Of this number, 4,427 unique patient encounters were with face-to-face health care visits and 4,427 unique patient encounters were with telehealth providers. The ANOVA results showed no significant differences in patient satisfaction management between the availability of providers to meet face-to-face with patients who met with providers in a telehealth setting. Possible social change implications are a shift from face-to-face visits to virtual visits structured in the need to shift all patients from the standard office visit system to the on-demand network opportunity that virtual telehealth and mobile commerce health care offers to allow the benefit of technology to assist these patients.

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Koppenhaver, II Kenneth E. "Effects of an Integrated Electronic Health Record on an Academic Medical Center." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2666.

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The debate about healthcare reform revolves around a triple aim of improving the health of populations, improving the patient experience, and reducing the cost of care. A major tool discussed in this debate has been the adoption of electronic health record (EHR) systems to record and guide care delivery. Due to low adoption rates and limited examples of success, the problem was a lack of understanding by healthcare organizations of how the EHR fundamentally changes an organization through the interactions of people, processes, and technology over time. The purpose of this case study was to explore the people, processes, and technology factors that change as a result of an EHR implementation. Complexity theory was used as the lens to evaluate the effects of the EHR on the holistic system of healthcare. Data were collected using semistructured interviews and observations of physicians, nurses, and administrators, as well as document reviews of organizational documents related to the EHR. Data were analyzed using open coding to identify themes and patterns of usage that redesign or restructure institutional resources. The results of this study demonstrated positive changes in the interactions of healthcare providers with increasing collaboration on process changes and reliance on EHR for communication. These findings may positively affect government policy and the organizational approach to adoption and ongoing use of EHRs to create organizational change beyond the implementation of such systems, thus benefiting both health care employees and patients.

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Warren, Richard Alton. "Exploring Strategies for Successful Implementation of Electronic Health Records." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4261.

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Adoption of electronic health records (EHR) systems in nonfederal acute care hospitals has increased, with adoption rates across the United States reaching as high as 94%. Of the 330 plus acute care hospital EHR implementations in Texas, only 31% have completed attestation to Stage 2 of the meaningful use (MU) criteria. The purpose of this multiple case study was to explore strategies that hospital chief information officers (CIOs) used for the successful implementation of EHR. The target population consists of 3 hospitals CIOs from a multi-county region in North Central Texas who successfully implemented EHRs meeting Stage 2 MU criteria. The conceptual framework, for this research, was the technology acceptance model theory. The data were collected through semistructured interviews, member checking, review of the literature on the topic, and publicly available documents on the respective hospital websites. Using methodological triangulation of the data, 4 themes emerged from data analysis: EHR implementation strategies, overcoming resistance to technology acceptance, strategic alignment, and patient wellbeing. Participants identified implementation teams and informatics teams as a primary strategy for obtaining user engagement, ownership, and establishing a culture of acceptance to the technological changes. The application of the findings may contribute to social change by identifying the strategies hospital CIOs used for successful implementation of EHRs. Successful EHR implementation might provide positive social change by improving the quality of patient care, patient safety, security of personal health information, lowering health care cost, and improvements in the overall health of the general population.

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Mandaza, Mapesa Nixjoen. "Health Information Technology Implementation Strategies in Zimbabwe." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2452.

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The adoption rate of health information technology (HIT) remains low in developing countries, where healthcare institutions experience high operating costs and loss of revenue, which are related to systems and processes inefficiency. The purpose of this case study was to explore strategies leaders in Zimbabwe used to implement HIT. The conceptual framework of the study was Davis's technology acceptance model (TAM). Data were gathered through observations, review of organizational documents (i.e., policies, procedures, and guidelines), and in-depth interviews with a purposive sample of 10 healthcare leaders and end-users from hospitals in Zimbabwe who had successfully implemented HIT. Transcribed interview data were coded and analyzed for emerging themes. Implementation strategies, overcoming barriers to adoption, and user acceptance emerged as the themes most healthcare leaders associated with successful HIT projects. Several subthemes also emerged, including: (a) the importance of stakeholder involvement, (b) the importance of management buy-in, and (c) the low level of IT literacy among healthcare workers. The strategies identified in this study may provide a foundation on which healthcare leaders in developing countries can successfully adopt and implement HIT. The recommendations from this study could lead to positive social change by providing leaders with knowledge and skills to use information technology strategies to deliver better healthcare at lower costs while creating employment for local communities.

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Toure, Abdel Rahman. "Diffusion of Social Network Technology and Overuse among Health Industry Knowledge Workers." ScholarWorks, 2014. https://scholarworks.waldenu.edu/dissertations/76.

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Many organizations now realize the important role of social network technology (SNT) in building social capital and hence broadening their customer base. However, observations have indicated that, while working, many knowledge workers use SNT to engage in non-job related activities, potentially leading to a decrease in productivity. The purpose of this study was to examine the relationship between the usage of SNT and productivity in the health sector. The theoretical foundation of this study emanated from Rogers's theory of diffusion of innovations and Campbell, Rodney, Scott, and Christopher's theory of performance. Collection of data involved a self-administered survey designed with tools from SurveyMonkey. Out of 123 respondents, some were team members (67%), some were independent (24%), others were team leaders (8%), and a few were administrators (2%). A multiple linear regression analysis subsequent to correlation analysis between each of the 4 variables of SNT (frequency of SNT use, duration of cellphone-based SNT use, duration of PC-based SNT use, and performance rating) and knowledge worker productivity revealed a significant relationship between productivity and performance. The findings suggest that, of the 4 SNT variables, performance rating statistically predicts productivity of the health care professional. Managers may find these results informative in their effort to boost productivity among their health care professional workers. Further investigations are recommended to explore the association between productivity and SNT among knowledge workers.

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Fenner, Jr Melvin R. "The Relationship Between Technology Threat Avoidance and Innovation in Health Care Organizations." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4285.

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Most leaders of healthcare delivery organizations have increased their rate of technological innovation, but some still struggle to keep pace with other industries. The problem addressed in this study was that senior leaders in some rural ambulatory healthcare facilities failed to innovate, even with recent healthcare technological innovations, which could lead to increased medical errors and a loss of efficiency. The purpose of the study was to examine if a relationship exists between the avoidance of technology threats by senior leaders in ambulatory healthcare organizations and the innovation propensity of the organization. Technology threat avoidance theory served as the theoretical basis for this correlational study. The research questions were used to investigate the relationship between technology threat avoidance by senior leaders and the ways avoidance affects an organization's level of technological innovation. Data were collected from 90 respondents via an anonymous online survey, developed from the innovation culture measurement and the COPE measurement, and analyzed using multiple regression and Spearman's correlation. Organizations with senior leaders who actively avoided technology threats had significantly higher innovation propensity (Î² = .51, p = .001). The analysis also showed that rural healthcare delivery organizations tended to have lower innovation propensity (Î² = -.18, p = .05). The study social change implications enable the leaders of more health care delivery organizations to actively mitigate technology threats, rather than passively avoiding them. Properly handling these threats could allow management to make more informed decisions about technology implementations and thus increase their ability to provide meaningful, innovative care and to avoid one of the leading causes of death-medical errors.

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Arnaout, Ziad Hisham. "Diffusion of Technology in Small to Medium Medical Providers in Saudi Arabia." ScholarWorks, 2015. http://scholarworks.waldenu.edu/dissertations/1665.

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The Saudi ministry of health reported that government health care spending doubled from 2008 to 2011. To address increased demand, the government encouraged small to medium enterprise (SME) growth. However, SME leaders could not leverage technology as a growth enabler because they lacked strategies to address operating inefficiencies associated with technology. Only 50% of hospitals fully implemented information technology. The purpose of this phenomenological study was to explore lived experiences of SME leaders on strategies needed to accelerate technology implementation. This exploration drew on a conceptual framework developed from Wainwright and Waring's framework addressing issues of technology adoption. Data were collected from semistructured interviews of 20 SME leaders in Saudi Arabia. A modified van Kaam method was used to analyze participants' interview transcripts in search of common themes. The main themes were strategies to address human resources, clinical teams, funding, and organizational and leadership alignment to accelerate the diffusion of technology. Findings indicated that insurance companies influence SME operations, growth, and survival. Analysis of findings revealed the need for change in management, training, implementation follow up, and staff retention to accelerate technology implementation. Application of findings has the potential to promote positive social change in guiding SME leaders to be change agents and enabling them to create a reliable, sustainable health care delivery system.

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Otoo, Samuel O. "Successful Strategies for Implementing Health Information Technology in Primary Care Practice." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7949.

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Health information technology (HIT) owner-practitioners who adopt effective strategies for HIT implementation can improve primary facility care delivery and profitability. However, some HIT owner-practitioners have ineffective implementation strategies, so they have not realized the total revenue increases of more than 8%. Grounded in general systems theory, the purpose of this multiple case study was to explore successful strategies primary care practitioners (PCPs) use to implement HIT to improve primary facility care delivery and profitability. The participants included 6 owner-practitioners located in Queens County, NY, who successfully implemented HIT to improve facility care delivery and profitability. Data were collected through face-to-face interviews and a review of relevant practice documents. Data were analyzed using thematic analysis, yielding 3 themes: HIT education and training, costs of transitioning to HIT, and focusing on expected benefits of successful HIT implementation. By providing information on effective HIT strategies, the findings from this study could impact social change because PCPs may rely on faster and more accurate health information data to offer better diagnoses and enhance treatments for patients.

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Bosco-Lévy, Pauline. "Heart failure in France : chronic heart failure therapeutic management and risk of cardiac decompensation in real-life setting." Thesis, Bordeaux, 2019. http://www.theses.fr/2019BORD0348.

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En France, environ un million de personnes seraient touchées par l’insuffisance cardiaque (IC) ; on recense près de 70 000 décès liés à l’IC, et plus de 150 000 hospitalisations et cela, malgré une prise en charge thérapeutique bien codifiée. Ces chiffres devraient s’accroitre dans les années futures du fait notamment du vieillissement de la population.L’objectif de ce travail était d’étudier l’utilisation des traitements pharmacologiques indiqués dans le traitement de l’IC (beta bloquant, inhibiteur de l’enzyme de conversion, anti-aldostérone, antagoniste des récepteurs à l’angiotensine II, diurétiques, digoxine, ivabradine) en situation réelle de soin, et d’identifier les facteurs cliniques ou pharmacologiques associés à la survenue d’un épisode de décompensation cardiaque.Un premier travail a permis de mesurer la fiabilité des bases de données médico-administratives françaises pour identifier des patients IC.Une deuxième étude a permis d’estimer que 17 à 37% de patients IC n’étaient exposés à aucun traitement de l’IC dans l’année suivant une première hospitalisation pour IC.Les troisième et quatrième parties de cette thèse ont mis en évidence qu’environ un quart des patients IC étaient réhospitalisés dans les 2 ans suivant une première hospitalisation. Les principaux facteurs cliniques prédictifs de cette réhospitalisation étaient l’âge, l’hypertension artérielle, la fibrillation auriculaire et le diabète. L’association retrouvée entre l’utilisation de fer bivalent et la réhospitalisation pour IC, souligne l’importance du risque lié à la présence d’une anémie ou d’une déficience en fer dans la survenue d’un épisode de décompensation cardiaque.Ces résultats permettent de reconsidérer la prise en charge thérapeutique chez les patients IC et mettent en avant la nécessité de renforcer la surveillance des patients les plus à risque de décompenser leur IC
In France, around one million persons would be affected by heart failure (HF); there are nearly 70 000 deaths related to HF and more than 150 000 hospitalizations despite a well defined treatment management. These numbers should increase in the next years due in particular to the ageing of the population.The objective of this work was to study the use of the pharmacological treatments indicated in HF (beta-blocker, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone antagonist, diuretics, digoxin, ivabradine) in real-world setting and to identify the clinical or pharmacological predictors associated with a new episode of cardiac decompensation.A first work has enabled to estimate the accuracy of French claims databases in identifying HF patients.A second study estimated that 17 to 37% HF patients were not exposed to any HF treatment in the year following an incident HF hospitalization.The third and fourth parts of this thesis showed that almost one forth of HF patients was rehospitalized within the 2 years following a first hospitalization. The main clinical predictors of rehospitalization were age, high blood pressure, atrial fibrillation and diabetes. The association found between bivalent iron use and HF rehospitalization underlines the importance of the risk related to anemia or iron deficiency in the occurrence of a cardiac exacerbation episode.These results allow to reconsider the treatment management of HF patients and highlight the need to reinforce the surveillance of patients with a highest risk of cardiac exacerbation

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CHEN, YAN. "Comparisons and Applications of Quantitative Signal Detections for Adverse Drug Reactions (ADRs): An Empirical Study Based On The Food And Drug Administration (FDA) Adverse Event Reporting System (AERS) And A Large Medical Claims Database." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1203534085.

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Song, Won K. "Mobile Technology Deployment Strategies for Improving the Quality of Healthcare." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7431.

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Ineffective deployment of mobile technology jeopardizes healthcare quality, cost control, and access, resulting in healthcare organizations losing customers and revenue. A multiple case study was conducted to explore the strategies that chief information officers (CIOs) used for the effective deployment of mobile technology in healthcare organizations. The study population consisted of 3 healthcare CIOs and 2 healthcare information technology consultants who have experience in deploying mobile technology in a healthcare organization in the United States. The conceptual framework that grounded the study was Wallace and Iyer's health information technology value hierarchy. Data were collected using semistructured interviews and document reviews, followed by within-case and cross-case analyses for triangulation and data saturation. Key themes that emerged from data analysis included the application of disruptive technology in healthcare, ownership and management of mobile health equipment, and cybersecurity. The healthcare CIOs and consultants emphasized their concern about the lack of cybersecurity in mobile technology. CIOs were reluctant to deploy the bring-your-own-device strategy in their organizations. The implications of this study for positive social change include the potential for healthcare CIOs to emphasize the business practice of supporting healthcare providers in using secure mobile equipment deployment strategies to provide enhanced care, safety, peace of mind, convenience, and ease of access to patients while controlling costs.

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Ukaga, Christian Chikwem. "The Relationship Between Information Technology and Organizational Effectiveness as Perceived by Health Care Providers." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/607.

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The U.S. Congress has made health information technology a central component of the national quest to improve health care delivery. The problem addressed in this study was the uncertainty among healthcare providers regarding the benefits of health care information technology adoption relative to healthcare delivery processes and outcomes. The purpose of the study was to understand the effectiveness of information technology as perceived by healthcare providers. The research questions were designed to investigate the relationship between health information technology and organizational effectiveness, exchange of information, organizational process, organizational productivity, and direct personal care. Sociotechnical systems theory and Donabedian's framework for health care quality evaluation were the theoretical bases for this quantitative study. Data were provided through anonymous online survey of 116 healthcare workers, and analyzed using multiple regression and Spearman's correlation coefficient. The results of the study showed a statistically significant positive correlation between organizational effectiveness, organizational exchange of information, organizational process, organizational productivity, and healthcare information technology. No statistically significant correlation existed between personal care and health information technology. These findings suggest that providers' frequent use of healthcare information technology, like telemedicine, makes patients less involved. The implications for social change include enabling healthcare providers to develop an efficient and effective way to engage with patients, in order to achieve effective patient-centered organization.

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Pollard, Olivia L. "A Delphi Study Analysis of Best Practices for Data Quality and Management in Healthcare Information Systems." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7501.

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Healthcare in the US continues to suffer from the poor data quality practices processes that would ensure accuracy of patient health care records and information. A lack of current scholarly research on best practices in data quality and records management has failed to identify potential flaws within the relatively new electronic health records environment that affect not only patient safety but also cost, reimbursements, services, and most importantly, patient safety. The focus of this study was to current best practices using a panel of 25 health care industry data quality experts. The conceptual lens was developed from the International Monetary Fund's Data Quality Management model. The key research question asked how practices contribute to identifying improvements healthcare data, data quality, and integrity. The study consisted of 3 Delphi rounds. Each round was analyzed to identify consensus on proposed data quality strategies from previous rounds that met or exceeded the acceptance threshold to construct subsequent round questions. The 2 best practices identified to improve data collection were user training and clear processes. One significant and unanticipated finding was that the previous gold standard practices have become outdated with technological advances, leading to a higher potential for flawed or inaccurate patient healthcare data. There is an urgent need for health care leaders to maintain heightened awareness of the need to continually evaluate data collection and management policies, particularly as technology advances such as artificial intelligence matures. Developing national standards to address accurate and timely management of patient care data is critical for appropriate health care delivery decisions by health care providers.

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Ling, Meng-Chun. "Senior health care system." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2785.

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Senior Health Care System (SHCS) is created for users to enter participants' conditions and store information in a central database. When users are ready for quarterly assessments the system generates a simple summary that can be reviewed, modified, and saved as part of the summary assessments, which are required by Federal and California law.

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Maranganti, Kishore. "Strategies for Healthcare Payer Information Technology Integration After Mergers and Acquisitions." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5097.

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Despite the high rate of failure in merger and acquisition (M&A) transactions, many organizations continue to rely on M&As as their primary growth strategy and to address market competition. The purpose of this qualitative single case study was to explore strategies managers from a large healthcare payer in the midwestern United States used to achieve operational and strategic synergies during the postacquisition information technology (IT) integration phase. Haspeslagh and Jemison's acquisition integration approaches model was the conceptual framework for the study. Methodological triangulation was established by analyzing the data from the semistructured interviews of 6 senior executives and 6 IT strategists, discussion points produced in a focus group involving 4 acquisition integration leaders, and information gleaned from M&A periodicals. Data were analyzed using SaldaÃ±a's thematic analysis method and showed that the healthcare payer organization managers used the following 4 strategies to achieve the planned synergies: plan for expected business synergies from the postacquisition IT integration, make cultural harmonization a key element of change management, align and continuously evaluate the progress of postacquisition IT integration strategies against planned synergies, and preserve durability of acquired capabilities by granting autonomy to the acquired organization. The findings of this study could lead to positive social change by stimulating a business environment that might allow healthcare payers to expand their strategic capabilities and serve their local communities with new products and other choices that improve the quality of care, health outcomes, well-being, and longevity of the consumer.

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Guittet, Leo. "La transparence des données de santé issues des bases médico-administratives : Pour une ouverture des bases de données respectueuse de la vie privée." Thesis, Lyon, 2019. http://www.theses.fr/2019LYSE3028.

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Les données numérisées font aujourd’hui partie de notre quotidien. Parmi elles, les données de santé à caractère personnel représentent une frange particulièrement sensible à traiter et à partager car elles recèlent des renseignements relatifs à la vie privée des personnes. Elles font donc l’objet d’une protection spécifique par principe. Mais elles sont, dans le même temps, hautement convoitées du fait du potentiel qu’elles représentent pour l’amélioration de l’ensemble du système de santé. En France, deux grandes bases de données historiques, le SNIIRAM et le PMSI, sont dédiées à la récolte et au traitement des données de santé. Bien que ces bases ne contiennent aucune information directement identifiante, elles ont longtemps été verrouillées et accessibles à des conditions très strictes, parfois peu intelligibles, au nom du respect de la vie privée des individus. L’accès difficile à ces bases représente cependant une perte de connaissance avérée et des moyens juridiques et techniques existent pour assurer la sécurité des données et le droit au respect de la vie privée des individus. C’est notamment pour cette raison que les modalités d’accès aux données de santé à caractère personnel contenues dans ces bases ont été entièrement réformées et continuent de l’être. Pour bien comprendre le cheminement qui a conduit à l’ouverture récente des bases de données médico-administratives, cette étude s’attache à connaître le fonctionnement des accès à ces données depuis leur création jusqu’à nos jours. Au regard des typologies d’accès qui existent, cela demande de se positionner selon trois angles : celui des acteurs publics privilégiés qui bénéficient d’un accès permanent ; celui des acteurs publics ordinaires et des acteurs privés à but non lucratif qui peuvent accéder à certaines données en se pliant à un régime d’autorisation préalable ; celui des acteurs privés à but lucratif qui ont d’abord été mis à l’écart de l’accès aux données de santé avant d’y être finalement admis. L’évolution de l’accès à ces données sensibles est, encore aujourd’hui, au cœur de l’actualité à travers une réforme supplémentaire de la gouvernance des bases de données médico-administratives et de leur contenu. Ce nouveau projet entend faire cohabiter la protection du droit au respect de la vie privée avec l’accès le plus ouvert possible au plus grand nombre de données de santé
Digitized data is an integral part of our daily lives. Among them, personal health data represent a particularly sensitive group which must be processed and shared with care because they contain information relating to the private lives of individuals. They are therefore subject to special protection as a matter of principle. But at the same time, they are highly coveted because of their potential to improve the entire healthcare system. In France, two major historical databases, SNIIRAM and PMSI, are dedicated to the collection and processing of health data. Although these databases do not contain any personally identifying information, they have long been accessible only under very strict conditions, sometimes difficult to understand, in the name of respect for the privacy of individuals. However, difficult access to these databases represents a proven loss of knowledge, and legal and technical means exist to ensure data security and the right to privacy of individuals. It is for this reason in particular that the procedures for accessing the personal health data contained in these databases have been completely reformed and continue to be reformed. To fully understand the process that led to the recent opening of medico-administrative databases, this study focuses on how access to these data has worked from their creation to the present day. With regard to the types of access that exist, this requires positioning oneself from three angles: that of privileged public actors who benefit from permanent access; that of ordinary public actors and private non-profit actors who can access certain data by complying with a prior authorization regime; and that of private for-profit actors who were first excluded from access to health data before finally being admitted. The evolution of access to this sensitive data is still a headlining topic due to a further reform of the governance of medico-administrative databases and their content. This new project aims to ensure that the protection of the right to privacy is combined with the widest possible access to as much health data as possible

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Miller, Shaunette. "Strategies Hospital Leaders Use in Implementing Electronic Medical Record Systems." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3311.

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Some hospital leaders lacked strategies for implementing electronic medical record (EMR) systems. The purpose of this case study was to explore successful strategies that hospital leaders used in implementing EMR systems. The target population consisted of hospital leaders who succeeded in implementing EMR systems in a single healthcare organization located in the Los Angeles, California region. The conceptual framework used was Kotter's (1996) eight-step process for leading change, and data were collected from face-to-face recorded interviews with 5 participants and from company documents related to EMR design and development. Data were analyzed through methodological triangulation of data types, and exploring codes exhibiting high frequencies to identify principal themes and subthemes. The data coding revealed three primary themes. The first theme related to strategies addressing training, technology, and catalyzing team effort. The second theme related to strategies focusing on employees' concerns, and the third theme related to strategies for designing, developing, and disseminating workflow. The findings affirmed the conceptual framework of Kotter (1996) inasmuch as they showed that participating hospital leaders used one or more steps in Kotter's eight-stage process of creating, implementing, and sustaining significant change. The findings could effect social change by improving the quality of healthcare services provided to patients, which can subsequently benefit patients' families and communities through reducing the costs of healthcare.

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Denney, Kimberly B. "Assessing Clinical Software User Needs for Improved Clinical Decision Support Tools." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1563.

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Consolidating patient and clinical data to support better-informed clinical decisions remains a primary function of electronic health records (EHRs). In the United States, nearly 6 million patients receive care from an accountable care organization (ACO). Knowledge of clinical decision support (CDS) tool design for use by physicians participating in ACOs remains limited. The purpose of this quantitative study was to examine whether a significant correlation exists between characteristics of alert content and alert timing (the independent variables) and physician perceptions of improved ACO quality measure adherence during electronic ordering (the dependent variable). Sociotechnical theory supported the theoretical framework for this research. Sixty-nine physician executives using either a Cerner Incorporated or Epic Systems EHR in a hospital or health system affiliated ACO participated in the online survey. The results of the regression analysis were statistically significant, R2 = .108, F(2,66) = 3.99, p = .023, indicating that characteristics of alert content and timing affect physician perceptions for improving their adherence to ACO quality measures. However, analysis of each independent variable showed alert content highly correlated with the dependent variable (p = .007) with no significant correlation found between workflow timing and the dependent variable (p = .724). Understanding the factors that support physician acceptance of alerts is essential to third-party software developers and health care organizations designing CDS tools. Providing physicians with improved EHR-integrated CDS tools supports the population health goal of ACOs in delivering better patient care.

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Quarranttey, George K. "Falls and Related Injuries Based on Surveillance Data: U.S. Hospital Emergency Departments." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2011.

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Falls can lead to unintentional injuries and possibly death, making falls an important public health problem in terms of related health care cost, incurred disabilities, and years of life lost. Approximately 1 in every 3 Americans ages 65 years and older is at risk of falling at least once every year. Children, young adults, and middle-aged adults are also vulnerable to falls. The purpose of this study was to examine the epidemiology of falls and fall-related injuries using surveillance data from nationally representative samples of hospital emergency departments in United States. The study was guided by a social-ecological model on the premise that multiple levels of risk factors affect health. Using a cross-sectional study and archival data from NEISS-AIP between 2009 and 2011, the result of multiple logistic regression indicated that age, gender, race and body part affected were significantly associated with hospitalization due to falls (p < .001) and incident locale independently predicted hospitalization due to falls in which hospitalization due to falls was considered a proxy measure of fall severity. The odds in each of the groups for fall injuries were (a) older adults versus children, 1.07 (95% CI: 1.05-1.08); (b) males versus females, 1.23 (95% CI: 1.21-1.26); (c) Blacks versus Whites, 2.12 (95% CI: 2.11-2.13); (d) body part extremities versus head area, 0.98 (95% CI: 0.97-0.99); and (e) outside home versus inside home, 1.14 (95% CI: 1.13-1.15). The results of this study may be important in forming and implementing age-specific prevention strategies and specialized safety training programs for all age groups, thereby reducing deaths, disabilities, and considerable health care cost associated with hospitalization due to fall-related injuries.

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Beck, Morgane. "Stratégies de prise en charge de la polyarthrite rhumatoïde : quelle place pour les médicaments biosimilaires ?" Thesis, Strasbourg, 2017. http://www.theses.fr/2017STRAJ039/document.

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Le coût des biomédicaments impacte lourdement le fardeau financier déjà important imposé par la polyarthrite rhumatoïde (PR) à la société. Le but de ce travail était de rechercher les motivations de la prescription des médicaments biosimilaires en rhumatologie, tout particulièrement pour prendre en charge les patients atteints de PR. Les travaux effectués ont permis d’estimer les économies annuelles réalisables en France avec le médicament biosimilaire de l’infliximab à 13,6 millions d’EUR, pour la seule prise en charge de la PR. Par ailleurs, une enquête menée auprès des rhumatologues et pharmaciens a permis d’identifier les principaux enjeux liés à l’utilisation de ces médicaments. Enfin, le suivi de leur utilisation en région Grand Est entre 2015 et 2016 rend compte de leur utilisation encore modeste. La mise sur le marché régulière de médicaments biosimilaires, combinée à l’expérience croissante des acteurs et aux dispositifs d’incitation mis en place, devraient permettre de faire progresser la part d’utilisation de ces médicaments dans les prochaines années, et de s’assurer qu’ils tiennent bien leurs engagements sur le plan des économies réalisées
Biological drugs are associated with high procurement costs and heavily impact the financial burden imposed by rheumatoid arthritis on society. The purpose of this work was to investigate the benefits of using biosimilar drugs in rheumatoid arthritis patients. This work showed the introduction of biosimilar inﬂiximab could lead to substantial annual cost savings of up to €13.6 million nationally, to treat rheumatoid arthritis patients only. Moreover, a biosimilar survey involving rheumatologists and pharmacists allowed us to identify the main issues at stake. Finally, the monitoring of their use in Grand Est region between 2015 and 2016 account for their relatively low utilization rate. The regular launch of new biosimilar medicines, together with growing experience of healthcare players and incentive policies, should allow to increase biosimilar uptake in the future, and also to make sure they meet well their commitments in terms of savings generated

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Ozurigbo, Evangeline C. "Leveraging Artificial Intelligence to Improve Provider Documentation in Patient Medical Records." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5398.

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Clinical documentation is at the center of a patient's medical record; this record contains all the information applicable to the care a patient receives in the hospital. The practice problem addressed in this project was the lack of clear, consistent, accurate, and complete patient medical records in a pediatric hospital. Although the occurrence of incomplete medical records has been a known issue for the project hospital, the issue was further intensified following the implementation of the 10th revision of International Classification of Diseases (ICD-10) standard for documentation, which resulted in gaps in provider documentation that needed to be filled. Based on this, the researcher recommended a quality improvement project and worked with a multidisciplinary team from the hospital to develop an evidence-based documentation guideline that incorporated ICD-10 standard for documenting pediatric diagnoses. Using data generated from the guideline, an artificial intelligence (AI) was developed in the form of best practice advisory alerts to engage providers at the point of documentation as well as augment provider efforts. Rosswurm and Larrabee's conceptual framework and Kotter's 8-step change model was used to develop the guideline and design the project. A descriptive data analysis using sample T-test significance indicated that financial reimbursement decreased by 25%, while case denials increased by 28% after ICD-10 implementation. This project promotes positive social change by improving safety, quality, and accountability at the project hospital.

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Gueguen, Juliette. "Evaluation des médecines complémentaires : quels compléments aux essais contrôlés randomisés et aux méta-analyses ?" Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS072/document.

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Les médecines complémentaires sont nombreuses et variées, leur recours est largement répandu et en hausse. Selon les pratiques, les données d’évaluation sont plus ou moins riches, mais il y a peu de conclusions consensuelles quant à leur efficacité, même en cas de littérature abondante. Nous commencerons par un état des lieux de l’adéquation des méthodes conventionnelles utilisées pour l’évaluation du médicament, à savoir de l’essai contrôlé randomisé (ECR) et des méta-analyses, pour l’évaluation des médecines complémentaires.A travers trois applications pratiques, nous réfléchirons ensuite à l’apport d’autres méthodes, moins reconnues à ce jour dans le champ de l’evidence based medecine mais pouvant apporter d’autres éclairages. En particulier, nous discuterons de l’intérêt des méthodes mixtes, des études qualitatives et de l’exploitation des grandes bases de données médico-administratives. Nous réaliserons une revue mixte sur l’évaluation de l’hypnose pour le travail et l’accouchement, une étude qualitative sur l’expérience du qi gong par des patientes hospitalisées pour anorexie mentale sévère, et nous étudierons le potentiel d’exploitation du Système National d'Information Inter Régimes de l'Assurance Maladie (SNIIRAM) pour évaluer les médecines complémentaires. Les deux premiers axes nous amèneront à questionner le choix des critères de jugement et des instruments de mesure utilisés dans les ECR et nous inciteront à accorder davantage de place et de légitimité à la perspective du patient. Plus largement, cela nous invitera à remettre en cause la suprématie traditionnellement accordée aux études quantitatives pour la remplacer par une vision non hiérarchique mais synergique des approches qualitatives et quantitatives. Le troisième axe nous permettra d’identifier les limites actuelles à l’exploitation du SNIIRAM pour l’évaluation des médecines complémentaires, à la fois sur le plan technique et sur le plan de la représentativité. Nous proposerons des mesures concrètes pour rendre possible et pertinente son exploitation dans le champ de l'évaluation des médecines complémentaires.Enfin, dans la discussion générale, nous tiendrons compte du fait que l’évaluation des médecines complémentaires n’a pas pour but d’autoriser ou non une mise sur le marché. Ainsi, contrairement à l'évaluation des médicaments, l'évaluation des médecines complémentaires ne s'inscrit pas toujours dans une visée de prise de décision. Nous soulignerons l’importance de tenir compte de la visée (visée de connaissance ou visée de décision) dans l’élaboration d’une stratégie de recherche et nous proposerons deux stratégies différentes en nous appuyant sur la littérature et les résultats issus de nos trois exemples d'application. Concernant la stratégie de recherche à visée de prise de décision, nous montrerons l’importance des étapes de définition de l’intervention, d’identification des critères de jugement pertinents, et d’optimisation de l’intervention, avant la réalisation d’essais pragmatiques visant à évaluer l’efficacité en vie réelle. Nous verrons comment la volonté d’évaluer ces pratiques nous renvoie à des défis en terme de réglementation et nous soulignerons par ailleurs la nécessité d’évaluer la sécurité de ces pratiques en développant des systèmes de surveillance adaptés
Complementary medicines are numerous and varied, their use is widespread and increasing.Quality and quantity of evaluation data depend on the type of complementary medicines, but there are few consensual conclusions about their effectiveness, even in the case of abundant literature. We will start with an inventory of the adequacy of the conventional methods used for drug evaluation, namely randomized controlled trials (RCT) and meta-analyzes, for the evaluation of complementary medicines. Through three practical applications, we will then consider the contribution of other methods, less recognized to date in the field of evidence-based medicine but potentially contributive to shed light on other perspectives. In particular, we will discuss the advantages of mixed methods, qualitative studies and the exploitation of large health administrative databases. We will conduct a mixed-method review of the assessment of hypnosis for labor and childbirth, a qualitative study on the experience of qi gong by patients hospitalized for severe anorexia nervosa and we will study the potential of the French national health insurance database (SNIIRAM) to evaluate complementary medicines. The first two axis will lead us to question the choice of outcomes and measurement tools used in RCTs and to value and legitimate the patient's perspective. More broadly, it will invite us to question the hierarchical vision of qualitative and quantitative research that traditionally attributes supremacy to quantitative studies. It will encourage us to replace it with a synergistic vision of qualitative and quantitative approaches. The third axis will enable us to identify the current limits to the use of SNIIRAM for the evaluation of complementary medicines, both technically and in terms of representativeness. We will propose concrete measures to make its exploitation possible and relevant in the field of evaluation of complementary medicines.Finally, in the general discussion, we shall take account of the fact that the evaluation of complementary medicines is not part of a marketing authorization process. Thus, contrary to drug evaluation, complementary medicines evaluation does not always imply decision making. We will emphasize the importance of considering the aim (aim of knowledge or aim of decision) in the development of a research strategy. We will propose two different strategies based on the literature and the results from our three examples. Concerning the research strategy aimed at decision-making, we will show the importance of defining the intervention, identifying the relevant outcomes, and optimizing the intervention first, before carrying out pragmatic clinical trials to evaluate its effectiveness. We will discuss the regulatory challenges complementary medicine evaluation confronts us to, and stress the need to assess the safety of these practices by developing appropriate monitoring systems

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Maugard, Charlotte. "Analyse des données massives de source assurantielle de la Mutualité Sociale Agricole, pour la surveillance en santé au travail des travailleurs agricoles en France." Thesis, Université Grenoble Alpes (ComUE), 2019. http://www.theses.fr/2019GREAS035.

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Introduction : La surveillance sanitaire et la vigilance (identification de nouveaux risques en particulier) représentent un enjeu majeur dans le champ santé-travail. En complément des études épidémiologiques classiques, l’analyse systématique, sans a priori, de données collectées en routine pourrait être un atout pour la détection précoce de pathologies en lien avec le travail. Dans ce contexte, la Mutualité Sociale Agricole (MSA), le régime de protection sociale dédié aux travailleurs agricoles français, a souhaité développer son activité de vigilance en exploitant ses données médico-administratives, utilisées pour le remboursement de prestations de santé. En partenariat avec l’Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (Anses), un projet de fouille des données a donc été mis en place dans lequel ce travail de thèse s’inscrit. L’objectif de la thèse consiste plus précisément à tester, sans hypothèses préalables, l'existence ou non d'associations entre les activités agricoles et les pathologies reconnues en tant qu’affection de longue durée (ALD).Méthode : Les travaux présentés ont été menés sur la population de non-salariés (chefs d’exploitation ou d’entreprise) affiliés à la MSA, en disposant d’une part de données de cotisations, renseignant au niveau individuel, les activités professionnelles, caractéristiques démographiques et socio-économiques, et d’autre part, de données médico-administratives renseignant les déclarations de pathologies reconnues en ALD et informations associées dont la pathologie codée en CIM-10. Grâce à l’accord de la CNIL, un identifiant unique a été créé pour que, pour la première fois, ces données administratives et médico-administratives puissent être fusionnées et restructurées afin de permettre l’application de modèles. Des modèles de régression logistique ont été utilisés, en adaptant la sélection de variables pour chaque ALD et en utilisant la validation croisée afin de limiter le surajustement des modèles. Plusieurs méthodes ont été testées pour mieux prendre en compte les facteurs de confusion potentiels. Ces différents modèles ont ensuite été évalués via des mesures de robustesse et appliqués aux données à deux niveaux de précision pour la pathologie (ALD et CIM-10). Les associations statistiques entre chaque combinaison d’activité professionnelle et de pathologie ont été caractérisées par leur p-valeur, corrigées pour les tests multiples, et la valeur de l’odds ratio correspondant.Résultats : Le traitement des données a permis d’étudier une population constituée de 899 212 non-salariés affiliés entre 2006 et 2016. Au sein de cette population, il a été possible d’identifier 100 706 individus avec au moins une déclaration d’ALD sur la période d’observation. La méthodologie appliquée a mis en évidence 54 associations statistiquement significatives entre une activité professionnelle et une ALD, permettant à la fois de capturer des déterminants de santé déjà connus ou suspectés mais aussi de générer des hypothèses intéressantes. Après ajustement sur des facteurs de confusion, les secteurs agricoles les plus associés à des pathologies, faisant l’objet d’ALD chez les non-salariés, sont la viticulture, l’exploitation de bois, le paysagisme, et les entreprises de jardins ou de reboisement.Discussion : Ce travail de thèse apporte une première démonstration de la faisabilité et de la pertinence de l’analyse systématique des données collectées en routine à des fins assurantielles, sur l’ensemble de la population agricole, pour rechercher des risques sanitaires associés aux diverses activités professionnelles. Les « signaux » ainsi mis en évidence seront investigués à l’aide d’un groupe d’experts. D’autres modèles pourront être testés, au premier rang desquels les modèles de survie. Cette approche pourra ainsi constituer un outil précieux contribuant au dispositif de vigilance sanitaire des risques professionnels agricoles
Introduction: Health surveillance and vigilance (identification of new risks in particular) represent a major challenge in the field of occupational health. In addition to classical epidemiological studies, the systematic analysis, without a priori, of data collected routinely could be an asset for the early detection of diseases related to work. In this context, the social protection scheme dedicated to French agricultural workers, known as “Mutualité Sociale Agricole” (MSA), wanted to develop its vigilance activity by exploiting its medico-administrative data, used for the reimbursement of health expenditures. In partnership with the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), a data mining project has been set up in which this thesis work fits. The aim of the thesis is, more precisely, to test, without any prior assumptions, the existence of associations between agricultural activities and pathologies recognized as long-term disease (LTD).Method: The work presented was conducted on self-employed population (heads of farms or enterprises) affiliated to the MSA. It relied on the one hand on a contributors’ database which includes, at the individual level, information about occupational activities, demographic and socio-economic characteristics, and on the other hand, on a medico-administrative database with declarations of long-term diseases (LTD) and associated information like ICD-10 diseases. Thanks to the agreement of the French Data Protection Authority (CNIL), a unique identifier was created so that, for the first time, these administrative and medico-administrative data could be merged and restructured to allow the application of models. Logistic regression models were performed, adapting variable selection for each LTD and using cross-validation to limit over-fitting of models. Several methods have been tested to better take into account potential confounders. These different models were evaluated via robustness measures and applied at two-level of precision for pathology (LTD and ICD-10). The statistical associations between each combination of occupational activity and LTD were characterized by p-values, corrected for multiple tests, and odds ratio.Results: Data management allowed us to consider a population of 899 212 self-employed affiliated between 2006 and 2016. Among them, it was possible to identify 100 706 individuals with at least one declaration of LTD over the observation period. The applied methodology revealed 54 statistically significant associations between an occupational activity and an LTD, making it possible to capture already known or suspected health determinants but also to generate interesting hypotheses. After adjusting for confounding factors, the agricultural sectors most associated with LTD, among the self-employed, are viticulture, timber exploitations, landscaping and gardening or reforestation.Discussion: This thesis provides a first demonstration of the feasibility and relevance of the systematic analysis of data collected routinely for insurance purposes, concerning the overall agricultural population, to search for health risks associated with occupational activities. The statistical "signals" thus highlighted will then be investigated by a group of experts from different scientific and occupational fields. Other models should be tested like survival models. This approach may thus be a valuable tool contributing to the health surveillance system dedicated to agricultural workers

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Bazile, Emmanuel Patrick. "Electronic Medical Records (EMR): An Empirical Testing of Factors Contributing to Healthcare Professionals’ Resistance to Use EMR Systems." NSUWorks, 2016. http://nsuworks.nova.edu/gscis_etd/964.

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The benefits of using electronic medical records (EMRs) have been well documented; however, despite numerous financial benefits and cost reductions being offered by the federal government, some healthcare professionals have been reluctant to implement EMR systems. In fact, prior research provides evidence of failed EMR implementations due to resistance on the part of physicians, nurses, and clinical administrators. In 2010, only 25% of office-based physicians have basic EMR systems and only 10% have fully functional systems. One of the hindrances believed to be responsible for the slow implementation rates of EMR systems is resistance from healthcare professionals not truly convinced that the system could be of substantive use to them. This study used quantitative methods to measure the relationships between six constructs, namely computer self-efficacy (CSE), perceived complexity (PC), attitude toward EMR (ATE), peer pressure (PP), anxiety (AXY), and resistance to use of technology (RES), are predominantly found in the literature with mixed results. Moreover, they may play a significant role in exposing the source of resistance that exists amongst American healthcare professionals when using Electronic Medical Records (EMR) Systems. This study also measured four covariates: age, role in healthcare, years in healthcare, gender, and years of computer use. This study used Structural Equation Modeling (SEM) and an analysis of covariance (ANCOVA) to address the research hypotheses proposed. The survey instrument was based on existing construct measures that have been previously validated in literature, however, not in a single model. Thus, construct validity and reliability was done with the help of subject matter experts (SMEs) using the Delphi method. Moreover, a pilot study of 20 participants was conducted before the full data collection was done, where some minor adjustments to the instrument were made. The analysis consisted of SEM using the R software and programming language. A Web-based survey instrument consisting of 45 items was used to assess the six constructs and demographics data. The data was collected from healthcare professionals across the United States. After data cleaning, 258 responses were found to be viable for further analysis. Resistance to EMR Systems amongst healthcare professionals was examined through the utilization of a quantitative methodology and a cross-sectional research measuring the self-report survey responses of medical professionals. The analysis found that the overall R2 after the SEM was performed, the model had an overall R2 of 0.78, which indicated that 78% variability in RES could be accounted by CSE, PC, ATE, PP, and AXY. The SEM analysis of AXY and RES illustrated a path that was highly significant (β= 0.87, p < .001), while the other constructs impact on RES were not significant. No covariates, besides years of computer use, were found to show any significance differences. This research study has numerous implications for practice and research. The identification of significant predictors of resistance can assist healthcare administrators and EMR system vendors to develop ways to improve the design of the system. This study results also help identify other aspects of EMR system implementation and use that will reduce resistance by healthcare professionals. From a research perspective, the identification of specific attitudinal, demographic, professional, or knowledge-related predictors of reference through the SEM and ANCOVA could provide future researchers with an indication of where to focus additional research attention in order to obtain more precise knowledge about the roots of physician resistance to using EMR systems.

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Bartholomew, Kimberly W. "Patient Portals: Achieving Technology Acceptance and Meaningful Use in Independent Physician-Managed Practices." NSUWorks, 2016. http://nsuworks.nova.edu/gscis_etd/969.

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As the bulk of medical health records shift from paper-based file systems to electronic formats, the promise of the transformation process called healthcare reform included adding efficiencies to medical practice workflows, lower costs, improved quality of care and most important, and the freeing of patient information from traditional propriety silos. With this incoming largess of protected health information data now viewable through online patient portals, patients can be empowered to become educated and active in their own health care decisions, but only if they have admission to their information. A digital divide currently exists in many medical practices where only a very few patients have access to their personal health information. The primary goal was to facilitate organizational change needed for physician-managed practices to increase patient adoption and meaningful use of patient portals for secure communication, wellness education, review of labs and other tests, and receipt of clinical summaries. The methodology utilized the appreciative inquiry 4-D model as the underlying basis of three phases: Phase 1-fundamental study, Phase 2-strategic action plan, and Phase 3 supporting organizational change. The physicians or providers in independent medical practices are the key determinate of the organizational workflows. The results have added significantly to the understanding of organizational change as related to patient engagement and the adoption and meaningful use of patient portals in independent physician-managed clinics. As medical practices and their physician leaders raise patient portal workflow processes to a higher level of importance, it is expected that patients will begin to adopt these procedures as their preferred methods and bring about a change in the patient-provider relationship.

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Kidwai, Asif. "Technology Acceptance and Compliance in Obstructive Sleep Apnea Patients." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5209.

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The focus of this study is the problem of declining trend in obstructive sleep apnea (OSA) patient compliance. Studies reported improved compliance in patients with chronic diseases due to technology-based interventions. However, researchers have not investigated the advantages of technology to improve the compliance of OSA patients in detail. The specific problem was the lack of engagement between patients and healthcare managers, resulting in low compliance within OSA patients. The purpose of this qualitative study was to evaluate how technology-based interventions can improve OSA patient engagement with the healthcare managers resulting in improved compliance with treatment procedures. In this study, the technology acceptance model was used as the instrument in evaluating the information collected through interviews with 20 healthcare managers about their attitudes toward usage, perceived usefulness, and perceived ease of use. The transcribed interviews were open-coded using the RQDA library in R Studio. In general, results from this study indicated that the healthcare managers showed a positive attitude towards the use of technology for patient engagement and expressed that the technology is useful for patient engagement and is easier to use. However, they identified technology-related and patient-related challenges in implementing technology for patient engagement. Further, the respondents identified process-related and patient-related opportunities in using technology for patient engagement. Results from this study have practice and policy implications by enabling healthcare managers to devise better compliance plans for OSA patient management. The findings could have a social benefit by helping healthcare managers to implement technology-based interventions to better achieve a higher compliance resulting in better patient health at lower costs.

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Lee, Terence H. "Regression Analysis of Cloud Computing Adoption for U.S. Hospitals." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/588.

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Industrial experts agree that cloud computing can significantly improve business and public access to low cost computing power and storage. Despite the benefits of cloud computing, recent research surveys indicated that its adoption in U.S. hospitals is slower than expected. The purpose of this study was to understand what factors influence cloud adoption in U.S. hospitals. The theoretical foundation of the research was the diffusion of innovations and technology-organization-environment framework. The research question was to examine the predictability of cloud computing adoption for U.S. hospitals as a function of 6 influential factors: relative advantage, compatibility, complexity, organizational size, structure, and culture. The research methodology included a cross-sectional survey with an existing validated questionnaire. A stratified random sample of 118 information technology managers from qualified U.S. hospitals completed the questionnaire. The categorical regression analysis rendered F statistics and R2 values to test the predictive models. The research results revealed that all 6 influential factors had significant correlations with the public cloud adoption intent (adjusted R2 = .583) while only the 3 technological factors had significant correlations with the private cloud adoption intent (adjusted R2 = .785). The recommendation is to include environmental factors and increase sample size in the similar future research. The developed predictive models provided a clearer understanding among hospital IT executives and cloud service providers of cloud adoption drivers. The potential implications for positive social change can be the increase of efficiency and effectiveness in U.S. hospital operation once their speed of cloud adoption has increased.

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Vlaar, Tim. "Association des activités professionnelles et de l’exposition aux métaux avec deux maladies neurodégénératives à partir du Système National des Données de Santé." Thesis, Université Paris-Saclay (ComUE), 2019. http://www.theses.fr/2019SACLS529/document.

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Peu d’études françaises ont abordé le rôle des expositions chimiques autres que les pesticides dans les maladies neurodégénératives. Des interrogations persistent notamment sur le rôle de l’exposition environnementale ou professionnelle aux métaux dans la maladie de Parkinson (MP) et sur l’existence d’un excès de maladies du motoneurone (MMN) parmi les militaires qui peuvent être exposés au plomb ou à d’autres produits. Nous avons abordé ces questions en France à travers des études nationales au sein du Système National des Données de Santé (SNDS). Nous avons observé une augmentation de l’incidence de la MP (2010-2014) dans les cantons caractérisés par des proportions élevées de travailleurs dans les secteurs de l’agriculture, la métallurgie et l’industrie textile ; l’exposition professionnelle aux pesticides, métaux et solvants respectivement pourraient contribuer à ces associations. Par ailleurs, nous avons observé une incidence de la MMN (2010-2016) plus élevée de 16% chez les hommes de 50 ans et plus affiliés à la Caisse nationale militaire de sécurité sociale par rapport aux hommes de la population générale. Le tabagisme et des facteurs professionnels pourraient expliquer cette association. Enfin, nous avons utilisé des données de biosurveillance à partir de mousses prélevées dans les régions rurales pour étudier le rôle des retombées atmosphériques en métaux (cuire, fer, mercure, manganèse, plomb, zinc) dans la MP. Son incidence (2010-2015) était 4% plus élevée dans les régions où la concentration en métaux dans les mousses était la plus élevée. Une association positive et statistiquement significative est retrouvée pour le cuivre et le mercure. En utilisant différents indicateurs pour approcher l’exposition aux métaux, ce travail souligne la complexité de l’étude du rôle étiologique de nuisances dont les déterminants d’exposition sont à la fois environnementaux et professionnels
Few French studies have examined the role of chemical exposures other than pesticides in neurodegenerative diseases. There are still uncertainties regarding the role of environmental or occupational exposure to metals in Parkinson’s disease (PD) and the excess risk of motor neuron disease (MND) among military personnel who can be exposed to lead and other products. We have examined these questions in France through nationwide incidence studies within national health insurance databases (Système National des Données de Santé, SNDS). We observed an increased PD incidence (2010-2014) in areas characterized by high proportions of workers in agriculture, metallurgy and textile sectors; occupational exposure to pesticides, metals, or solvents respectively may contribute to these associations. Furthermore, we observed a 16% increased incidence of MND (2010-2016) among men aged 50 years and older covered by the national military social security fund (Caisse nationale militaire de sécurité sociale) compared to men from the general population. This excess risk is possibly explained by smoking and occupational factors. Finally, we used biomonitoring data from mosses obtained in rural regions to investigate the role of atmospheric deposition of metals (copper, iron, mercury, manganese, lead, zinc) in PD. Its incidence (2010-2015) was 4% higher in areas where overall metal concentrations in mosses were the highest. There was a statistically significant positive association for copper and mercury. Using different indicators to assess exposure to metals, our work highlights the complexity of studies on the etiologic role of chemicals whose exposure determinants are both environmental and occupational

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