Lien précarité – durée et complexité des séjours hospitaliers en secteur de court séjour |
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| Authors: | J. Holstein D. Farge N. Taright L. Trinquart D. Manac’h T. Bastianic G. Chatellier |
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| Affiliation: | 1. Département d’information médicale, Assistance publique–Hôpitaux de Paris, 3, avenue Victoria, 75184 Paris cedex 04, France;2. Service de médecine interne, hôpital Saint-Louis, AP–HP, Paris, France;3. Département d’information médicale, hôpital Saint-Antoine, AP–HP, Paris, France;4. Unité de recherche clinique, hôpital européen Georges-Pompidou, France;5. Inserm, centres d’investigations épidémiologiques, 4, Paris, France;6. Direction des finances, Assistance publique–Hôpitaux de Paris, France;1. Department of Cardiology, University Hospital of Montpellier, Montpellier, France;2. Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France;4. Department of Medical Information, University Hospital of Montpellier, Montpellier, France;9. Department of Radiology, University Hospital of Montpellier, Montpellier, France;3. Department of Cardiology, University Hospital of Nimes, Nimes, France;5. Department of Cardiology, Clinique du Millenaire, Montpellier, France;6. Department of Cardiology, Clinique des Franciscaines, Nîmes, France;7. Department of Cardiology, Clinique St. Pierre, Perpignan, France;8. Department of Cardiology, General Hospital of Perpignan, Perpignan, France;1. The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia;2. Department of Surgery, Duke University School of Medicine, Durham, NC, USA;3. Department of Surgery, Rutgers Cancer Institute of New Jersey, NJ, USA;4. Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK;5. Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France;6. Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark;7. Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China;8. Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea;9. Department of Surgery, University of Hong Kong, Hong Kong;10. Department of Surgery, Brigham and Women''s Hospital, Boston, MA, USA;11. Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, UK;12. Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia;1. Benaroya Research Institute at Virginia Mason, Seattle, Wash;2. Department of Medicine, University of Washington, Seattle, Wash;3. Virginia Mason Medical Center, Seattle, Wash;1. Université Paris Sud, UMR/CNRS 8502 Laboratoire de Physique des Solides, Campus Universitaire d’Orsay – Université Paris-Saclay, Bâtiment, 510 91405, Orsay Cedex, France;2. Université Paris Sud, UMR/CNRS 8612 Institut Galien Paris Sud, Faculté de pharmacie, Université paris-Saclay, 5 rue Jean-Baptiste Clément, 92296, Châtenay-Malabry, France;3. Université Pierre et Marie Curie, Laboratoire de pharmacologie Paris 6, CHU Pitié Salpêtrière, 47 bd de l''Hôpital, 75013, Paris, France |
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| Abstract: | BackgroundSeveral studies have shown that socioeconomic deprivation is associated with increased hospitalization lengths of stay (LOS) and costs. Yet, the French DRG-based information system (PMSI) does not take deprived situations into account. Hence, we aimed at extracting routinely available variables measuring deprivation from the Hospital Information System and at assessing their association with severity of illness and hospital LOS.MethodsWe performed record linkage between the PMSI database concerning stays of patients aged more than 16 years in the short-stay sector of Assistance publique–Hôpitaux de Paris in 2007 and an administrative database which provided the following deprivation measures: recipients of Couverture Médicale Universelle (basic or complementary health insurances adapted for underprivileged French citizens) or Aide Médicale d’État (health and medical emergency insurances adapted for underprivileged non French citizens living in France) and homeless patients. We compared length of stays showing a deprivation measure to others after adjustment on morbidity, age and sex.ResultsAmong 352,721 stays, the prevalence of the deprivation measures ranged from 0.71% for “homelessness” to 6.24% for complementary Couverture Médicale Universelle. Stays showing a deprivation measure had specific illnesses and had more frequently associated comorbidities or complications than others. After adjustment, deprivation measures were associated with significantly increased LOS (by 5% for Couverture Médicale Universelle to 48% for emergency Aide Médicale d’État.ConclusionRoutine extraction of deprivation measures from Hospital Information Systems is feasible. Age, sex and illness being equal, these deprivation measures were associated with more complicated cases and increased LOS. We recommend that case mix-based hospital prospective payment systems take socioeconomic deprivation into account. |
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