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Évaluation d’impact d’une nouvelle organisation en chirurgie orthopédique sur les parcours de soins

Author

Listed:
  • Noémie Malléjac

    (IRDES Institut de recherche et documentation en économie de la santé)

  • Zeynep Or

    (IRDES Institut de recherche et documentation en économie de la santé)

Abstract

La coordination des soins avant et après une hospitalisation est importante pour améliorer la qualité de prise en charge des patients et l'efficience du système de santé. Différents protocoles de soins centrés sur le patient ont été développés dans la littérature médicale. Ils sont de plus en plus promus et employés dans les établissements de santé. Dans cette étude, nous évaluons l'impact de la mise en place d'un protocole de Réhabilitation améliorée après chirurgie (Raac) en chirurgie orthopédique sur les parcours de soins dans les cliniques privées. Les données mobilisées proviennent du Programme de médicalisation des systèmes d'information en Médecine, chirurgie, obstétrique (PMSI-MCO) concernant les patients ayant séjourné en établissement de santé pour pose de prothèse de hanche ou du genou dans les cliniques privées. Nous analysons l'impact de la Raac sur les durées de séjour, les modes de sortie (Soins de suite et de réadaptation (SSR) ou domicile) et la probabilité de réadmission à 30 et 90 jours. A partir de régressions en doubles différences, nous comparons les résultats des patients opérés dans les établissements labellisés Raac par le Groupe francophone de réhabilitation améliorée après chirurgie (Grace) avec ceux des patients pris en charge dans des cliniques témoins comparables. On isole l'effet de la Raac en prenant en compte l'impact potentiel d'autres facteurs tels que l'âge, le sexe du patient, son indice de co-morbidité et l'offre de soins proche de la résidence du patient. Les patients opérés dans un service de chirurgie qui pratique la Raac ont, en moyenne, une durée de séjour plus courte que ceux qui sont opérés dans un service de chirurgie classique (-0,4 jour). Ces patients ont une probabilité plus élevée de retour à domicile (OR 1,15), sans avoir un plus grand risque de réadmission. La labellisation Raac semble aussi avoir un impact positif sur le volume d'activité des établissements par le biais de la concurrence en qualité : toutes choses égales par ailleurs, les hôpitaux labélisés Raac ont enregistré un taux de croissance supérieur par rapport aux cliniques témoins.

Suggested Citation

  • Noémie Malléjac & Zeynep Or, 2019. "Évaluation d’impact d’une nouvelle organisation en chirurgie orthopédique sur les parcours de soins," Working Papers DT79, IRDES institut for research and information in health economics, revised Jun 2019.
    • Handle: RePEc:irh:wpaper:dt79
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    References listed on IDEAS

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    1. Corallo, Ashley N. & Croxford, Ruth & Goodman, David C. & Bryan, Elisabeth L. & Srivastava, Divya & Stukel, Therese A., 2014. "A systematic review of medical practice variation in OECD countries," Health Policy, Elsevier, vol. 114(1), pages 5-14.
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    2. Malléjac, Noémie & Or, Zeynep, 2025. "Hospital resilience in the Face of Covid-19 in France: A multilevel analysis of the impact of past practice quality on cancer surgery resumption," Health Policy, Elsevier, vol. 155(C).

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    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • L23 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Organization of Production
    • D04 - Microeconomics - - General - - - Microeconomic Policy: Formulation; Implementation; Evaluation

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