The French policy on medical practice variations
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1 The French policy on medical practice variations Arnaud Fouchard, medical advisor, French ministry of health Diapositive n 1 Direction générale de l offre de soins - DGOS
2 The French policy on medical practice variations A. What has been done in France since 2010 B. 2015: Going further Direction générale de l offre de soins Diapositive n 2 Direction générale de l offre de soins - DGOS
3 In 2010, a report from the French public hospitals union stated that 30% of medical acts were unwarranted Diapositive n 3 Direction générale de l offre de soins - DGOS
4 What consequences of unwarranted procedures from the French MoH perspective? These procedures are undergone by patients for no actual reason These procedures put patients in danger and can have severe consequences: radiations, general anesthesia, removing an organ These cares have a high cost for national insurance and for every taxpayer Diapositive n 4 Direction générale de l offre de soins - DGOS
5 What we call inappropriateness of care in France? q unwarranted procedures (mostly surgical but not exclusively) q unwarranted biological and radiological tests q unwarranted drug prescriptions q unwarranted rehabilitation stays q unwarranted overnight stays in hospital when outpatient care is possible q unwarranted emergency care when it s not an emergency or it could have been avoided through informing the patient better Diapositive n 5 Direction générale de l offre de soins - DGOS
6 Where to start? In 2011, selection of 19 DGRs based on 3 criteria: High volume (> per year) The activity has been growing over the last 3 years big medical variations across regions in standardized rates of use + 2 DRGS based on national and international literature + 11 procedures from the work of national insurance on medical practice variations à 32 national priorities Diapositive n 6 Direction générale de l offre de soins - DGOS
7 List of the 32 national priorities Gastrointestinal endoscopy Cholecysectomy Biliary tract disease Extracorporeal lithotripsy Carpal Tunnel Syndrome Hip replacement Knee prosthesis Tonsillectomies w/o adenoidectomy Appendicectomy Myringotomy under 18 Transurethral interventions or transcutaneous infection of the kidneys and urinary tract Diseases of the mouth and teeth extractions, dentures and repairs Shoulder arthroscopy Percutaneous coronary intervention (PCI) Respiratory infections and inflammations over 17 Cataract Bronchiolitis COPD with infection Spine surgery Caesarean section Thyroidectomy Oesophagectomy Total colectomy Benign prostatic hypertrophy Hysterectomy Pancreatectomy aneurysm of the abdominal aorta CABG Varices knee ligament aortic valve replacement Diapositive n 7 Direction générale de l offre de soins - DGOS
8 Information on medical practice variations across regions is available for professionals but they need to know where to search for it Diapositive n 8 Direction générale de l offre de soins - DGOS
9 Variations in gross and standardized rates of hip replacement Diapositive n 9 Direction générale de l offre de soins - DGOS
10 Trying to reduce inappropriateness of care : the French strategy ATIH Technical agency for information on hospitalization HAS High authority on health CNAMTS National Insurance Task group MoH, ATIH, HAS, CNAMTS, ARS Produces data to allow comparisons Analyses DRG and produces recommenda3ons and guidelines if needed Visits professionals to give them a profile of their prac3ce; Defines indicators to screen hospitals with high risk of inappropriateness Decides on main direc3ons; Produced a guide on How to work on appropriateness of care in regional agency 26 ARS Regional Agencies for health Diapositive n 10 Direction générale de l offre de soins - DGOS
11 Trying to reduce inappropriateness of care : the role of the region It chooses the most important priorities between the 32 By January 2014, all of them had made their diagnosis Conducts dialogues with health professionals over each priority to better understand local variations in medical practices By January 2014, half of them had done those negotiations Makes contracts with some hospitals to make them improve their practices 7 out of 26 were at this point early in 2014 Diapositive n 11 Direction générale de l offre de soins - DGOS
12 2015 : Going Further The French ministry of health is drafting a law so that every region will have to produce a program on appropriateness of care, setting priorities, action plan, and hospitals with which they wish to sign contracts; It also enforces contracts between regional agencies and hospitals with qualitative or quantitative targets and financial penalties if the objectives are not reached Diapositive n 12 Direction générale de l offre de soins - DGOS
13 What we have not done yet Made the information on medical variations public Introduced indicators of appropriateness of care in hospital certification Found a way to better implement the recommendations given to healthcare professionals Been able to assess the impact of our actions Diapositive n 13 Direction générale de l offre de soins - DGOS
14 What we could also do à We need you on this part Diapositive n 14 Direction générale de l offre de soins - DGOS
15 Thank you for your attention Diapositive n 15 Direction générale de l offre de soins - DGOS
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