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Prise en charge du handicap en France : étude des trajectoires de soins individuelles dans un hôpital de référence

Abstract : Disability is a major public health issue in France. A large proportion of the population in France and throughout the world is affected by at least one form of disability and the healthcare system is increasingly involved in managing it. The constant improvement of the quality of care and the optimisation of resources are simultaneously targeted by the decision-makers who define health policies. The care pathways followed by patients with motor disabilities are becoming longer and more complex as life expectancy increases and medical techniques evolve. There are few tools and methods for analysing the individual trajectories of these patients.Furthermore, French hospitals have, through the Programme de Médicalisation du Système d'Information (PMSI), an exhaustive medico-administrative database collecting information on the venues of patients through the various medical services. This work explores the possibility of using this database, initially gathered for the economic purpose of invoicing the care provided, to develop epidemiological research tools designed to inform and facilitate the evolution of the organisation of care.This work focuses on patients with spinal cord injuries and those with traumatic brain injuries or neuromuscular disorders, who are particularly concerned by the consequences of their pathologies in terms of motor function. The study took place at the Raymond Poincaré Hospital in Garches (AP-HP, Hauts-de-Seine), which is considered to be the national reference hospital for the management of motor disability. The work consisted in exploring the possibility of using these databases. A method of identifying these patients through the diagnostic coding of hospital stays was implemented. The different hospital trajectories were reconstructed, classified into coherent groups of care consumption and compared with each other. Finally, a method for visualising the flows within the trajectories was used in order to facilitate their understanding and appropriation.The completion of these different stages confirmed the possibility of using hospital medico-administrative databases as epidemiological research tools in the field of motor disability.
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Submitted on : Tuesday, November 30, 2021 - 5:59:09 PM
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Vincent Falgairou. Prise en charge du handicap en France : étude des trajectoires de soins individuelles dans un hôpital de référence. Médecine humaine et pathologie. Université Paris-Saclay, 2021. Français. ⟨NNT : 2021UPASR001⟩. ⟨tel-03457923⟩

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