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Méthode d'amélioration des pratiques - version anglaise

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Development of a general method to improve practice Written by, Armelle Desplanques-Leperre, MD, PhD, Marie Erbault, Nathalie Riolacci, MD, Bruno Bally, MD, Sylvie Legrain MD and Jean-Michel Chabot, MD. The remit of the French National Authority for Health (HAS) is to help improve the quality and safety of care. HAS develops programmes for practice improvement with the assistance of health professionals. Although good practice groups are being set up in France, French health professionals have not yet fully taken on board the ethos and methods of quality, and its corollary, practice appraisal. HAS’ objective was to test the acceptance of the improvement and assessment tools made available by a newly-developed method for the rapid development of practice improvement programmes. Examples of applications HAS applies the method to high-profile public health issues in France. Two of them represent contrasting situations: The management of patients with acute coronary syndrome (ACS): ACS is the second cause of mortality and morbidity in France. A key factor for survival is time to treatment. This depends on the emergency care pathway and on coordination between emergency services and cardiologists. Improving drug prescribing in the elderly: Improving drug prescribing in the elderly: The over-65s account for 16% of the French population and about 40% of out-of-hospital drug consumption.

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   Development of a general method to improve practice  Written by, Armelle Desplanques-Leperre, MD, PhD, Marie Erbault, Nathalie Riolacci, MD, Bruno Bally, MD, Sylvie Legrain MD and Jean-Michel Chabot, MD.  The remit of the French National Authority for Health (HAS) is to help improve the quality and safety of care. HAS develops programmes for practice improvement with the assistance of health professionals. Although good practice groups are being set up in France, French health professionals have not yet fully taken on board the ethos and methods of quality, and its corollary, practice appraisal. HAS’ objective was to test the acceptance of the improvement and assessment tools made available by a newly-developed method for the rapid development of practice improvement programmes.  Examples of applications    HAS applies the method to high-profile public health issues in France. Two of them represent contrasting situations: ƒ management of patients with acute coronary syndrome (ACS): ACS is the second cause of The mortality and morbidity in France. A key factor for survival is time to treatment. This depends on the emergency care pathway and on coordination between emergency services and cardiologists. ƒImproving drug prescribing in the elderly: Improving drug prescribing in the elderly: The over-65s  account for 16% of the French population and about 40% of out-of-hospital drug consumption. Good prescribing in the elderly, who often suffer from multiple diseases, is a challenge for practitioners. There are cases of underuse (e.g. cardiac insufficiency), overuse (e.g. hypnotics), and misuse (e.g. anticholinergics). Drug iatrogenicity accounts for 10% of hospital admissions in the over-65s and nearly 20% in octogenarians.  The aim of the programmes was to develop practical tools that would be easily available to all practitioners for improving and assessing practice and to widely publicize their availability. The method used to develop the tools was based on a detailed description of practice followed by the application of problem-solving techniques. For instance, to develop tools for ACS, we analysed in detail, with the close collaboration of practitioners, the sequence of steps in the care pathway, from the onset of the first symptoms, in order to identify problems (e.g. with regard to access to care).  The practice improvement programmes and tools were posted on the HAS website. They comprise prescribing aids (protocol; standard patient record, clinical pathway, treatment review table, reminders…) and assessment tools (prescription analysis, delay before patient is treated, treatment rate…). Each medical team or practitioner can choose the tools best adapted to his/her practice, and can include the use of the tools in their individual Continuing Professional Development (CPD) programme. The national CPD scheme on continuous quality improvement has been set up by HAS.  The improvement and assessment tools have attracted high interest with over 1000 new site visits each month. Work on drug prescribing in the elderly was presented by teams working in the primary care sector or in hospitals at a national venue in 2008. The itemisation of ACS management has led to several registries using the same set of indicators, thus enabling benchmarking. A national venue on ACS will be held in 2009. Standards for both topics have been included in the accreditation procedure for healthcare organisations.  Complex issues require (i) setting all stakeholders the same improvement objectives, (ii) widespread deployment of programmes to meet these objectives, (iii) publicising the work and experiences of care teams. Even if the issues are highly complex, the tools should be as simple as possible. We are currently identifying priority objectives to enhance the visibility of improvement programmes. The pilot programmes, are a pragmatic approach based on the description of practices and problem-solving which can answer grass-roots problems and meet the expectations and needs of practitioners. 
HAS/DAQSS/UPP/2009