Transcript Diapositive 1 - PERINAT-ARS-IDF

Assessing restructuration of
perinatal care in Ile de France
1998-2009
C. Crenn Hebert, APHP, Colombes, Perinatal Network
Hauts de Seine North, PERINAT-ARHIF, France
ORAH 2009
Create health information system
at regional level
Dr C. Crenn Hebert,
Dr C. Menguy,
E. Lebreton,
G. Echardour,
Dr A. Serfaty APHP,
J. Zeitlin
APHP, Perinatal Network Hauts de Seine North, France
Hal Montreuil Seine Saint-Denis, France
« PERINAT-ARHIF » , Paris, France
ARHIF, Paris, France
Hal Trousseau, Perinatal Network Eastern Paris, France
INSERM, UMR S953, UPMC Univ Paris 06, France
Content
• Background: Ile de France region and policies
• Method for creating information system:
– Health certificate
– Hospital discharge summary
• Results:
– Perinatal structures
– Perinatal indicators
– Focus on Hauts de Seine district
• Discussion
• Conclusion
Ile de France : > 1/5 French births
Background: perinatal policies
Perinatal care: a priority
by Regional health authority
Objective:
 80% very preterm births in level III perinatal centre (PC III)
 Level I: maternity unit without neonatal care
 Level IIA: on-site neonatal care
 Level IIB: on-site neonatal intensive care unit
 Level III: on-site neonatal resuscitation
 Specialised PCIII: foetal medicine or neonatal surgery
*L'action collective périnatalité en Ile de France, 1996-2000, A. Serfaty, E. Papiernik, ed ENSP 2005
Regional Health
Organization Schemes:
Assess and elaborate successive schemes
(1994, 1999, 2006)
In partnership with the regional health authority
and perinatal health clinicians
The need for data ….
 Regional birth commission Survey in 1998
1998: 8 Perinatal Centres level III
+ 2 specialised PCIII (foetal medicine or neonatal surgery)
135 maternity units- unequal distribution of PCIII over the 8 districts
1998: Regional birth commission Survey:
only 60% of very preterm births in PC III
57%
59%
82%
70%
59%
64%
40%
52%
Regionalisation of very preterm birth sites in the Paris region in 1998 ;
Annie Serfaty et al. Santé publique 2003, vol 15, no 4, pp. 491-502
Creating information system:
method
• Criteria:
Use of existing databases
Routine data
Data are available quickly
Data are validated
• Involving perinatal health professionals:
>Analysis to be shared between regional health
authority and data producer
1- Health certificates
• First one at birth (live birth): indicators of birth certificate (BC)
 parental demographics,
 antenatal period,
 delivery,
 newborn characteristics (gestational age, birth weight…),
 first week events
(followed by 2nd certificate at 9 months, 3rd certificate at 24 months)
• Sent to maternal and child protection services in district of
parents residence
• Common regional database from all districts: in progress from
2002
Hospital
Maternity unit,
Neonatal unit
Birth
certificates
MCPS of
residence district
(anonymous files)
Health
ministry
HEALTH CERTIFICATES:
Each livebirth (BC)
MATERNAL AND CHILD
PROTECTION SERVICES: MCPS
District of residence
Validation
Modification
“Perinat-arhif” statistician
Epidemiological research unit
Regional health authority
Data management
Common regional data base
Statistics
Analysis validated by
regional medical
group of MCPS Drs
2- Hospital Discharge Data System :
(French PMSI)
• Hospital Discharge Summary :
perinatal indicators set in IDF region, for every
hospital, depending of place of residence
 pregnant or mother stay
 newborn (live or stillborn > 2009) or neonate stay
 until 2008, no gestational age is notified
• But without any link Mother-Baby!
“PERINAT-ARHIF” system
Hospital
Maternity unit,
Neonatal unit
Hospital Discharge Data
System : HDDS
Unit Discharge Summary: UDS
HDDS
UDS
MID
Hospital Discharge
Summary
LINKING FILE
( anonymous files)
e-PMSI
Health Ministery
Quality Control
Audits
Validation
Modification
Data management
Perinatal data base
Statistics
Analysis validated by
Perinatal health
networks Medical
committees
Medical Information Department:
MID
Hospital Discharge Summary
+ Linking File: mother and baby
+ direct validation process+ audits
=
“PERINAT-ARHIF” system
“Perinat-arhif” team
Regional health authority
www.perinat-arhif.org
Download application programs 2006, 2007
Patient flows
But also:
- Regional summary tables
- Hospital summary tables …
85 perinatal indicators compatible:
. AUDIPOG (www.audipog.net)
. EUROPERISTAT (www.europeristat.com)
Completeness of the data
Comparison with civil registration « INSEE »
• Birth Certificates (BC)
2007
93.3%
• Hospital Discharge
Summary (HDS)
2007
95.4%
Great heterogeneity between each district
But giving feed-back to professionals seems to
improve the reliability
Completeness BC/district/ 2006 and 2007
/ source INSEE civil registration
100,0%
95,0%
Paris
Seine-et-Marne
Yvelines
90,0%
Essonne
Hauts-de-Seine
Seine-saint-Denis
Val-de-Marne
Val d'Oise
85,0%
80,0%
% 2006
% 2007
Completeness HDS 2006 AND 2007 / INSEE
100,0%
95,0%
Paris
Seine-et-Marne
Yvelines
Essonne
90,0%
Hauts-de-Seine
Seine-saint-Denis
Val-de-Marne
Val d'Oise
85,0%
80,0%
% 2006
% 2007
Results
Perinatal structures
Perinatal indicators
Focus on Hauts-de-Seine district
Restructuring perinatal care in IDF
1998
 170 000 births
 by IDF residents : source civil
registration INSEE
2007
 179 264 births
by IDF residents :
(INSEE)
 135 maternity units
 105 maternity units
 8 PC III
 14 PC III
 15 in 2008
 16 in 2009
2007 – 14 PC III (incl spec PCIII)
Deliveries and perinatal centre type
(source HDD)
100%
90%
21,4
23,5
24,4
19,5
19,6
80%
70%
19,7
60%
PC I : decrease
50%
PC II : stable
24,8
23,9
25,2
40%
30%
20%
34,2
33,1
30,8
2006
2007
2008
10%
0%
Type I
Type IIA
Type IIB
Type III
PC III: increase
Newborns with birth weight <1500g
(source HDD)
100%
90%
80%
70%
60%
76,6
80,1
78,3
11,6
12,7
50%
40%
30%
20%
10%
0%
12
6,9
5,4
5,9
4,5
2,9
3,1
2006
2007
2008
Type I
Type IIA
Type IIB
Type III
2007
80% Newborns <1500g born
in CP III (source HDD)
81%
76%
81% 83%
83%
87%
74%
77%
2007
78% Newborns <32 wk born
in PC III (source BC)
80%
73%
83%
81% 83%
78%
72%
75%
0% to 2,8% gestational age missing
Focus on Hauts-de-Seine (HdS)
district
Differences in populations between
north and south of district (2007)
source HDD
Residents in North
• <1500g : 1,04%*
* p= 0.03
Residents in South
• <1500g : 0,77%*
Impact of not having a PC III?
Differences in health care
Hauts de Seine North/ Hauts de Seine South (2007) (source HDD)
Residents in North
Residents in South
 < 1500g born in
PCIII: 74,4%*
 < 1500g born in PCIII:
91,3%*
 Multiple delivery in
PCIII:23,5%**
 Multiple delivery in PCIII
62,7%**
* p =0.003
**p<0.0001
2008 15th PC III in Hauts de Seine North
2008 Newborns <1500g born in PC III
(source HDD)
84%
72%
85% 86%
77%
90%
81%
77%
Results of opening PC III in North
2008 Hauts de Seine North/ Hauts de Seine South (source HDD)
Residents in North
Residents in South 92
• < 1500g born in PCIII:
83,6% (ns)
• < 1500g born in PCIII:
87,5% (ns)
• Multiple delivery in
PCIII: 45,3%**
• Multiple delivery in
PCIII: 59,7%**
**p=0.001
Results of opening PC III in North
2008 Hauts de Seine North/ Hauts de Seine South (source HDD)
Residents in North 92
Residents in South 92
• < 1500g born in PC I or
IIA: 7,0%
• < 1500g born in PC I or
IIA: 8,0%
• Multiple delivery in PC I
or IIA: 39,9%**
• Multiple delivery in PCI
or IIA: 26,8%**
**p=0.002
Discussion
• Change in perinatal structures may be
monitored at different levels
• Routine data information important for
planning of maternity care
• Evolution in perinatal health indicators
may also reflect:
– Changes in health of the population
– Changes in medical practices among health
professionals
Discussion
• Relevance of the initial indicator is questionable
(rate of in-born very preterm birth)
• In Hauts de Seine district, previous PC level IIB
is upgraded to PC level III
• Hospital discharge data provided only birth
weight , but similar data are obtained from birth
certificates with gestational age in 2007
Thoroughness and accuracy of the data:
hard to achieve…
Conclusion
• Combining analysis from 2 routine
information systems helps to provide
validated data for a regional vision of
restructuration
• Analysis at perinatal network level and
smaller territorial scales is important to
access population needs and the
adequacy of health care provision.
Thank you for your attention
Any Questions?
1994-2009: Government policies in
France
 Change in organization of perinatal care
–
–
–
–
Level I: maternity unit without neonatal care
Level IIA: on-site neonatal care
Level IIB: on-site neonatal intensive care unit
Level III: on-site neonatal resuscitation
 Change in medical practice
• Toward regionalisation: place of birth according to risk level
• In utero-transport to avoid negative effect of post-natal
transport
2007 – 14 PC III
Paris
30820
27743
18624
24937
20331
19899
18978
17932
Living Births district volumes differ, PC III capacities also
Réseaux de périnatalité d'Ile de France
Réseau Périnatal 92 Nord
Hôp Louis Mourier
Hôp Max Fourestier
923
Cli Lambert
Hôp Beaujon
IH Franco-Britannique
CH Neuilly Courbevoie
Hôp Américain
Cli Sainte Isabelle
Cli Les Martinets
CPN III
CPN II B
922
CPN II A
CPN I
Établissement AP-HP
Établissement Public de Santé
Établissement PSPH
Établissement Privé à but non lucratif
Établissement Privé à but lucratif
© 2008 ARHIF-APHP-CRAMIF tous droits réservés
Réseaux de périnatalité d'Ile de France
Réseau Périnatal 92 Sud
Possibilité de collaboration avec
Réseau Périnatal 92 Nord
CMC Foch
922
CH des Quatre Villes (site Saint-Cloud)
CH des Quatre Villes (site Sèvres)
Pôle de santé du Plateau (site Meudon)
CHU Antoine Beclère
921
Cli Ambroise Paré
Hôp privé Antony
912
CPN III
CH d' Orsay
Cli de l' Yvette
CPN II B
CPN II A
CPN I
Établissement AP-HP
Établissement Public de Santé
Établissement PSPH
Établissement Privé à but non lucratif
Établissement Privé à but lucratif
© 2008 ARHIF-APHP-CRAMIF tous droits réservés