ObjectivesAccreditation in France relies on a mandatory 4-year cycle of self-assessment and a peer review of 82 standards, among which 14 focus priority standards (FPS). Hospitals are also required to measure yearly quality indicators (QIs—5 in 2010). On advice given by the accreditation committee of HAS (Haute Autorité en Santé), based on surveyors proposals and relying mostly on compliance to standards, accreditation decisions are taken by the board of HAS. Accreditation is still perceived by hospitals as a burdensome process and a simplification would be welcomed. The hypothesis was that a more limited number of criteria might give sufficient amount of information on hospitals overall quality level, appraised today by accreditation decisions.DesignThe accuracy of predictions of accreditation decisions given by a model, Partial Least Square-2 Discriminant Analysis (PLS2-DA), using only the results of FPS and QIs was measured. Accreditation decisions (full accreditation (A), recommendations or reservation (B), remit decision or non-accreditation (C)), results of FPS and QIs were considered qualitative variables. Stability was assessed by leave one out cross validation (LOOCV).Setting and participantsAll French 489 acute care organisations (ACO) accredited between June 2010 and January 2012 were considered, 304 of them having a rehabilitation care sector (RCS).ResultsAccuracy of prediction of accreditation decisions was good (89% of ACOs and 91% of ACO-RCS well classified). Stability of results appeared satisfactory when using LOOCV (87% of ACOs and 89% of ACO-RCS well classified). Identification of worse hospitals was correct (90% of ACOs and 97% of ACO-RCS predicted C were actually C).ConclusionsUsing PLS2-DA with a limited number of criteria (QIs and FPS) provides an accurate prediction of accreditation decisions, especially for underperforming hospitals. This could support accreditation committees which give advices on accreditation decisions, and allow fast-track handling of ‘safe’ reports.
Objectives: To evaluate the trajectory of productivity loss in patients diagnosed with lumbar disc herniation or spinal stenosis before and after surgery. MethOds: Patients who underwent surgery for spinal stenosis or lumbar disc herniation during 2000-2012 were identified from the national spine surgery register "Swespine". Additional data were extracted from Swedish registries including the National Patient Register and the Social Security Agency register. Productivity loss was measured as the sum of days with sick insurance benefits multiplied with the proportion of the patient's working time covered by a benefit. The main diagnosis registered at surgery was used in the analysis. Patients were followed for two years before and two years after surgery and were only included if in working age (19-64 years). Results: 18,315 patients who underwent surgery for lumbar disc herniation, and 11,511 patients who underwent surgery for spinal stenosis were identified for inclusion. In patients operated for disc herniation, productivity loss gradually increased during the year leading up to surgery, peaking at the first month post-surgery at almost full time work absence (25.3 days/month), and then gradually decreased. Mean days of productivity loss per month two years and year one before surgery was 5.2 and 9.4 days respectively, and 11.4 year one and 6.8 days year two post-surgery. Patients operated for spinal stenosis had a similar trajectory in productivity loss in relation to surgery, with a peak at the first month post-op (27.5 days/month). In this group, mean productivity loss/month was 12.0 year two and 15.4 year one pre-op, and 17.3 year one and 12.5 year two post-surgery. cOnclusiOns: Productivity loss after lumbar surgery returned to a level similar to the level two years before surgery. The trajectory was similar across the diagnosis groups, although the loss in spinal stenosis patients was higher over the four year time period.
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