Ignite Creation Date:
2024-05-06 @ 7:52 AM
Last Modification Date:
2024-10-26 @ 11:53 AM
Study NCT ID:
NCT02617251
Status:
COMPLETED
Last Update Posted:
2023-02-03
First Post:
2015-11-19
Brief Title:
Impact of Deprivation on Hospital Care Efficiency in Paediatrics
Sponsor:
Assistance Publique - Hôpitaux de Paris
Organization:
Assistance Publique - Hôpitaux de Paris
Study Overview
Official Title:
Impact of Deprivation on Hospital Care Efficiency in Paediatrics
Status:
COMPLETED
Status Verified Date:
2018-02
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
PRECAPED
Brief Summary:
Many studies have shown that deprived patients consumed more healthcare resources than non-deprived patients in particular in terms of increased length of stay LOS and readmission rates which has an impact on hospital efficiency and the healthcare system as a whole There are many types of indicators available to assess deprivation in a hospital setting and French decision makers are currently using reliance on public aids to allocate additional funding to hospitals based on the percentage of deprived patients they admit However there are limits to this method it only assesses one dimension of deprivation the target population often does not know about the existence of those aids and they have a clear threshold effect An alternative solution is to use ecological deprivation indices which are obtained by aggregating different variables measured at a specific time and place ie the patients place of residence at the time of care One such index the FDep was developed specifically in France although others such as the Carstairs index and the European deprivation index also exist
The primary objective of this study is to study the association between deprivation measured by the FDep and hospital care efficiency in paediatric and neonatology patients measured by the difference between patient LOS and the national average LOS of their diagnosis-related group DRG The secondary objectives are to carry out a budget impact analysis on the impact of deprivation for hospitals with a paediatric or neonatology ward to study the association between deprivation and readmission at 15 days to study the relation between FDep and the currently used deprivation indicators and to assess the added value of the FDep compared to those indicators and whether or not it should be used in routine practice
In order to do so an exhaustive retrospective study using the French hospital claims database will be carried out for the years 2012-2014 Deprivation indices will be calculated based on patients postcode The primary endpoint will be calculated using the national LOS present in the French national cost study Similarly the budget impact will look at the difference between production costs derived from the national cost study after adjusting for LOS and the statutory health insurances tariffs which will allow us to assess whether a hospital stay is associated with a gain a loss or is budget-neutral for the hospital Readmissions at 15 days will be identified through record linkage
Descriptive analyses will summarise both hospital and patient characteristics Uni- and bivariate analyses will be carried out by focusing of the variables of interest eg average deprivation index by legal status of the hospital mean LOS depending on the number of paediatric beds etc The deprivation index will be divided into quantiles as is the norm and the endpoints will be assessed for each of those quantiles An ANOVA or a Kruskal-Wallis test if the ANOVA hypotheses are not met will test whether the results differ between each quantile For readmission rates a Chi² test will be performed
In order to study the association between deprivation and the endpoints the investigators will model each endpoint using as the main explanatory variable the deprivation index Three main types of explanatory variables will be added to the model patient characteristics age sex severity level etc hospital characteristics legal status size number of full-time equivalent etc and environmentcontext characteristics number of paediatricians for 1000 inhabitants rural vs urban area etc
In order to assess the added benefit of using the deprivation index vs the current indicators a sub-cohort will be constructed in Paris teaching hospitals AP-HP as unfortunately whether the patient receives public aids is not present in the hospital claim database but is available only at the local level The investigators will look at the distribution of patients with public aids in each quantile of the deprivation index and run the previous models using the two types of indicators one after the other and comparing the statistical performance of each pair of models
The primary objective of this study is to study the association between deprivation measured by the FDep and hospital care efficiency in paediatric and neonatology patients measured by the difference between patient LOS and the national average LOS of their diagnosis-related group DRG The secondary objectives are to carry out a budget impact analysis on the impact of deprivation for hospitals with a paediatric or neonatology ward to study the association between deprivation and readmission at 15 days to study the relation between FDep and the currently used deprivation indicators and to assess the added value of the FDep compared to those indicators and whether or not it should be used in routine practice
In order to do so an exhaustive retrospective study using the French hospital claims database will be carried out for the years 2012-2014 Deprivation indices will be calculated based on patients postcode The primary endpoint will be calculated using the national LOS present in the French national cost study Similarly the budget impact will look at the difference between production costs derived from the national cost study after adjusting for LOS and the statutory health insurances tariffs which will allow us to assess whether a hospital stay is associated with a gain a loss or is budget-neutral for the hospital Readmissions at 15 days will be identified through record linkage
Descriptive analyses will summarise both hospital and patient characteristics Uni- and bivariate analyses will be carried out by focusing of the variables of interest eg average deprivation index by legal status of the hospital mean LOS depending on the number of paediatric beds etc The deprivation index will be divided into quantiles as is the norm and the endpoints will be assessed for each of those quantiles An ANOVA or a Kruskal-Wallis test if the ANOVA hypotheses are not met will test whether the results differ between each quantile For readmission rates a Chi² test will be performed
In order to study the association between deprivation and the endpoints the investigators will model each endpoint using as the main explanatory variable the deprivation index Three main types of explanatory variables will be added to the model patient characteristics age sex severity level etc hospital characteristics legal status size number of full-time equivalent etc and environmentcontext characteristics number of paediatricians for 1000 inhabitants rural vs urban area etc
In order to assess the added benefit of using the deprivation index vs the current indicators a sub-cohort will be constructed in Paris teaching hospitals AP-HP as unfortunately whether the patient receives public aids is not present in the hospital claim database but is available only at the local level The investigators will look at the distribution of patients with public aids in each quantile of the deprivation index and run the previous models using the two types of indicators one after the other and comparing the statistical performance of each pair of models
Detailed Description:
None
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None