[Entre dynamique d'amélioration de la qualité des soins et conformisme administratif : comportements des établissements de santé français face au paiement à la performance (P4P)].

Le paiement à la performance (P4P) continue de se développer dans les systèmes de santé des pays industrialisés, malgré des preuves encore assez limitées de son efficacité. Cette étude propose de comprendre le comportement des établissements de santé face à ce nouveau mode de paiement en se basant sur l'expérimentation de P4P hospitalier conduite en France. Nous avons, pour cela, combiné une approche quantitative basée sur un questionnaire auprès des établissements participants et une analyse qualitative dans neuf établissements afin de mieux identifier les processus à l'œuvre.

Implementing hospital pay-for-performance: Lessons learned from the French pilot program.

Despite a wide implementation of pay-for-performance (P4P) programs, evidence on their impact in hospitals is still limited. Our objective was to assess the implementation of the French P4P pilot program (IFAQ1) across 222 hospitals. The study consisted of a questionnaire among four leaders in each enrolled hospital, combined with a qualitative analysis based on 33 semi-structured interviews conducted with staff in four participating hospitals.

[Analysis of hospital outpatient care of a rare disease: cystic fibrosis].

Introduction: Following the generalization of neonatal screening, the French CF Care Network has become structured around 45 qualified centres, the French CF Society, 2 national expertise centres, the Patient Registry and the National Protocol of CF Care in collaboration with the Vaincre Ia Mucoviscidose patient association. This organization and progress in treatment have resulted in the outpatient follow-up of a growing number of patients. Since 2010, the CF Network representatives have been conducting an assessment of outpatient follow-up to identify difficulties in complying with national and international clinical practice guidelines.

[What are the conditions for the success of public health interventions?].

This article aims to identify the optimal conditions necessary for the implementation of public health interventions. In order to approach this question, the authors relied upon a review of the health promotion literature and on three evaluation reports on the processes undertaken within the framework of French regional health programmes and their British equivalent counter-parts. Based on the synthesis of this work, the article puts forth recommendations for carrying out public health interventions at the national, regional and local level.

Toward a global approach of biochemistry in hospitals.

This article summarizes three different presentations delivered at the CRESGE congress by three members of GREBIO, a reflection group about biochemistry; created in the Paris hospitals, this group was concerned with these problems at a time of great technological change. Physicians, biochemists and administrators have been working in GREBIO for 7 years, with the methodological assistance of management from the School of Mines; they used new approaches, and careful investigations on the field and proposed analyses sometimes upsetting but always enriching the questionings. Starting from these results, briefly described, GREBIO proposed the creation of an observatory for biochemistry, that could take into account both the complexity and diversity in the laboratories.