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Après la phase aigüe d’états pathologiques graves, la poursuite des soins, que ce soit à domicile ou dans une structure de moyenne ou de longue durée, est nécessaire chez un grand nombre de patients. Les études concernant le bénéfice des différentes modalités de prise en charge sont cependant peu nombreuses.
Ce mémoire et celui de Nathalie Bouillot ont pour objectif d’apporter une contribution, certes limitée, à l’évaluation du bilan de la prise en charge dans les structures de moyenne durée, appelées en Belgique « services spécialisés ou services Sp ».Plus précisément, il s’agit de comparer deux services de type « Sp chronique » sous le point de vue du bilan de la prise en charge. L’Institut Albert 1er et Reine Elisabeth à Bruxelles et le Centre de revalidation du Centre hospitalier de Jolimont-Lobbes à Saint-Vaast feront l’objet de cette comparaison.
Les soins de moyenne durée-soins de suite ou soins de réadaptation-ont pour objectif une réinsertion sociale des malades capables de retrouver une vie autonome. Le bilan attendu de l’hospitalisation dans un service Sp est donc une amélioration de l’état clinique du patient et de son autonomie.
Il nous a semblé intéressant, pour évaluer le bilan de la prise en charge dans un service Sp, d’utiliser les outils AGGIR et PATHOS. Ces outils ont la particularité de définir des indicateurs globaux, le premier d’autonomie et le second de niveaux de soins requis, caractéristiques d’une population de patients âgés en situation de poly pathologie.
La méthodologie utilisé consiste à évaluer le bilan de la prise en charge dans les services Sp sans évaluer le bilan individuel pour chacun des patients mais en exploitant les données saisies et indicateurs globaux des outils AGGIR et Pathos.
La comparaison du bilan de la prise en charge des deux services « Sp chronique » sous le point de vue de l’autonomie des patients fait l’objet du mémoire de Nathalie Bouillot.
Le présent mémoire est consacré à la comparaison du bilan de la prise en charge de deux services « Sp chronique » sous le point de vue de l’évolution de l’état clinique des patients. Il permettra aussi de montrer que le schéma d’évaluation du bilan de la prise en charge à l’aide du modèle PATHOS est un instrument pertinent pour distinguer deux services « Sp chronique » ayant des recrutements différents

Rehabilitation --- Evaluation Studies as Topic

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Treatment Outcome --- Clinical Trials as Topic --- Evaluation Studies as Topic --- Quality of Life --- Research Design --- Quality of Health Care

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Undertaken at the request of the Veterans Health Administration, this is a quantitative analysis of the Veterans Equitable Resource Allocation (VERA) system, which allocates the congressionally appropriated medical care budget to the Veterans Integrated Service Networks (VISNs).

Veterans. --- Veterans - Care - United States. --- Veterans --- Health Resources --- Evaluation Studies as Topic --- Delivery of Health Care --- Health Care Evaluation Mechanisms --- Investigative Techniques --- Persons --- Health Planning --- Health Care Economics and Organizations --- Health Care Quality, Access, and Evaluation --- Quality of Health Care --- Health Care --- Care --- Health and hygiene --- United States. --- Appropriations and expenditures. --- United States --- North America --- Americas --- Geographic Locations --- Health Resources. --- Evaluation Studies as Topic. --- Delivery of Health Care. --- Health Care Evaluation Mechanisms. --- Investigative Techniques. --- Persons. --- Health Planning. --- Health Care Economics and Organizations. --- Health Care Quality, Access, and Evaluation. --- Quality of Health Care. --- North America. --- Americas. --- Geographic Locations.

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One of the most challenging issues for clinical trial investigators, sponsors, and regulatory officials is the interpretation of experimental results that are composed of the results of multiple statistical analyses. These analyses may include the effect of therapy on multiple endpoints, the assessment of a subgroup analysis, and the evaluation of a dose-response relationship in complex mixtures. Multiple Analyses in Clinical Trials: Fundamentals for Clinical Investigators is an essentially nonmathematical discussion of the problems posed by the execution of multiple analyses in clinical trials. It concentrates on the rationale for the analyses, the difficulties posed by their interpretation, easily understood solutions, and useful problem sets. This text will help clinical investigators understand multiple analysis procedures and the key issues when designing their own work or reviewing the research of others. This book is written for advanced medical students, clinical investigators at all levels, research groups within the pharmaceutical industry, regulators at the local, state, and federal level, and biostatisticians. Only a basic background in health care and introductory statistics is required. Dr. Lemuel A. Moyé, M.D., Ph.D. is a physician and Professor of Biometry at the University of Texas School of Public Health. He has been Co-Principal Investigator of two multinational clinical trials examining the role of innovative therapy in post myocardial infarction survival (SAVE) and the use of cholesterol reducing agents in post myocardial infarction survival in patients with normal cholesterol levels (CARE). He has authored over one hundred articles in journals such as the Journal of the American Medical Association, the New England Journal of Medicine, Statistics in Medicine, and Controlled Clinical Trials. From the reviews: From the reviews: "A quick scan of the book indicates that it is not a typical statistics book…You can jump in almost anywhere and just start reading…I like the book’s organization. There is a chapter on clinical trials. Then there are several chapters that explain the situations that arise from the occurrence of multiple analyses. Particular emphasis is given to multiple endpoints, situations where one continues a study to follow up on unanticipated results, and to subgroup analyses, interventions that impact only a fraction of the subjects in a study. The author is equally adept at describing clinical trials for the statistician as at explaining statistics to the clinical investigator. I enjoyed leafing through this book and would certainly enjoy have the opportunity to sit down and read it." Technometrics, August 2004 "Moyé’s background as a statistician and MD makes him especially qualified to write this book…The clinical trial examples are a major strength of the book…His medical background and extensive clinical trials experience shine through." Statistics in Medicine, 2004, 23:3551-3559 "The many examples from well known clinical trials are clearly one of the strengths of this book. It is also fascinating to share the author's experience with the FDA where he attended many meetings of Advisory Committees."Biometrics, December 2005 "According to the preface, this book is written for clinical investigators and research groups within the pharmaceutical industry, medical students and regulators. … I admire the eloquency of the author. … The author does a remarkable job … . Without any doubt, the book is a valuable source of ideas for the intended audience. For statisticians it is an interesting source of experimental setups, that are actually used in practice and that consequently are worth while to be studied." (dr H. W. M. Hendriks, Kwantitatieve Methoden, Issue 72B41, 2005) "The book is entertaining and informative, sufficiently informal to recruit and retain the intended non-statistical readership, but sufficiently formal to detail methods. The author effectively sets up each issue with examples and conceptual discussion, grounding all in realistic examples." (T. A. Louis, Short Book Reviews, Vol. 24 (2), 2004) "Here in this book is a special situation for clinical trials in which the investigator must do statistical analyses for a number of different response measurements. … The author felt that the clinical investigators needed a book that they could understand. This book is his effort to reach that audience. … I like the book’s organization. … I enjoyed leafing through this book and would certainly enjoy having the opportunity to sit down and read it." (Eric R. Ziegel, Technometrics, Vol. 46 (3), August, 2004) "This book is written primarily for clinical researchers who are interested in designing and analysing clinical trials. It concentrates on elucidating problems arising from multiple analyses in clinical trials … . In general, the book is well written and easy to follow. … Although this book is written for clinical investigators, I find it a useful reference book for statisticians in the pharmaceutical industry … . Furthermore, senior statisticians may find the non-technical discussions and practical examples useful." (Shuying Yang, Pharmaceutical Statistics, Issue 3, 2004) "Without any doubt, the book is a valuable source of ideas for the intendend audience. For statisticians, it is an interesting source of experimental setups, that are actually used in practice and that consequently are worthwhile to be studied." (Dr. H.W.M. Hendriks, Kwantitatieve Methoden).

Mathematical statistics --- Clinical trials --- Multivariate analysis --- Multivariate Analysis --- Clinical Trials as Topic --- Research Design --- Evaluation Studies as Topic --- Analysis of Variance --- Epidemiologic Study Characteristics as Topic --- Research --- Methods --- Statistics as Topic --- Epidemiologic Methods --- Investigative Techniques --- Science --- Health Care Evaluation Mechanisms --- Natural Science Disciplines --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Public Health --- Quality of Health Care --- Disciplines and Occupations --- Health Care Quality, Access, and Evaluation --- Environment and Public Health --- Health Care --- Medical Research --- Mathematical Statistics --- Mathematics --- Medicine --- Health & Biological Sciences --- Physical Sciences & Mathematics --- Statistical methods --- Medicine. --- Statistics. --- Biomedicine. --- Biomedicine general. --- Statistics for Life Sciences, Medicine, Health Sciences. --- Medicine/Public Health, general. --- Statistics . --- Biomedicine, general. --- Clinical trials. --- Statistical analysis --- Statistical data --- Statistical science --- Econometrics --- Health Workforce

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Drugs --- Pharmaceutical industry --- Metabolic Phenomena --- Pharmacological Phenomena --- Kinetics --- Natural Science Disciplines --- Investigative Techniques --- Fluids and Secretions --- Chemicals and Drugs --- Evaluation Studies as Topic --- Drug Discovery --- Body Fluids --- Chemistry --- Methods --- Drug Evaluation, Preclinical --- Chemistry Techniques, Analytical --- Metabolism --- Pharmacokinetics --- Pharmaceutical Preparations --- Biochemical Phenomena --- Phenomena and Processes --- Physiological Phenomena --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Anatomy --- Disciplines and Occupations --- Chemical Phenomena --- Health & Biological Sciences --- Pharmacy, Therapeutics, & Pharmacology --- Chemical Phenomenon --- Chemical Process --- Physical Chemistry Phenomena --- Physical Chemistry Process --- Physicochemical Phenomenon --- Physicochemical Process --- Chemical Concepts --- Chemical Processes --- Physical Chemistry Concepts --- Physical Chemistry Processes --- Physicochemical Concepts --- Physicochemical Phenomena --- Physicochemical Processes --- Chemical Concept --- Chemistry Process, Physical --- Chemistry Processes, Physical --- Concept, Chemical --- Concept, Physical Chemistry --- Concept, Physicochemical --- Concepts, Chemical --- Concepts, Physical Chemistry --- Concepts, Physicochemical --- Phenomena, Chemical --- Phenomena, Physical Chemistry --- Phenomena, Physicochemical --- Phenomenon, Chemical --- Phenomenon, Physicochemical --- Physical Chemistry Concept --- Physicochemical Concept --- Process, Chemical --- Process, Physical Chemistry --- Process, Physicochemical --- Processes, Chemical --- Processes, Physical Chemistry --- Processes, Physicochemical --- Anatomies --- Physiological Concepts --- Physiological Phenomenon --- Physiological Process --- Physiological Processes --- Concept, Physiological --- Concepts, Physiological --- Phenomena, Physiological --- Phenomenas, Physiological --- Phenomenon, Physiological --- Physiological Concept --- Process, Physiological --- Processes, Physiological --- Biochemical Concepts --- Biochemical Phenomenon --- Biochemical Process --- Phenomena, Biochemical --- Biochemical Processes --- Biochemical Concept --- Concept, Biochemical --- Concepts, Biochemical --- Phenomenon, Biochemical --- Process, Biochemical --- Processes, Biochemical --- Molecular Biology --- Pharmaceutic Preparations --- Pharmaceutical Products --- Pharmaceuticals --- Preparations, Pharmaceutical --- Drug --- Pharmaceutical --- Pharmaceutical Preparation --- Pharmaceutical Product --- Preparation, Pharmaceutical --- Preparations, Pharmaceutic --- Product, Pharmaceutical --- Products, Pharmaceutical --- Pharmacology --- Drug Dosage Calculations --- ADME --- ADME-Tox --- ADMET --- Absorption, Distribution, Metabolism, Elimination, and Toxicology --- Absorption, Distribution, Metabolism, and Elimination --- Drug Kinetics --- Kinetics, Drug --- LADMER --- Liberation, Absorption, Distribution, Metabolism, Elimination, and Response --- Metabolic Phenomenon --- Metabolic Process --- Metabolism Concepts --- Metabolism Phenomena --- Process, Metabolic --- Processes, Metabolic --- Anabolism --- Catabolism --- Metabolic Concepts --- Metabolic Processes --- Concept, Metabolic --- Concept, Metabolism --- Concepts, Metabolic --- Concepts, Metabolism --- Metabolic Concept --- Metabolism Concept --- Phenomena, Metabolic --- Phenomena, Metabolism --- Phenomenon, Metabolic --- Analytical Chemistry Methods --- Analytical Chemistry Techniques --- Analytical Chemistry Method --- Analytical Chemistry Technique --- Chemistry Method, Analytical --- Chemistry Methods, Analytical --- Chemistry Technique, Analytical --- Method, Analytical Chemistry --- Methods, Analytical Chemistry --- Technique, Analytical Chemistry --- Techniques, Analytical Chemistry --- Drug Evaluation Studies, Preclinical --- Drug Evaluations, Preclinical --- Evaluation Studies, Drug, Preclinical --- Evaluation, Preclinical Drug --- Evaluations, Preclinical Drug --- Medicinal Plants Testing, Preclinical --- Preclinical Drug Evaluation --- Preclinical Drug Evaluations --- Drug Screening --- Evaluation Studies, Drug, Pre-Clinical --- Drug Screenings --- Screening, Drug --- Screenings, Drug --- Methodological Studies --- Methodological Study --- Procedures --- Studies, Methodological --- Study, Methodological --- Method --- Procedure --- Body Fluid --- Fluid, Body --- Fluids, Body --- Drug Prospecting --- Discovery, Drug --- Prospecting, Drug --- High-Throughput Screening Assays --- Bioprospecting --- Critique --- Evaluation Indexes --- Evaluation Methodology --- Evaluation Report --- Evaluation Research --- Methodology, Evaluation --- Pre-Post Tests --- Qualitative Evaluation --- Quantitative Evaluation --- Theoretical Effectiveness --- Use-Effectiveness --- Critiques --- Effectiveness, Theoretical --- Evaluation Methodologies --- Evaluation Reports --- Evaluation, Qualitative --- Evaluation, Quantitative --- Evaluations, Qualitative --- Evaluations, Quantitative --- Indexes, Evaluation --- Methodologies, Evaluation --- Pre Post Tests --- Pre-Post Test --- Qualitative Evaluations --- Quantitative Evaluations --- Report, Evaluation --- Reports, Evaluation --- Research, Evaluation --- Test, Pre-Post --- Tests, Pre-Post --- Use Effectiveness --- Secretions and Fluids --- Investigative Technics --- Investigative Technic --- Investigative Technique --- Technic, Investigative --- Technics, Investigative --- Technique, Investigative --- Techniques, Investigative --- Natural Sciences --- Physical Sciences --- Discipline, Natural Science --- Disciplines, Natural Science --- Natural Science --- Natural Science Discipline --- Physical Science --- Science, Natural --- Science, Physical --- Sciences, Natural --- Sciences, Physical --- Pharmacologic Phenomena --- Pharmacologic Phenomenon --- Pharmacologic Process --- Pharmacological Concepts --- Pharmacological Phenomenon --- Pharmacologic Processes --- Pharmacological Processes --- Concept, Pharmacological --- Concepts, Pharmacological --- Pharmacological Concept --- Phenomena, Pharmacologic --- Phenomena, Pharmacological --- Phenomenon, Pharmacologic --- Phenomenon, Pharmacological --- Process, Pharmacologic --- Processes, Pharmacologic --- Processes, Pharmacological --- Medical innovations --- Pharmaceutical analysis --- Analysis --- Technological innovations --- pharmacokinetics --- Adulteration and analysis --- Techniques --- Technique