title: [Biological procedures, civil and military health facilities, and recommendations of good practice and hospital reform: the example of diabetes management].
abstract: In the context of implementing hospital reforms, the objective of this work was to compare practice in relation to evidence-based guidelines and recommendations for good practice in diabetes screening and management. Laboratory test consumption was determined for patients hospitalized for diabetes in 2005 in three public hospitals (one civilian, two military) taking care of diabetic patients and performing related biological tests. For the 395 admissions in these three hospitals during 2005 [Diagnosis-related group (DRG) 10M02V "Diabetes, age 36 to 69 years without co-morbidity"], the average length of stay and the number of biological acts ["B"] performed were lower than those given by the French national health cost study scale and by the Montpellier University Hospital database. In terms of qualitative coherence between the guidelines for treatment and the recommendations, the total number of biological acts ["B"] is higher than if one were to strictly apply the good practice suggested by the French Health Authority. These three hospitals have and apply different guidelines for practice in the area of diabetes management. The implementation of reforms such as DRG-based payment scales may be an additional leverage to ensure that the recommendations of best practices are effective. Improved methods and tools for data collection and monitoring are essential, especially for estimating revenue and expenditure.
authors.affiliation: Service de biologie médicale, Hôpital d'instruction des armées Bégin, 69, avenue de Paris, 00498 Armées, 94160 Saint-Mandé, France.
authors.forename: Eliane
authors.initials: E
authors.lastname: Garrabé
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Bréchat
authors.forename: Patrick
authors.initials: P
authors.lastname: Romary
authors.forename: Bruno
authors.initials: B
authors.lastname: Massit
authors.forename: Taly
authors.initials: T
authors.lastname: Meas
authors.forename: Roland
authors.initials: R
authors.lastname: Rymer
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Guillausseau
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D003953:Diagnosis-Related Groups / Q000191:economics; D004469:Economics, Hospital; D005602:France; D006442:Glycated Hemoglobin / Q000032:analysis; D018166:Health Care Reform / Q000191:economics; D006739:Hospital Administration / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006772:Hospitals, Military / Q000592:standards; D006801:Humans; D007325:Institutional Practice / Q000191:economics / Q000592:standards*; D007902:Length of Stay; D008875:Middle Aged; D011634:Public Health; D012040:Regional Health Planning; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin