HDR defense of Bastien Boussat on 02/23/23

Bastien BOUSSAT from BCM team will defend his habilitation to supervise research on thursday, february 23, 2023 at 4pm on:

" Health Services Performance Measurement:
Development and Use of Quality and Safety of Care Indicators. "


bullet Jury

  • Marie-Thérèse LECCIA, PUPH, Université Grenoble Alpes, Presidente
  • José LABARERE, PUPH, Université Grenoble Alpes, Reporter
  • Philippe MICHEL, PUPH, Université Claude Bernard Lyon 1, Reporter
  • Laurent BOYER, PUPH, Aix-Marseille Université, Reporter
  • Olivier PALOMBI, PUPH, Université Grenoble Alpes, Examiner
  • William GHALI, Full Professor, Université de Calgary, Examiner

bullet Abstract

Measuring and reporting on the quality of health care has become fundamental in recent years. Indeed, quality is now supplanting volume as the main index of performance in the health sector. The public expects real transparency and healthcare organizations are following this trend by publicly reporting on the performance of hospitals and physicians. More and more indicators of quality and safety of care have been integrated into health care financing programs, whether in terms of penalties as in the USA or incentives as in France.

Faced with this growing development, it is necessary to have tools that measure quality and safety of care. While many indicators exist, most have low validity, making comparisons and public reporting unfair to health care institutions, which can damage both their finances and their reputation. Several examples can be cited. Patient Safety Indicators are produced from diagnostic codes for hospital stays in hospital claim databases. However, this information only partially reflects the complexity of care, and is subject to differences in terms of validity (differences between hospitals and national health systems). Readmission indicators are another metric used by health systems. The underlying logic of readmission reduction programs is that the majority of readmissions are preventable, resulting from adverse events or poor quality management. However, this assumption is invalidated when readmissions are studied using clinical data and methods adapted to take into account the subjective nature of avoidability.

Health systems need to develop new approaches, taking into account the complexity and methodological issues of measuring quality and safety. Methodological innovations are needed to make progress in this area. Artificial intelligence could be used to explore electronic medical record (EMR) data in greater detail. Another approach concerns the use of improved ontologies to classify health conditions, such as the new International Classification of Diseases ICD-11, which incorporates new classifications adapted to the issue of adverse events.

In addition to the problem of imperfect validity, quality and safety indicators are not sufficiently integrated into the health services. Measurement alone is minimally effective, but measuringt he quality and safety of care and reporting data back to clinicians in microsystems is more impactful. Even better yet are strategies that pair measurement with intervention.

My current research and my project for the coming years aim to develop new quality and safety indicators. My hospital activity is also related to the use and collection of quality and safety indicators. As a researcher in the BCM team of the TIMC laboratory, my future project is based on two main objectives:
- The development of new indicators of quality and safety of care, based on 1/ the use of artificial intelligence algorithms applied to data from computerized medical records; and 2/ the new ontologies and classifications of diseases (ICD-11).
- The development of interventions centered on the feedback of automated indicators continuously provided to health professionals.