Health access and care pathways:
The question of access to care, especially for people with chronic diseases or others who are frail or dependent, is a central concern of policy makers seeking to improve the performance of the healthcare system. This first research theme is focused on understanding how health policies and other interventions affect care pathways.
A major project in which the team is currently engaged is the evaluation of the Territoire de Soins Numérique (TSN) project, a large-scale field experiment that involves deploying digital tools and e-health strategies in five French regions with the goal of improving health outcomes through better coordination of care. Beyond analysing the impact of this specific experiment, the project provides the opportunity for a richer understanding of the concept of care pathways and methods for identifying and analysing these pathways using clinical and administrative data.
Understanding health care pathways is important for other ongoing projects conducted in collaboration with other research teams. For example, EMOS is collaborating with other U1219 Inserm researchers with expertise in the area of aging on a project evaluating “medical homes” for Alzheimer patients. Another collaborative project, led by ARS and implemented by the CCECQA, focuses on patients who have had cerebral vascular incidents, examining the relationship between care pathways and post-stroke sequelae.
The care pathway a patient follows depends critically on having access to care, which depends importantly on financial factors. The EMOS team is currently engaged in research that considers issues of access for three vulnerable populations: poor households, students and migrants. For these populations, the research focuses on the identification of barriers to healthcare access and the evaluation of public policies aimed at facilitating healthcare access (ACS , AME, CMU-C).
For these projects, the team leverages data from a variety of sources including medico-administrative databases (PMSI SNIIRAM, CAF), longitudinal cohort data (3C, I-Share, cardiovascular neurovascular Aquitaine registers), general population surveys (ESPS) and specially designed surveys of specific populations.
Health activity efficiency:
Research in this area is focused on linking the cost and performance of health interventions (therapeutic, diagnostic, preventive, organizational) in order to maximize population health within a given budget. This work is carried out in close collaboration with the Methodological Support Unit for Clinical and Epidemiological Research (USMR) of the Bordeaux University Hospital Centre and the CIC 14-01 Clinical Epidemiology Unit. The research is based on clinical studies or decision models, leveraging existing data as much as possible. Examples of such data include:
- Cohorts and registries: for example, the EMOS unit is participating in a research project using data from an Aquitaine HIV registry (GECSA) with the objective of estimating the utilization of care and analysing the relevance of care pathways.
- Medical and administrative databases: the EMOS unit is currently working with data from the National Health Insurance Inter-regime Information System (SNIIR-AM), using probabilistic matching techniques to link this data with data from clinical studies.
The statistical methods and probabilistic modelling applied to the analysis of efficiency and value analysis of information are central to the activity of this axis.
Hospital performance and management:
The third research theme focuses on the performance of health care organizations and activities within hospitals.
The MoSTRA project, funded under the PREPS ministerial research call for proposals (Research Program Performance of the Healthcare System), analyses the effectiveness and efficiency of a combination of treatment strategies implemented by organizations in medicine, surgery and obstetrics. This project applies a combination of quantitative and qualitative methods to analyse 30 health facilities in four French regions six months before and eighteen months after the implementation of the intervention.
In addition, as part of a contracted project between ISPED and the healthcare department of the Bordeaux University Hospital aiming to optimize the human resources management, EMOS researchers are conducting an analysis that seeks to understand factors that determine the attractiveness of night shift schedules, thereby affecting employee retention.
This theme focusing on hospital performance is closely linked to work related to the appropriateness of care, conducted in conjunction with the Health Evaluation Method Unit of the Bordeaux CHU. This research involves defining and validating indicators that can be used to evaluate the impact of various interventions on the appropriateness of care.