Program for medicalizing information systems in France: a management and quality assessment tool

Objective: We analyzed data reported in the scientific literature to assess how the program for medicalizing information systems employed in France for budget management and allocation could be used to evaluate health care quality. A management tool: In France the PMSI (Programme de Medicalisation des Systemes d'Information) is used outside health care facilities to plan an allocate health care budgets. Within each facility, it can be used to coordinate external and internal resource allocations. The goal is to medicalize management decisions. Certain methods are based on calculations of total costs per hospital stay and others on the construction of budgets for individual units. A quality assessment tool: Medical criteria of final outcome of health care, for example mortality, are widely used for interhospital comparisons. The PMSI can be a useful tool for monitoring inter-hospital comparisions if three prerequisites are met: comparable data, identification of convenient tracers of care episodes or clinical situations, and multifactorial adjustment to account for Variations in rates. The most widely used adjustment factors concern patient characteristics: age, sex, case severity, comorbidity, socio-economic level and hospital characteristics: size and status, number of stays and interventions, emergency and intensive care activity, referral practices.