Since the publication of the results of the last evaluation last February, what has been the state of the quality and safety of care within establishments? On Wednesday, December 18, the High Authority for Health (HAS) published the results of its quality indicators collected over the past year on Qualiscope*. In a context of difficulties in accessing care, it is in fact “ all the more important for professionals to take stock of their practices, their difficulties but also their successes », argues Professor Lionel Collet, president of the HAS, in the introduction to the presentation of the figures. While these highlight an overall and constant improvement in the indicators, progress is still expected on some of them. Or a conclusion in the same line as that of the year 2023, where it signaled points for vigilance.
Patient satisfaction still on the rise
This year, like every year since the evaluation was implemented in 2016, the level of patient satisfaction continues to increase in three of the targeted sectors : 79.5 out of 100 in outpatient surgery (+0.6 points compared to 2023)76.7 out of 100 in medical care and rehabilitation (SMR, +1 point)and 74.8 out of 100 in medicine-surgery-obstetrics (MCO) over 48 hours (+0.5 points). In detail, the HAS underlines the very good scores in MCO for medical and paramedical care or even reception, where satisfaction exceeds a score of 70. On the other hand, the results on the organization of discharge (65 ) and rooms and meals (68.4) still stand out with room for improvement.
Outpatient surgery highly rated and HAD in progress
In outpatient surgery, the indicators relating to hospitalization (medical care, reception) and its preparation present very good scores; but this is less the case for the post-operative period. Particularly for everything related to pain management, which remains a cause of early re-hospitalizations and anxiety when it is poorly managed. “ Its anticipation by prescribing analgesics before admission represents a major issue in outpatient surgery.. » Fewer than 4 out of 10 patients had received a prescription for painkillers before admission. Finally, establishments still fail to write the liaison letter upon discharge from hospitalization : if its indicator gains 7 points compared to the previous year, it is correctly carried out for less than 7 out of 10 patients.
Finally, on the home hospitalization side (HAD), patient record keeping and coordination of care are both improving: to 89% (+3.5 points compared to 2021) and 78% (+8 % compared to 2021), respectively.
Measuring 21 indicators
In 2024, the HAS measured 21 indicators, in the usual sectors of activity: medicine-surgery-obstetrics (MCO), including outpatient surgery, medical and rehabilitation care (SMR), home hospitalization (HAD ) and psychiatry. As every year, it relied on data from questionnaires, patients and establishments, patient files, and the medicalization of information systems program (PMSI, which collects data for all hospitalizations taking place on French territory in order to calculate the financing of establishments and determine the organization of care). Thus, 1.35 million patients responded, of which 760,000 had been treated in outpatient surgery, 530,000 in MCO lasting more than 48 hours and 49,000 in SMR.
The life expectancy of a patient suffering from severe psychiatric illness is 20% lower than that observed in the general population.
In psychiatry, indicators are still insufficient
There remains psychiatry, as in previous years, whose various indicators still need to be improved. “ The life expectancy of a patient suffering from severe psychiatric illness is 20% lower than that observed in the general population. », underlines the HAS. The leading cause of excess mortality identified is suicide, but accidents and medical causes are also over-represented: cardiovascular and respiratory diseases are distinguished by a morbidity rate of between 30 and 60%. HAS notes, however, that the indicators it has designed to assess the quality of psychiatric care are tending to improve:
- The cardiovascular and metabolic assessment in adult patients increased by 9 points compared to 2021, and is carried out in 69% of patients.
- The gastrointestinal assessment is carried out in 46% of patients, or +17.5 points.
- And the identification and the offer of help in stopping addictions are “ workforce » in 65% of patients (i.e. +10.6 points).
Consumption of hydroalcoholic gel still falling
HAS finally looked at the protection and hygiene measures put in place by caregivers. And on the prevention of healthcare-associated infections, it notes a decline in the use of hydroalcoholic solutions, for the second year in a row: their consumption amounts to 79%, or -3 points compared to the previous year, when it already showed a decline of 11 points. When presenting this quality indicator in 2023, the Agency highlighted the relaxation of barrier measures put in place during the Covid pandemic to explain this decline. “ The percentage of establishments achieving a satisfactory level (100% of their personalized consumption objective) declines from 33% in 2023 to 28% in 2024. The drop in this indicator since 2021 is certainly explained by the relaxation of measures resulting from the health crisis », she notes today.
Progress expected on the vaccination of health professionals
As for the anti-flu vaccination for caregiversindicator integrated in 2022 as part of the 2022-2025 national strategy for the prevention of infections and antibiotic resistance, the results are even less good: only 19% of establishments have reached or exceeded an intermediate level (set by the World Health Organization at 75% of healthcare professionals). We must therefore promote vaccination more strongly, in particular through organizational improvement actions, encourages the HAS. And to recall, for all practical purposes, its own recommendations on the vaccination obligations of professionals. New indicators of quality perceived by the patient will be measured in 2025: the experience of patients hospitalized full-time in adult psychiatry and the experience of patients, hospitalized in MCO, on hand hygiene. Other indicators are also being developed: the experience of women in maternity and the experience of patients in emergency rooms. », Finally announces the HAS in conclusion.
Update on establishment certification
In terms of establishment certification, the results are also generally positive, with 70% of public and private establishments evaluated as part of the process.
– 87% of establishments show good or very good results.
– 23% obtain the “High quality of care” rating. University hospitals and cancer centers are the most numerous to obtain it.
– 13% do not meet the quality of care requirements defined by the framework.
– et 9% are certified under conditions (i.e., demonstrate rapid improvement within 6-12 months).
– The 4% of non-certified establishments will be subject to a visit between 12 and 24 months. « The HAS alerts the ARS of the decision not to certify these establishments so that they can offer support solutions. » Many establishments located overseas (with the exception of Réunion) and in Normandy are showing insufficient results, she also warns.
Access the results of the evaluation on the quality and safety of care
*Qualiscope is the online service that allows everyone to find out about the quality and safety of care in all health establishments, both public and private.
