Développement et analyse d'indicateurs sur le réseau de la santé montréalais
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
RESUME : Afin de mieux evaluer le fonctionnement en «reseau» du reseau de sante montrealais, l’agence de la sante et des services sociaux de Montreal a eu recours a une equipe de recherche de l’Ecole Polytechnique. Le fonctionnement en « reseau » fait reference aux liaisons entre les differents etablissements de sante qui collaborent et travaillent d’une facon complementaire afin d’offrir les meilleurs services medicaux aux patients dans les plus courts delais. Le fonctionnement en reseau se base principalement sur un systeme de reference inter-etablissements des patients. Nous avons debute par un inventaire de bases de donnees (BDD) dont dispose l’agence. Le but etait de reperer les BDD potentielles qui aideront a atteindre l’objectif principal d’aider l’Agence a effectuer une meilleure repartition des ressources afin d’absorber la fluctuation de la demande et de s’assurer que les ressources soient disponibles, au bon moment et au bon endroit afin d’offrir un service de qualite aux patients. Nous avons retenu une base jumelee contenant les actes enregistres par la regie de l’assurance maladie du Quebec (RAMQ). Seules les donnees des annees 2001 et 2009 seront analysees dans le present memoire. Les donnees etant agregees et regroupees pour des raisons de confidentialite, nous avons analyse les actes sans les relier a un patient particulier et sans recreer sa trajectoire dans le reseau. Par la suite, des indicateurs ont ete developpes pour analyser les references des actes qui se font entre les 12 centres de sante et de services sociaux (CSSS). Deux principaux indicateurs ont ete mis en place : l’adherence et l’autonomie. L’adherence permet d’evaluer le pourcentage d’actes faits a l’interieur d’un territoire pour ses citoyens, tandis que l’autonomie indique, pour un territoire, si une reference faite par un medecin a eu lieu dans le meme territoire. Ceci determine a quel point les CSSS sont autonomes et capables d’absorber la demande. D’apres les resultats obtenus, les CSSS COTE-DES-NEIGES - METRO - PARC-EXTENSION et PIERREFONDS - LAC SAINT-LOUIS forment un monopole en ayant les taux d’adherence ainsi que les taux d’autonomie les plus eleves. Nous notons egalement que le CSSS COTE-DES-NEIGES - METRO - PARC-EXTENSION est le plus grand recepteur d’actes referes. D’autres CSSS, tel que COTE-SAINT-LUC - NDG - MONTREAL-OUEST eprouvent plus de difficultes a repondre a la demande et a servir les citoyens de leur secteur regional en priorite. Les etudes ont egalement demontre que le nombre d’etablissements et leur type (cliniques medicales, centre hospitaliers, etc.) ont une influence directe sur les indicateurs. Les differentes specialites offertes dans les CSSS peuvent egalement avoir un impact sur les taux d’adherence et d’autonomie. L’agence devra alors mettre en place des strategies pour renforcer et augmenter les taux d’adherence des patients a leur CSSS. De plus, celle-ci doit egalement trouver des moyens pour rendre les CSSS plus autonomes et capables d’absorber une grande partie de la demande sans devoir diriger les patients vers d’autres CSSS par manque de specialites ou en raison du depassement de la capacite dans leurs etablissements.-----------ABSTRACT : To better assess the network operations of Montreal's health care system, the Agency for Health and Social Services of Montreal fall back on a research team at Ecole Polytechnique. Network operations refers to connections between the various health institutions that collaborate and work together in a complementary manner to provide the best medical services to patients in the shortest time. The network operations are based primarily on inter- institutions patient referral system. We started with an inventory of databases (BDD) available to the agency. The goal was to identify potential BDD that will help to achieve the main objective. In other words, we aimed to help the Agency in performing a better allocation of resources to absorb demand fluctuations and ensuring that resources are available at right time and the right place to provide quality service to patients. The research team chose a combined database containing the records registered by the authority of the Health Insurance of Quebec (RAMQ). Only data for the years 2001 and 2009 will be analyzed herein. Unfortunately, the trajectory of a patient could not be traced since the data have been shortened and combined for confidentiality reasons. Subsequently, key indicators were developed to analyze the referenced acts among the 12 health and social services centers (CSSS). Two main indicators were introduced: the adhesion and autonomy. The adhesion is used to evaluate the percentage of acts that are made within a territory for citizens of the territory. The autonomy indicates for each territory if a reference is made by a physician in the same territory or not. This determines if the CSSS are autonomous and able to absorb demand. According to the results, the CSSS COTE-DES-NEIGES - METRO - PARC-EXTENSION and PIERREFONDS - LAC SAINT LOUIS form a monopoly by having the highest rate of adhesion and autonomy and the CSSS COTE -DES-NEIGES - METRO - PARC-EXTENSION is the largest receiver of referred acts. On the other hand, some CSSS as COTE-SAINT-LUC - NDG - MONTREAL-OUEST encounter difficulties in meeting the demand and prioritizing the citizens of their regional sector. The analyses have also shown that the number of establishments and their category (medical clinics, hospital center, etc.) have a direct influence on the indicators. The different specialties offered in the CSSS can also vary the rates. The agency will then develop strategies to strengthen and increase the adherence of patients to their CSSS. It must also find ways to make the CSSS more independent and able to absorb a larger number of patients without having to refer them to other CSSS because of over-capacity in their health institutes or a lack in the available specialities.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it