The medical repositories often take the form of algorithms that assist the medical decision. Gradually worked out a true algorithmic approach, one of the most spectacular examples is in psychiatry. Since the 1950s, the American Psychiatric Association has indeed undertaken the task of creating an encyclopedic exhaustive classification of mental disorders and to define for each a rigorous diagnostic procedure in an algorithmic form. The effort of standardization of language is essential. The question is not whether there is a real depression well or poorly described by the nomenclature. It is rather to ensure that all clinicians have the same language to compare patients' conditions and patterns of care, to improve the quality of care, or simply to code the same way the forms of support hospitals or insurance agencies.
[...] Agent's first care (primary care), it is also paid by capitation and very involved in managing the NHS. The concept of primary care is not familiar to France. Social Security is responsible for curative care, while prevention is expected to return to the state and departments. The mission of “primary care” is distributed among actors, budgets and different institutions. The responsibility of doctors in public health depends on a combination of cultural factors, physician involvement in management and a sense of belonging to a structured organization. [...]
[...] What is the quality of the process used and results achieved? 3. Those supported are met? 4. What is the specific contribution of the network organization in the degree of achievement of objectives, quality processes and outcomes? 5. What are the indirect effects, positive or negative, induced by the network? The combination of CME and evaluation networks produces a virtuous cycle of continuous improvement of care processes. The challenge for a network, is obviously to enable this kind of feedback loop. [...]
[...] The apparent conflict between the Order of Paris and the general practitioners who adhered to the conventional option of "gatekeeper" has shown that communication in this area was difficult. It is difficult, even illegal, to take advantage of membership in a specific system of care network (or chain), since such an approach, akin to some of the advertising violates the rules of the confraternity. It is necessary that an agreement is reached to allow the promotion of healthcare networks and their members. [...]
[...] The rights and obligations regarding the reimbursement of medical expenses vary from one insurance plan to another. Doctors often retain and apply the appropriate form for most of their patients. They are reluctant, for ethical reasons to change their practices depending on the mode of payment of the note or consultation. They belong apparently he, the recommendations made by the HMO, which appear conservative, both medically and economically. The mimicry between peers also plays a role: those who do not treat many patients belong to a network, but are in frequent contact with colleagues who do, tracing their practice on the latter. [...]
[...] model of medical behavior corresponds to an organized practice, set by experts and not by the intuition of a clinician, in short, a practice more scientific. It seeks to promote clinical practice based on a systematic approach to scientific literature, looking for specific answers to specific questions, making a critical assessment of the validity and usefulness of what holds this literature, seeking to apply this education of patients and real people, and leading the performance evaluation of the practitioner. Such practice is very demanding for the physician, who must train. [...]
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