The CRIOAc healthcare network in France: A nationwide Health Ministry program to improve the management of bone and joint infection
The CRIOAc healthcare network in France: A nationwide Health Ministry program to improve the management of bone and joint infection
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DOI：
10.1016/j.otsr.2018.09.016
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发表时间：
2019-02-01
影响因子：
2.3
通讯作者：
Lambotte, Jean Christophe
中科院分区：
文献类型：
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作者：
Ferry, Tristan;Seng, Piseth;Lambotte, Jean Christophe
背景：骨与关节感染（BJIs）在工业化国家具有重要的临床和经济影响。它的管理需要多学科的方法，以及对最复杂病例的丰富经验，以限制治疗失败，运动残疾和截肢风险。据我们所知，目前没有专门管理BJI的国家组织。是否有可能在国家一级建立一个网络，由整形外科医生、感染学家和微生物学家在当地举行多学科会议，以促进区域中心招募和管理复杂骨关节感染患者？假设：一个国家的医疗网络与区域标记的中心创造了一个动态，提高招聘，管理，教育，和临床研究领域的复杂BJI.Patients和方法：我们描述了这个独特的国家医疗网络的历史，它是如何工作的，指定的任务托付给CRIOAcs，评估网络的活动在第一个十年，最后讨论的观点。结果：CRIOAc网络中的24个中心的标签允许领土的网格化，并有可能在法国每个地区管理复杂的BJI。设计并使用了一个专门的安全国家在线信息系统，以便利多学科协商会议期间的决策。自2012年10月至2017年6月，在该网络所属机构举行了4553次多学科咨询会议，讨论了19,961人的34,607例病例。人工关节感染占所有BJI的38%（7585/19，961）。在所有讨论的病例中，复杂性发生率为61%（21，110/34，607）（与抗生素耐药性、感染复发、患者合并症相关）。2014年举办了一次全国科学会议，并在BJI领域推出了国家研究生文凭。全国各学科之间和各标记中心之间的教育、临床研究和互动的促进发挥了协同优势，极大地促进了BJI患者的管理。讨论：CRIOAc网络在法国的建立需要时间，法国卫生部也有成本。然而，这一网络极大地促进了BJI在法国的管理，并允许将复杂的BJI的管理集中在已获得显著技能的中心。据我们所知，在BJI领域没有其他类似的全国性网络。(C)2018年由Elsevier Masson SAS出版。
Background: Bone and joint infections (BJIs) have a major clinical and economic impact in industrialized countries. Its management requires a multidisciplinary approach, and a great experience for the most complicated cases to limit treatment failure, motor disability and amputation risk. To our best knowledge there is not currently national specific organization dedicated to manage BJI. Is it possible to build at a national level, a network involving orthopaedic surgeons, infectiologists and microbiologists performing locally multidisciplinary meetings to facilitate the recruitment and the management of patients with complex bone and joint infection in regional centers?Hypothesis: A national healthcare network with regional labeled centers creates a dynamic that improves the recruitment, the management, the education, and the clinical research in the field of complex BJI.Patients and methods: We describe the history of this unique national healthcare network and how it works, specify the missions confided to the CRIOAcs, evaluate the activity of the network over the first decade, and finally discuss perspectives.Results: The labelling of 24 centers in the CRIOAc network allowed for a meshing of the territory, with the possibility of management of complex BJI in each region of France. A dedicated secure national online information system was designed and used to facilitate decision-making during multidisciplinary consultation meetings. Since October 2012 to June 2017, 4553 multidisciplinary consultation meetings have been performed in the structures belonging to the network, with 34,607 cases discussed in 19,961 individual. Prosthetic joint infections represented 38% (7585/19,961) of all BJIs. Among all the cases discussed, the rate of complexity was of 61% (21,110/34,607) (related to antibiotic resistance, infection recurrence, patient co morbidities). A national scientific meeting was created and a national postgraduate diploma in the field of BJI was launched in 2014. The promotion of education, clinical research and interactivity between each academic discipline and between each labeled centers across the country has synergized the strengths and have greatly facilitated the management of patients with BJI.Discussion: The setting up of the CRIOAc network in France took time, and has a cost for the French Ministry of Health. However, this network has greatly facilitated the management of BJI in France, and allowed to concentrate the management of complex BJI in centers that have significantly gained skills. There is, to our knowledge, no other exemple of such nationwide network in the field of BJI. (C) 2018 Published by Elsevier Masson SAS.