In 2006, 6,509 patients with end-stage renal disease living in 16 regions covering 48(M) inhabitants (79% of the French population), started renal replacement therapy (dialysis or preemptive graft): median age was 71 years; 3% had a preemptive graft. The overall crude annual incidence rate of renal replacement therapy for end-stage renal disease was 137 per million population (pmp) in 16 regions that met exhaustivity, with significant differences in sex and age-adjusted incidence across regions (107 to 179 pmh). At initiation, more than one patient out of two had at least one cardiovascular disease and 37% diabetes (88% Type 2 non-insulin-dependent diabetes). On December 31, 2006, 25,774 patients living in these 16 regions were on dialysis: median age was 69.5 years. On December 31, 19,491 patients were living with a functioning graft: median age was 53 years. The overall crude prevalence rate of dialysis was 536 pmp in 15 regions. The overall crude prevalence rate of renal graft was 409 pmp in 15 regions. The overall crude prevalence rate of renal replacement therapy for end-stage renal disease was 945 pmp in 15 regions, with significant differences in age-adjusted prevalence across regions (765 to 1061 pmh). In the 2002-06 cohort of 18,264 incident patients, the overall one-year survival rate was 82%, 72% at 2 years and 63% at 3 years. Survival decreased with age, but remained above 50% at 2 years in patients older than 75 at RRT initiation. Among the 6,321 new patients starting dialysis in 2006 in the 16 regions, 6% had a BMI lower than 18.5 kg/m(2) and 17% a BMI higher than 30. At initiation, 62% had a haemoglobin value lower than 11g/l and 9% an albumin value lower than 25g/l. The first haemodialysis was started in emergency in 30% of the patients and with a catheter in 48%. On December 31, 2006, 8% treated in the dialysis units of the 16 regions received peritoneal dialysis, of which 38% were treated with automated peritoneal dialysis. 95% of the patients on haemodialysis had 3 sessions per week, with a median duration of 4 hours. In 2006, 2,144 patients received a renal graft. On December 31, 2006, 4,838 patients were on the waiting list for a renal graft in the transplantation centres of the 16 regions.

Second certification process of healthcare organisations (V2) has a main challenge: clinical care improvement through strengthening of clinical practices appraisal (CPA). The approach is based on standards focused on CPA. Besides a specified policy devoted to clinical practices appraisal (Table 1 - standard 6c), CPA in V2 has 3 key objectives: appropriateness of hospitalization and acts, a priori and a posteriori management of healthcare-related risk and clinical practices related to specific diseases. First results show that issues the more evaluated by healthcare organisations are appropriateness of antibiotics and anti-thrombosis orders (Table 1 - 44c), safety in medication management, urinary catheterization and seclusion (Table 1 - 45a), adverse events such as falls and bedsores (Table 1 - 45b). Regarding diseases (Table 1 - 46), cancer, coronary disease, stroke and diabetes are the more evaluated in medicine, cancer, antibiotic prophylaxis and hip prosthesis in surgery, delivery and cesarean section in obstetrics, suicide in psychiatry, pain and nutrition in long term care or readaptation. CPA in V2 is in tune with current French law context which makes mandatory individual CPA and continuous medical training, while physicians'accreditation of at-risk specialties is a voluntary process.

Beyond a social and professional requirement, assessing physician practices has become a legal obligation. The success of this assessment, i.e., its utility for the quality of the healthcare provided to patients requires that it be integrated into routine medical procedure.