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Nathalie Fourcade

2017-18 Harkness Fellow Deputy Director Directorate for Research, Studies, Assessment and Statistics (DREES) Ministry of Health and Social Affairs



Placement: New York State Psychiatric Institute at Columbia University  

Mentor: Harold Pincus, M.D. (Professor and Vice Chair, Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center)

Co-mentor: Lisa Dixon, M.D, M.P.H. (Professor and Director, Division of Behavioral Health Services and Policy Research, Columbia University Medical Center)

Project: Quality Indicators to Promote Mental Healthcare Quality

Nathalie Fourcade, M.Sc., M.Soc.Sc., M.Econ, M.Stat., is a 2017-18 French Harkness Fellow in Health Care Policy and Practice. She is currently the Deputy Director and Head of the Health Department of the Directorate of Research, Studies, Assessment and Statistics (DREES) in the French Ministry of Health and Social Affairs. Fourcade was instrumental in the creation of the National Suicide Observatory at DREES, and oversees a staff of 50 people responsible for producing statistics, simulations and assessments on the French healthcare system. She previously served as Head of the Department of Statistics, Forecasts and Studies at the National Family Allowances Office (CNAF) and Head of the Redistribution and Old Age Pensions Division at the French Treasury (Ministry of the Economy), where she specialized in macroeconomics. Fourcade holds three Master’s degrees: in Social Sciences from Ecole Normale Superieure Fontenay-Saint Cloud, in Economics from the Paris School of Economics, and in Statistics from ENSAE Paris Tech. She passed the Agregation, a competitive examination of the French education system, in Human and Social Sciences. 

Project Abstract: Quality improvement requires measurement, and quality indicators are a crucial link between scientific evidence and high quality healthcare. Yet measurement alone is insufficient, as the successful implementation of quality indicators depends on a wide array of conditions. This project will analyze these conditions, from understanding variations in care to establishing accountability and incentives, and practice characteristics, including healthcare professionals’ autonomy. The importance of other phenomena, such as the quality of the scientific evidence that quality indicators reflect, will also be considered. This work focuses on the field of mental health as the stakes in improving efficiency are particularly high and quality indicators are more difficult to produce and utilize.

Case studies will be conducted to see how quality indicators are put in place and how they affect the various the actors in mental health care. The case studies will consist of a review of available written materials, site visits and interviews with key informants, relating to structures (e.g quality measurement infrastructures), process (e.g. the production and use of quality indicators) and outcomes. This project aims to identify strategies for quality indicator implementation that will help promote evidence-based medicine within mental healthcare in the U.S. The strategies will be analyzed to determine which might be adapted for use in France.