O estudo trata do fenômeno do movimento em sistemas urbanos. Investiga seu condicionamento pelo espaço edificado e a maneira como é abordado pelo planejamento institucional. Particulariza a análise para o processo de conurbação e dirige a atenção para o caso da Região Metropolitana de Porto Alegre – RMPA. A motivação surge em função dos conflitos relacionados ao sistema viário principal estipulado em cada município da Região, evidenciados a partir da justaposição de seus planos diretores vigentes em 2006, elaborados ou revisados por força do Estatuto da Cidade. Tal fato denota dificuldades das partes na compreensão de sua inserção na totalidade metropolitana. Como decorrência, objetiva-se examinar de que maneira o processo de estruturação espacial da conurbação influenciou a formação de rotas priorizadas pelo movimento em diferentes escalas na RMPA, e em que medida essas rotas estão presentes no entendimento que planejadores urbanos locais e regionais possuem sobre as possibilidades de deslocamentos mais amplos: entre bairros, setores e cidades. A pesquisa, conduzida sob o enfoque da complexidade e apoiada na teoria e na metodologia da Sintaxe Espacial, permitiu identificar, a partir de relações topológicas e geométricas existentes na configuração representativa da malha viária, redes de espaços públicos de circulação com maior potencialidade de abrigar o movimento de passagem na escala global da conurbação e o movimento restrito aos limites municipais: a Rede Metropolitana de Escolha – RMeE e a Rede Municipal de Escolha – RMuE. O processamento das informações georreferenciadas possibilitou a sobreposição dessas redes com o sistema viário principal dos municípios e, portanto, a avaliação do grau de coincidência entre seus espaços, a hierarquia espacial emergente com base na potencial quantidade de movimento, sua distribuição geográfica e sua conectividade. Em termos quantitativos, as conclusões apontam para existência de uma grande concentração dos espaços com maior potencialidade de movimento em seus níveis hierárquicos mais elevados, em que pese o conjunto de rotas ressaltadas na Rede Metropolitana de Escolha – RMeE, apresente uma melhor distribuição geográfica do que o conjunto das vias que integram os sistemas viários principais dos municípios pesquisados, indicados pelos respectivos planos diretores. De outro lado, os espaços correspondentes aos sistemas viários principais dos municípios tendem a coincidir em maior número com aqueles pertencentes às redes municipais de escolha (RMuE). Embora sem diferenças significativas, tal fato denota uma compreensão parcial, na maioria dos municípios analisados, em relação ao movimento de passagem regional por parte dos planejadores municipais. A análise qualitativa permite discutir, no âmbito de cada município, a incidência dos níveis hierárquicos emergentes, a relações existentes entre espaços de maior movimento de passagem e uso do solo, bem como o papel econômico desempenhado no contexto regional, entre outros. O estudo permitiu concluir que os princípios básicos detectados no processo de construção da integração espacial sintática, em especial o da centralidade e da linearidade, ficam bastante evidenciados no processo de estruturação da Região Metropolitana de Porto Alegre. Ao final, são apontadas as possibilidade de aplicação da pesquisa realizada em estudos futuros. / The study focuses on movement phenomenon within large urban systems. It investigates how it is affected by built environment and the way institutional urban planning approaches it. The analysis targets specifically effects conurbation processes might produce on movement, using The Metropolitan Region of Porto Alegre Metropolitan Region – MRPA - as a case study. From main streets system autonomous definition within each MRPA municipality, driven by federal legislation directives and deadlines, conflictive strategies became evident in 2006, when the entire metropolitan system was not apprehended as a whole. The metropolitan area individual parts juxtaposition displayed the misunderstandings and limits each municipality faces to fulfill their interactive roles within metropolitan totality. The analysis focuses these processes disruptive consequences for the conurbation spatial structure and pin out their impact on main movement routes within the RMPA. For that, different scale routes are examined in order to depict how these scales are operated by urban planners, locally and regionally, and to precise the limits they face to understand mobility alternatives among neighborhoods, sectors and cities. The problem is approached as a complex system, and draws from Space Syntax theory and methods to describe and analyze the whole RMPA spatial configuration. This allowed to identify the circulation system and open spaces network topological and geometrical structures, to evaluate the relations which contribute to enhance movement potential through the entire conurbated system and compare these routes to the potential through movement within each municipality – both Metropolitan Choice Network (MeCN) and Municipal Choice Network (MuCN). GIS appliances allowed superposing both networks (MeCN and MuCN) to each municipal main street system and evaluate their coherence degree towards the emergent spatial hierarchy based on potential movement, geographical distribution and connectivity. Conclusions drawn from quantitative analysis indicate that higher potential through movement clusters into higher hierarchy spaces, depicting MeCN routes that also display better geographical distribution than those composing each municipality main street systems such as defined in each Municipal Master Plan, mostly coincident to those depicted by MuCN. Even without outstanding differences, results denote partial understanding of the through movement regional system by municipalities’ urban planners. The qualitative analysis was based on the relations between land use labels intensities and through potential movement to discuss emergent hierarchical levels occurrence within each municipality and to evaluate their role within the metropolitan area regional economy. Conclusions drawn from qualitative analysis indicate that Porto Alegre Metropolitan Region spatial structure enhances its linear integration and centrality depicted through space syntax methods. The evidence provided means that topological and geometrical relations exceeds metrical ones in driving these processes. These findings point out to further applications towards large scale circulation systems problem solving and Space Syntax as a valid tool in orienting future regional and metropolitan development strategies.

A dissertação aborda as dimensões econômica e morfológica da organização espacial da atividade industrial na Região Metropolitana de Porto Alegre - RMPA, propondo interfaces entre a Ciência Econômica e o Planejamento Urbano e Regional. O objetivo da pesquisa consiste em identificar se e como as propriedades morfológicas das redes de circulação urbana e rodoviária são capazes de informar tendências em processos de organização espacial da atividade industrial em ambientes urbanos. Neste sentido, foi realizado um estudo de caso multidimensional e multiescalar a partir de cinco recortes espaciais de cinco municípios da RMPA – Alvorada, Cachoeirinha, Gravataí, Porto Alegre e Viamão – e seus complexos industriais, áreas contínuas de zoneamento funcional destinados à indústria. A hipótese é de que os potenciais de movimento e as probabilidades de fluxo, depreendidas por medidas de centralidade morfológicas e espaciais captam padrões locacionais e de organização espacial das atividades industriais. Isto é verificado a partir da correlação geoestatística entre análises configuracionais da rede de circulação urbana, apoiadas nas concepções teórico-metodológicas da sintaxe espacial, e as análises econômico-locacionais, da localização das estruturas industriais, fundamentadas nas teorias econômicas. Os resultados dispostos permitiram concluir que existem correlações estatísticas significativas entre a lógica de organização espacial da indústria em áreas urbanas e as propriedades morfológicas multiescalares da configuração espacial da rede de circulação urbana, indicando que hierarquias de centralidade morfológica, informando potenciais de movimento e probabilidades de fluxo na rede urbana de circulação, captam tendências do processo de organização produtiva. / Dissertation addresses the economical and morphological dimensions of industrial activities spatial organization in the Porto Alegre’s Metropolitan Region – PAMR, proposing interfaces between Economic Science and Urban and Regional Planning. The research objective is to describe and analyse if and how the morphological properties of road and circulation urban networks are able to inform trends about the industrial activities spatial organization processes in urban areas. The empirical study multidimensional and multiscalar analyses encompasses PMAR’s five municipalities – Alvorada, Cachoeirinha, Gravataí, Porto Alegre and Viamão and their industrial complexes, continuous industrial-dedicated functional zones. The hypothesis is that movement potentials and flow probabilities informed by centralities´ hierarchies correlate to industry locational patterns and spatial organization. This is verified applying geostatistical correlations between road circulation networks spatial configuration measures, based on space syntax methodology; and locational analyses of industrial structures placement, based on economic theories. Results makes it possible to conclude that there are significant statistical correlations between industrial spatial organization logics in urban areas and multiscalar centrality measures for road circulation networks, indicating that the urban centralities hierarchies – and the network morphological properties – capture trends about this process.

A dissertação aborda as dimensões econômica e morfológica da organização espacial da atividade industrial na Região Metropolitana de Porto Alegre - RMPA, propondo interfaces entre a Ciência Econômica e o Planejamento Urbano e Regional. O objetivo da pesquisa consiste em identificar se e como as propriedades morfológicas das redes de circulação urbana e rodoviária são capazes de informar tendências em processos de organização espacial da atividade industrial em ambientes urbanos. Neste sentido, foi realizado um estudo de caso multidimensional e multiescalar a partir de cinco recortes espaciais de cinco municípios da RMPA – Alvorada, Cachoeirinha, Gravataí, Porto Alegre e Viamão – e seus complexos industriais, áreas contínuas de zoneamento funcional destinados à indústria. A hipótese é de que os potenciais de movimento e as probabilidades de fluxo, depreendidas por medidas de centralidade morfológicas e espaciais captam padrões locacionais e de organização espacial das atividades industriais. Isto é verificado a partir da correlação geoestatística entre análises configuracionais da rede de circulação urbana, apoiadas nas concepções teórico-metodológicas da sintaxe espacial, e as análises econômico-locacionais, da localização das estruturas industriais, fundamentadas nas teorias econômicas. Os resultados dispostos permitiram concluir que existem correlações estatísticas significativas entre a lógica de organização espacial da indústria em áreas urbanas e as propriedades morfológicas multiescalares da configuração espacial da rede de circulação urbana, indicando que hierarquias de centralidade morfológica, informando potenciais de movimento e probabilidades de fluxo na rede urbana de circulação, captam tendências do processo de organização produtiva. / Dissertation addresses the economical and morphological dimensions of industrial activities spatial organization in the Porto Alegre’s Metropolitan Region – PAMR, proposing interfaces between Economic Science and Urban and Regional Planning. The research objective is to describe and analyse if and how the morphological properties of road and circulation urban networks are able to inform trends about the industrial activities spatial organization processes in urban areas. The empirical study multidimensional and multiscalar analyses encompasses PMAR’s five municipalities – Alvorada, Cachoeirinha, Gravataí, Porto Alegre and Viamão and their industrial complexes, continuous industrial-dedicated functional zones. The hypothesis is that movement potentials and flow probabilities informed by centralities´ hierarchies correlate to industry locational patterns and spatial organization. This is verified applying geostatistical correlations between road circulation networks spatial configuration measures, based on space syntax methodology; and locational analyses of industrial structures placement, based on economic theories. Results makes it possible to conclude that there are significant statistical correlations between industrial spatial organization logics in urban areas and multiscalar centrality measures for road circulation networks, indicating that the urban centralities hierarchies – and the network morphological properties – capture trends about this process.

O estudo trata do fenômeno do movimento em sistemas urbanos. Investiga seu condicionamento pelo espaço edificado e a maneira como é abordado pelo planejamento institucional. Particulariza a análise para o processo de conurbação e dirige a atenção para o caso da Região Metropolitana de Porto Alegre – RMPA. A motivação surge em função dos conflitos relacionados ao sistema viário principal estipulado em cada município da Região, evidenciados a partir da justaposição de seus planos diretores vigentes em 2006, elaborados ou revisados por força do Estatuto da Cidade. Tal fato denota dificuldades das partes na compreensão de sua inserção na totalidade metropolitana. Como decorrência, objetiva-se examinar de que maneira o processo de estruturação espacial da conurbação influenciou a formação de rotas priorizadas pelo movimento em diferentes escalas na RMPA, e em que medida essas rotas estão presentes no entendimento que planejadores urbanos locais e regionais possuem sobre as possibilidades de deslocamentos mais amplos: entre bairros, setores e cidades. A pesquisa, conduzida sob o enfoque da complexidade e apoiada na teoria e na metodologia da Sintaxe Espacial, permitiu identificar, a partir de relações topológicas e geométricas existentes na configuração representativa da malha viária, redes de espaços públicos de circulação com maior potencialidade de abrigar o movimento de passagem na escala global da conurbação e o movimento restrito aos limites municipais: a Rede Metropolitana de Escolha – RMeE e a Rede Municipal de Escolha – RMuE. O processamento das informações georreferenciadas possibilitou a sobreposição dessas redes com o sistema viário principal dos municípios e, portanto, a avaliação do grau de coincidência entre seus espaços, a hierarquia espacial emergente com base na potencial quantidade de movimento, sua distribuição geográfica e sua conectividade. Em termos quantitativos, as conclusões apontam para existência de uma grande concentração dos espaços com maior potencialidade de movimento em seus níveis hierárquicos mais elevados, em que pese o conjunto de rotas ressaltadas na Rede Metropolitana de Escolha – RMeE, apresente uma melhor distribuição geográfica do que o conjunto das vias que integram os sistemas viários principais dos municípios pesquisados, indicados pelos respectivos planos diretores. De outro lado, os espaços correspondentes aos sistemas viários principais dos municípios tendem a coincidir em maior número com aqueles pertencentes às redes municipais de escolha (RMuE). Embora sem diferenças significativas, tal fato denota uma compreensão parcial, na maioria dos municípios analisados, em relação ao movimento de passagem regional por parte dos planejadores municipais. A análise qualitativa permite discutir, no âmbito de cada município, a incidência dos níveis hierárquicos emergentes, a relações existentes entre espaços de maior movimento de passagem e uso do solo, bem como o papel econômico desempenhado no contexto regional, entre outros. O estudo permitiu concluir que os princípios básicos detectados no processo de construção da integração espacial sintática, em especial o da centralidade e da linearidade, ficam bastante evidenciados no processo de estruturação da Região Metropolitana de Porto Alegre. Ao final, são apontadas as possibilidade de aplicação da pesquisa realizada em estudos futuros. / The study focuses on movement phenomenon within large urban systems. It investigates how it is affected by built environment and the way institutional urban planning approaches it. The analysis targets specifically effects conurbation processes might produce on movement, using The Metropolitan Region of Porto Alegre Metropolitan Region – MRPA - as a case study. From main streets system autonomous definition within each MRPA municipality, driven by federal legislation directives and deadlines, conflictive strategies became evident in 2006, when the entire metropolitan system was not apprehended as a whole. The metropolitan area individual parts juxtaposition displayed the misunderstandings and limits each municipality faces to fulfill their interactive roles within metropolitan totality. The analysis focuses these processes disruptive consequences for the conurbation spatial structure and pin out their impact on main movement routes within the RMPA. For that, different scale routes are examined in order to depict how these scales are operated by urban planners, locally and regionally, and to precise the limits they face to understand mobility alternatives among neighborhoods, sectors and cities. The problem is approached as a complex system, and draws from Space Syntax theory and methods to describe and analyze the whole RMPA spatial configuration. This allowed to identify the circulation system and open spaces network topological and geometrical structures, to evaluate the relations which contribute to enhance movement potential through the entire conurbated system and compare these routes to the potential through movement within each municipality – both Metropolitan Choice Network (MeCN) and Municipal Choice Network (MuCN). GIS appliances allowed superposing both networks (MeCN and MuCN) to each municipal main street system and evaluate their coherence degree towards the emergent spatial hierarchy based on potential movement, geographical distribution and connectivity. Conclusions drawn from quantitative analysis indicate that higher potential through movement clusters into higher hierarchy spaces, depicting MeCN routes that also display better geographical distribution than those composing each municipality main street systems such as defined in each Municipal Master Plan, mostly coincident to those depicted by MuCN. Even without outstanding differences, results denote partial understanding of the through movement regional system by municipalities’ urban planners. The qualitative analysis was based on the relations between land use labels intensities and through potential movement to discuss emergent hierarchical levels occurrence within each municipality and to evaluate their role within the metropolitan area regional economy. Conclusions drawn from qualitative analysis indicate that Porto Alegre Metropolitan Region spatial structure enhances its linear integration and centrality depicted through space syntax methods. The evidence provided means that topological and geometrical relations exceeds metrical ones in driving these processes. These findings point out to further applications towards large scale circulation systems problem solving and Space Syntax as a valid tool in orienting future regional and metropolitan development strategies.

Aujourd'hui la vie au travail est caractérisée par une grande complexité, une imprévisibilité, et une insécurité. L'intérêt pour l'employabilité a été suscité par l'impact économique des pénuries de compétences et de main-d'œuvre et la nature changeante des carrières ainsi que par l'érosion de la sécurité de l'emploi. Pour assurer la sécurité d'emploi de ses salariés qui sont garants de son adaptation et de sa performance, l'entreprise doit mener des actions pour maintenir et développer leur employabilité. La finalité de cette recherche est de comprendre comment les pratiques RH influencent l'employabilité et l'implication organisationnelle. La réponse à cette problématique contribue à proposer aux organisations une approche adaptée de l'utilisation des pratiques RH qu'elles ont à leur disposition. Deux types de méthodologie ont été croisés. D'abord une étude qualitative exploratoire a été menée auprès d'un échantillon multi-acteur de 21 personnes (Dirigeants, DRH et salariés). Elle a visé à enrichir et à vérifier la pertinence du modèle proposé à l'issue de l'analyse de la littérature, à identifier les pratiques RH favorables à l'employabilité et à explorer le concept de l'employabilité à travers une explicitation de ses dimensions. Ensuite une étude quantitative, auprès de 266 salariés, nous a permis de vérifier le type de relations qui peuvent exister entre les pratiques RH, l'employabilité et l'implication organisationnelle. Notre recherche montre que, d'une manière générale, les pratiques RH influencent positivement l'employabilité et l'implication organisationnelle notamment la dimension affective. Cette étude propose cinq familles de pratiques RH (l'organisation qualifiante et la mobilité, la formation et l'évaluation, la communication, la GPEC et la rémunération) qui agissent sur l'employabilité (individuelle, par les compétences, et interne/externe) et sur l'implication organisationnelle (affective et calculée). / Today working life is characterized by highly complex, unpredictability and insecurity. The interest for employability was motivated by the economic impact of skills shortages and labor force; the changing nature of careers, and the erosion of job security.To ensure the job security of its employees who are guarantors of its adaptation and its performance, the organization must take action to maintain and to develop their employability.The purpose of our study is to understand how HR practices influence employability and organizational commitment. The answer to this issue helps organizations provide a suitable method in terms how to use HR practices which they have at their disposal approach.Two types of methodology were crossed. First, an exploratory qualitative study was conducted with a multi-actor sample, 21 persons (executives, DHR and employees) were interviewed. It aimed to enrich and to verify the relevance of the research model proposed after the literature review; to identify HR practices in favor to employability; and to explore the concept of employability through an explanation of its dimensions. Then a quantitative study among 266 employees helps us to confirm the type of relationship that may exist between HR practices, employability and organizational commitment.Our research shows that in a general way, HR practices positively influence the employability and organizational commitment particularly affective dimension. This study suggests five families of HR practices (the learning organization and mobility, training and evaluation, communication, compensation and management planning of employment and skills) acting on employability (individual approach, skills approach, and internal / external approachs) and organizational commitment (affective dimension and continuance dimension).

This licentiate thesis presents the density functional theory study on clean energy materials relevant for catalysis applications, and for solid oxide fuel cells. In the first part of the thesis the metal supported ultrathin films, namely ScN/Mo, MgO/Mo and NaF/Mo are considered, and the Cu atom adsorption and charging on them is explored.The comparative study of these different films allows us to provide recommendations regarding the choice of materials, in order to promote adatom charging. The modulation of the adatom charge, by changing the material of the film, also paves the way for the design of novel catalysts. Moreover, the detailed investigation of the Cu/NaF/Mo caseshows a correlation between the charge redistribution upon the adsorption and the anharmonicity of the accompanying distortion. Overall, the research commands a fresh view on the adatom charging mechanism. In the second part of the thesis the gadolinium doped ceria, used asoxide electrolyte in solid oxide fuel cells, is studied. The employment of the cluster expansion method together with the density functional theory calculations provides the description of the configurational energy spectrum of dopants and oxygen vacancies in terms of effective pair and three site interactions. The chosen method allows one to predict the energy of anarbitrary configuration. Moreover, the effect of volume change on the strength of interactions is investigated, which is relevant for the modelling ofoxide electrolytes at operating temperatures of solid oxide fuel cells,i.e. when volume expansion is notable. / <p>QC 20150521</p>

No description available.

This thesis is a theoretical study of configurational and magnetic interactions in multicomponent solids. These interactions are the projections onto the configurational and magnetic degrees of freedom of the underlying electronic quantum mechanical system, and can be used to model, explain and predict the properties of materials. For example, the interactions govern temperature induced configurational and magnetic order-disorder transitions in Heusler alloys and ternary nitrides. In particular three perspectives are studied. The first is how the interactions can be derived from first-principles calculations at relevant physical conditions. The second is their consequences, like the critical temperatures for disordering, obtained with e.g. Monte Carlo simulations. The third is their origin in terms of the underlying electronic structure of the materials. Intrinsic defects in the half-Heusler system NiMnSb are studied and it is found that low-energy defects do not destroy the important half-metallic property at low concentrations. Deliberate doping of NiMnSb with 3d-metals is considered and it is found that replacing some Ni with extra Mn or Cr creates new strong magnetic interactions which could be beneficial for applications at elevated temperature. A self-consistent scheme to include the effects of thermal expansion and one-electron excitations in the calculation of the magnetic critical temperature is introduced and applied to a study of Ni1−xCuxMnSb. A supercell implementation of the disordered local moments approach is suggested and benchmarked for the treatment of paramagnetic CrN as a disordered magnetic phase. It is found that the orthorhombic-to-cubic phase transition in this nitride can be understood as a first-order magnetic order-disorder transition. The ferromagnetism in Ti1−xCrxN solid solutions, an unusual property in nitrides, is explained in terms of a charge transfer induced change in the Cr-Cr magnetic interactions. Cubic Ti1−xAlxN solid solutions displays a complex and concentration dependent phase separation tendency. A unified cluster expansion method is presented that can be used to simulate the configurational thermodynamics of this system. It is shown that short range clustering do influence the free energy of mixing but only slightly change the isostructural phase diagram as compared to mean-field estimates.

L’utilisation des services de santé est au centre de l’organisation des soins. La compréhension des processus qui déterminent cette utilisation est essentielle pour agir sur le système de santé et faire en sorte qu’il réponde mieux aux besoins de la population. L’objectif de cette thèse est de comprendre le phénomène complexe qu’est l’utilisation des services de santé en s’intéressant à la pratique des médecins omnipraticiens. En nous appuyant sur le cadre théorique de Donabedian, nous décomposons les déterminants de l’utilisation des services de santé en trois niveaux : le niveau individuel, le niveau organisationnel, et le niveau environnemental. Pour tenir compte de la complexité des phénomènes de cette étude nous proposons de nous appuyer sur l’approche configurationnelle. Notre question de recherche est la suivante : dans quelle mesure le mode d’exercice des omnipraticiens influence-t-il la prestation des services et comment l’environnement géographique et la patientèle modulent-ils cette relation ? Nous avons utilisé des bases de données jumelées du Collège des médecins du Québec, de la Régie d’assurance maladie du Québec et de la banque de données iCLSC. Notre échantillon est constitué des médecins omnipraticiens de l’année 2002, ayant satisfait aux critères d’inclusion, ce qui représente près de 70% de la population totale. Des analyses de correspondances multiples et des classifications ascendantes hiérarchiques ont été utilisées pour réaliser la taxonomie des modes d’exercice et des contextes géographiques. Nous avons construit des indicateurs d’utilisation des services de santé pour apprécier la continuité, la globalité, l’accessibilité et la productivité. Ces indicateurs ont été validés en les comparant à ceux d’une enquête populationnelle. Nous présentons tout d’abord les modes d’exercice des médecins qui sont au nombre de sept. Deux modes d’exercice à lieu unique ont émergé : le mode d’exercice en cabinet privé d'une part, caractérisé par des niveaux de continuité et productivité élevés, le mode d’exercice en CLSC d'autre part présentant un niveau de productivité faible et des niveaux de globalité et d'accessibilité légèrement au-dessus de la moyenne. Dans les cinq autres modes d’exercice, les médecins exercent leur pratique dans une configuration de lieux. Deux modes d’exercice multi-institutionnel réunissent des médecins qui partagent leur temps entre les urgences, les centres hospitaliers et le cabinet privé ou le CLSC. Les médecins de ces deux groupes présentent des niveaux d’accessibilité et de productivité très élevés. Le mode d’exercice le moins actif réunit des médecins travaillant en cabinet privé et en CHLSD. Leur niveau d’activité est inférieur à la moyenne. Ils sont caractérisés par un niveau de continuité très élevé. Le mode d’exercice ambulatoire regroupe des médecins qui partagent leur pratique entre le CLSC, le cabinet privé et le CHLSD. Ces médecins présentent des résultats faibles sur tous les indicateurs. Finalement le mode d’exercice hospitaliste réunit des médecins dont la majorité de la pratique s’exerce en milieu hospitalier avec une petite composante en cabinet privé. Dans ce mode d’exercice tous les indicateurs sont faibles. Les analyses ont mis en évidence quatre groupes de territoires de CSSS : les ruraux, les semi-urbains, les urbains et les métropolitains. La prévalence des modes d’exercice varie selon les contextes. En milieu rural, le multi-institutionnel attire près d’un tiers des médecins. En milieu semi-urbain, les médecins se retrouvent de façon plus prédominante dans les modes d’exercice ayant une composante CLSC. En milieu urbain, les modes d’exercice ayant une composante cabinet privé attirent plus de médecins. En milieu métropolitain, les modes d’exercice moins actif et hospitaliste attirent près de 40% des médecins. Les omnipraticiens se répartissent presque également dans les autres modes d’exercice. Les niveaux des indicateurs varient en fonction de l’environnement géographique. Ainsi l’accessibilité augmente avec le niveau de ruralité. De façon inverse, la productivité augmente avec le niveau d’urbanité. La continuité des soins est plus élevée en régions métropolitaines et rurales. La globalité varie peu d’un contexte à l’autre. Pour pallier à la carence de l’analyse partielle de l’organisation de la pratique des médecins dans la littérature, nous avons créé le concept de mode d’exercice comme la configuration de lieux professionnels de pratique propre à chaque médecin. A notre connaissance, il n’existe pas dans la littérature, d’étude qui ait analysé simultanément quatre indicateurs de l’utilisation des services pour évaluer la prestation des services médicaux, comme nous l’avons fait. Les résultats de nos analyses montrent qu’il existe une différence dans la prestation des services selon le mode d’exercice. Certains des résultats trouvés sont documentés dans la littérature et plus particulièrement quand il s’agit de mode d’exercice à lieu unique. La continuité et la globalité des soins semblent évoluer dans le même sens. De même, la productivité et l’accessibilité sont corrélées positivement. Cependant il existe une tension, entre les premiers indicateurs et les seconds. Seuls les modes d’exercice à lieu unique déjouent l’arbitrage entre les indicateurs, énoncé dans l’état des connaissances. Aucun mode d’exercice ne présente de niveaux élevés pour les quatre indicateurs. Il est donc nécessaire de travailler sur des combinaisons de modes d’exercice, sur des territoires, afin d’offrir à la population les services nécessaires pour l’atteinte concomitante des quatre objectifs de prestation des services. Les modes d’exercice émergents (qui attirent les jeunes médecins) et les modes d’exercice en voie de disparition (où la prévalence des médecins les plus âgés est la plus grande) sont préoccupants. A noter que les modes d’exercice amenés à disparaître répondent mieux aux besoins de santé de la population que les modes d’exercice émergents, au regard de tous nos indicateurs. En conclusion, cette thèse présente trois contributions théoriques et trois contributions méthodologiques. Les implications pour les recherches futures et la décision indiquent que, si aucune mesure n’est mise en place pour renverser la tendance, le Québec risque de vivre des pénuries dans la prestation des services en termes de continuité, globalité et accessibilité. / Health services utilization is central to healthcare organization. Understanding the processes that determine utilization is essential to influence the health system and to ensure that it better meets the needs of the population. The objective of this thesis is to understand the complex phenomenon of health services utilization by looking at general practitioners' practices. Using Donabedian's theoretical framework, we decomposed determinants of utilization at three levels: individual, organizational and environmental. We chose a configurational approach to account for the complex nature of the phenomenon under study. Our question is the following: To what extent does the type of practice influence delivery of health services, and how do geographical environment and patient populations mediate this relationship? We used combined data sources from the Collège des médecins du Québec, the Régie de l'assurance maladie du Québec and the iCLSC databases. Almost 70% of family physicians practicing in 2002 met the selection criteria. Multiple correspondence analyses and ascending hierarchical classifications were used to create a taxonomy of practices and a taxonomy of geographical contexts. We constructed services utilization indicators to assess continuity, comprehensiveness, accessibility and productivity. These indicators were validated using a population survey. The results first present physicians' profiles of practice. Two single-site profiles emerged. Private clinic practice is characterized by high levels of continuity and productivity. CLSC practice is typified by low productivity level and slightly above average levels of comprehensiveness and accessibility. Five other practice profiles include physicians who practice in different combinations of sites (multi-sites profiles). Two multi-institutional profiles of practice include physicians who divide their time in two different patterns, among emergency departments, hospital centres and private clinics or CLSCs. The levels of accessibility and productivity for physicians in these two groups are very high. The profile combining private clinics and long-term care facilities (the less active profile) includes physicians with below average productivity, and very high level of continuity. An ambulatory practice profile includes physicians who work in CLSCs, private clinics and long-term care facilities. Physicians in this profile, show low levels for all indicators. Finally, the hospital-based practice includes physicians who practice mainly in hospitals but also occasionally in private clinics. Our analyses highlighted four groups of CSSS territories: rural, semi-urban, urban, and metropolitan. The prevalence of practice profiles vary based on context. In rural settings, about a third of physicians opt for multi-institutional practices. In semi-urban settings, physicians predominantly work in practices that include a CLSC component. In urban settings, more physicians choose a profile of practice with a private clinic component. Finally, in metropolitan areas, the less active and more hospital-based type of practice attracts close to 40% of physicians. General practitioners are almost equally split among the other profiles of practices. Indicator levels vary according to geographical environment. As a result, accessibility increases with level of rurality. Conversely, productivity increases with level of urbanity. Continuity of care is higher in metropolitan and rural areas. Comprehensiveness changes little among contexts. We will refer back to the initial research question to look at the results and compare them with the literature. To offset the shortcomings of the limited analysis of physicians' practice organization found in the literature, we defined type of practice concept as the configuration of each physician's professional practice site To our knowledge, no other study reported in the literature has analyzed four service utilization indicators simultaneously to assess delivery of medical services. Results of our analyses show that there is a difference in service delivery based on type of practice. Some results are documented in the literature, especially as regards single-site type of practice. We will then present the relationships among indicators. Care continuity and comprehensiveness seem to be evolving in the same direction. Productivity and accessibility are also positively correlated. However, there is a certain tension between the former and the latter indicators. Only single-site types do not fit the indicators, as articulated in the state of current knowledge. No type of practice showed high levels for the four indicators. It is therefore necessary to work on combinations of practice types in the territories to offer the population the services required to reach all four care delivery objectives. Emerging types of practice (which attract young doctors) and those that are dying out (where the prevalence of older physicians is highest) are discussed in the next section. It should be noted that the types of practice that are vanishing address the population's health needs better than emerging types, in terms of indicators. In conclusion, this thesis presents three theoretical and three methodological contributions. The implications for future research and decision making point out that if no measures are implemented to reverse the trend, Quebec risks to see deficiencies in delivery of services in terms of continuity, comprehensiveness and accessibility.

La thèse a pour objectif d’étudier l’influence du financement des soins de santé sur la performance des systèmes de soins compte tenu des caractéristiques organisationnelles sanitaires des systèmes. Elle s’articule autour des trois objectifs suivants : 1) caractériser le financement des soins de santé à travers les différents modèles émergeant des pays à revenu élevé ; 2) apprécier la performance des systèmes de soins en établissant les divers profils apparaissant dans ces mêmes pays ; 3) examiner le lien entre le financement et la performance en tenant compte du pouvoir modérateur du contexte organisationnel des soins. Inspirée du processus de circulation de l’argent dans le système de soins, l’approche a d’abord consisté à classer les pays étudiés – par une analyse configurationnelle opérationnalisée par les analyses de correspondance multiples (ACM) et de classification hiérarchique ascendante (CHA) – dans des modèles types, chacun représentant une configuration particulière de processus de financement des soins de santé (article 1). Appliquée aux données recueillies auprès des 27 pays de l’OCDE à revenu élevé via les rapports Health Care in Transition des systèmes de santé des pays produits par le bureau Européen de l’OMS, la banque de données Eco-Santé OCDE 2007 et les statistiques de l’OMS 2008, les analyses ont révélé cinq modèles de financement. Ils se distinguent selon les fonctions de collecte de l’argent dans le système (prélèvement), de mise en commun de l’argent collecté (stockage), de la répartition de l’argent collecté et stocké (allocation) et du processus de paiement des professionnels et des établissements de santé (paiement). Les modèles ainsi développés, qui vont au-delà du processus unique de collecte de l’argent, donnent un portrait plus complet du processus de financement des soins de santé. Ils permettent ainsi une compréhension de la cohérence interne existant entre les fonctions du financement lors d’un éventuel changement de mode de financement dans un pays. Dans un deuxième temps, nous appuyant sur une conception multidimensionnelle de la performance des systèmes, nous avons classé les pays : premièrement, selon leur niveau en termes de ressources mobilisées, de services produits et de résultats de santé atteints (définissant la performance absolue) ; deuxièmement, selon les efforts qu’ils fournissent pour atteindre un niveau élevé de résultats de santé proportionnellement aux ressources mobilisées et aux services produits en termes d’efficience, d’efficacité et de productivité (définissant ainsi la performance relative) ; et troisièmement, selon les profils types de performance globale émergeant en tenant compte simultanément des niveaux de performance absolue et relative (article 2). Les analyses effectuées sur les données collectées auprès des mêmes 27 pays précédents ont dégagé quatre profils de performance qui se différencient selon leur niveau de performance multidimensionnelle et globale. Les résultats ainsi obtenus permettent d’effectuer une comparaison entre les niveaux globaux de performance des systèmes de soins. Pour terminer, afin de répondre à la question de savoir quel mode – ou quels modes – de financement générerait de meilleurs résultats de performance, et ce, dans quel contexte organisationnel de soins, une analyse plus fine des relations entre le financement et la performance (tous définis comme précédemment) compte tenu des caractéristiques organisationnelles sanitaires a été réalisée (article 3). Les résultats montrent qu’il n’existe presque aucune relation directe entre le financement et la performance. Toutefois, lorsque le financement interagit avec le contexte organisationnel sanitaire pour appréhender le niveau de performance des systèmes, des relations pertinentes et révélatrices apparaissent. Ainsi, certains modes de financement semblent plus attrayants que d’autres en termes de performance dans des contextes organisationnels sanitaires différents. Les résultats permettent ainsi à tous les acteurs du système de comprendre qu’il n’existe qu’une influence indirecte du financement de la santé sur la performance des systèmes de soins due à l’interaction du financement avec le contexte organisationnel sanitaire. L’une des originalités de cette thèse tient au fait que très peu de travaux ont tenté d’opérationnaliser de façon multidimensionnelle les concepts de financement et de performance avant d’analyser les associations susceptibles d’exister entre eux. En outre, alors que la pertinence de la prise en compte des caractéristiques du contexte organisationnel dans la mise en place des réformes des systèmes de soins est au coeur des préoccupations, ce travail est l’un des premiers à analyser l’influence de l’interaction entre le financement et le contexte organisationnel sanitaire sur la performance des systèmes de soins. / The aim of this thesis is to investigate the influence of health care financing on the performance of health care systems when organizational characteristics of health care system contexts are taken into consideration. It focuses on the following three objectives: 1) to characterize health care financing across the various models emerging in high-income countries; 2) to assess the performance of these health care systems by identifying the different profiles seen in these countries; and 3) to examine the relationship between health care financing and system performance, taking into account the moderating influence of the organizational context of health care. Inspired by the revenue flow process in health care systems, the approach adopted consisted in first classifying the countries studied – using configurational analysis operationalized through multiple components analysis (MCA) and ascending hierarchical classification (AHC) – into typical models, each representing a particular configuration of health care financing processes (article 1). Analysis of data collected on 27 high-income OECD countries from the Health Care in Transition reports produced by the WHO Regional Office for Europe, the 2007 Éco-Santé OCDE database and the 2008 WHO statistics revealed five financing models. These models differ among themselves in terms of the functions of collecting money (collection), pooling the collected funds (pooling), distributing the collected and pooled funds (allocation) and paying the professionals and health care establishments (payment). The models thus developed, which extend beyond the simple process of collecting money, provide a more complete picture of the health care financing process. As such, they enable a better understanding of the internal coherence that exists among the four health care financing functions that will impact any change in a country’s health care financing system. Next, based on a multidimensional conception of health care system performance, we classified the same 27 countries according to three parameters: (1) their levels of resources mobilized, health care services provided and health outcomes achieved (absolute performance); (2) the efforts they invested to achieve higher levels of health outcomes in proportion to resources mobilized and health care services provided, in terms of efficiency, efficacy and productivity (relative performance); and (3) the overall performance profiles that emerged when absolute performance and relative performance were combined (article 2). The analyses we carried out on the data collected for these 27 countries produced four profiles that were differentiated in their multidimensional and overall performance. The results thus obtained allow us to compare overall health care system performance among high-income countries. Finally, to answer the question of what financing modalities would generate the best performance, and in what types of health care organizational contexts, we carried out an in-depth analysis of the relations between health care financing and health care system performance (as defined above), taking into account the organizational characteristics of the health care contexts (article 3). The analysis revealed almost no direct relations between health care financing and health care performance. However, when we looked at interactions between financing and health care organizational contexts to capture the level of system performance, some relevant relations emerged. Thus, in terms of performance, some health care financing modalities would appear to be more appealing than others, depending on the organizational characteristics of the health care context. These results can help health care system stakeholders to understand that there is only an indirect relationship between financing and system performance, due to the interaction between health care financing and the organizational characteristics of health care contexts. One original aspect of this thesis lies in the fact that very few studies have attempted to operationalize the concepts of health care system financing and performance using multidimensional approaches before analyzing any relationships that might exist between them. Furthermore, despite the relevance of taking into account the organizational characteristics of health care contexts in health system reforms, this thesis is the one of the first to analyze the impact of the interaction between health care financing and organizational contexts on health care system performance.