Sicras-Mainar Antoni, Serrat-Tarrés Josep, Navarro-Artieda Ruth, Llausí-Sellés Rosa, Ruano-Ruano Ignasi, González-Ares Josep Antón
Planning Management, Badalona Serveis Assistencials, SA, Badalona, Barcelona, Spain.
Eur J Public Health. 2007 Dec;17(6):657-63. doi: 10.1093/eurpub/ckm044. Epub 2007 Apr 30.
To determine the referral rate (RR) per centre, its main causes and the adjusted efficiency indexes, through the retrospective implementation of the Adjusted Clinical Groups (ACG) in a Spanish primary care setting.
Design descriptive-retrospective study. Attended patients by five primary care teams (PCT) during the year 2004 were included. General parameters, age, gender, dependent (visits and episodes), and comorbidity of each patient relative to each ACG are used as measures. The RR was defined as the quotient between the number of referrals and the visits made. Efficiency Index (EI) was established dividing the observed by the expected referrals obtained by indirect standardization. Statistical significance P<0.05.
Studied patients 81,335 (use: 76.9%), 5.0+/-3.6 episodes and 7.9+/-7.8 visits/patient/year. Percentage of visits with a referral, adjusted for morbidity burden, was 7.5% (CI: 7.3-7.7); age: 48.3+/-22.7 years (women: 55.9%), P=0.000. The average of referrals was of 59.6 per 100 attended patients/year (P=0.000). Visits and episodes explain 34.1-68.1%, respectively (P=0.000), the explanatory power of the classification's variability was of 23.6% (P=0.0001). EI per centre were: 0.95 (CI: 0.82-1.08); 0.78 (CI: 0.63-0.93); 0.88 (CI: 0.73-1.03); 1.15 (CI: 1.03-1.27) and 1.08 (CI: 0.95-1.21), P=0.034 (family practice); and 0.83 (CI: 0.70-0.96); 0.83 (CI: 0.68-0.98); 0.84 (CI: 0.70-0.98); 1.24 (CI: 1.12-1.36) and 1.16 (CI: 1.03-1.29), P=0.041 (paediatrics), respectively.
Adjusted morbidity by ACG explains an important part of the referrals variability. The study results must be interpreted cautiously even after adjustment by age, gender and morbidity. Should the results be confirmed, it would allow an improvement in the measurement of referrals for clinical management in the PCT.
通过在西班牙初级保健环境中回顾性实施调整后的临床分组（ACG），确定每个中心的转诊率（RR）、其主要原因以及调整后的效率指标。
设计描述性回顾性研究。纳入了2004年期间由五个初级保健团队（PCT）诊治的患者。使用每个患者相对于每个ACG的一般参数、年龄、性别、依赖情况（就诊次数和发作次数）以及合并症作为衡量指标。RR定义为转诊次数与就诊次数的商。通过间接标准化获得的预期转诊次数除以观察到的转诊次数来确定效率指数（EI）。统计学显著性P<0.05。
研究患者81335例（使用率：76.9%），每位患者每年发作5.0±3.6次，就诊7.9±7.8次。经发病率负担调整后的转诊就诊百分比为7.5%（置信区间：7.3 - 7.7）；年龄：48.3±22.7岁（女性：55.9%），P = 0.000。每年每100例就诊患者的平均转诊次数为59.6次（P = 0.000）。就诊次数和发作次数分别解释了34.1% - 68.1%（P = 0.000），分类变异性的解释力为23.6%（P = 0.0001）。每个中心的EI分别为：0.95（置信区间：0.82 - 1.08）；0.78（置信区间：0.63 - 0.93）；0.88（置信区间：0.73 - 1.03）；1.15（置信区间：1.03 - 1.27）和1.08（置信区间：0.95 - 1.21），P = 0.034（家庭医疗）；以及0.83（置信区间：0.70 - 0.96）；0.83（置信区间：0.68 - 0.98）；0.84（置信区间：0.70 - 0.98）；1.24（置信区间：1.12 - 1.36）和1.16（置信区间：1.03 - 1.29），P = 0.041（儿科学）。
ACG调整后的发病率解释了转诊变异性的重要部分。即使在按年龄、性别和发病率进行调整后，研究结果也必须谨慎解释。如果结果得到证实，将有助于改善PCT中临床管理转诊的测量。
