Service de médecine interne, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
Orthop Traumatol Surg Res. 2013 Oct;99(6):731-5. doi: 10.1016/j.otsr.2013.04.005. Epub 2013 Sep 9.
In France, primary-care physicians referring patients for admission can choose between public and private hospitals. The factors that govern their choices are unknown.
Among all patient admissions reported from 1997 to 2011 by primary-care physicians participating in the Sentinels(®) network, we identified those due to orthopaedic conditions or trauma. We then identified the factors associated with referral to a private hospital rather than to a public hospital.
Of 45,960 admissions reported to Sentinels(®) in 1997-2011, 2794 (6.1%) were for orthopaedic/trauma care. The main reasons for admission were hip fractures (27.5%), elective orthopaedic surgery (15.5%), fractures of the humerus (5.9%), wrist fractures (5.4%), soft-tissue lesions of the forearm or hand (5.0%), and spinal injuries (4.5%). Private hospitals were chosen more often for orthopaedic/trauma patients than for patients with other conditions (40% vs. 21.6% of cases, P<0.0001). When fracture of the humerus was used as the reference, referral to private hospitals was significantly more common for elective surgery (odds ratio, 3.30 [2.02-5.40]) and hip fracture (odds ratio, 1.50 [1.03-2.18]) and significantly less common for spinal injuries (odds ratio, 0.35 [0.19-0.66]). Other factors associated with referral to private hospitals were patient age, admission decision during an office visit or in a non-emergent setting, and admission decision made by the patient's usual physician.
Specific factors seem to govern decisions by primary-care physicians to refer orthopaedic/trauma patients to private vs. public hospitals. Identical pricing scales for private and public hospitals will be implemented soon in France, a change that requires further analyses.
Level IV.
在法国，负责转介患者入院的初级保健医生可在公立医院和私立医院之间进行选择。但目前尚不清楚影响他们选择的因素有哪些。
我们从 1997 年至 2011 年参与 Sentinels(®)网络的初级保健医生报告的所有患者入院记录中，确定了因骨科疾病或外伤而入院的患者。然后，我们确定了与转至私立医院而非公立医院相关的因素。
在 1997 年至 2011 年 Sentinels(®)报告的 45960 例入院患者中，2794 例（6.1%）因骨科/外伤而入院。入院的主要原因是髋部骨折（27.5%）、择期骨科手术（15.5%）、肱骨干骨折（5.9%）、腕部骨折（5.4%）、前臂或手部软组织损伤（5.0%）和脊柱损伤（4.5%）。与其他疾病患者相比，私立医院收治的骨科/外伤患者更多（40% vs. 21.6%，P<0.0001）。当以肱骨干骨折为参照时，择期手术（比值比，3.30[2.02-5.40]）和髋部骨折（比值比，1.50[1.03-2.18]）的转院率明显更高，而脊柱损伤（比值比，0.35[0.19-0.66]）的转院率明显更低。其他与私立医院转院相关的因素包括患者年龄、门诊或非紧急情况下的入院决策以及患者常规医生做出的入院决策。
初级保健医生决定将骨科/外伤患者转至私立医院而非公立医院的决策似乎受特定因素的影响。法国即将实施私立和公立医院相同的定价标准，这一变化需要进一步分析。
IV 级。
