Fr
Contribution to the EMD Meeting 8 & 9 December, 2000
Abstract
The Sentinel Surveillance of Referral to Hospital in French Primary Care
L. Letrilliart & A.
Flahault,
Dr Letrilliard is a practicing general practitioner and medical epidemiologist performing his PhD thesis. He is in charge of the epidemiological study and the organization of the French sentinel network “Réseau Sentinelle” drived by the INSERM U-444, Paris, WHO Collaborating Centre for Electronic Disease Surveillance. Dr Letriliard is also a member of the WONCA International classification Committee.
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Letrilliart L, Viboud C, Boelle P, Flahault A. Automatic coding of
reasons for hospital referral from general medicine free-text reports. JAMIA 2000;Symp
Suppl:487-91.
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Letrilliart L, Guiguet M, Flahault A. Reliability of report coding of
hospital referrals in primary care versus practice-based coding. Eur J Epidemiol 2000;16:653-9.
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Letrilliart L, Guiguet
M, Hanslik T, Flahault A. Complications nosocomiales détectées en médecine
générale (abstract). Rev Epidemiol Sante Publ 2000;48:3S117.
Background: Several pathways exist to get hospitalised in the French free-access health care system. However no data on the referral status are available, even from the national hospital information system called PMSI, regarding the way patients are admitted to hospital. In addition, although complications of hospitalisation are increasingly assessed in the inpatient setting, those arising after discharge have been little studied apart from postoperative nosocomial infections. Our aim was to describe the hospital referral process in primary care in France and to assess complications of all type diagnosed by GPs in the postdischarge period.
Methods: A follow-up outcome study nested within a surveillance system of hospital referrals performed by GPs from the French Sentinel network since July 1997. Data on each referral to hospital are collected by Sentinel GPs and transmitted on a weekly basis via tele-informatics (Internet or Minitel) to the database centre, where a systematic quality control is performed. In particular, reason(s) for referral are entered in a free-text format, and subsequently coded according to the ICPC classification, using an automated tool based on string matching specifically developed to that end. Each reported case of complication that occurred within 30 days of discharge has been investigated through a telephone interview with the GP and the responsible hospital physician. This project was covered by an overall approval of the French Commission Nationale de l’Informatique et des Libertés (CNIL) allowing surveys conducted on the Sentinel system.
Results: Since July 1997, 12 000 referrals to hospital have been individually described by 305 GPs. This system
provides information on the characteristics of patients referred to hospital and on the circumstances of the referral, including the reason(s) for referral. By using the statistical procedures applied on the Sentinel system for the incidence estimation of communicable disease, we could estimate that around 1.3 million hospital admissions result each year from GPs’ referrals, which hardly accounts for 10 % of all admissions in French hospitals. Moreover, we observed a seasonal in GPs’ hospital referrals, with a regular increase during summer. Ninety-two cases of nosocomial complications have been reported and investigated during the first two years of the project, including 21 nosocomial infections, 31 adverse drug reactions and 40 complications of other type. We estimated at 1.2 per thousand admissions (95%CI, 1.0-1.5 per thousand) the rate of nosocomial adverse events detected in general practice within 30 days of discharge.
Conclusion: The surveillance of hospital referrals is the first attempt on the Sentinel system for systematically
collecting data on GPs’ clinical practice. It provides epidemiological information to both public health community and participating GPs (through regular feedback procedures). This project, which initially has been funded through a grant from the French Institut National de la Santé et de la Recherche Médicale, will be completed soon.
DrLaurent Letrilliard
INSERM U – 444 27 rue Chaligny F-75571 Paris Cedex 12 France
+33 1 44 73 84 47 fax +33 1-44-73-84-54 letrilli@u444.jussieu.fr
http://www.ulb.ac.be/esp/emd/fr_letrilliard.htm