title: Primary-care physicians' patient referral patterns to private versus public hospitals for orthopaedic or trauma surgery-- French Sentinels® database, 1997-2011.
abstract: BACKGROUND
  In France, primary-care physicians referring patients for admission can choose between public and private hospitals. The factors that govern their choices are unknown.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level IV.
authors.affiliation: Service de médecine interne, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France. Electronic address: ac.labaisse@gmail.com.
authors.forename: A-C
authors.initials: AC
authors.lastname: Rousseau
authors.forename: T
authors.initials: T
authors.lastname: Blanchon
authors.forename: C
authors.initials: C
authors.lastname: Turbelin
authors.forename: J
authors.initials: J
authors.lastname: Cabane
authors.forename: T
authors.initials: T
authors.lastname: Hanslik
authors.forename: J-M
authors.initials: JM
authors.lastname: Feron
authors.forename: B
authors.initials: B
authors.lastname: Rousseau
authors.forename: L
authors.initials: L
authors.lastname: Fardet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery; D005602:France; D019538:Health Care Surveys; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019637:Orthopedic Procedures / Q000592:standards / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D058007:Physicians, Primary Care / Q000592:standards / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D012307:Risk Factors; D014947:Wounds and Injuries / Q000601:surgery*
keywords: Fractures; Orthopaedics; Private hospital admission; Public hospital admission