Improving quality of care in general practice

Family Medicine Network (FaMe-Net) is a practice-based research network (PBRN) affiliated to the Radboud University Medical Centre in Nijmegen, the Netherlands. FaMe-Net is the world’s oldest (1967) and still functioning PBRN. It is known for highly accurate and uniform registration.

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FaMe-Net offers a diversity of coded data from general practice:

Registration of Episodes of Care

Registration of diagnosis according to the International Classification of Primary Care (ICPC-2) and the International Classification of Diseases and Related Health Problems (ICD-10)

Registration of Reason for encounter (RFE) and interventions according to the International Classification of Primary Care (ICPC-2)

Registration of a comprehensive list of patient’s personal and contextual factors

Mission

FaMe-Net aims to contribute to scientifically improving the quality of general practitioner care. To this end, the foundation uses systematically obtained data on patient contacts in general practice.

Vision

We believe it is important to substantiate family medicine by coding uniformly; taking into account individual patient factors, daily functioning and patient context. We find it important that the data and information we collect are (partly) freely accessible for use by third parties. We facilitate scientific research and publications that use our data to interpret general practice care. We support the use of our data for education and training of healthcare providers such as medical students, general practitioners and specialists.

Strategy

The general practices affiliated with the foundation record the following data uniformly and systematically:

Patient’s Reason for Encounter (RFE), diagnosis and diagnostic and therapeutic interventions performed by the general practitioner (according to the ICPC (International Classification of Primary Care))
Comprehensive context data of the patient
Functioning of the patient
The episode in which the patient’s question results in the final diagnosis and policy.

The foundation supports practices to ensure uniformity and thus quality of data through regular meetings and coding agreements.

Episode of Care registration explained

Learn how doctor-patient consultation in the office results in the registration of data in an Episode of Care in just four infographics.

Historic background

In the Netherlands, almost all inhabitants are listed with a general practitioner (GP) / family physician (FP), who deals with all health problems requiring professional medical care and is the gatekeeper to specialist care. The Dutch health care is explained here.

FaMe-Net is the continuation of two PBRNs, that fused in 2013: the Continuous Morbidity Registration (CMR) Nijmegen, registering epidemiology since 1967, and the ‘Transition Project’, registering since 1985. Both are built around episode registration, in which all information belonging to one health problem comes together in an episode of care.

The founding father of the world’s first PBRN (the Continuous Morbidity Registration), was Frans Huygen. He was professor in general practice in Nijmegen, the Netherlands, studying morbidity patterns in families, using data from the CMR. Moreover, he published the first edition of the medical textbook ‘Family Medicine’ in 1978, describing family medicine using data from the CMR.

FaMe-Net uses TransHis as its electronic patient record. TransHis is only used by the general practices participating in FaMe-Net.

Participating general practices

Currently (2022), FaMe-Net covers 6 general practices with more than 40.000 patients and 30 GPs.

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Current general practices	Number of enlisted patients (2022)	Start date of registering within FaMe-Net
Huisartsenpraktijk Amstelveen-Zuid	3774	17-04-1989
Huisartsenpraktijk Oosterhout	9847	02-12-2012
Universitair gezondheidscentrum Heijendael	5447	01-01-2013
Huisartsenpraktijk Thermion	11333	13-05-2013
Huisartsenpraktijk Bast en van Damme	2225	01-06-2019
Wijkgezondheidscentrum Lindenholt	9950	01-01-2021
Total	42576

Previous general practices	Number of enlisted patients at end of registration	Start date of registering within FaMe-Net	End date of registering within FaMe-Net
Huisartsenpraktijk Franeker (Het Bolwerk)	5660	01-01-1995	31-12-2016
Huisartsenpraktijk Olst (P. Dijksterhuis)	2533	01-09-2001	31-12-2018