Many studies indicate huge regional and hospital-level differences in health care performance. In order to increase health system efficiency, it is important to know the reasons behind the ...differences and analyse the effects of those factors that can be affected by health policy. The aim of this study is to evaluate and compare various organisational factors and health policy interventions in the performance of the care of hip fracture patients in Finland. We analysed the relationship between organisational factors (hospital volume, regional concentration of treatments) and performance. The focus is also on the effects of two macro-level organisational changes (integration of production of all health and social services in one provider) and two micro-level interventions (integrated patient pathway interventions, aiming to discharge patients as soon as possible). Our results indicate that macro-level integration of the production or financing of health and social services, bigger hospital volumes, and the concentration of the acute phase of care in fewer hospitals within hospital districts were not consistently related to efficiency in the care of hip fracture patients. Instead, efficiency can be increased using micro-level interventions aiming to coordinate patient pathways at the patient group level.
•Evaluates various organisational factors and interventions on care of hip fracture.•Use rich data covering almost all first-time hip fracture patents in Finland during a 14-year period.•Integration and hospital volume were not consistently related to performance.•Efficiency can be increased using micro-level interventions aiming to coordinate patient pathways.
Background and purpose - Implant survival of cemented total hip arthroplasty (THA) in elderly patients is higher than that of uncemented THA. However, a higher mortality rate in patients undergoing ...cemented THA compared with uncemented or hybrid THA has been reported. We assessed whether cemented fixation increases peri- or early postoperative mortality compared with uncemented and hybrid THA.
Patients and methods - Patients with osteoarthritis who received a primary THA in Finland between 1998 and 2013 were identified from the PERFECT database of the National Institute for Health and Welfare in Finland. Definitive data on fixation method and comorbidities were available for 62,221 THAs. Mortality adjusted for fixation method, sex, age group, and comorbidities among the cemented, uncemented, and hybrid THA was examined using logistic regression analysis. Reasons for cardiovascular death within 90 days since the index procedure were extracted from the national Causes of Death Statistics and assessed separately.
Results - 1- to 2-day adjusted mortality after cemented THA was comparable to that of the uncemented THA group (OR 1.2; 95% CI 0.24-6.5). 3- to 10-day mortality in the cemented THA group was comparable to that in the uncemented THA group (OR 0.54; CI 0.26-1.1), and in the hybrid THA group (OR 0.64, CI 0.25-1.6). Pulmonary embolism or cardiovascular reasons as a cause of death were not over-represented in the cemented THA group.
Interpretation - Early peri- and postoperative mortality in the cemented THA group was similar compared with that of the hybrid and uncemented groups.
Abstract Objective Our aim was to assess the impact of the most commonly used typical and atypical antipsychotics on mortality of patients with first-onset schizophrenia. Method We conducted a ...nationwide, register-based, five-year follow-up study of all patients presenting with first-onset of schizophrenia between 1998 and 2003. Details of reimbursed medicines were obtained from the register of Social Insurance Institution. Results After adjusting for age, gender, comorbid physical diseases and patient group, the use of second generation antipsychotics (SGAs), especially clozapine, olanzapine and quetiapine, was associated with reduced risk of all-cause mortality in patients with schizophrenia, while clozapine associated with lower suicide risk. First generation antipsychotics (FGAs), specifically levomepromazine, thioridazine or clorprothixene, were associated with increased risk of all-cause mortality. The FGAs, particularly clorprothixene, were associated with decreased suicide mortality. An increased likelihood for cardiovascular deaths was found among users of levomepromazine. In antidepressants, the use of mirtazapine associated with increased risk of suicide. Conclusions Differences exist between FGAs' and SGAs' use in relation to mortality. These differences remain even when the patient's physical illness are taken into account when prescribing antipsychotic medication.
OBJECTIVES:The number of critical care survivors is growing, but their long-term outcomes and resource use are poorly characterized. Estimating the cost-utility of critical care is necessary to ...ensure reasonable use of resources. The objective of this study was to analyze the long-term resource use and costs, and to estimate the cost-utility, of critical care.
DESIGN:Prospective observational study.
SETTING:Seventeen ICUs providing critical care to 85% of the Finnish adult population.
PATIENTS:Adult patients admitted to any of 17 Finnish ICUs from September 2011 to February 2012, enrolled in the Finnish Acute Kidney Injury (FINNAKI) study, and matched hospitalized controls from the same time period.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We primarily assessed total 3-year healthcare costs per quality-adjusted life-years at 3 years. We also estimated predicted life-time quality-adjusted life-years and described resource use and costs. The costing year was 2016. Of 2,869 patients, 1,839 (64.1%) survived the 3-year follow-up period. During the first year, 1,290 of 2,212 (58.3%) index episode survivors were rehospitalized. Median (interquartile range) 3-year cumulative costs per patient were $49,200 ($30,000–$85,700). ICU costs constituted 21.4% of the total costs during the 3-year follow-up. Compared with matched hospital controls, costs of the critically ill remained higher throughout the follow-up. Estimated total mean (95% CI) 3-year costs per 3-year quality-adjusted life-years were $46,000 ($44,700–$48,500) and per predicted life-time quality-adjusted life-years $8,460 ($8,060–8,870). Three-year costs per 3-year quality-adjusted life-years were $61,100 ($57,900–$64,400) for those with an estimated risk of in-hospital death exceeding 15% (based on the Simplified Acute Physiology Score II).
CONCLUSIONS:Healthcare resource use was substantial after critical care and remained higher compared with matched hospital controls. Estimated cost-utility of critical care in Finland was of high value.
Background and purpose - The influence of hospital volume on the outcome of total knee joint replacement surgery is controversial. We evaluated nationwide data on the effect of hospital volume on ...length of stay, re-admission, revision, manipulation under anesthesia (MUA), and discharge disposition for total knee replacement (TKR) in Finland.
Patients and methods - 59,696 TKRs for primary osteoarthritis performed between 1998 and 2010 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified into 4 groups according to the number of primary and revision knee arthroplasties performed on an annual basis throughout the study period: 1-99 (group 1), 100-249 (group 2), 250-449 (group 3), and ≥ 450 (group 4). The association between hospital procedure volume and length of stay (LOS), length of uninterrupted institutional care (LUIC), re-admissions, revisions, MUA, and discharge disposition were analyzed.
Results - The greater the volume of the hospital, the shorter was the average LOS and LUIC. Smaller hospital volume was not unambiguously associated with increased revision, re-admission, or MUA rates. The smaller the annual hospital volume, the more often patients were discharged home.
Interpretation - LOS and LUIC ought to be shortened in lower-volume hospitals. There is potential for a reduction in length of stay in extended institutional care facilities.
Nordic comparative health economics research stands out internationally both by its access to excellent patient data and its long-time commitment to rigorous analyses. In this article, we present the ...methodological foundations and the results from two types of performance analyses – comparative analyses of health care outcomes and costs at hospital level and similar analyses at the disease level. In the concluding part, we discuss strength and weaknesses of the Nordic comparative analyses, and how we should develop Nordic comparative health economics research further.
Background
Early term birth is associated with increased need for hospital care during the early postnatal period. The objective of this study was to assess the morbidity and health care‐related ...costs during the first 3 years of life in children born early term.
Methods
Data come from a population‐based birth cohort study in the municipalities of Helsinki, Espoo, and Vantaa, Finland using data from the national medical birth register and outpatient, inpatient, and primary care registers. All surviving infants born in 2006–08 (n = 29 970) were included. The main outcome measures were morbidities, based on ICD‐10 codes recorded during inpatient and outpatient hospital visits, and health care costs, based on all care received, including well child visits (specialised care, primary care, private care, and medications).
Results
7.0% of children born full term had at least one of the studied morbidities by 3 years of age. This percentage was significantly higher in children born early term: 8.6% (adjusted odds ratio 1.2, 95% confidence interval (CI) 1.1, 1.4). The increased morbidity of children born early term was attributed to obstructive airway diseases and ophthalmological and motor problems. Health care‐related costs during the first 3 years of life were 4813€ (95% CI 4385, 5241) per child in the early term group, higher than for full term children 4047€ (95% CI 3884, 4210).
Conclusions
Infants born early term have increased morbidity and higher health care‐related costs during early childhood than full term infants. Early term birth seems to be associated with a health disadvantage.
In Finland, occupational healthcare (OHC) provides alternative access to curative ambulatory primary healthcare for a large proportion of the employed. Providers of occupational and private ...healthcare can also refer patients to public secondary healthcare, possibly providing better access to specialized medicine. We investigate the determinants of the use of OHC and associations between the use of OHC and other ambulatory service sectors and distributions of ambulatory healthcare. We find that the probability of using OHC is positively associated with the size of the employing organization and is higher for those with higher incomes but does not vary strongly between patients with different health conditions. Those who use OHC visit public health centres less often, but the negative association is not strong: the use of occupational healthcare seems to be associated with an overall higher use of ambulatory services. The results show that ambulatory healthcare is not allocated according to need in Finland. Those with higher incomes are in better health and use more OHC and private healthcare.
Published: Online July 2022
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