Gerontology Research Center and School of Health Sciences, University of Tampere, Tampere, Finland.
Scand J Public Health. 2013 Aug;41(6):604-15. doi: 10.1177/1403494813484396. Epub 2013 Apr 19.
To analyse whether transitions between care settings differ between municipalities in the last 2 years of life among older people in Finland.
Data were derived from Finnish national registers, and include all those who died in 2002 and 2003 at the age of 70 or older except those living in very small municipalities (n=67,027). Data include admissions and discharges from health and social care facilities (university hospitals, general hospitals, health centres, residential care facilities) and time spent outside care facilities for 730 days prior to death. Three-level negative binomial regression analyses were performed to study the effect of municipal factors on (1) the total number of all care transitions, (2) the number of transitions between home and different care facilities, and (3) transitions between different care facilities.
The municipality of residence had only a minor effect on the total number of care transitions, but greater variation between municipalities was found when different types of care transition were examined separately. Largest differences were found in care transitions involving specialised care. Age structure, urbanity, and economic situation of the municipality had an impact on several different care transitions.
The total number of care transitions in 2 final years of life was approximately similar irrespective of the municipality of residence, but the findings imply differences in transitioning specialised care. Potentially, this may suggest inequality between the municipalities, but more detailed studies are needed to confirm the factors underlying these differences.
分析在芬兰，老年人在生命的最后 2 年中，在不同的医疗保健服务机构之间的转院情况是否存在差异。
数据来源于芬兰国家登记处，包括所有在 2002 年和 2003 年 70 岁或以上去世的人群，但不包括居住在非常小的城镇（n=67,027）的人群。数据包括从卫生和社会保健机构（大学医院、综合医院、健康中心、养老院）的入院和出院记录，以及在去世前的 730 天内，在护理设施外的时间。采用三级负二项回归分析来研究市政因素对（1）所有护理转院的总数、（2）家庭和不同护理机构之间的转院数量、（3）不同护理机构之间的转院数量的影响。
居住的城镇对护理转院的总数仅有微小影响，但在单独检查不同类型的护理转院时，发现城镇之间的差异更大。在涉及专业护理的转院中，差异最大。城镇的年龄结构、城市化程度和经济状况对几种不同的护理转院都有影响。
在生命的最后 2 年中，护理转院的总数大致相似，无论其居住的城镇如何，但研究结果表明，在专业护理的转院中存在差异。这可能表明城镇之间存在不平等，但需要更详细的研究来证实导致这些差异的因素。
