Service System Research, National Institute for Health and Welfare (THL), Helsinki, Finland.
Network of Academic Health Centres and Department of General Practice and Primary Health Care, Helsingin Yliopisto, Helsinki, Finland.
BMJ Open. 2019 Jul 18;9(7):e029592. doi: 10.1136/bmjopen-2019-029592.
A persistent finding in research concerning healthcare and hospital use in Western countries has been regional variation in the medical practices. The aim of the current study was to examine trends in the regional variation of avoidable hospitalisations, that is, hospitalisations due to conditions treatable in ambulatory care in Finland in 1996-2013 and the influence of different healthcare levels on them.
Use of hospital inpatient care in 1996-2013 among the total population in Finland.
Altogether 1 931 012 hospital inpatient care episodes among all persons residing in Finland identified from administrative registers in Finland in 1996-2013 and alive in 1 January 1996.
We examined hospitalisations due to avoidable causes including vaccine-preventable hospitalisations, hospitalisations due to complications of chronic conditions and acute conditions treatable in ambulatory care. We calculated annual age-adjusted rates per 10 000 person-years. Multilevel models were used for studying time trends in regional variation.
There was a steep decline in avoidable hospitalisation rates during the study period. The decline occurred almost exclusively in hospitalisations due to chronic conditions, which diminished by about 60%. The overall correlation between hospital district intercepts and slopes in time was -0.46 (p<0.05) among men and -0.20 (ns) among women. Statistically highly significant diminishing variation was found in hospitalisations due to chronic conditions among both men (-0.90) and women (-0.91). The variation was mainly distributed to the hospital district level.
The results suggest that chronic conditions are managed better in primary care in the whole country than before. Further research is needed on whether this is the case or whether this has more to do with supply of hospital care.
在西方国家有关医疗保健和医院使用的研究中，一个持续存在的发现是医疗实践的区域性差异。本研究的目的是研究芬兰 1996-2013 年可避免住院治疗的区域性变化趋势，即因可在门诊治疗的疾病而住院治疗的情况，以及不同医疗水平对其的影响。
芬兰 1996-2013 年总人口的住院治疗使用情况。
1996-2013 年期间从芬兰行政登记册中确定的所有居住在芬兰的人中，共有 1931012 例住院治疗病例，这些人在 1996 年 1 月 1 日时仍存活。
我们检查了因可避免的原因而导致的住院治疗，包括可通过疫苗预防的住院治疗、因慢性病并发症和可在门诊治疗的急性疾病而导致的住院治疗。我们计算了每年每 10000 人年的年龄调整后发生率。使用多水平模型研究了区域性变化的时间趋势。
在研究期间，可避免的住院治疗率急剧下降。这种下降几乎完全发生在慢性病导致的住院治疗中，减少了约 60%。男性的医院区截距和时间斜率之间的总体相关性为-0.46（p<0.05），女性为-0.20（ns）。在男性（-0.90）和女性（-0.91）中，慢性病导致的住院治疗中，可观察到统计学上显著的变异程度显著降低。这种变异主要分布在医院区一级。
结果表明，与以前相比，全国范围内的慢性病在初级保健中的管理情况更好。需要进一步研究这种情况是否属实，或者这是否与医院护理的供应更多有关。
