芬兰门诊护理敏感疾病地理差异的个体和地区层面因素：一项基于登记册的研究

Individual and Area-level Factors Contributing to the Geographic Variation in Ambulatory Care Sensitive Conditions in Finland: A Register-based Study.

作者信息

Satokangas Markku, Arffman Martti, Antikainen Harri, Leyland Alastair H, Keskimäki Ilmo

机构信息

Department of General Practice and Primary Health Care, Network of Academic Health Centres, University of Helsinki.

Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki.

出版信息

Med Care. 2021 Feb 1;59(2):123-130. doi: 10.1097/MLR.0000000000001454.

DOI:10.1097/MLR.0000000000001454

PMID:33201086

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7899221/

Abstract

BACKGROUND

Measuring primary health care (PHC) performance through hospitalizations for ambulatory care sensitive conditions (ACSCs) remains controversial-recent cross-sectional research claims that its geographic variation associates more with individual socioeconomic position (SEP) and health status than PHC supply.

OBJECTIVES

To clarify the usage of ACSCs as a PHC performance indicator by quantifying how disease burden, both PHC and hospital supply and spatial access contribute over time to geographic variation in Finland when individual SEP and comorbidities were adjusted for.

METHODS

The Finnish Care Register for Health Care provided hospitalizations for ACSCs (divided further into subgroups of acute, chronic, and vaccine-preventable causes) in 2011-2017. With 3-level nested multilevel Poisson models-individuals, PHC authorities, and hospital authorities-we estimated the proportion of the variance in ACSCs explained by selected factors at 3 time periods.

RESULTS

In age-adjusted and sex-adjusted analysis of total ACSCs the variances between hospital authorities was nearly twice that between PHC authorities. Individual SEP and comorbidities explained 19%-30% of the variance between PHC authorities and 25%-36% between hospital authorities; and area-level disease burden and arrangement and usage of hospital care a further 14%-16% and 32%-33%-evening out the unexplained variances between PHC and hospital authorities.

CONCLUSIONS

Alongside individual factors, areas' disease burden and factors related to hospital care explained the excess variances in ACSCs captured by hospital authorities. Our consistent findings over time suggest that the local strain on health care and the regional arrangement of hospital services affect ACSCs-necessitating caution when comparing areas' PHC performance through ACSCs.

摘要

背景

通过对非卧床护理敏感疾病（ACSC）的住院情况来衡量初级卫生保健（PHC）绩效仍存在争议——近期的横断面研究称，其地理差异与个体社会经济地位（SEP）和健康状况的关联度高于初级卫生保健服务的供应情况。

目的

通过量化在调整个体SEP和合并症的情况下，疾病负担、初级卫生保健和医院服务供应以及空间可及性如何随时间对芬兰的地理差异产生影响，以阐明将ACSC用作初级卫生保健绩效指标的情况。

方法

芬兰医疗保健登记册提供了2011 - 2017年期间ACSC的住院情况（进一步细分为急性、慢性和可通过疫苗预防病因的亚组）。我们使用三级嵌套多水平泊松模型——个体、初级卫生保健机构和医院机构——估计了在三个时间段内选定因素所解释的ACSC方差比例。

结果

在对所有ACSC进行年龄和性别调整后的分析中，医院机构之间的方差几乎是初级卫生保健机构之间方差的两倍。个体SEP和合并症解释了初级卫生保健机构之间19% - 30%以及医院机构之间25% - 36%的方差；地区层面的疾病负担以及医院护理的安排和使用又分别解释了14% - 16%和32% - 33%——从而平衡了初级卫生保健机构和医院机构之间无法解释的方差。