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Analysing current trends in care of acute myocardial infarction using PERFECT data.

https://arctichealth.org/en/permalink/ahliterature133898
Source
Ann Med. 2011 Jun;43 Suppl 1:S14-21
Publication Type
Article
Date
Jun-2011
Author
Unto Häkkinen
Juha Hartikainen
Merja Juntunen
Antti Malmivaara
Mikko Peltola
Ilkka Tierala
Author Affiliation
National Institute for Health and Welfare, Helsinki, Finland. unto.hakkinen@thl.fi
Source
Ann Med. 2011 Jun;43 Suppl 1:S14-21
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Female
Finland - epidemiology
Hospital Costs - statistics & numerical data - trends
Humans
Male
Middle Aged
Myocardial Infarction - economics - epidemiology - therapy
Outcome and Process Assessment (Health Care) - economics - statistics & numerical data - trends
Quality Assurance, Health Care - statistics & numerical data - trends
Registries - statistics & numerical data
Abstract
This article in the supplement issue on the Performance, Effectiveness, and Costs of Treatment episodes (PERFECT)-project describes the PERFECT AMI (acute myocardial infarction) Database, which is developed to measure the performance of hospitals and hospital districts in Finland. We analyse annual trends and regional differences in performance indicators and whether the utilisation of services and costs of hospital care are related to improvement in survival of AMI patients.
The study population consists of ten annual cohorts (1998-2007) of patients hospitalised for AMI.
Since 1998 the treatment pattern has changed rather radically, the utilisation rate of percutaneous coronary intervention (PCI) has increased and coronary procedures have been performed earlier after myocardial infarction. Outcome measured by various measures of mortality has improved considerably. However, trends in the development of the use of services and outcomes are not similar between hospital districts. An increase in cost was positively and statistically significantly related to decrease in mortality, but the effect was not very strong.
There is potential for decreased mortality from actions that do not increase the costs and for enhancing performance in the regions and hospitals with poor performance.
PubMed ID
21639713 View in PubMed
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Direct costs of patients with stroke can be continuously monitored on a national level: performance, effectiveness, and Costs of Treatment episodes in Stroke (PERFECT Stroke) Database in Finland.

https://arctichealth.org/en/permalink/ahliterature134915
Source
Stroke. 2011 Jul;42(7):2007-12
Publication Type
Article
Date
Jul-2011
Author
Atte Meretoja
Markku Kaste
Risto O Roine
Merja Juntunen
Miika Linna
Matti Hillbom
Reijo Marttila
Terttu Erilä
Aimo Rissanen
Juhani Sivenius
Unto Häkkinen
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland. atte.meretoja@fimnet.fi
Source
Stroke. 2011 Jul;42(7):2007-12
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cerebral Hemorrhage - economics
Databases, Factual
Economics, Medical
Female
Finland
Health Care Costs
Humans
Inpatients
Male
Middle Aged
Outpatients
Registries
Stroke - economics - therapy
Subarachnoid Hemorrhage - economics
Abstract
Treatment of stroke consumes a significant portion of all healthcare expenditure. We developed a system for monitoring costs from individual patient data on a national level in Finland.
Multiple national administrative registers were linked to gain episode-of-care data on all hospital-treated patients with incident stroke over the years 1999 to 2007 (n = 94,316). Inpatient and specialist outpatient costs were evaluated with a cost database, long-term care costs with fixed prices, and medication costs with true retail prices.
For the patients of Year 2007, the mean 1-year costs after an ischemic stroke were $29 580, after an intracerebral hemorrhage $36,220, and after a subarachnoid hemorrhage $42,570, valued in Year 2008 U.S. dollars. Only part of these costs are attributable to stroke, because the annual costs prior to stroke were significant, $8900 before ischemic stroke, $7600 before intracerebral hemorrhage, and $4200 before subarachnoid hemorrhage. Older patients with ischemic stroke, and, among patients with ischemic stroke and subarachnoid hemorrhage, women, incurred higher costs. The mean estimated lifetime costs were $130,000 after ischemic stroke or intracerebral hemorrhage and $80,000 after subarachnoid hemorrhage. Annually $1.6 billion is spent in the care of Finnish patients with stroke, which equals to 7% of the national healthcare expenditure, or 0.6% of the gross domestic product. Costs of patients with stroke are increasing with prolonged survival and the aging population.
Treatment of patients with stroke is a large national investment. Setting up a nationwide system for continuous monitoring of stroke costs is feasible. Cost data should optimally be evaluated in conjunction with effectiveness and performance indicators.
PubMed ID
21527757 View in PubMed
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Monitoring the performance of hip fracture treatment in Finland.

https://arctichealth.org/en/permalink/ahliterature133895
Source
Ann Med. 2011 Jun;43 Suppl 1:S39-46
Publication Type
Article
Date
Jun-2011
Author
Reijo Sund
Merja Juntunen
Peter Lüthje
Tiina Huusko
Unto Häkkinen
Author Affiliation
National Institute for Health and Welfare (THL), Helsinki, Finland. reijo.sund@thl.fi
Source
Ann Med. 2011 Jun;43 Suppl 1:S39-46
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Female
Finland - epidemiology
Hip Fractures - economics - epidemiology - therapy
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care) - economics - statistics & numerical data
Registries - statistics & numerical data
Abstract
This article in the supplement on the PERFormance, Effectiveness, and Costs of Treatment episodes (PERFECT)-project aims to measure the performance and quality of hip fracture treatment by analysing annual trends and regional differences in developed performance indicators.
The PERFECT Hip Fracture Database contains all hip fracture patients identified from the Hospital Discharge Register in Finland since 1999. Follow-up data from several administrative registers were also linked to the database. Several risk-adjusted performance indicators were developed.
In 2007 (compared with 1999), 4.1 percentage points fewer patients had died and 7.5 percentage points more patients were at home four months after fracture. The mean length of treatment had shortened from about 50 to about 45 days, and the mean costs of treatment per patient during the year following hip fracture had increased from about €18,000 to almost €20,000. There was extensive variation between the hospitals in the proportion of patients with an operative delay longer than two days and clear differences between hospital districts in several performance indicators.
Outcomes of hip fracture treatment in Finland have been improved in recent years, but regional variation exists. Register-based data are useful for performance assessment of hip fracture treatment.
PubMed ID
21639716 View in PubMed
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Stroke monitoring on a national level: PERFECT Stroke, a comprehensive, registry-linkage stroke database in Finland.

https://arctichealth.org/en/permalink/ahliterature141223
Source
Stroke. 2010 Oct;41(10):2239-46
Publication Type
Article
Date
Oct-2010
Author
Atte Meretoja
Risto O Roine
Markku Kaste
Miika Linna
Merja Juntunen
Terttu Erilä
Matti Hillbom
Reijo Marttila
Aimo Rissanen
Juhani Sivenius
Unto Häkkinen
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, PO Box 340, FI-00029 HUS, Finland. atte.meretoja@fimnet.fi.
Source
Stroke. 2010 Oct;41(10):2239-46
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Databases, Factual
Female
Finland - epidemiology
Humans
Incidence
Male
Middle Aged
Population Surveillance
Recurrence
Registries
Stroke - epidemiology
Abstract
Stroke databases are established to systematically evaluate both the treatment and outcome of stroke patients and the structure and processes of stroke services. Comprehensive data collection on this common disease is resource-intensive, and national stroke databases often include only patients from selected hospitals. Here we describe an alternative national stroke database.
We established a nationwide stroke database with multiple administrative registry linkages at the individual-patient level. Information on comorbidities; treatments before, during, and after stroke; living status; recurrences; case fatality; and costs were collected for each hospital-treated stroke patient.
The current database includes 94 316 patients with incident stroke between January 1999 and December 2007, with follow-up until December 2008. Annually, 10 500 new patients are being added. One-year recurrence was 13% and case fatality was 27% during the study period. In 2007, 86% of patients survived 1 month and 77% were living at home at 3 months, but the proportion treated in stroke centers (62%) or with nationally recommended secondary preventive medication after ischemic stroke (49%) was still suboptimal.
In comparison with other national stroke databases, our method enables higher coverage and more thorough follow-up of patients. Information on long-term recurrences, case fatality, or costs is not often included in national stroke databases. Our database has low maintenance costs, but it lacks detailed data on in-hospital processes. Use of national administrative data, where such linkage is possible, saves resources, achieves high rates of long-term follow-up, and allows for comprehensive monitoring of the burden of the disease.
PubMed ID
20798363 View in PubMed
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