To determine whether birth and care in the highest-level hospitals (level III) compared with birth in or postnatal transfer to lower-level hospitals (level II) are associated with 5-year morbidity in very preterm children.
A cohort study.
All surviving 5-year-old children born very preterm (gestational age
Copayments are common measures intended to control drug expenditures and promote rational prescribing. In Finland, new antiglaucoma drugs start with a high copayment, but once sufficient clinical experience is available, they are reevaluated and can receive a lower copayment status.
This study assessed the effect of changes in copayment level on the adoption of 2 antiglaucoma drugs.
A retrospective analysis was performed from 1997 to 2001 using the Finnish national register of reimbursed drug purchases, which covers approximately 98% of all antiglaucoma drug purchases in the country. There were 172,293 purchases of dorzolamide (plain or combined with timolol) and 281,377 purchases of latanoprost. An interrupted time-series design from approximately 30 months before and 20 months after the change in copayment was used in the analysis. The main outcome measures were the numbers of defined daily doses (DDDs) purchased and the monthly numbers of patients who purchased the study drugs for the first time before and after the change in copayment.
A substantial increase in consumption of both dorzolamide and latanoprost was seen immediately after the introduction of the lower copayment. The monthly consumption of dorzolamide was 60,713 DDDs higher and the monthly consumption of latanoprost was 49,330 DDDs higher than expected according to the utilization trend during the higher copayment period. Twelve months later, the observed consumption of dorzolamide was 109% higher and that of latanoprost was 21% higher than if the copayment had remained the same. The number of new patients using the study drugs peaked within 2 months of the lower copayment, but the amount consumed per patient per day remained quite stable.
Decreasing the copayment of a new antiglaucoma drug to the same level as the copayments of alternative drugs accelerated the adoption of these new products in Finland.
This study revisits the debate on the 'red herring', i.e. the claim that population aging will not have a significant impact on health care expenditure (HCE), using a Finnish data set. We decompose HCE into several components and include both survivors and deceased individuals into the analyses. We also compare the predictions of health expenditure based on a model that takes into account the proximity to death with the predictions of a na?ve model, which includes only age and gender and their interactions. We extend our analysis to include income as an explanatory variable. According to our results, total expenditure on health care and care of elderly people increases with age but the relationship is not as clear as is usually assumed when a na?ve model is used in health expenditure projections. Among individuals not in long-term care, we found a clear positive relationship between expenditure and age only for health centre and psychiatric inpatient care. In somatic care and prescribed drugs, the expenditure clearly decreased with age among deceased individuals. Our results emphasize that even in the future, health care expenditure might be driven more by changes in the propensity to move into long-term care and medical technology than age and gender alone, as often claimed in public discussion. We do not find any strong positive associations between income and expenditure for most non-LTC categories of health care utilization. Income was positively related to expenditure on prescribed medicines, in which cost-sharing between the state and the individual is relatively high. Overall, our results indicate that the future expenditure is more likely to be determined by health policy actions than inevitable trends in the demographic composition of the population.
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.
Our aim was to assess the impact of the most commonly used typical and atypical antipsychotics on mortality of patients with first-onset schizophrenia.
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.
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.
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.
To analyse the association between quality of care and technical (productive) efficiency in institutional long-term care wards for the elderly.
One hundred and fourteen public health centre hospitals and residential homes in Finland.
Wards were divided into two categories according to their rank in the quality distribution, considering 41 quality variables separately. The technical efficiency scores of the good- and poor-quality groups were compared using cross-sectional data.
Data envelopment analysis was used for calculating technical efficiency. The Mann-Whitney test and correlation coefficients were used to explore the association between quality and efficiency.
The wards where quality indicators indicated less pro-active (passive) nursing practice and more dependent patients-for instance, in terms of very high prevalence of bedfast residents or very high prevalence of daily physical restraints-performed more efficiently than the comparison group.
The results suggest that an association may exist between technical efficiency and unwanted dimensions of quality. Hence, the efficiency and quality of care are essential aspects of management and performance measurement in elderly care.
To examine the association between patient injury claims and well-known quality indicators and to assess whether claims can be utilised in performance measurement.
Data were derived from administrative registers and comprised hip and knee replacement patients (n=34181) in Finland from 1998 to 2003. Hospital-level correlations were calculated between claims and quality indicators (5-year revision rate, 1-year deep infection rate, and 14-day readmission rate), while logistic regression analysis was used to analyze patient-level data for an association between claims and quality indicators.
Correlations between claims and revisions as well as claims and infections were statistically significant, with correlation coefficients ranging from 0.21 to 0.62. In the regression analysis, both the revision and the infection indicator had a positive and statistically significant association with filing a claim (OR 1.002; 95% CI 1.001-1.003 and 1.001; 1.00005-1.001, respectively) and obtaining compensation (1.003; 1.001-1.005 and 1.001; 1.0003-1.002, respectively).
A claims indicator has the potential to be applied as a quality indicator. It should be complemented, however, with other indicators or actions to improve its acceptability by health professionals and to mitigate its possible undesirable effects.
The importance of using valid case-mix systems in long-term care is addressed by comparing the predictive power of different case-mix models, and by applying them in the calculation of technical efficiency scores of care units.
To construct different case-mix models a statistical clustering technique (Automatic Interaction Detection) was used. Technical efficiency score were calculated using data envelopment analysis (DEA).
The Resource Utilization Groups (RUG-III/22) classification explained 39% of resident specific cost, compared with 16% for a functional dependency scale in the Finnish patient information system HILMO.
When assessing the economic performance of long-term care units it is important to pay attention to the predictive validity of the case-mix measure to be used. The choice of case-mix measure significantly affected how units were rated in efficiency.