Incidence of short-term community hospital stays and clinical profiles of patients: the Finnish Community Hospital Cohort Study.

OBJECTIVE: A community hospital system covers the entire population of Finland. Yet there is little research on the system beyond routine statistics. More knowledge is needed on the incidence of hospital stays and patient profiles. We investigated the incidence of short-term community hospital stays and the features of care and patients. DESIGN: Prospective observational study. SETTING: Community hospitals in the catchment area of Kuopio University Hospital in Finland. SUBJECTS: Short-term (up to one month) community hospital stays of adult residents. MAIN OUTCOME MEASURES: The outcome was the incidence rate of short-term community hospital stays according to age, sex and the first underlying diagnoses. RESULTS: A number of 13,482 short-term community hospital stays were analyzed. The patients' mean age was 77 years. The incidence rate of short-term hospital stays was 28.6 stays per 1000 person-years among residents aged <75 years and 419.0 among residents aged ≥75 years. In men aged <75 years, the hospital stay incidence was about 40% higher than in women of the same age but in residents aged ≥75 years incidences did not differ between sexes. The most common diagnostic categories were vascular and respiratory diseases, injuries and mental illnesses. CONCLUSIONS: The incidence rate of short-term community hospital stays increased sharply with age and was highest among women aged ≥75 years. Care was required for acute and chronic conditions common in older adults. IMPLICATIONS: Community hospitals have a substantial role in hospital care of older adults.

Finland has a broad network of community hospitals covering the entire population. More knowledge is needed on incidences and patient profiles of community hospital stays.The incidence of short-term community hospital stays increased sharply with age and was the highest among women aged ≥75 years.Vascular and respiratory diseases accounted for most of the community hospital admissions.Community hospitals play an important role in the care of an aging population.

Factors Associated With Discharge Destination in Older Patients: Finnish Community Hospital Cohort Study.

OBJECTIVES: Primary care physician-led community hospitals provide basic hospital care for older people in Finland. Yet little is known of the outcomes of the care. We investigated factors associated with discharge destination after hospitalization in a community hospital and the role of active rehabilitation during the stay. DESIGN: Prospective observational study. SETTING AND PARTICIPANTS: Short-term community hospital stays of older adults (≥65 years) living in the Kuopio University Hospital district in central and eastern Finland. METHODS: Data on short-term (1-31 days) hospital stays from 51 community hospitals were collected with an electronic survey between January and June 2016. Physicians, secretaries, and rehabilitation staff from each community hospital completed the data collection form. Discharge destination was defined as home, residential care or death, and active rehabilitation as frequency of rehabilitation at least once a day. Analyses were conducted using the Bayesian approach and the BayesiaLab 9.1 tool. RESULTS: Data of 11,628 community hospital stays were analyzed. The patients' mean age was 81.6 years (SD 7.9), and 57.5% were women. A younger age (65-74 years), a high number of rehabilitation staff (>2 per 10 patients), and receiving rehabilitation at least once a day were associated with discharging patients to their own homes. Daily rehabilitation was associated with returning to home in all patient groups. CONCLUSIONS AND IMPLICATIONS: Older patients admitted to a community hospital for any reason may benefit from active rehabilitation. The role of community hospitals in the acute care and rehabilitation of older patients is important in aging societies.

Challenges of audit of care on clinical quality indicators for hypertension and type 2 diabetes across four European countries.

BACKGROUND: The purpose of the study was to measure clinical quality by doing an audit of clinical records and to compare the performance based on clinical quality indicators (CQI) for hypertension and type 2 diabetes across seven European countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. METHODS: Two common chronic conditions in primary care (PC), hypertension and type 2 diabetes, were selected for audit. The assessment of CQI started with a literature review of different databases: Organization for Economic Co-operation and Development, World Health Organization, European Commission European Community Health Indicators, US National Library of Medicine. Data were collected from clinical records. RESULTS: Although it was agreed to obtain the clinical indicators in a similar way from each country, the specific data collection process in every country varied greatly, due to different traditions in collecting and keeping the patients' data, as well as differences in regulation regarding access to clinical information. Also, there was a huge variability across countries in the level of compliance with the indicators. CONCLUSIONS: Measurement of clinical performance in PC by audit is methodologically challenging: different databases provide different information, indicators of quality of care have insufficient scientific proof and there are country-specific regulations. There are large differences not only in quality of health care across Europe but also in how it is measured.

Integrated primary health care: Finnish solutions and experiences.

BACKGROUND: Finland has since 1972 had a primary health care system based on health centres run and funded by the local public authorities called 'municipalities'. On the world map of primary health care systems, the Finnish solution claims to be the most health centre oriented and also the widest, both in terms of the numbers of staff and also of different professions employed. Offering integrated care through multi-professional health centres has been overshadowed by exceptional difficulties in guaranteeing a reasonable access to the population at times when they need primary medical or dental services. Solutions to the problems of access have been found, but they do not seem durable. DESCRIPTION OF POLICY PRACTICE: During the past 10 years, the health centres have become a ground of active development structural change, for which no end is in sight. Broader issues of municipal and public administration structures are being solved through rearranging primary health services. In these rearrangements, integration with specialist services and with social services together with mergers of health centres and municipalities are occurring at an accelerated pace. This leads into fundamental questions of the benefits of integration, especially if extensive integration leads into the threat of the loss of identity for primary health care. DISCUSSION: This article ends with some lessons to be learned from the situation in Finland for other countries.

Review of the sanitary epidemiological services in the Kyrgyz Republic: report on an interagency mission to the Kyrgyz Republic: Kyrgyzstan, 21 September–6 October 2000

In Kyrgyzstan, as in all former Soviet Union countries, a vertically organized sanitary epidemiological service (SES) is responsible for providing part of the services related to the health protection. Though SES acquired a relativelystrong position during the existence of the Soviet Union, currently SES faces serious financial problems of trying to make ends meet with a low level of spending about US$0.30 per capita in Kyrgyzstan at the end of the 1990s.Reforming the SES has lagged behind the development of other components of the health care system in the country. It became evident that, in spite of some plans to restructure the SES, the strategic vision of the reform still remained as a future challenge. Therefore, a review team was designated to include experts relevant to the three main functions of SES epidemiology, sanitary hygiene and laboratory services. The review covered how the SES operates and how it is structured, assessment of the existing functions and structures and the recommendations on how to revise and restructure SES. The ultimate purpose was to make the SES even more effective and efficient, keeping in mind the scarcity of financial and other resources.

Exploring health policy development in Europe

Countries in Europe have long recognized that good health care, though essential, is not in itself sufficient to improve health or to reduce the increasing gaps in health status between the rich and the poor. In 1984, together with WHO, they adopted what has become known as the health for all policy. By the late 1990s, over half the European Member States had developed national health policies in line with health for all. This called for a radical shift from health services planning to an approach based on setting objectives and targets for health, requiring partnerships with industry, agriculture and commerce, and settings such as workplaces and schools. It also required changes in action to ensure a fairer distribution of the determinants of health, such as income, education, employment opportunities, and adequate food and housing. This book provides a comprehensive review of health for all policy development in all 51 Member States. It draws together the main policy lessons from over 20 years of experience in Europe. It also identifies some of the future challenges for policy-makers throughout the Region, such as increasing inequities in health, social exclusion, demographic changes, rising expectations and the rapidly expanding developments in information and technology. It will be of use to those in health administrations interested in health policy development, to their colleagues in other sectors and departments whose work may have an effect on health, and to decision-makers at national, regional and local levels who must take action for health and development.