structural changes in finnish health care
DESCRIPTION
basics of current structure National Project and other ongoing changes expected changes as extrapolated from challenges evaluation, the ingredient too often absent. Structural changes in Finnish health care. most Finnish health care is public - PowerPoint PPT PresentationTRANSCRIPT
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Association between the effectiveness of intervention and patients age
Age
90
80
70
60
50
40
30
20
score difference (after-before)
.3
.2
.1
0.0
-.1
-.2
Sex
female
male
*
15D-profiles in cataract patients before (green) and after (red) the operation as compared with age-adjusted normal population (blue)
Kaavio1
0.8440.82890.8415
0.88320.7730.9219
0.89080.91740.9174
0.82610.86030.8427
0.82990.80820.8154
0.98110.96970.9752
0.96710.95870.9622
0.84350.8520.8419
0.78320.80130.8176
0.84110.8770.8685
0.72350.77670.7743
0.87840.9060.8994
0.87630.89060.8963
0.80080.83830.8367
0.75870.79820.7809
15D-scorePopulation .8484before .8577after .8650
Vest
Kaihi ennen
Kaihi jlkeen
Dimensions
values
Sheet1
moveseehearbreathsleepeatspeechelimuactmentaldiscodeprdistrvitalsex
Vest0.8440.88320.89080.82610.82990.98110.96710.84350.78320.84110.72350.87840.87630.80080.7587
Kaihi ennen0.82890.7730.91740.86030.80820.96970.95870.8520.80130.8770.77670.9060.89060.83830.7982
Kaihi jlkeen0.84150.92190.91740.84270.81540.97520.96220.84190.81760.86850.77430.89940.89630.83670.7809
Sheet1
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
15D-lukemaVest .8484Kaihi ennen .8577Kaihi jlkeen .8650
Vest
Kaihi ennen
Kaihi jlkeen
Dimensiot
Tasoarvot
15D-profiilit ja -lukemat kaihipotilailla ennen ja jlkeen hoidon sek ik- ja sukupuolivakioidulla normaalivestll
Sheet2
Sheet3
*
Health related quality of life in patients with esophageal cancer
Kaavio1
0.91051739130.83
0.82597222220.83
0.739760.84
Radical surgery
Palliative treatment
Taul1
Statistics
MOVE1SEE1HEAR1BREATH1SLEEP1EAT1SPEECH1ELIM1UACT1MENTAL1DISCO1DEPR1DISTR1VITAL1SEX1D15SCORETMOVE1TSEE1THEAR1TBREATH1TSLEEP1TEAT1TSPEECH1TELIM1TUACT1TMENTAL1TDISCO1TDEPR1TDISTR1TVITAL1TSEX1TD15SCORKMOVE1KSEE1KHEAR1KBREATH1KSLEEP1KEAT1KSPEECH1KELIM1KUACT1KMENTAL1KDISCO1KDEPR1KDISTR1KVITAL1KSEX1KD15SCOR
NValid35353535353535353535353535353535232323232323232323232323232323236666666666666666
Missing00000000000000001212121212121212121212121212121229292929292929292929292929292929
Mean0.950.910.950.910.830.900.920.870.860.930.820.830.820.830.790.880.870.940.960.840.800.870.870.850.680.920.750.850.820.720.620.830.820.930.920.600.680.820.870.800.610.880.670.680.730.650.580.76
Median11110.76151111110.76510.72510.77130.70950.908111110.76151110.72110.7024110.77130.70950.830.85645110.587350.76150.8231110.5671510.70240.76510.72510.77130.575950.77085
Std. Deviation0.12453814340.17494416380.12272362860.16280596570.19502245480.20349067540.20787784040.17225656640.20541774420.14472244590.22139970440.15666119340.19648565030.1778628830.23256604410.09020657260.23142556760.12872670.0970046130.18497672340.22110105590.23443874820.22850356260.20441484050.28055839590.21597149830.19571485270.20523222930.23122816740.23002895860.3300626180.12124443350.21933700780.11154192040.12925436420.25540030340.24233131590.19378424080.30737013790.31200753840.2419647640.18414744820.31878601230.12925436420.23329244020.20127183360.14629669510.1530574271
Variance0.01550974920.03060546050.0150610890.02650578250.03803375790.0414084550.04321319650.02967232470.04219644960.02094458640.04901782910.02454272950.03860661080.03163520520.05408696490.00813722570.05355779330.01657056330.00940989490.03421638820.04888567690.05496152660.05221387810.0417854270.07871301350.04664368810.03830430360.04212026790.05346646540.05291332180.10894133180.01470021260.0481087230.01244160.01670669070.0652293150.05872446670.0375523320.09447640170.0973487040.0585469470.03391028270.10162452170.01670669070.05442536270.0405103510.0214027230.023426576
Skewness-2.6087305126-2.4833187461-2.559208006-1.5137100192-1.2008993992-2.4750166961-2.5019943781-0.9076250227-1.4369226547-1.5680171192-0.8310450007-0.9940755282-0.8118230242-0.5627395832-0.6647427667-0.8791627332-2.2486445836-2.3957820362-1.8430640439-0.5021312885-1.0467025517-2.0571582303-2.0351420407-1.0249301546-0.402233849-2.7682782916-0.2172807465-1.9328589727-1.4296075144-0.8444807366-0.2355956493-0.7304945856-0.6885018879-0.9682458366-0.96824583660.3773880013-0.5742920413-0-2.4494897428-0.96824583660.7627334289-0.9682458366-0.410032083-0.96824583660.0911814442-1.4493049402-0-0.1681521935
Std. Error of Skewness0.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.39769404430.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.84515425470.84515425470.84515425470.84515425470.84515425470.84515425470.84515425470.84515425470.84515425470.84515425470.84515425470.84515425470.84515425470.84515425470.84515425470.8451542547
Kurtosis6.34485244266.4162866836.71894769851.00620825691.32731800227.17844887955.3756249171-0.34862558971.75560301180.4829545455-0.59874062232.41780282990.2926373789-0.8428253125-0.77971867270.26001522135.62446858296.04634817831.5218045113-1.14984496450.45108597814.87672679124.2365519146-0.0884167802-0.78610616876.8533940516-0.40865570854.9440696312.27938600130.6863133779-1.47211014520.1614469615-0.9373847888-1.875-1.8750.29689739530.2959666487-3.33333333336-1.875-0.6586241391-1.875-1.2027461711-1.875-1.8750.9375719529-3.3333333333-0.9768311717
Std. Error of Kurtosis0.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.77779439110.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379881.74077655961.74077655961.74077655961.74077655961.74077655961.74077655961.74077655961.74077655961.74077655961.74077655961.74077655961.74077655961.74077655961.74077655961.74077655961.7407765596
Minimum0.47290.31370.46110.47710.30150.0710.24710.39580.21820.64340.3960.30530.26330.51520.24860.64780.0780.49010.74970.47710.30150.0710.12980.39580.07850.19560.3960.15760.12550.12530.13180.55040.47290.7840.74970.25810.30150.64620.24710.39580.41330.64340.20830.51480.47860.29570.44240.5391
Maximum11111111111111111111111111111110.995111111111110.765110.77130.70950.9581
MovingSeeingHearingBreathingSleepingEatingSpeechEliminationUsual activitiesMental functionDiscomfort and symptomsDepressionDistressVitalitySexual activity
0.950.910.950.910.830.900.920.870.860.930.820.830.820.830.79
0.870.940.960.840.800.870.870.850.680.920.750.850.820.720.62
0.820.930.920.600.680.820.870.800.610.880.670.680.730.650.58
15D score before treatment0.88
15D score3 months after treatment0.83
15D score 12 months after treatment0.76
Taul1
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
Before treatment
3 months after treatment
12 months after treatment
Taul2
0
0
0
Taul3
Statistics
THERAPIAMOVE1SEE1HEAR1BREATH1SLEEP1EAT1SPEECH1ELIM1UACT1MENTAL1DISCO1DEPR1DISTR1VITAL1SEX1D15SCORETMOVE1TSEE1THEAR1TBREATH1TSLEEP1TEAT1TSPEECH1TELIM1TUACT1TMENTAL1TDISCO1TDEPR1TDISTR1TVITAL1TSEX1TD15SCORKMOVE1KSEE1KHEAR1KBREATH1KSLEEP1KEAT1KSPEECH1KELIM1KUACT1KMENTAL1KDISCO1KDEPR1KDISTR1KVITAL1KSEX1KD15SCOR
radikaaliNValid23232323232323232323232323232323181818181818181818181818181818185555555555555555
Missing0000000000000000555555555555555518181818181818181818181818181818
Mean0.97708260870.89336521740.94392173910.97370434780.86593478260.93846956520.91677826090.93141304350.90170869570.93798260870.85652173910.82681304350.80310869570.85721739130.83885652170.91051739130.90691666670.9520.94437777780.82430.82751666670.85011111110.85417777780.82770.71768888890.90077777780.71746666670.84794444440.81712222220.71712777780.66774444440.82597222220.779740.91360.899880.581980.667380.858480.849420.758320.592180.857360.661340.664980.736460.624960.549240.73976
Median111111111110.76510.7251110.91991110.84880.880751110.72110.7024110.77130.70950.84510.7129110.47710.76151110.413310.70240.76510.72510.77130.44240.7033
Std. Deviation0.10990794760.20380058350.13585315250.08712266940.17100433970.13711638860.2029355360.13305933850.16363147870.13820153810.2198965190.16029016670.20785928790.17249829420.20518716030.06821393250.16298302420.09240320850.10707649580.19270524890.21271276750.25257648550.24840837710.21597733540.25418539530.24103173220.19278452460.22491159110.2525539140.24213078820.30569752110.12995623160.22367101510.11830807240.13709495610.28062723850.26750709710.19378424080.33670711610.33093396920.26405771530.1953178640.3559205220.13709495610.26077733410.21488694240.14629669510.1650944215
Variance0.0120797570.04153467780.01845607910.00759035950.02924248420.0188009040.04118283180.01770478750.02677526080.01909966510.04835447910.02569293750.04320548360.02975566150.04210177080.00465314060.02656346620.00853835290.01146537590.03713531290.04524672150.0637948810.06170672180.04664620940.06461021520.05809629590.03716587290.05058522380.06378347950.05862731860.09345097440.01688862210.0500287230.01399680.0187950270.0787516470.0715600470.0375523320.1133716820.1095172920.0697264770.0381490680.1266794180.0187950270.0680048180.0461763980.0214027230.027256168
Skewness-4.7958315233-2.2153986881-2.6046695088-3.1403996439-1.6157455264-1.8430640439-2.51747286-1.4678377789-1.5535181619-1.8430640439-1.2501049383-1.25202463-0.8540294843-0.8745337199-0.8511482315-0.7820469523-1.5359402095-1.4609882296-1.4609882296-0.4543302973-1.1253595808-1.9504734491-1.8640335353-0.8381585108-0.4127264077-2.355424929-0.0876181207-1.9440783688-1.4425727329-1.0016889354-0.4105418063-0.820718473-0.302162592-0.6085806195-0.60858061950.7222700242-0.3098379972-0.6085806195-2.2360679775-0.60858061951.1947433128-0.6085806195-0.3134087733-0.60858061950.0543880026-1.15964278410.60858061950.262429592
Std. Error of Skewness0.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.48133666150.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.5362778990.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.9128709292
Kurtosis234.4588654696.85543452428.60544217693.98755701991.52180451135.74779699140.16063492061.94216551491.52180451130.22494311283.90677266530.4628055856-0.3214515549-0.59778148720.26474591591.39198247260.13660714290.1366071429-1.21490302110.66040935214.27942574473.3118248025-0.4947799386-0.90782580884.5718547122-0.12152403994.41553394761.88089695920.8967427573-1.18033095210.0068873902-1.2020144827-3.3333333333-3.33333333330.4569217369-0.4585428499-3.33333333335-3.3333333333-0.0275105096-3.3333333333-2.2831885543-3.3333333333-3.0023678472-0.2182394878-3.3333333333-1.1051299999
Std. Error of Kurtosis0.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379880.93476379881.03779508261.03779508261.03779508261.03779508261.03779508261.03779508261.03779508261.03779508261.03779508261.03779508261.03779508261.03779508261.03779508261.03779508261.03779508261.03779508262222222222222222
Minimum0.47290.31370.46110.69760.30150.64620.24710.68450.41330.64340.3960.30530.26330.51520.44240.73610.47290.7840.74970.47710.30150.0710.12980.39580.21820.19560.3960.15760.12550.12530.13180.55040.47290.7840.74970.25810.30150.64620.24710.39580.41330.64340.20830.51480.47860.29570.44240.5391
Maximum11111111111111111111111111111110.995111111111110.765110.77130.70950.9581
palliatiivinenNValid1212121212121212121212121212121255555555555555551111111111111111
Missing0000000000000000777777777777777711111111111111111111111111111111
Mean0.900.950.960.790.760.830.910.770.770.910.750.840.840.760.700.830.760.901.000.880.720.930.940.940.531.000.880.860.840.710.440.831.001.001.000.700.760.651.001.000.7210.700.770.730.770.710.84
Median1110.69760.7615110.68450.72110.70240.76510.862550.77130.70950.864611110.76151110.4133110.76510.72510.77130.24860.82461110.69760.76150.6462110.72110.70240.76510.72510.77130.70950.8384
Std. Deviation0.14135826820.09768967560.09742914290.20424640870.22628002560.28737421070.2262509240.19130317420.25373968570.16127841820.21621183780.15590245690.17842024170.17916717180.26340089910.10675853380.40003932560.228034212300.16563130140.25429795520.15822417010.13268827380.14109588940.349412645700.16300223310.12866002880.15056893110.20457496180.39138999480.0951873836
Variance0.019982160.00954327270.00949243790.04171659550.051202650.0825839370.05118948060.03659690450.06438382810.02601072820.04674755880.02430557610.03183378270.03210087550.06938003360.01139738450.1600314620.05199960200.0274337280.064667450.0250348880.0176061780.019908050.12208919700.0265697280.0165534030.0226710030.0418509150.1531861280.009060638
Skewness-0.8124038405-1.3266499161-2.0552372126-0.1865770343-0.6910389189-1.9666220339-2.7986857565-0.0436288021-1.018555227-1.3266499161-0.2989023859-0.5219637245-0.6207822723-0.137417345-0.2261777047-0.2972774103-1.7726017296-2.2360679775-0.6085806195-1.2404547974-2.2360679775-2.2360679775-2.23606797750.2205107564-0.60858061950.60858061950.60858061950.37740337350.84541590030.7013279052
Std. Error of Skewness0.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.63730200550.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.91287092920.9128709292
Kurtosis-1.65-0.32592592592.64-1.403055791-0.10766840794.02913214387.9079944077-0.3768007330.6324718326-0.3259259259-0.6355387175-0.0867232094-0.5947825675-0.8505003792-1.1756046028-0.84488263352.94799344015-3.33333333332.841350053555-0.2497244126-3.3333333333-3.3333333333-3.3333333333-0.9938153832-1.56375839952.1161029023
Std. Error of Kurtosis1.23224647391.23224647391.23224647391.23224647391.23224647391.23224647391.23224647391.23224647391.23224647391.23224647391.23224647391.23224647391.23224647391.23224647391.23224647391.23224647392222222222222222
Minimum0.71290.7840.74970.47710.30150.0710.24710.39580.21820.64340.3960.51480.47860.51520.24860.64780.0780.490110.69760.30150.64620.70330.68450.078510.70240.76510.72510.51520.13180.71061110.69760.76150.6462110.72110.70240.76510.72510.77130.70950.8384
Maximum11111111111111111111111111111110.97641110.69760.76150.6462110.72110.70240.76510.72510.77130.70950.8384
radikaali
MovingSeeingHearingBreathingSleepingEatingSpeechEliminationUsual activitiesMental functionDiscomfort and symptomsDepressionDistressVitalitySexual activity
0.980.890.940.970.870.940.920.930.900.940.860.830.800.860.84
0.910.950.940.820.830.850.850.830.720.900.720.850.820.720.67
0.780.910.900.580.670.860.850.760.590.860.660.660.740.620.55
Radical surgeryPalliative treatment
15D score before treatment0.910.83
15D score 3 mo after treatment0.830.83
15D score 12 mo after treatment0.740.84
palliatiivinen
MovingSeeingHearingBreathingSleepingEatingSpeechEliminationUsual activitiesMental functionDiscomfort and symptomsDepressionDistressVitalitySexual activity
0.900.950.960.790.760.830.910.770.770.910.750.840.840.760.70
0.760.901.000.880.720.930.940.940.531.000.880.860.840.710.44
1.001.001.000.700.760.651.001.000.7210.700.770.730.770.71
Lhttaso
MovingSeeingHearingBreathingSleepingEatingSpeechEliminationUsual activitiesMental functionDiscomfort and symptomsDepressionDistressVitalitySexual activity
Radical surgery0.980.890.940.970.870.940.920.930.900.940.860.830.800.860.84
Palliative group0.900.950.960.790.760.830.910.770.770.910.750.840.840.760.70
Taul3
0.97708260870.90691666670.77974
0.89336521740.9520.9136
0.94392173910.94437777780.89988
0.97370434780.82430.58198
0.86593478260.82751666670.66738
0.93846956520.85011111110.85848
0.91677826090.85417777780.84942
0.93141304350.82770.75832
0.90170869570.71768888890.59218
0.93798260870.90077777780.85736
0.85652173910.71746666670.66134
0.82681304350.84794444440.66498
0.80310869570.81712222220.73646
0.85721739130.71712777780.62496
0.83885652170.66774444440.54924
Before treatment
3 months after treatment
12 months after treatment
Before treatment
3 months after treatment
12 months after treatment
Radical surgery
Palliative treatment
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Radical surgery
Palliative group
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Conclusionsa systematic measurement of effectiveness and cost-effectiveness should be mandatory in the futuredata feeding should be automatic (EPR)follow-up should be extended to yearsinformation gained should start guiding allocative (political) decisions
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Evaluation, the missing ingredientto be evaluated, examples:practices: pharyngeal tonsillectomyservice provision: private off-hour activitiesallocation: 15-D measures as guidesskills: MDs and managementdivision of labor: nurse practitionersICT: still a paradox or something more?
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Endpiecemissing: a new strong culture, wherethe future vision is clear and shared by all counterpartscontracting systems are modern measuring instruments are in place and usedgood performance is rewardednothing is done without evaluationthus far most of this is lacking...