What does information about referrals reveal about the service network?

Objective To identify the most important referring parties in the Finnish health care system. Design A record linkage study based on nationwide administrative registers. Setting The hospital discharge register during 1996 to 2000. Subjects The total Finnish population and the population of four hospital districts. Main outcome measures Discharges of individuals by the most important referring parties. Results The five most important referring parties in order of magnitude are as follows: health centre, no referral, clinic/unit of the same hospital, hospital other than a health centre, and private health care. The five most important referring parties for those aged over 75 are the same mentioned above. There were regional differences in referral practices. Conclusions Differences or changes in referral profiles as a function of time cannot be taken as a direct measure of the impact of possible interventions or as an indication of an actual difference between the areas compared. One should also always be aware about any related metaknowledge

Use of information on the shared customers of healthcare services to support care pathway planning

Objective To describe information concerning the use of more than one type of institutional social welfare and healthcare service during one year. Design A record linkage study based on nationwide administrative registers. Setting The National Hospital Discharge Register covering the whole of Finland in 1995, 1997 and 1999. Subjects The total Finnish population of 5.1 million. Main outcome measures Discharges of the same individuals from different types of services. Results The percentage of patients/clients using more than one type of service in 1995 and 1999 varied from 21% to 68%, depending on the type of service. High and increasing figures were found in organisations taking care of the elderly and people with multiple problems in primary healthcare institutions. Conclusions The level of integration in the Finnish social welfare and healthcare system is high and seems to be increasing, especially in health centres. Within one year a client uses many kinds of inpatient services. This may at best represent a functioning system of care pathways and at worst mean overlapping work and lack of coordination. This information is of great importance to senior officers in care pathway planning

A theoretical framework for health information systems

HIS = health information syste