title: Effects of municipality factors on care transitions.
abstract: OBJECTIVE
  To analyse whether transitions between care settings differ between municipalities in the last 2 years of life among older people in Finland.
  
  
  METHODS
  Data were derived from Finnish national registers, and include all those who died in 2002 and 2003 at the age of 70 or older except those living in very small municipalities (n=67,027). Data include admissions and discharges from health and social care facilities (university hospitals, general hospitals, health centres, residential care facilities) and time spent outside care facilities for 730 days prior to death. Three-level negative binomial regression analyses were performed to study the effect of municipal factors on (1) the total number of all care transitions, (2) the number of transitions between home and different care facilities, and (3) transitions between different care facilities.
  
  
  RESULTS
  The municipality of residence had only a minor effect on the total number of care transitions, but greater variation between municipalities was found when different types of care transition were examined separately. Largest differences were found in care transitions involving specialised care. Age structure, urbanity, and economic situation of the municipality had an impact on several different care transitions.
  
  
  CONCLUSIONS
  The total number of care transitions in 2 final years of life was approximately similar irrespective of the municipality of residence, but the findings imply differences in transitioning specialised care. Potentially, this may suggest inequality between the municipalities, but more detailed studies are needed to confirm the factors underlying these differences.
authors.affiliation: Gerontology Research Center and School of Health Sciences, University of Tampere, Tampere, Finland. mari.s.aaltonen@uta.fi
authors.forename: Mari
authors.initials: M
authors.lastname: Aaltonen
authors.forename: Leena
authors.initials: L
authors.lastname: Forma
authors.forename: Pekka
authors.initials: P
authors.lastname: Rissanen
authors.forename: Jani
authors.initials: J
authors.lastname: Raitanen
authors.forename: Marja
authors.initials: M
authors.lastname: Jylhä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002947:Cities; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D006268:Health Facilities / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Aged; care transition; health and social services; last 2 years of life; multilevel analysis; municipality; negative binomial regression analysis; specialised care