Helge GarÃ¥sen The Trondheim Model - NSDM

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Definitions and abbreviations ADL CI DRG EUR HER IP GDP LEON NHS NOK OECD 1 OR RCT REK SD Activities of daily living Confidence Interval Payments by Results (the Norwegian system) Euro Electronic health records Individual Plan Gross Domestic Products “Laveste Effektive Omsorgs Nivå” (Lowest Level of Effective Care) National Health Service Norwegian Kroner Organisation for Economic Co-operation and Development Odds ratio Randomised controlled trial Regional Ethical Committee for Medical Research Standard Deviation Definitions of Community Hospital - Cottage Hospital - General Practitioners Hospital - Intermediate Department - Nursing Home; see chapter 1.11 page 16. 1 Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Korea, Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Spain, Sweden, Turkey, United Kingdom, United States. 16
1.0 Introduction 1.1 Are older patients treated properly? During spring 2001 several older patients in medical departments at St. Olavs University Hospital were defined to be long-term nursing home patients. However, they had to remain in the general hospital for several weeks waiting for beds to become available at nursing homes. Some of these patients were transferred to empty beds in the heart clinic at St. Elisabeth’s Hospital, and, according to anecdotes from the nurse coordinating the use of nursing homes’ beds in <strong>Trondheim</strong>, after a while many of these patients improved their functional status (ADL) and were therefore able to return to their own homes. At the same time the municipality established a “transit- nursing- home” where patients could stay while they were waiting for long-term nursing home beds instead of remaining staying at the general hospital. Annual reports surrendered by the manager of this department described that as many as 20 % of these patients could return to their homes after spending a number of weeks at the “transit-nursing home”. <strong>The</strong>se stories about older patients defined as nursing-home-patients improving their functional status and returning home after spending time in stimulating surroundings, made me, as Chief Medical Officer, and my leader, the Chief Executive Officer, wonder if there might be a missing link in the chain of care; i.e. something was possibly missing in “the chain of care” between the general hospital and community care. 1.2 Older people and medical care Western societies are spending an increasing share of national budgets on health care consumption (1). In many of these societies health and social care services are under severe financial pressure and hospital beds are being closed and staff is being shed, this is indeed the case in the UK and Norway (2-3). In the coming decades there will be an increasing number of older people in all Western societies (1,4), in particular there will be a large increase in the number of those above 90 years of age by 2020, and by 2025 there will also be a rather dramatic increase in the number of people above 80 years of age (1,4). People are living longer, and most of the elderly persons are functioning better and better in their daily activities. Nevertheless, the proportion of hospital beds being occupied by older patients in all Western European countries is 17
Page 1 and 2: Helge Garåsen The Trondheim Model
Page 3 and 4: Trondheimsmodellen Forbedring av ko
Page 5 and 6: Table of content Summary...........
Page 7 and 8: Summary Study I Background Optimal
Page 9 and 10: (p=0.003), and mean difference in c
Page 11 and 12: Studie II Bakgrunn Formålet med st
Page 13 and 14: Acknowledgments These studies were
Page 15: List of papers The thesis is based
Page 19 and 20: documented the benefits of using mu
Page 21 and 22: When composing an expert panel, it
Page 23 and 24: 1.8 Are there any alternatives to g
Page 25 and 26: In the publication Scenario 2030 th
Page 27 and 28: trust between the patient and healt
Page 29 and 30: structured communication formulas (
Page 31 and 32: predicted increases in per capita h
Page 33 and 34: A study in Denmark has shown that a
Page 35 and 36: general hospital care. One of the c
Page 37 and 38: the municipalities of Trondheim and
Page 39 and 40: As the study in question dealt with
Page 41 and 42: quality of life and/or life expecta
Page 43 and 44: 4.2.0 Study population Study II - I
Page 45 and 46: All data was collected by the autho
Page 47 and 48: An important task was to write disc
Page 49 and 50: to the community health system, and
Page 51 and 52: to information about the health car
Page 53 and 54: 2004 and 2005. This solution was us
Page 55 and 56: 100 % said they were treated with r
Page 57 and 58: compared between groups using covar
Page 59 and 60: care and need for long-term nursing
Page 61 and 62: 6.1 Study I - the panel study 6.1.1
Page 63 and 64: e difficult for only one profession
Page 65 and 66: there were eleven cases with zero a
Page 67 and 68:
trial. Participating departments at
Page 69 and 70:
circumstances, successful diagnoses
Page 71 and 72:
6.4 Costs 6.4.1. Cost assessments E
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workers, physiotherapists, occupati
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The good results shown in several s
Page 77 and 78:
6.8 Discussion of the results 6.8.1
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to be increased with more than 99 %
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In study I all patient data was han
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Main conclusions study II: 1. Care
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12. Slaets JP, Kaufmann RH, Duivnvo
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40. Jakobsen G. Specialised palliat
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69. Ramrakha S, Giles A: Take a let
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98. Kvamme OJ. Samarbeid mellom leg
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127. Krummenauer F. Differenzenplot
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157. Kaplan RM. The significance of
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10.0. Appendices 10.1 VAS for refer
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10.2 VAS for discharge letters. Stu
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10.3 Criteria for inclusion. Study
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10.4 Procedures for including patie
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Behov for følge av sykepleier / hj
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10.6 Consent formula. Study II SAMT
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Recruitment 14 Dates defining the p
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Personlig hygiene Ja Av og til Nei
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eller andre steder der personen van
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Ikke med i pleietyngdegrunnlaget i
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Tjenester IPLOS Lov om sosiale tjen
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11.0 Original papers I-IV 119
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BMC Health Services Research BioMed
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BMC Health Services Research 2007,
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Page 129:
Page 133 and 134:
BMC Public Health BioMed Central Re
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BMC Public Health 2007, 7:68 http:/
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Page 139 and 140:
Page 141:
Page 145 and 146:
Medisin og vitenskap Originalartikk
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Originalartikkel MEDISIN OG VITENSK
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Scandinavian Journal of Public Heal
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Dissertations at the Faculty of Med
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68. Trond Sand: THE EFFECTS OF CLIC
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139. Fabio Antonaci: CHRONIC PAROXY
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198. Nanna Kurtze: THE SIGNIFICANCE
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251. Aslak Steinsbekk: HOMEOPATHY I
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305. Elisabeth Olstad: GLUTAMATE AN
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Helge GarÃ¥sen The Trondheim Model - NSDM

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