Helge Garåsen The Trondheim Model - NSDM

1.8 Are there any alternatives to general hospital care?
There are neither any standardised guidelines on how to perform care at nursing-homes or
community hospitals as alternatives to admissions to general hospital or as follow-up after
discharge from general hospitals, nor how to perform suitable community home care as
alternatives to inpatient care for the elderly.
Some questions have to be addressed when considering alternatives to general hospital care:
• Is it a real alternative or rather a supplement?
• Is it a better management alternative or rather an increase in activity?
• Is it cost effective compared to standard general hospital health services?
• Will it provide equivalent or better patient outcome (mortality, functional status and
quality of life)?
In order to find better models for collaboration, the municipality of Trondheim and St. Olavs
University Hospital have, in the course of the last thirteen years, systemised collaboration
through formalised agreements (39,42).
1.9 Alternatives to general hospital care - The Trondheim Model
As a result of the collaboration between the municipality and the city general hospital, several
new models for patient care have been established and evaluated in Trondheim (16,39-40).
Extended stroke unit service and early supported discharge (16) have demonstrated the high
level of efficiency of close collaboration between community health care and hospital
specialists resulting in better patient outcomes. Other examples of this collaboration are the
palliative care ward at Havstein Nursing Home (39-40) where close collaboration has made it
possible to provide care to cancer patients at primary level with patient outcome comparable
to general hospital care (40), and later on the intermediate care department at Søbstad
Teaching Nursing Home (39). Both at Søbstad and at Havstein St.Olavs University Hospital
contributes 3 million NOK per year and thereby partially finances the increased costs for the
municipality.
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