Helge Garåsen The Trondheim Model - NSDM

• The health benefit of the stay at hospital
• Could the patient be treated without being hospitalised
o By a GP
o At outpatient departments
o At a nursing home
o By home care
o By other professionals
o By social care services
The panels used a standardised evaluation protocol with a visual analogue scale (VAS) from
one to eight (119–120). Before the main study began a pilot study, of five admission letters,
was performed where the expert panels examined, discussed and tested the evaluation
protocol thoroughly in two meetings.
Each panel member examined copies of referral and discharge letters individually. Consensus
was defined to exist only if the difference between the group members did not exceed two on
the VAS scale. If this criterion was met, the panel’s evaluation was defined as being the
median of the three group members. Otherwise, the case was discussed in a meeting, using the
Delphi technique (36-38,118) with the participants of the panel and with the project
coordinator (HG), as a mediator, the mediator took no active part in the discussion. This
methodology was also used for cases evaluated by both panels. To show the level of
consensus between the panels the agreement between the panels on the 25 referral and
discharge letters evaluated by both panels was presented separately. The panels’ consensus
evaluation as well as each expert’s evaluation was recorded for every referral and discharge
letter.
4.1.2.2 Assessments of the benefits of hospitalisation
Before assessing the benefits achieved by care in a general hospital, it was necessary to
consider what the consequences for the patient would have been if he had been treated
elsewhere for his current problem. Benefits attributable to general hospital care could be
classified according to five different criteria. One criterion was benefits for the patients,
another benefits for other persons; e.g. a psychiatric patient displaying improper behaviour
prior to treatment. Whilst a third criterion could be social benefits; e.g. ill people with nobody
in their social network capable of assisting them at home. A fourth criterion could be gains in
40