Helge Garåsen The Trondheim Model - NSDM

An important task was to write discharge letters to the family physician describing the
patients’ medical history, actual situation and to elucidate areas that would require follow up
by the physician.
Care at the different departments at the general hospital and communication with primary
health care followed normal routines.
4.2.3 Patients’ functional status (ADL)
There is no consensus or consistency on how to measure patients’ functional status before a
disease or injury, during a disease, or as sequels after a disease, due to age or other mental or
physical handicaps. This complicates comparisons between studies and the interpretation of a
large proportion of the studies. However, there are several studies using person level data on
functional status (e.g. ADL) as measures for patient outcome and service evaluation (2,134-
136).
There are several instruments for monitoring activities of daily living (ADL) as a measure of
need for care. Prior to this study we discussed several instruments and decided to use the
instrument that has been used in the municipality of Trondheim since 1993. It is well known
by the professionals, used on an everyday basis not only when new patients are allocated
community health services, but also when there are changes in the patients’ physical or
mental status. Two nurses in each municipal unit are certified to carry out assessments of the
patients and to register the results in the electronic patient record system on each patient
(Gerica).
Gerix (131-133) is a system for the registration of patient data for patients who have been
allocated care services at primary care level. Ministry of Social Affairs (SHD), Ministry of
Local Government and regional Development (KRD), The Norwegian Association of Local
and Regional Authorities (KS) and Statistics of Norway (SSB) developed the system in the
beginning of the 1990s.
One of the main objectives with Gerix was to identify each patient’s degree of need for care
by measuring 17 different fields for ADL (132).
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