Helge Garåsen The Trondheim Model - NSDM

Table of content
Summary............................................................................................7
Norsk sammendrag (Norwegian summary).................................................10
Acknowledgments ...........................................................................13
List of papers...................................................................................15
Definitions and abbreviations...............................................................16
1.0 Introduction...............................................................................17
1.1 Are older patients treated properly?.........................................................................17
1.2 Older people and medical care ................................................................................17
1.3 Health care consumption among older people in Norway........................................19
1.4 Financing and organising of health care in Norway .................................................19
1.5 Description of an expert panel – the nominal group technique.................................20
1.6 Description of the Delphi technique ........................................................................21
1.7 Definition of an older patient in Study I and Study II ..............................................21
1.8 Description of Community Hospital - Cottage Hospital - General Practitioners
Hospital - Intermediate Care Department - Nursing Home ............................................21
1.8 Description of intermediate care..............................................................................22
1.8 Are there any alternatives to general hospital care? .................................................23
1.9 Alternatives to general hospital care - The Trondheim Model..................................23
2.0 Background...................................................................................24
2.1 The demand for health care among older people in the future..................................24
2.2 A revisit to the principle of LEON ..........................................................................25
2.3 Patients’ rights ........................................................................................................26
2.4 Where do the patients want to get care?...................................................................27
2.5 Quality of the written communication between health personnel .............................28
2.6 Inappropriate admissions and discharges.................................................................29
2.7 The cost of health care for patients with a poor prognosis........................................30
2.8 Interventions to reduce inappropriate health care for older people at hospitals.........31
2.9 Transferring duties from hospitals to primary care...................................................33
2.10 A silent paradigm shift – from general hospital care to primary care......................34
2.11 The chain of care – is there a missing link? ...........................................................34
3.0 Objectives and hypothesis...............................................................35
3.1 The main objectives of the thesis.............................................................................35
3.2 Hypothesis ..............................................................................................................36
4.0 Patients and Methods .....................................................................36
4.1.0 Study population. Study I - The quality of written communication between a
general hospital and general practitioners......................................................................36
4.1.1 Study design.........................................................................................................37
4.1.2 Assessments of outcomes.....................................................................................38
4.1.2.1 Quality of referral and discharge letters.............................................................38
4.1.2.2 Assessments of the benefits of hospitalisation ...................................................40
4.1.2.3 Assessments of care level..................................................................................41
4.1.2.4 Assessments of alternatives to general hospital care ..........................................41
4.1.3 Statistical analyses study I....................................................................................42
4.2.0 Study population Study II – Intermediate care at a community hospital................43
4.2.1 Study design.........................................................................................................44
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