Helge Garåsen The Trondheim Model - NSDM

The reasons for choosing these consensus methods were (36-38):
- There are no common care programs that define the content of appropriate care for older
patients at hospitals or in community care.
- There are no particular professional standards that define what kind of information
should be passed from one professional or team to another when handing over
responsibility, to enable delivery of appropriate health care.
- There are no standards that define what level of care is suitable for each patient.
- There are no other clearly defined methods to evaluate the quality of referral and
discharge letters.
- Consensus methods are aids to synthesise information in a wider range than common
statistical methods for decision-making both in clinical practice and in health service
development.
- The ability of a group of experts with no prior history of communication with one
another to effectively discuss a problem as a group.
- Participants can respond at their convenience.
- The anonymity of participants provides them with the opportunity to freely express
opinions and positions.
6.1.2. The composition of the expert panels
The credibility of a consensus technique depends heavily upon the panel composition. Some
studies have shown that panels with different stakeholders were rating the same statements
differently (124,146-147). In all likelihood each profession will have difficulty formulating a
definition of quality or a gold standard that will be relevant for other professions. Every
professional will focus on their own needs and standards according to their particular interests
and the type of care they provide. A cardiologist and orthopaedist will usually have quite
different interpretations. Another interesting trend is a tendency to over-estimate the effects of
one’s own specialty (148), and a single disciplinary panel is more likely to rate a particular
indication as appropriate than a multidisciplinary panel (149-150).
Most older patients have several diseases, use several medicines and often have low ADLscores,
and as a consequence there is a complicated, multimorbidity frame in most cases
where different settings have to be considered. With this broad perspective in mind, it would
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