Helge Garåsen The Trondheim Model - NSDM

6.4.2. Censuring of costs
Patients were followed from the time of admission to the general hospital and until 360 days
of follow-up or until time of death. There were no dropouts during the observation period
except for deaths. Estimates of average costs might be biased due to dropouts and also due to
censoring techniques (141-143). In our case censoring was due to deaths only. We therefore
recorded all data and costs for each patient individually from the moment of randomisation
and until 360 days of follow-up or until death and then estimated the average care costs per
patient per day and the total costs depending on where the patient had actually received care.
6.4.2. Sensitivity analysis
As a sensitivity analysis we calculated how much the intermediate care costs would have to
be increased and the general hospital costs decreased to render the observed differences
insignificant.
We found that the costs per day at intermediate care had to be increased by 99 % or general
hospital costs decreased by 57 % before the mean differences in average total treatment costs
per day became insignificant (p>0.05).
6.5 Care level
Fragile older people can be overwhelmed by the complexity of the expensive high technology
general hospital care, and the benefits of medical interventions may be offset by loss of
functional independence, complications from multiple medication, and simple despondency,
especially during inpatient care.
There is evidence that geriatric care can improve older patient outcomes (10,166), though not
as dramatically as some had hoped (166). Cohen et al has, in a RCT including 1388 patients,
showed that neither inpatient nor outpatient intervention had a significant effect on mortality
nor any synergistic effects between the two interventions (162). However, Cohen found a
functional decline with inpatient evaluation and an improvement in mental health with
outpatient evaluation (162).
A major goal in all programmes is to prevent or delay admission to long-term nursing homes.
Many of the programmes rely on interdisciplinary teams with nurse specialists, social
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