Helge Garåsen The Trondheim Model - NSDM

This study, along with others studies (64,66-72), demonstrated the need of establishing better
systems for exchanging descriptions of care and other patient information between primary
and secondary level. We believe that it is an urgent matter in the near future to establish a
consensus between health professionals in primary care and in general hospitals on the
obligations, limitations and possibilities at each level of care. There is too little knowledge
and too many uncertainties about the duties, responsibilities and possibilities of the different
care systems.
6.8.2. Study II – Paper II-IV
This study demonstrated that intermediate care at a community hospital was professionally an
equal alternative to prolonged general hospital care; and that this type of care was cost
effective.
After six and twelve months of follow-up patients offered intermediate care had lower
readmission rates (p=0.03) and a higher number of patients independent of community care
(p=0.02) than patients given traditional prolonged care at a general hospital. The differences
in total days in institutions were minor. The differences in number of deaths and the need for
home care were in favour of the intervention group, and there was even a statistically
significant difference in the number of deaths after 12 months. The results from this trial
were consistent with other comparable studies (14,95-96).
As all patients actively received standardised care regimes during their stay at the general
hospital, at the community hospital, at the rehabilitation departments or when given
community home care services, we believe that average costs per day and per hour provided a
correct estimate of all costs. Capital costs were not included in the analyses. This might
represent a weakness in the overall costs, but will most likely lead to underestimating the
costs of the general hospital group. Costs for the intervention group were lower mainly due to
a) costs at community hospital were lower, and b) the intervention group did not incur a
sufficiently higher number of total treatment days to offset this effect. As noted previously,
however, both community hospital and general hospital costs were average costs as measured
from the accounts. The suggestion of this trial that care can be provided at an intermediate
level at a community hospital to a lower cost than equivalent care at a general hospital, is
robust, as the sensitivity analyses imply that the price per day at the community hospital had
78