Helge Garåsen The Trondheim Model - NSDM

to be increased with more than 99 % to reach a level similar to that estimated for general
hospital care.
The present study appears to be the first randomised controlled trial where included patients
have been an unselected general hospital population above 60 years of age. Another strength
of this trial was that all patients received the same optimal care in the initial phase of their
illness before randomisation.
As one of the authors, blinded as to which group the patients belonged to, collected all the
information from medical records and from the patient administrative systems, information
bias by collection was possible. As all the data concerned objective measures such as
readmissions, use of home care and number of deaths, the registration was considered to be
accurate.
Several efforts have been developed to reduce days of care and to facilitate discharge from
general hospitals including discharge planning, nurse led inpatient care, hospital at home,
general practitioners hospitals, community hospitals and patients hotels (96). Some studies
have found a better functional outcome and reduced mortality when elderly patients were
treated at a specialised geriatric ward (10-12), whilst the benefit of early supported discharge
of stroke patients was ascribed to the structured collaboration between primary and secondary
health care (20-46).
Several community hospitals in Norway are comparable to community hospitals in England
(47) and general practitioner hospitals in Holland (43) where some studies have explored their
appropriateness (14,43-44,95). In Norway the use of nursing homes and community hospitals
may have been overlooked as appropriate alternatives, and research on such models has been
sparse (44-45).
Which components contributed to the results?
A limitation with the provision of intermediate care is the lack of possibility to identify which
of the components is most the effective. However, some of the main components in the
intervention were assessments of ADL along with the close, continuous communication and
cooperation with each patient, his social and professional networks in order to identify the
best supportive solutions. This communication, including the continuous dialogue with the
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