Helge GarÃ¥sen The Trondheim Model - NSDM

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primary and secondary level do not agree as to the definition of good quality as far as referral and discharge letters are concerned. Furthermore they do not agree as to the benefits of admission to a general hospital. Study II Background Demographic changes combined with increasing pressure on general hospital beds and other health services by the elderly make allocation of resources to the most efficient care level a vital issue. The aim of study II was to study the efficacy of intermediate care at a community hospital compared to standard prolonged care at a general hospital over a period, with six and 12 months follow-up. Methods In a randomised controlled trial, study II, of 142 patients, aged 60 or more admitted to a general hospital due to acute illness or exacerbation of a chronic disease, 72 (intervention group) were randomised to intermediate care at a community hospital and 70 (general hospital group) to prolonged general hospital care. The results are based on intention-to-treat analyses and are adjusted for age, gender, ADL and diagnosis. Results Readmissions to general hospital In the intervention group 14 patients (19.4 %) were readmitted compared to 25 patients (35.7 %) in the general hospital group (p= 0.03). Results after six months After 26 weeks 18 (25.0 %) patients in the intervention group were independent of community care compared to seven (10.0 %) in the general hospital group (p=0.02). There was an insignificant reduction in the number of deaths and an insignificant increase in the number of days of inpatient care in the intervention group. The number of patients admitted to long-term nursing homes from the intervention group was insignificantly higher than from the general hospital group. Mean total health services costs per patient in the intervention group for the first six months were EUR 9829 (95 % CI 7396-12262) compared to EUR 14071 (95 % CI 10717-17424) in the general hospital group. The mean difference in costs was EUR 4242 (95 % CI 152-8331) 8
(p=0.003), and mean difference in cost per day at risk per patient was EUR 37 (95 % CI 1-71) (p=0.003). Results after 12 months Thirty-five patients, 13 (18.1 %) of all patients included in the intervention group and 22 (31.4 %) in the general hospital group, died within 12 months (p= 0.03). Patients in the intervention group were observed during a longer period of time than in the general hospital group; 335.7 (95 % CI 312.0-359.4) versus 292.8 (95 % CI 264.1-321.5) days (p=0.01). There were statistically no differences in the need for long-term primary level care or in the number of admissions or days spent in general hospital beds. Average total health services costs per patient per observed day were EUR 76 (95 % CI 56- 95) for the intervention group and EUR 100 (95 % CI 80-120) for the general hospital group (p=0.03). Trial registration ClinicalTrials.gov NCT00235404 Conclusions Study II Intermediate care in a community hospital significantly decreased the number of readmissions for the same disease to general hospital and a significantly higher number of patients were independent of community care after 26 weeks of follow-up. There was no increase in mortality and number of days in institutions. Care at intermediate level in a community hospital was cost effective from a health service perspective and contributes to better patient outcome as more patients had better functional status and significantly fewer patients were dead after 12 months follow-up. 9
Page 1 and 2: Helge Garåsen The Trondheim Model
Page 3 and 4: Trondheimsmodellen Forbedring av ko
Page 5 and 6: Table of content Summary...........
Page 7: Summary Study I Background Optimal
Page 11 and 12: Studie II Bakgrunn Formålet med st
Page 13 and 14: Acknowledgments These studies were
Page 15 and 16: List of papers The thesis is based
Page 17 and 18: 1.0 Introduction 1.1 Are older pati
Page 19 and 20: documented the benefits of using mu
Page 21 and 22: When composing an expert panel, it
Page 23 and 24: 1.8 Are there any alternatives to g
Page 25 and 26: In the publication Scenario 2030 th
Page 27 and 28: trust between the patient and healt
Page 29 and 30: structured communication formulas (
Page 31 and 32: predicted increases in per capita h
Page 33 and 34: A study in Denmark has shown that a
Page 35 and 36: general hospital care. One of the c
Page 37 and 38: the municipalities of Trondheim and
Page 39 and 40: As the study in question dealt with
Page 41 and 42: quality of life and/or life expecta
Page 43 and 44: 4.2.0 Study population Study II - I
Page 45 and 46: All data was collected by the autho
Page 47 and 48: An important task was to write disc
Page 49 and 50: to the community health system, and
Page 51 and 52: to information about the health car
Page 53 and 54: 2004 and 2005. This solution was us
Page 55 and 56: 100 % said they were treated with r
Page 57 and 58: compared between groups using covar
Page 59 and 60:
care and need for long-term nursing
Page 61 and 62:
6.1 Study I - the panel study 6.1.1
Page 63 and 64:
e difficult for only one profession
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there were eleven cases with zero a
Page 67 and 68:
trial. Participating departments at
Page 69 and 70:
circumstances, successful diagnoses
Page 71 and 72:
6.4 Costs 6.4.1. Cost assessments E
Page 73 and 74:
workers, physiotherapists, occupati
Page 75 and 76:
The good results shown in several s
Page 77 and 78:
6.8 Discussion of the results 6.8.1
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to be increased with more than 99 %
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In study I all patient data was han
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Main conclusions study II: 1. Care
Page 85 and 86:
12. Slaets JP, Kaufmann RH, Duivnvo
Page 87 and 88:
40. Jakobsen G. Specialised palliat
Page 89 and 90:
69. Ramrakha S, Giles A: Take a let
Page 91 and 92:
98. Kvamme OJ. Samarbeid mellom leg
Page 93 and 94:
127. Krummenauer F. Differenzenplot
Page 95 and 96:
157. Kaplan RM. The significance of
Page 97 and 98:
10.0. Appendices 10.1 VAS for refer
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10.2 VAS for discharge letters. Stu
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10.3 Criteria for inclusion. Study
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10.4 Procedures for including patie
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Behov for følge av sykepleier / hj
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10.6 Consent formula. Study II SAMT
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Recruitment 14 Dates defining the p
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Personlig hygiene Ja Av og til Nei
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eller andre steder der personen van
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Ikke med i pleietyngdegrunnlaget i
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Tjenester IPLOS Lov om sosiale tjen
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11.0 Original papers I-IV 119
Page 123 and 124:
BMC Health Services Research BioMed
Page 125 and 126:
BMC Health Services Research 2007,
Page 127 and 128:
Page 129:
Page 133 and 134:
BMC Public Health BioMed Central Re
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BMC Public Health 2007, 7:68 http:/
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Page 139 and 140:
Page 141:
Page 145 and 146:
Medisin og vitenskap Originalartikk
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Originalartikkel MEDISIN OG VITENSK
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Scandinavian Journal of Public Heal
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Dissertations at the Faculty of Med
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68. Trond Sand: THE EFFECTS OF CLIC
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139. Fabio Antonaci: CHRONIC PAROXY
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198. Nanna Kurtze: THE SIGNIFICANCE
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251. Aslak Steinsbekk: HOMEOPATHY I
Page 163 and 164:
305. Elisabeth Olstad: GLUTAMATE AN
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