Reablement in a small municipality, a survival analysis

Background: Reablement is a municipal service given to patients at home. The purpose of the service is to assist recovery after hospital discharges or other sudden changes in a patient’s functional level. The service is often provided by a team of nurses, physiotherapists, and occupational therapists. The purpose of this paper is to compare users of this service to users who receive traditional home care services. Outcomes to be measured are risk of long-term care and mortality. Methods: All users of health and care services in a Norwegian municipality were eligible for inclusion. Data was extracted from the local user administrative database. Users were divided in two groups: those who received reablement and those home care users who did not receive reablement service. Propensity score matching was used to match users based on age, sex, and level of functioning in activities of daily living (ADL). Survival analysis was deployed to test if the reablement users had different risk of becoming long-term care users, and whether the mortality rate differed for this group. Results: 153 reablement users were included in the study. These were matched to 153 non-reablement home care users. The groups had similar distributions of age, sex, and level of functioning when starting their service trajectories. Regressions showed that reablement users had lower risk of using long-term care services in the study period (time at risk up to 4 years), and lower mortality. However, none of these estimates were statistically significant. Conclusions: The study indicates that the reablement users in one municipality had lower use of long -term care and lower mortality when properly estimated, but numbers were too small for statistical significance to be found.publishedVersio

Budgeting in public hospital trusts: Surplus, optimism, and accuracy

Hospitals in Norway are organized as trusts, required to follow the same accounting principles as the private sector, and responsible for funding their own investments. Thus, being able to run with a surplus has been an important part of their management. We analyze hospital budgeting for the whole sector over a 9-year period, looking at the size of the budget surplus, degree of optimism bias, and degree of budget accuracy when comparing to the actual financial results. Our findings indicate that on average, health trusts budget with a relatively small surplus. We find indications for optimism bias, but also examples of pessimism bias. Large health trusts seem to have a higher degree of accuracy of the budgeted results. Trusts that fail to meet budgeted results have a lower budgeted surplus the following period. Capital intensity, an indication of need for new investments, is not associated with budget surplus, degree of optimism, or budget accuracy.acceptedVersio

Estimert insidens av kronisk utmattelsessyndrom/myalgisk encefalopati i Norge mellom 2016-2018

Kronisk utmattelsessyndrom/myalgisk encefalopati (CFS/ME) er en kompleks og kronisk sykdom som er assosiert med en betydelig reduksjon i livskvalitet for de rammede. I denne studien estimerer vi insidensraten for ME i den norske befolkningen mellom 2016 og 2018. Data om pasienter er innsamlet fra Norsk pasientregister (NPR). Populasjonen er definert av alle pasienter behandlet i spesialisthelsetjenesten som har blitt diagnostisert med CFS/ME mellom 2016-2018. Vi finner at 5 556 nye pasienter ble diagnostisert med CFS/ME i perioden 2016-2018. Insidensraten var på 36.1 per 100 000 person-år. Av disse var 4 347 kvinner, som betyr at insidensraten for kvinner relativt til menn var 3.7. Vi finner at forekomsten av CFS/ME varierer med alder, og vi finner to alderstopper i gruppene 15-19 og 35-39 år. Vi finner høyere insidens for den samlede populasjonen, sammenlignet med tidligere norsk forskning

Estimert insidens av kronisk utmattelsessyndrom/myalgisk encefalopati i Norge mellom 2016-2018 : en registerstudie

Kronisk utmattelsessyndrom/myalgisk encefalopati (ME/CFS) er en kompleks og kronisk sykdom som er assosiert med en betydelig reduksjon i livskvalitet for de rammede. I denne studien estimerer vi insidensraten for ME/CFS i den norske befolkningen mellom 2016 og 2018. Data om pasienter er innsamlet fra Norsk pasientregister (NPR). Populasjonen er definert av alle pasienter behandlet i spesialisthelsetjenesten som har blitt diagnostisert med ME/CFS mellom 2016-2018. Vi finner at 5 556 nye pasienter ble diagnostisert med ME/CFS i perioden 2016-2018. Insidensraten var på 36.1 per 100 000 person-år. Av disse var 4 347 kvinner, som betyr at insidensraten for kvinner relativt til menn var 3.7. Vi finner at forekomsten av ME/CFS varierer med alder, og vi finner to alderstopper i gruppene 15-19 og 35-39 år. Vi finner høyere insidens for den samlede populasjonen, sammenlignet med tidligere norsk forskning

Estimert insidens av kronisk utmattelsessyndrom/myalgisk encefalopati i Norge mellom 2016-2018: en registerstudie

Kronisk utmattelsessyndrom/myalgisk encefalopati (ME/CFS) er en kompleks og kronisk sykdom som er assosiert med en betydelig reduksjon i livskvalitet for de rammede. I denne studien estimerer vi insidensraten for ME/CFS i den norske befolkningen mellom 2016 og 2018. Data om pasienter er innsamlet fra Norsk pasientregister (NPR). Populasjonen er definert av alle pasienter behandlet i spesialisthelsetjenesten som har blitt diagnostisert med ME/CFS mellom 2016-2018. Vi finner at 5 556 nye pasienter ble diagnostisert med ME/CFS i perioden 2016-2018. Insidensraten var på 36.1 per 100 000 person-år. Av disse var 4 347 kvinner, som betyr at insidensraten for kvinner relativt til menn var 3.7. Vi finner at forekomsten av ME/CFS varierer med alder, og vi finner to alderstopper i gruppene 15-19 og 35-39 år. Vi finner høyere insidens for den samlede populasjonen, sammenlignet med tidligere norsk forskning.publishedVersio

Ikääntyneiden kuolinpaikat Suomessa ja Norjassa

Aims: This study aimed to find out how place of death varied between countries with different health and social service systems. This was done by investigating typical groups (concerning age, sex and end-of-life trajectory) of older people dying in different places in Finland and Norway. Methods: The data were derived from national registers. All those who died in Finland or Norway at the age of ⩾70 years in 2011 were included. Place of death was analysed by age, sex, end-of-life trajectory and degree of urbanisation of the municipality of residence. Two-proportion z-tests were performed to test the differences between the countries. Multinomial logistic regression analyses were performed separately for both countries to find the factors associated with place of death. Results: The data consisted of 68,433 individuals. Deaths occurred most commonly in health centres in Finland and in nursing homes in Norway. Deaths in hospital were more common in Norway than they were in Finland. In both countries, deaths in hospital were more common among younger people and men. Deaths in nursing homes were commonest among frail older people, while most of those who had a terminal illness died in health centres in Finland and in nursing homes in Norway. Conclusions: Both Finland and Norway have a relatively low share of hospital deaths among older people. Both countries have developed alternatives to end-of-life care in hospital, allowing for spending the last days or weeks of life closer to home. In Finland, health centres play a key role in end-of-life care, while in Norway nursing homes serve this role.Aims: This study aimed to find out how place of death varied between countries with different health and social service systems. This was done by investigating typical groups (concerning age, sex and end-of-life trajectory) of older people dying in different places in Finland and Norway. Methods: The data were derived from national registers. All those who died in Finland or Norway at the age of ⩾70 years in 2011 were included. Place of death was analysed by age, sex, end-of-life trajectory and degree of urbanisation of the municipality of residence. Two-proportion z-tests were performed to test the differences between the countries. Multinomial logistic regression analyses were performed separately for both countries to find the factors associated with place of death. Results: The data consisted of 68,433 individuals. Deaths occurred most commonly in health centres in Finland and in nursing homes in Norway. Deaths in hospital were more common in Norway than they were in Finland. In both countries, deaths in hospital were more common among younger people and men. Deaths in nursing homes were commonest among frail older people, while most of those who had a terminal illness died in health centres in Finland and in nursing homes in Norway. Conclusions: Both Finland and Norway have a relatively low share of hospital deaths among older people. Both countries have developed alternatives to end-of-life care in hospital, allowing for spending the last days or weeks of life closer to home. In Finland, health centres play a key role in end-of-life care, while in Norway nursing homes serve this role.Peer reviewe

Hospital productivity and the Norwegian ownership reform – A Nordic comparative study

In a period where decentralisation seemed to be the prominent trend, Norway in 2002 chose to re-centralise the hospital sector. The reform had three main aims; cost control, efficiency and reduced waiting times. This study investigates whether the hospital reform has improved hospital productivity using the other four major Nordic countries as controls. Hospital productivity measures are obtained using data envelopment analysis (DEA) on a comparable dataset of 728 Nordic hospitals in the period 1999 to 2004. First a common reference frontier is established for the four countries, enveloping the technologies of each of the countries and years. Bootstrapping techniques are applied to the obtained productivity estimates to assess uncertainty and correct for bias. Second, these are regressed on a set of explanatory variables in order to separate the effect of the hospital reform from the effects of other structural, financial and organizational variables. A fixed hospital effect model is used, as random effects and OLS specifications are rejected. Robustness is examined through alternate model specifications, including stochastic frontier analysis (SFA). The SFA approach in performed using the Battese & Coelli (1995) one stage procedure where the inefficiency term is estimated as a function of the set of explanatory variables used in the second stage in the DEA approach. Results indicate that the hospital reform in Norway seems to have improved the level of productivity in the magnitude of approximately 4 % or more. While there are small or contradictory estimates of the effects of case mix and activity based financing, the length of stay is clearly negatively associated with estimated productivity. Results are robust to choice of efficiency estimation technique and various definition of when the reform effect takes place.Efficiency; productivity; DEA; SFA; hospitals

Hospitals' discharge tendency and risk of death - An analysis of 60,000 Norwegian hip fracture patients

Purpose: A reduction in the length of hospital stay may threaten patient safety. This study aimed to estimate the effect of organizational pressure to discharge on 60-day mortality among hip fracture patients. Patients and Methods: In this cohort study, hip fracture patients were analyzed as if they were enrolled in a sequence of trials for discharge. A hospital’s discharge tendency was defined as the proportion of patients with other acute conditions who were discharged on a given day. Because the hospital’s tendency to discharge would affect hip fracture patients in an essentially random manner, this exposure could be regarded as analogous to being randomized to treatment in a clinical trial. The study population consisted of 59,971 Norwegian patients with hip fractures, hospitalized between 2008 and 2016, aged 70 years and older. To calculate the hospital discharge tendency for a given day, we used data from all 5,013,773 other acute hospitalizations in the study period. Results: The probability of discharge among hip fracture patients increased by 5.5 percentage points (95% confidence interval (CI)=5.3– 5.7) per 10 percentage points increase in hospital discharges of patients with other acute conditions. The increased risk of death that could be attributed to a discharge from organizational causes was estimated to 3.7 percentage points (95% CI=1.4– 6.0). The results remained stable under different time adjustments, follow-up periods, and age cut-offs. Conclusion: This study showed that discharges from organizational causes may increase the risk of death among hip fracture patients.publishedVersio

High volumes of recent surgical admissions, time to surgery, and 60-day mortality

Aims: Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. Methods: This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions. Results: Among 60,072 patients, mean age was 84.6 years (SD 6.8), 78% were females, and median time to surgery was 20 hours (IQR 11 to 29). Overall, 14% (8,464) were dead 60 days after admission. A high (75th percentile) proportion of recent surgical admission compared to a low (25th percentile) proportion resulted in 20% longer time to surgery (95% confidence interval (CI) 16 to 25) and 20% higher 60-day mortality (hazard ratio 1.2, 95% CI 1.1 to 1.4). Conclusion: A high volume of recently admitted acute surgical patients, indicating probable competition for surgical resources, was associated with delayed surgery and increased 60-day mortality.publishedVersio

How do busy hospital circumstances affect mortality and readmission within 60 days : A cohort study of 680 000 acute admissions in Norway

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Elsevier in Health Policy on 21/5/2022.Available online: doi.org/10.1016/j.healthpol.2022.05.008acceptedVersio