The influence of an intermediate care hospital on health care utilization among elderly patients - a retrospective comparative cohort study

Background: An intermediate care hospital (ICH) was established in a municipality in Central Norway in 2007 to improve the coordination of services and follow-up among elderly and chronically ill patients after hospital discharge. The aim of this study was to compare health care utilization by elderly patients in a municipality with an ICH to that of elderly patients in a municipality without an ICH. Methods: This study was a retrospective comparative cohort study of all hospitalized patients aged 60 years or older in two municipalities. The data were collected from the national register of hospital use from 2005 to 2012, and from the local general hospital and two primary health care service providers from 2008 to 2012 (approx. 1,250 patients per follow-up year). The data were analyzed using descriptive statistics and analysis of covariance (ANCOVA). Results: The length of hospital stay decreased from the time the ICH was introduced and remained between 10% and 22% lower than the length of hospital stay in the comparative municipality for the next five years. No differences in the number of readmissions or admissions during one year follow-up after the index stay at the local general hospital or changes in primary health care utilization were observed. In the year after hospital discharge, the municipality with an ICH offered more hour-based care to elderly patients living at home (estimated mean = 234 [95% CI 215-252] versus 175 [95% CI 154-196] hours per person and year), while the comparative municipality had a higher utilization of long-term stays in nursing homes (estimated mean = 33.3 [95% CI 29.0-37.7] versus 21.9 [95% CI 18.0-25.7] days per person and year). Conclusions: This study indicates that the introduction of an ICH rapidly reduces the length of hospital stay without exposing patients to an increased health risk. The ICH appears to operate as an extension of the general hospital, with only a minor impact on the pattern of primary health care utilization

Evaluation of hospital ward layouts in recent norwegian hospitals

Objective – This paper presents current results from evaluations of two recently built Norwegian hospitals and aims towards collecting data to develop guidelines for hospital ward layouts. Background – There is a growing interest in making decisions on hospital design based on evidence and post occupancy evaluations. Research question – Which design solutions, investigated in evaluations of different hospitals, can give valuable input to guidelines for best design and layout principles of hospital wards? Methods – Six hospital cases were chosen to represent different layout solutions of ward design. This paper presents and compares two of them. The methods included assessment of floorplans, walk-through evaluations with hospital staff, semi-structured focus group interviews and individual interviews. The combination of methods was used to investigate layout of wards, workstations and patient rooms. Focus was also on patients’ comfort and possibilities of observation of patients as well as work processes in the workstations. Data and photos of specific areas were collected, interviews transcribed, analysed and summarised. Results – The results show both similarities and variations in design solutions concerning architectural layouts of wards, workstation, patient room and bathroom. The cases have following common features: Single-bed patient rooms, large windows providing daylight and view, wards divided into 3 smaller units – bed clusters organized around workstations, each monitoring 8-9 patient rooms. Both hospitals have open workstations located in the corridor and including a small glass-sheltered work area and ‘support rooms’ nearby. Differences: The distance and visual contact between the workstations and the patient beds vary. One ward case provides bathrooms shared by two adjacent patient rooms, the other a private bathroom for each patient room. Furthermore, one ward includes a centrally placed patient leisure/waiting room with library while the other offers several small social areas for patients in addition to kitchen/dining room. Perceived comfort, satisfaction and functionality differ relating to the design solutions. The linear design of wards gave a better overview and shorter walking distances than the L-shape. Open workstations functioned well and made the staff available for patients and nearest relatives but showed challenges with confidentiality and capacity. Both patients and staff were satisfied with single-bed rooms and report improved rest, confidentiality and containing infections. Conclusion – The current evaluation provides preliminary results for design solutions concerning layout of wards, workstations and patient rooms. These solutions are associated with positive impact on experiences of architectural quality, functionality and patient and staff satisfaction and may therefore influence current guidelines for hospital wards.publishedVersio

Little in Norway: a prospective longitudinal community-based cohort from pregnancy to child age 18 months

The Little in Norway (LiN) project is a cross-disciplinary prospective longitudinal study starting in pregnancy. It was set up to investigate maternal and paternal mental health functioning in the transition to parenthood, detect pathways to healthy and aberrant child development and generate new knowledge about mechanisms underlying differential child mental health susceptibility.publishedVersio

Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study

Background: Traumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available. Objective: This study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts. Methods: This is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended–Trauma (RCS E–Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire–Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E–Trauma and NPCS at the time of a patient’s discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected. Results: The project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022. Conclusions: This study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation

Innagerende atferd i barnehagen : hvilke utfordringer møter vi i arbeidet med de innagerende barna i barnehagen? : hvordan kan vi utvikle og øke de innagerende barnas sosiale kompetanse?

Denne masteroppgaven belyser temaet innagerende atferdsvansker i forhold til barn i førskolealder. Terje Ogden og Ingrid Lund er begge enige om at barn med atferdsvansker allerede i førskolealder kan utvikle alvorlige atferdsvansker, både når det gjelder utagerende og innagerende atferdsvansker. Det kanskje ikke alle er klar over er at innagerende atferdsvansker kan være like problematisk som utagerende atferdsvansker i barnehagealder. Min problemstilling er som følgende: Hvilke utfordringer møter vi i arbeidet med de innagerende barna i barnehagen? Hvordan kan vi utvikle og øke de innagerende barnas sosiale kompetanse? Begrepet atferdsvansker er et velkjent begrep som er relativt godt kjent blant de som arbeider i barnehagen. Når man derimot kommer inn på begrepet innagerende atferdsvansker kan det virke som om mange er usikre på hva det begrepet kan bety. For å kunne møte de innagerende barna på deres egne premisser er det viktig å vite hva innagerende atferdsvansker er, hvilke utfordringer man kan møte og ikke minst hvilke tiltak som kan hjelpe disse barna i deres samspill med andre mennesker i barnehagesammenheng. I masteroppgaven har jeg jeg omtalt teori som belyser begrepene knyttet til innagerende atferdsvansker. I denne forbindelse har jeg også valgt å konsentrere meg om Sterns teori rundt det nyfødte barnet og dets tilknytningsprosesser. Denne teorien sier noe om hvordan det lille barnet reagerer på det tidligste samspillet med sine nære og hvilke konsekvenser det kan ha for den senere utviklingen. Ved siden av det har jeg benyttet meg av teori knyttet til begrepene sosial kompetanse og barns medvirkningsrett i barnehagen. Jeg har brukt relevant teori fra de to Rammeplanene for barnehagen, samtidig som jeg har sammenlignet dem med tanke på det som er sagt om aktuell teori. Jeg har også omtalt begrepet anerkjennelse fordi jeg mener dette kan knyttes til hvordan de voksne burde være i sin relasjon med de innagerende barna i barnehagen. Problemstillingene mine har blitt belyst gjennom det kvalitative forkningsintervjuet. Jeg utarbeidet en intervjuguide med 10 spørsmål som ble sendt til informantene i god tid. Jeg intervjuet 1 styrer, 3 pedagogiske ledere og 3 fagarbeidere. Mitt formål med denne undersøkelsen var å få et innblikk i hvilken kjennskap informantene hadde til begreper knyttet til innagerende atferdsvansker, hvilke utfordringer de mente de møtte i forhold til den innagerende barnegruppen i barnehagen og hvilke tiltak de så på som viktige for å utvikle og øke de innagerende barnas sosiale kompetanse. Intervjuundersøkelsen avdekket at informantene hadde kunnskap om hvem det innagerende barnet i barnehagen var, men at de var usikre på teorien innen feltet innagerende atferdsvansker. Under intervjuundersøkelsen kom det også ganske klart frem at de voksne var bekymret over at de innagerende barna kunne bli litt ”borte” i forhold til de mer aktive barna. Hovedutfordringene blant informantene dreide seg om det å klare å se barnet, og det å klare å etablere kontakt med det innagerende barnet, samt det å få barnet til å knytte kontakter med andre i barnehagemiljøet. På tiltakssiden ble lekegrupper og det å la det innagerende barnet være i mindre grupper, sett på som et viktig tiltak for å utvikle de innagerende barnas sosiale kompetanse. I intervjuene ble det nevnt få tiltak knyttet til voksen – barn tiltak. Undersøkelsen viser at samarbeid mellom barnehage og foreldre er vektlagt i stor grad, samtidig som PPT blir sett på som en svært viktig samarbeidspartner. Informantene i undersøkelsen er opptatt av å utvikle sin egen kompetanse innen dette feltet, men at det kan være vanskelig å følge opp den innagerende barnegruppen fordi mye av tiden kan gå med på å aktivisere de som hele tiden krever mer

Enhancing knowledge and coordination in obesity treatment: a case study of an innovative educational program

Currently, there is a lack of knowledge, organisation and structure in modern health care systems to counter the global trend of obesity, which has become a major risk factor for noncommunicable diseases. Obesity increases the risk of diabetes, cardiovascular diseases, musculoskeletal disorders and cancer. There is a need to strengthen integrated care between primary and secondary health care and to enhance care delivery suited for patients with complex, long-term problems such as obesity. This study aimed to explore how an educational program for General Practitioners (GPs) can contribute to increased knowledge and improved coordination between primary and secondary care in obesity treatment, and reports on these impacts as perceived by the informants.publishedVersio

Enhancing knowledge and coordination in obesity treatment: a case study of an innovative educational program

Currently, there is a lack of knowledge, organisation and structure in modern health care systems to counter the global trend of obesity, which has become a major risk factor for noncommunicable diseases. Obesity increases the risk of diabetes, cardiovascular diseases, musculoskeletal disorders and cancer. There is a need to strengthen integrated care between primary and secondary health care and to enhance care delivery suited for patients with complex, long-term problems such as obesity. This study aimed to explore how an educational program for General Practitioners (GPs) can contribute to increased knowledge and improved coordination between primary and secondary care in obesity treatment, and reports on these impacts as perceived by the informants