Areas of consensus on unwarranted and warranted transfers between nursing homes and emergency care facilities in Norway: a Delphi study

Background Transferring residents from nursing homes (NHs) to emergency care facilities (ECFs) is often questioned as many are terminally ill and have access to onsite care. While some NH to ECF transfers have merit, avoiding other transfers may benefit residents and reduce healthcare system costs and provider burden. Despite many years of research in this area, differentiating warranted (i.e., appropriate) from unwarranted NH to ECF transfers remains challenging. In this article, we report consensus on warranted and unwarranted NH to ECF transfers scenarios. Methods A Delphi study was used to identify consensus regarding warranted and unwarranted NH to ECF transfers. Delphi participants included nurses (RNs) and medical doctors (MDs) from NHs, out-of-hours primary care clinics (OOHs), and hospital-based emergency departments. A list of 12 scenarios and 11 medical conditions was generated from the existing literature on causes and medical conditions leading to transfers, and pilot tested and refined prior to conducting the study. Three Delphi rounds were conducted, and data were analyzed using descriptive and comparative statistics. Results Seventy-nine experts consented to participate, of whom 56 (71%) completed all three Delphi rounds. Participants reached high or very high consensus on when to not transfer residents, except for scenarios regarding delirium, where only moderate consensus was attained. Conversely, except when pain relieving surgery was required, participants reached low agreement on scenarios depicting warranted NH to ECF transfers. Consensus opinions differ significantly between health professionals, participant gender, and rurality, for seven of the 23 transfer scenarios and medical conditions. Conclusions Transfers from nursing homes to emergency care facilities can be defined as warranted, discretionary, and unwarranted. These categories are based on the areas of consensus found in this Delphi study and are intended to operationalize the terms warranted and unwarranted transfers between nursing homes and emergency care facilities.publishedVersio

Patient flows through Valhalla : A survival analysis in the context of short-term care institutions

Individuals experiencing functional decline may often require some form of assistance in order to reassume their activities of daily living. A common form of rehabilitation is a stay at a short-term institution, yet readmissions to such care facilities often occur. Home-based reablement has surfaced in Norway during the past ten years and aims to assist the user in reaching their own activity goals through a self-committed and intensive program, assisted by health care workers. The objective of this study isinquiring into the patient flows between home-nurse areas and short-term institutions in southern Norway over the course of three years. We examine individual characteristics such as gender, age, cohabitation and reablement participation assessing the differences in risk of admission and readmission based on these variables. To achieve this, we use multiple-spell discrete-time survival analysis andestimate several logistic regression models. Through our methods, we conclude that males, the elderly and cohabitants all have higher likelihoods of admission and readmission to short-term institutions than their respective counterparts. For reablement, participants are at signifcantly higher risk of admission, but a marginally lower risk of readmission, compared to non-participants in a similar situation

Patient flows through Valhalla : A survival analysis in the context of short-term care institutions

Master's thesis Business Administration BE501 - University of Agder 2019Individuals experiencing functional decline may often require some form of assistance in order to reassume their activities of daily living. A common form of rehabilitation is a stay at a short-term institution, yet readmissions to such care facilities often occur. Home-based reablement has surfaced in Norway during the past ten years and aims to assist the user in reaching their own activity goals through a self-committed and intensive program, assisted by health care workers. The objective of this study isinquiring into the patient flows between home-nurse areas and short-term institutions in southern Norway over the course of three years. We examine individual characteristics such as gender, age, cohabitation and reablement participation assessing the differences in risk of admission and readmission based on these variables. To achieve this, we use multiple-spell discrete-time survival analysis andestimate several logistic regression models. Through our methods, we conclude that males, the elderly and cohabitants all have higher likelihoods of admission and readmission to short-term institutions than their respective counterparts. For reablement, participants are at signifcantly higher risk of admission, but a marginally lower risk of readmission, compared to non-participants in a similar situation

Never-smokers and the fraction of breast cancer attributable to second-hand smoke from parents during childhood: the Norwegian Women and Cancer Study 1991–2018

Background - Second-hand smoke (SHS) is not an established risk factor for breast cancer. We examined exposure to SHS from parents during childhood and breast-cancer risk overall and by oestrogen- and progesterone-receptor status in the Norwegian Women and Cancer Study. Furthermore, we utilized our nationally representative prospective cohort study to estimate the fraction of breast cancer attributable to parental SHS during childhood. Methods - We followed 45 923 never-smoking women, aged 34–70 years, who completed a baseline questionnaire between 1991 and 2007 through linkages to national registries through December 2018. We used Cox proportional-hazards models to estimate age-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). We estimated the attributable and the population attributable fraction of breast cancer with 95% CIs. Results - During a mean follow-up of 19.8 (6.8) years, 2185 women developed invasive breast cancer, confirmed by histology. Women exposed to SHS from parents during childhood had an 11% higher (95% CI: 1.02–1.22) risk of breast cancer compared with those who were not. No difference was found for oestrogen (Pheterogeneity = 0.31) and progesterone (Pheterogeneity = 0.95) receptor status. For women exposed, the attributable fraction was 10.3% (95% CI: 1.8–18.0), whereas the population attributable fraction of breast cancer was 7.0% (95% CI: 1.0–13.0). Conclusions - Our results suggest that 1 in 14 breast-cancer cases could have been avoided in the absence of SHS exposure from parents during childhood in a population of never-smoking women. The cancer burden attributable to SHS may be underestimated