INOREG. INnovations in use Of REGister data in analyzing effects of health care interventions in primary care.
Recent strategic initiatives from the Norwegian government and parliament calls out for research on how multimorbidity, primary and municipal health care services influence work participation, functioning, quality of life and use of specialized care for chronic patients. Although the vast majority of care occurs outside of hospitals, this care has been difficult to capture and limited in research. Focusing on two important chronic groups, patients with Chronic Obstructive Pulmonary Disease (COPD) and Musculoskeletal disorders (MSD), the INOREG project will meet exactly this need. The primary aim of the project is to identify ways of improving care in the municipality, resulting in higher social and working life participation, reduced hospitalization, better functioning and overall quality of life for the patients involved. This is achieved using a novel approach combining analyses of primary and municipal care patient register data and in-depth studies of patients having particularly good or poor results of treatment. In short, identify combinations of care that seems to work well, and those that do not seem to work. We will also identify the characteristics of patients that are especially vulnerable to poor outcomes. The results should inform policy makers on how services can be designed in order to prepare for the expected future challenges to the overall sustainability of the health system, both due to the increase in the share of elderly and the increase in patients with chronic diseases. In the long term, this may contribute to better coordination and use of care services as well as reduced health inequality.
INOREG addresses two of the main policy challenges related to the primary and municipal health care system: The need for more information on how variations in health care services and multimorbidity affect outcomes, and the lack of a necessary data foundation onto which the future direction and design of the services can be based. We will
undertake register-based analyses to find effects of multimorbidity, primary and municipal care variables on outcomes such as employment, hospital admissions and quality of life, concentrating on two patient groups that represent different needs: Chronic Obstructive Pulmonary Disease and Musculoskeletal disorders. Both groups use a wide range of the health services offered by municipalities and primary care. They are both care intensive and vulnerable to sick leaves, disbility benefits, hospitalization and poor functioning. This means that there are cost savings to be made by first identifying characteristics of patients at particularly high risk of poor outcomes, and second by improving services within primary and municipal care for these patients. By supplementing these quantitative data with qualitative data using mixed-method methodology, INREG will identify reasons and determinants for variability in patient pathways and the outcomes mentioned above. This will be done through in-depth studies of the decisions and prioritizations at micro-level using individual patient journals. Emphasis will then be put on identification of interventions and services modifiable by the municipalities, and that can be implemented in community health care. Through four work packages we will obtain knowledge on how to obtain data of high quality as well as how to use and interpret the data. We will also develop analytical methods that can be applied extracted data from the planned registry. Through close cooperation with municipalities, clinicians and patients, INOREG targets relevant topics for the stakeholders.