Variations in trajectories, utilisation and costs in Norwegian municipal in-patient acute care units

How to avoid unnecessary emergency hospital admissions has gained national and international urgency due to ageing populations and an increasing burden of chronic diseases. In Europe, different forms of so-called “admission avoidance intermediate care” (AAIC) schemes have been introduced in order to meet growing demands for sufficient, accessible, high-quality and affordable health and long-term care services. In Norway, municipal in-patient acute care (MipAC) was launched as part of the Coordination Reform in 2012 with the explicit aim to reduce pressure on expensive specialist care services and provide patients with services closer to home. Today, more than 200 MipAC units have been implemented across Norway, but we have little context-sensitive knowledge about the quality, use and costs of the MipAC service and the intended and unintended outcomes of such models. The overall objective of this project is to address these gaps and to contribute with new and updated knowledge on the role of AAIC schemes in general, and MipAC in particular, in ensuring sustainable health care services in Norway. The project utilises a range of health and administrative data from national registries and data from ongoing and concluded projects. The project’s main objective will be addressed through four work packages. In the first work package, we set the stage for our project by conducting a realist review of AAIC schemes in high-income European countries, focusing on explaining relationships between contexts, mechanisms of success and outcomes (including cost/resource use outcomes). In the second work package, we investigate the MipAC units’ role in existing care service users’ trajectories. The third work package assesses variation in utilisation of MipAC, whereas the fourth work package addresses the economic credentials of the MipAC scheme, taking variations in organisational and municipal contexts into account.

Nationally as well as internationally, the issue how to avoid emergency hospital admissions has gained urgency against the backdrop of ageing populations and an increasing burden of chronic diseases. In Europe, different forms of admission avoidance intermediate care (AAIC) schemes have been introduced in order to meet growing demands for sufficient, accessible, good quality and affordable health and long-term care services. In Norway, municipal in-patient acute care (MIPAC) was launched as part of the Coordination Reform in 2012 with the explicit aim to reduce pressure on expensive specialist care services and provide patients with services closer to home. Today, more than 200 MIPAC units have been implemented across Norway, but we have little context-sensitive knowledge about the quality, use and costs of the MIPAC service and the intended and unintended outcomes of AAIC models. The overall objective of the proposed project is to address this gap and to contribute with new and updated knowledge on the role of AAIC schemes in general, and MIPAC in particular, in ensuring sustainable health care services in Norway. The project utilises a range of existing health data from the new Health Analysis Platform (www.helsedata.no), administrative registry data and own data from ongoing and concluded projects. The project’s main objective will be addressed through four work packages. In the first work package, we set the stage for our project by conducting a realist review of AAIC schemes in high-income European countries, focusing on explaining relationships between contexts, mechanisms of success and outcomes (including cost/resource use outcomes). In the second work package, we investigate the MIPAC units’ role in existing care service users’ trajectories. The third work package assesses variation in utilisation of MIPAC, whereas the fourth work package addresses the economic credentials of the MIPAC scheme with reference to organisational and municipal contexts.