Earlier hospital discharge: a challenge for Norwegian municipalities
Aim: In order to improve patient outcomes and minimize health care costs, many Western countries are attempting to reduce the length of stay in hospitals by transferring responsibilities from specialist care to primary care. In Norway, the Coordination Reform was implemented in 2012 to enhance this development. As a result, the number of patients discharged to the municipal health care services has increased significantly. We investigate the extent to which nurses in nursing homes and home care services feel equipped to provide adequate care for patients discharged from hospitals after the reform.
Data: Altogether, 1,938 nurses representing around 80% of Norwegian municipalities assessed their experiences of this reform.
Results: An increase in the number of poorly functioning patients discharged to the municipality services was reported. Regardless of place of work, concerns were raised about limited resources in terms of personnel, equipment and competence, as well as an increase in hospital readmission rates. Negative reports on care provision for recently discharged patients came most frequently from nurses in municipalities which generally had low incomes, diverted limited resources to the health care sector and relied heavily on home-based care.
Conclusion: Insufficient transfer of resources to the home care services may have hampered the ability to fulfil the Coordination Reform’s intentions of providing safe care to patients in their own homes as an alternative to prolonged hospital stays. Due to a marked increase in reported hospital readmissions, it is not obvious that shorter lengths of stays have reduced overall health care costs.
Clarke, A., & Rosen, R. (2001). Length of stay: How short should hospital care be? The European Journal of Public Health, 11(2), 166-170. https://doi.org/10.1093/eurpub/11.2.166
Deraas, T. S., Berntsen, G. R., Hasvold, T., & Førde, O. H. (2011). Does long-term care use within primary health care reduce hospital use among older people in Norway? A national five-year population-based observational study. BMC health services research, 11(1), 1. https://doi.org/10.1186/1472-6963-11-287
EUROSTAT. (2015). Hospital discharge and length of stay statistics. Retrieved from http://ec.europa.eu/eurostat/statistics-explained/index.php/Hospital_discharges_and_length_of_stay_statistics#Main_statistical_findings.
Gautun, H., Kjerstad, E. & Kristiansen, F. (2001). Mellom to senger? Eldre sykehuspasienter og det kommunale pleie- og omsorgstilbudet. SNF-rapport 57/01.
Gautun, H. & Syse, A. (2013). Samhandlingsreformen. Hvordan tar de kommunale helse- og omsorgstjenestene i mot det økte antallet pasienter som skrives ut fra sykehusene? NOVA Rapport 8/13. https://doi.org/10.7577/nova/rapporter/2013/8
Gautun, H. & Grødem, A. S. (2015). Prioritising care services: Do the oldest users lose out? International Journal of Social Welfare, 24(1), 73-80. https://doi.org/10.1111/ijsw.12116
Gautun, H., Martens, C. T. & Veenstra, M. (2016). Samarbeidsavtaler og samarbeid om utskriving av pasienter. Tidsskrift for omsorgsforskning, 2(2), 88-93. https://doi.org/10.18261/issn.2387-5984-2016-02-03
Holmås, T. H., Kamrul Islam, M., & Kjerstad, E. (2013). Between two beds: inappropriately delayed discharges from hospitals. International Journal of Health Care Finance and Economics, 13(3), 201-217. https://doi.org/10.1007/s10754-013-9135-4
Januleviciute, J., Askildsen, J.E., Kaarboe, O., Siciliani, L., Sutton, M. (2015). How do hospitals respond to price changes? Evidence from Norway. Health Econ, 25(5), 620-636. https://doi.org/10.1002/hec.3179
Kjekshus, L. E. (2005). Primary health care and hospital interactions: effects for hospital length of stay. Scandinavian journal of public health, 33(2), 114-122. https://doi.org/10.1080/14034940410019163
Kroneman, M., & Siegers, J. J. (2004). The effect of hospital bed reduction on the use of beds: a comparative study of 10 European countries. Social science & medicine, 59(8), 1731-1740. https://doi.org/10.1016/j.socscimed.2004.01.03
Langørgen, A. (2004). Needs, economic constraints, and the distribution of public home-care. Applied Economics, 36(5), 485-496. https://doi.org/10.1080/00036840410001682197
Melberg, H.A., & Hagen, T. (2016). Liggetider og reinnleggelser i somatiske sykehus før og etter Samhandlingsreformen. Tidsskrift for omsorgsforskning, 02(2), 143-158. https://doi.org/10.18261/issn.2387-5984-2016-02-09
National Budget. (2012). Innst. 2 S (2011–2012).
National Budget. (2015). Innst. 2 S (2014–2015).
Norwegian Directorate of Health. (2016). Samdataspesialisthelsetjenesten 2015. Retrieved from: https://helsedirektoratet.no/Lists/Publikasjoner/Attachments/1219/Samdata%20Spesialisthelsetjenesten%202015%20IS-2485.pdf
Norwegian Ministry of Health and Care Services. (2008-2009). The Coordination Reform. (47).
OECD. (2011). Health at a glance: OECD indicators. Retrieved from http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/05/index.html;jsessionid=347cdtfdmp3bf.x-oecd-live-03?itemId=/content/chapter/health_glance-2011-33-en&_csp_=7437a3773df7eb771d0f1145cc7940bf. https://doi.org/10.1787/health_glance-2011-en
Purdy, S., Paranjothy, S., Huntley, A., Thomas, R., Mann, M., Huws, D., & Elwyn, G. (2012). Interventions to reduce unplanned hospital admission. Bristol: National Institute for Health Research.
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