Variations in patient trajectories and experiences, utilisation and costs in municipal in-patient acute care services (MIPAC)

A project funded by the Research Council of Norway (grant number 324959) and the Norwegian University of Science and Technology (NTNU)

Project summary

Nationally as well as internationally, the issue how to avoid ‘unnecessary’ 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.

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 MIPAC project is to address this gap and to contribute with new and updated knowledge on the role of AAIC services in ensuring sustainable health care services. The project utilises a range of existing health data from the Health Analysis Platform (www.helsedata.no), administrative registry data and data from previous projects.

The project’s main objective will be addressed through six work packages. In the first work package, we set the stage for our project through a realist review of AAIC schemes in high-income countries, focusing on explaining relationships between contexts, mechanisms of success and 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.

Work packages five and six constitute projects that have been added to the original research programme (WP1-4). In these two work packages we investigate patient experiences and outcomes in different types of MIPAC services (WP5) and similarities and differences in the intermediate care service landscape in Norway and Denmark (WP6).

Publications

Publications pending. The following manuscripts are under review in international peer-reviewed journals (please do not hesitate to contact the authors by e-mail if you have any questions about the papers):

Rijal, S., Skinner, M.S., Briscoe, S., Yang, F. & Anderson, R. Providing effective and efficient hospital admission avoidance inpatient care: a realist review of Norwegian municipal inpatient acute care services. Under review. (WP1). Contact: sujan.rijal@ntnu.no

Udesen, S.E.J., Sogstad, M., Veenstra, M., Lassen, A. & Skinner, M.S. Municipal intermediate care services in Denmark and Norway: A cross-country comparative analysis. Under review. (WP6) Contact: marianne.skinner@ntnu.no

Yang, F., Burrell, L.V., Sogstad, M. & Skinner, M.S. Facility and Regional Variations in Admission and Discharge Patterns within Step-Up Intermediate Care: A cross-sectional study of Municipal Inpatient Acute Care Services in Norway. Under review. (WP2&3) Contact: fan.yang@ntnu.no

Yang, F., Skinner, M.S., Rijal, S., Lovell, A., Burrell, L., Sogstad, M. & Anderson, R. Approaches to analyse and use patient flow between care settings: a systematic review. Under review. (WP2) Contact: fan.yang@ntnu.no

Principal investigator

Marianne S. Skinner
Associate Professor
Centre for Care Research
NTNU Gjøvik