Registry research for the health care services - Regforsk
Registry research for the health care services - Regforsk
We are an interdisciplinary research group applying new methods to study the health care services, mainly by use of registry data. Such observational data can be used to assess causes of effects, under certain conditions. In Norway we have access to an array of rich registries for both primary-, and specialist health care, but also for a wide range of other welfare schemes. It is also possible to link these registries with cohort studies such as The Trøndelag Health Study (The HUNT Study).
Randomized controlled trials are the primary method for answering questions about cause and effect, but decisions about the organization of the health care services are rarely based on such trials. There are both practical and ethical barriers to randomization of interventions at system level, and therefore, health care service research is largely based on registry data. Our novelty lies in mimicking randomized trials to analyze these observational data.
The aim of Regforsk, is to contribute to an improved understanding of the mechanisms driving structural, organizational, and financial conditions in the Norwegian health service, studying capacity, health care use, patient safety and clinical treatment effects, using routinely collected registry data.
Regforsk consists of experienced national and international researchers from varied scientific backgrounds (epidemiology, various clinical specialties in medicine, mathematics and statistics, social science, and economics). The environment originates from the Department of Public Health and Nursing (ISM) at the Norwegian University of Science and Technology (NTNU), and Center for Health Care Improvement at St. Olavs University Hospital.
Featured work from our research environment
We have studied effects of referrals of elderly patients from out-of-hours services to hospitals in cases where the referral indication is not obvious - cases where some doctors would have chosen not to refer the patient. The study finds that such referrals lead to slightly more use of health services, but that those who are referred have significantly lower mortality over the next six months. You can read more about results and methods in the article, with accompanying Editorial.
We studied perinatal mortality and the risk of transport delivery among similar populations with different hospital volumes and travel times. This study is published preprint here.
At a population level, we found that high-volume delivery units lowered perinatal mortality rates. Conversely, longer travel times increased the risk of transport delivery but did not distinctly impact perinatal mortality.
In Norway, we benefit from high-quality healthcare services. However, there are concerns about hospital capacity during peak periods. We used Norwegian register data to study this.
We found that elderly patients admitted during busier circumstances showed similar mortality and readmissions to those admitted during less busy periods but showed a higher risk of being discharged outside daytime working hours. Despite limited effects of busyness on a hospital level, there could still be harmful effects of local situations. Further analyses from the same data material show, for example, that when the home ward is full, patients with heart failure have a greater risk of being treated in another ward, longer length of stay and higher mortality.
We have also seen that elderly people with hip fractures are vulnerable in busy situations. This study revealed that treatment for these cases is impacted when there's a surge in patients requiring emergency surgery. During these high-demand periods, the time taken to perform surgery on hip fracture patients increased by 20 percent compared to quieter times. Additionally, our findings show that when the operating theater is crowded, there's a 20 percent increase in the 60-days mortality rate for hip fracture patients.
In a study that includes all Norwegian children born between 1989 and 1998, children born in November-December had an 80 percent higher chance of being prescribed ADHD medication, compared to children born in January-February. For children born preterm (before week 37 of pregnancy), this effect lasted through adolescence and into young adulthood, unlike what we found for their term-born peers. These findings suggest that children born preterm are vulnerable to long-term effects of being relatively immature, and that they require careful follow-up from the school system and health care professionals.
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