Fewer deaths occur when the elderly are treated locally

Older people with health problems often need some form of intermediate level monitoring, care, and treatment services.

They may not need the resources of a hospital but do require somewhat more advanced help than a nursing home can usually offer. Intermediate care units are primarily intended to replace an acute hospital admission, but are occasionally also used following admission.

“Intermediate care units are the newest trend in health policy, and Norway is way ahead of the curve in this regard,” Pål Erling Martinussen says. He is a professor in the Department of Sociology and Political Science at NTNU.

This is a sort of middle ground between a hospital and a nursing home that is located close to patients’ homes – a sort of local community hospital, if you like. Norway has been developing this service over the last ten years as part of the Norwegian Care Coordination Reform implemented in 2012.

A group of researchers from NTNU, SINTEF and UiO have now studied how this service affects various indicators that can provide evidence of the quality of healthcare in Norway.

And they have good news.

Fewer deaths and fewer readmissions to hospital 

“All Norwegian municipalities had to set up municipal acute care units following the healthcare decentralisation and coordination reform in 2012,” Martinussen says.

These municipal acute care units are referred to as MAUs in professional jargon. 

The introduction took place gradually. The aim was to provide a good, integrated service that tailored to each individual user. 

Not all reforms within the healthcare system are met with joy and jubilation. However, after this reform, it appears that the healthcare service is better for older patients who require this form of follow-up. 

“We’ve found that the introduction of these medical units is associated with both lower mortality and fewer readmissions,” Martinussen says.

But this finding only applies to the oldest patients. The correlation is also significantly stronger when the MAUs are organised as larger entities and are well staffed by medical professionals.

Such an intermediate level of healthcare service is thus associated with lower mortality rates for the elderly. This suggests that healthcare services within municipalities has improved since the introduction of MAUs. Furthermore, fewer individuals need to be readmitted to the hospital for further treatment.

Worthy of implementation by other countries

For mortality, the research group examined patients over 80 years of age. They examined individuals aged 67 and older for hospital readmission rates. The improvement was significant for both factors. 

“Our findings are a strong indication that MAUs have worked as intended. Health services for the elderly may have improved by shifting some treatment from hospitals to where people live. However, this should be followed up by further research,” Martinussen says.

Further research could potentially confirm whether there is a direct correlation between the introduction of MAUs and the reduction in mortality and readmission rates observed among the elderly. 

Experts believe that such healthcare reforms could be successfully implemented elsewhere.

“Our research group believes that countries with healthcare systems similar to Norway’s can achieve good results if they introduce similar local services for their patients,” he says. 

Reference:

 Hilland et al. Stayin’ alive: The introduction of municipal in-patient acute care units was associated with reduced mortality and fewer hospital readmissions, Social Science & Medicine, 2023.

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