Tron Anders Moger

• Moger, Tron Anders; Tjerbo, Trond; Vøllestad, Nina Køpke; Hellesø, Ragnhild; Holte, Jon Helgheim & Amundsen, Olav [Show all 18 contributors for this article] (2026). From data collection to action: Health registry data in chronic care management and policy. Journal of Public Health Research. ISSN 2279-9028. 15(4). doi: 10.1177/22799036261495552. Full text in Research Archive
• Holte, Jon Helgheim; Moger, Tron Anders; Edvardsen, Anne; Tjerbo, Trond; Vøllestad, Nina Køpke & Hellesø, Ragnhild [Show all 7 contributors for this article] (2026). Long-term patterns of health services utilization after hospitalization for COPD. A nationwide registry-based study from Norway. Respiratory Medicine. ISSN 0954-6111. 260. doi: 10.1016/j.rmed.2026.108958. Full text in Research Archive Show summary

  Chronic obstructive pulmonary disease (COPD) is commonly regarded as an ambulatory care-sensitive condition (ACSC), for which targeted outpatient and primary care can improve patients' outcomes and reduce their risk of hospitalization. Yet little is known about how COPD patients' use of such services evolves in real-life settings. Using national health registry data from Norway (2008–2020), linked to demographic and socioeconomic registers, we explore how COPD patients' combined use of primary and specialist services evolves in the first four years after an acute respiratory hospital episode, and assess whether these patterns align with clinical guidelines and vary by sociodemographic characteristics. A two-stage clustering approach was employed to identify individuals with similar care trajectories. The 13 057 patients were first grouped by the number of respiratory hospital episodes after the index episode (0, 1–2, or 3+), then K-medoid clustering was performed within each group to identify similar patterns of respiratory-related outpatient and primary health service utilization. Four distinct care trajectories emerged within each group, with similar combination patterns: (1) predominantly GP services (most common), (2) GP and outpatient services, (3) GP, out-of-hours primary care and infrequent outpatient services, and (4) frequent physiotherapist, GP and outpatient services (rarest). Notably, groups 2 and 4 had higher income and education than groups 1 and 3, and many patients do not follow care trajectories according to current guidelines for COPD treatment. Understanding the mechanisms that explain these variations in health services use, and their implications for care quality and equity, is essential for improving COPD management in universal healthcare systems.

• Godager, Geir; Kaarbøe, Oddvar Martin; Moger, Tron Anders & Aars, Ole Kristian (2026). Content matters - sending emails to ensure appropriate use of laboratory fees. Journal of Behavioral and Experimental Economics. ISSN 2214-8043. 123. doi: 10.1016/j.socec.2026.102599. Full text in Research Archive Show summary

  This study examines communication interventions' impact on general practitioners' (GPs) claiming of fees for laboratory tests. GPs, who recently claimed laboratory fees, were randomly assigned to two intervention groups (Mild and Strong) or a control group. Initially, both intervention groups received an email emphasizing the importance of utilizing lab tests judiciously, the range of conditions tested, and the need for patients to bear the costs of unnecessary tests. In a subsequent phase, a reminder email was sent with different content. The Mild group received a reiteration of the initial email, while the Strong group was reminded of the economic consequences and potential impact on access to other healthcare services, as stated in the ethical guidelines of the Norwegian Medical Association. Results show that the first email had no effect on either intervention group. However, the reminder email significantly influenced the Strong group, leading to a reduction in tests and conditions. Importantly, this effect differed statistically from the impact observed in the Mild group in terms of test utilization.

• Dahl-Hansen, Eline; Bjørk, Marte-Helene; Wollertsen, Yvonne Myrtvedt; Pesonen, Henri; Gilhus, Nils Erik & Koht, Jeanette [Show all 9 contributors for this article] (2026). Needs-based epilepsy follow-up: seizure control, treatment adherence and patient care. Epilepsy & Behavior. ISSN 1525-5050. 182. doi: 10.1016/j.yebeh.2026.111088. Full text in Research Archive
• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Show all 8 contributors for this article] (2026). Use of primary care physiotherapy and its associations with clinical and socioeconomic outcomes in musculoskeletal disorders: a cohort study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1). doi: 10.1080/02813432.2026.2660328. Full text in Research Archive Show summary

  Isolating the effects of outpatient care on hospitalisation in observational data is challenging. We estimate the effects of factors believed to influence hospital admissions in patients with COPD. The factors were related to outpatient care and social factors, motivated by recommendations in COPD guidelines and the literature. We applied linked national and municipal registry data on 25,369 COPD patients in Oslo and Trondheim 2008–2019. Yearly frequency and type of healthcare contacts (respiratory and non-respiratory, across providers), together with comorbidities, were used as proxies for patients’ health status. We constructed samples matched on the full set of proxy variables to estimate the effect of each factor on future COPD hospital admissions. Overall, 9.8% of follow up years had at least one COPD hospital admission. Findings indicated beneficial effects of several of the factors. Care interaction between general practitioner (GP) and other health providers, follow-up by GP within 30 days after COPD hospital discharge and counselling/psychotherapy by GP showed significant reductions of 2.9, 4.9 and 1.4% points in the rate of next-year COPD hospital admissions, respectively. The effects are noteworthy when extrapolated to the entire Norwegian COPD population. A reduction of 1% point could result in up to 1,500 fewer patients experiencing one or more COPD hospital admissions during a year. In the absence of detailed clinical information, creating samples that are multidimensionally matched on health service use and comorbidities as pragmatic proxies for health status could be a viable approach for estimating the effects of other factors.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Edvardsen, Anne & Bragstad, Line Kildal [Show all 9 contributors for this article] (2026). Matching on health status to estimate the effects of outpatient care and social factors in patients with COPD: a Norwegian registry‑based study. BMC Health Services Research. 26(1). doi: 10.1186/s12913-026-14285-9. Full text in Research Archive Show summary

  Isolating the effects of outpatient care on hospitalisation in observational data is challenging. We estimate the effects of factors believed to influence hospital admissions in patients with COPD. The factors were related to outpatient care and social factors, motivated by recommendations in COPD guidelines and the literature. We applied linked national and municipal registry data on 25,369 COPD patients in Oslo and Trondheim 2008–2019. Yearly frequency and type of healthcare contacts (respiratory and non-respiratory, across providers), together with comorbidities, were used as proxies for patients’ health status. We constructed samples matched on the full set of proxy variables to estimate the effect of each factor on future COPD hospital admissions. Overall, 9.8% of follow up years had at least one COPD hospital admission. Findings indicated beneficial effects of several of the factors. Care interaction between general practitioner (GP) and other health providers, follow-up by GP within 30 days after COPD hospital discharge and counselling/psychotherapy by GP showed significant reductions of 2.9, 4.9 and 1.4% points in the rate of next-year COPD hospital admissions, respectively. The effects are noteworthy when extrapolated to the entire Norwegian COPD population. A reduction of 1% point could result in up to 1,500 fewer patients experiencing one or more COPD hospital admissions during a year. In the absence of detailed clinical information, creating samples that are multidimensionally matched on health service use and comorbidities as pragmatic proxies for health status could be a viable approach for estimating the effects of other factors.

• Ki, Yeujin; Mcaleavey, Andrew Athan; Moger, Tron Anders & Moltu, Christian (2026). Moving beyond global scores: the added value of clinical dimensions for assessing HRQoL in mental disorders. Quality of Life Research. ISSN 0962-9343. 35, p. 1–9. doi: 10.1007/s11136-025-04099-3. Full text in Research Archive Show summary

  Purpose Health-Related Quality of Life (HRQoL) is an important outcome in health services research, but the suitability of generic HRQoL instrument for mental health populations is debated. This study investigates how clinical mental health dimensions (Norse Feedback, NF) supplement the generic HRQoL instruments (EuroQol five-dimensions five-level, EQ-5D-5 L) to explain their subjective well-being, defined by self-rated health (EuroQol Visual Analogue Scale, EQ-VAS) and life satisfaction. Methods In a cross-sectional study, 307 adults in specialized mental health treatment in Norway completed the EQ-5D-5 L and the modified NF. We compared a baseline regression model using only EQ-5D-5 L dimensions with a comprehensive model using factors derived from an Exploratory Factor Analysis of all 33 combined dimensions: 5 from EQ-5D-5 L and 28 from NF. Results Factor analysis yielded five factors, two of which (‘Behavioral problems/externalizing’ and ‘Social/life stability’) consisted exclusively of clinical dimensions not captured by the EQ-5D-5L. A comprehensive model using these factor scores significantly improved explanatory power over a baseline EQ-5D-5L model. The adjusted R² increased by 8.4% points for EQ-VAS (from 23.5 to 31.9%) and by 17.3% points for life satisfaction (from 41.1% to 58.4%). The dominant ‘Psychological distress’ factor was key to this improvement, integrating the single EQ-5D-5L ‘Anxiety/depression’ dimension with eleven clinical dimensions like Internal avoidance and Hopelessness. Conclusion While the EQ-5D-5 L is valuable, its assessment of well-being in this population is significantly enhanced by incorporating some clinical dimensions. Particularly, mental health-specific dimensions such as Internal avoidance, Intrusive memories, Self-contempt and Hopelessness played crucial roles to understand the gap between generic HRQoL and their sense of overall well-being.

• Haavaag, Silje Bjørnsen; Obstfelder, Aud Uhlen; Hellesø, Ragnhild; Moger, Tron Anders; Amundsen, Olav & Tjerbo, Trond [Show all 9 contributors for this article] (2026). Patient Work in Long-Term Conditions. Qualitative Health Research. ISSN 1049-7323. doi: 10.1177/10497323261430632. Full text in Research Archive Show summary

  Long-term conditions are one of the major causes to morbidity and death worldwide. Management of such conditions in healthcare settings has been framed as a challenge for healthcare systems, and people living with long-term conditions often experience fragmented care. Integrated care approaches have been advocated as the solution, but few studies include the work done by patients and its significance for care processes. The present study aimed to explore the work of people with long-term conditions in the unfolding of their care trajectories. The study is based on semi-structured interviews of people living with chronic obstructive pulmonary disease and musculoskeletal disorders. The participants were all home-dwelling and living in Norway. Reflexive thematic analysis was used to guide the analysis. Theory about work as theorized by Strauss et al. was central to the analysis. The persons highlight that they feel that it is up to them to ask questions and initiate care, that they monitor their bodies to be equipped to act adequately when changes occur, and that they engage in deliberative interaction with healthcare personnel. The findings add depth to current knowledge and highlight that people living with long-term conditions participate in the unfolding of their care trajectories by doing comprehensive work. Framing what people with long-term conditions do when participating in their care trajectories as work brings forth aspects of healthcare use that may be less visible for healthcare personnel and enables addressing individual care trajectories as intertwined with patient work.

• Moger, Tron Anders; Nardin, Sahand Barati; Holen, Åsne Sørlien; Moshina, Nataliia & Hofvind, Solveig Sand-Hanssen (2025). An economic scenario analysis of implementing artificial intelligence in BreastScreen Norway–Impact on radiologist person-years, costs and effects. Journal of Medical Screening. ISSN 0969-1413. 33(1). doi: 10.1177/09691413251372829. Full text in Research Archive Show summary

  Objective To study the implications of implementing artificial intelligence (AI) as a decision support tool in the Norwegian breast cancer screening program concerning cost-effectiveness and time savings for radiologists. Methods In a decision tree model using recent data from AI vendors and the Cancer Registry of Norway, and assuming equal effectiveness of radiologists plus AI compared to standard practice, we simulated costs, effects and radiologist person-years over the next 20 years under different scenarios: 1) Assuming a €1 additional running cost of AI instead of the €3 assumed in the base case, 2) varying the AI-score thresholds for single vs. double readings, 3) varying the consensus and recall rates, and 4) reductions in the interval cancer rate compared to standard practice. Results AI was unlikely to be cost-effective, even when only one radiologist was used alongside AI for all screening exams. This also applied when assuming a 10% reduction in the consensus and recall rates. However, there was a 30–50% reduction in the radiologists’ screen-reading volume. Assuming an additional running cost of €1 for AI, the costs were comparable, with similar probabilities of cost-effectiveness for AI and standard practice. Assuming a 5% reduction in the interval cancer rate, AI proved to be cost-effective across all willingness-to-pay values. Conclusions AI may be cost-effective if the interval cancer rate is reduced by 5% or more, or if its additional cost is €1 per screening exam. Despite a substantial reduction in screening volume, this remains modest relative to the total radiologist person-years available within breast centers, accounting for only 3–4% of person-years.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Døhl, Øystein & Bragstad, Line Kildal [Show all 9 contributors for this article] (2025). Predictors, Healthcare Utilization and Costs Related to Short-Term Stays in Patients with COPD: A Registry-Based Analysis in Norway. Clinical Epidemiology. Volume 17, p. 707–719. doi: 10.2147/clep.s521958. Full text in Research Archive Show summary

  Background: Chronic obstructive pulmonary disease (COPD) incurs significant healthcare costs, often accompanied by multimorbidity. Advanced patients may need short-term stays for rehabilitation, treatment, or respite to maintain home living. Aim: To identify predictors for a first short-term stay and study the healthcare utilization and costs compared with similar patients without a short-term stay. Patients and Methods: Data on COPD patients in the cities Oslo and Trondheim 2010–2019 and including information on specialist, primary and long-term care, diagnoses, sociodemographics and -economics were collected from national and municipal registries, resulting in a sample of 24,613 patients. Using discrete time survival models, we identified predictors for a short-term stay. We described the costs before and after admission, and the duration of living at home, compared to non-recipients matched on age, comorbidities and healthcare use. Results: Depression, anxiety, mental disorders, alcoholism, prior hospitalization and reception of home care were associated with higher odds of short-term stays. One to two GP visits for respiratory diseases, being in the top quartile for GP visits for non-respiratory diseases, visits to specialists, and physiotherapist visits for non-respiratory issues were significantly associated with lower odds of short-term institutional stay. Patients admitted to short-term stays incurred markedly higher costs both in the year before admission and during subsequent years compared to matched non-recipients, primarily due to increased use of inpatient and home care services. Conclusion: Prior receipt of home care, unlike standard outpatient services, was linked to a higher likelihood of short-term stays. This suggests that some outpatient services may delay the need for such stays, or that patients already in municipal services are more readily admitted. Additionally, patients with psychosocial issues may have greater care needs, indicating that resource allocation aligns with these needs. The findings suggest that by the time short-term stays are required, health deterioration has already become considerable.

• Ki, Yeu Jin; Mcaleavey, Andrew Athan; Øien, Janne-Merete Torset; Moger, Tron Anders & Moltu, Christian (2025). Measuring health-related quality of life: a qualitative study of mental health patients’ experiences of impacts of mental health issues. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 20(1), p. 1–16. doi: 10.1080/17482631.2025.2465209. Full text in Research Archive Show summary

  Background Existing instruments used in health economics to measure health-related quality of life (HRQoL) have been criticized as they might not sufficiently reflect the HRQoL impacts of mental health problems. Our study investigates mental health patients’ experiences of such impacts with a view to identifying potential domains that conventional HRQoL instruments might overlook. Methods Semi-structured, in-depth interviews were conducted with 16 participants receiving specialist mental health services in Norway. Interviews were analysed using reflexive thematic analysis. Results Five main themes were identified describing mental disorders' impact on patients’ HRQoL: “Reduced functioning impacts”, “Mental process impacts”, “Social impacts”, “Fragility”, and “Sleep difficulty”. While some overlap with conventional HRQoL instruments exists, distinct dimensions were identified, notably, “Fragility,” encompassing unpredictability and inflexibility in daily life. Conclusions The findings suggest that comprehensive assessment should consider broader mental health impacts beyond anxiety and depression, including cognitive difficulties, obstructive self-perception, and feelings of meaninglessness. Additionally, the impact of unpredictability on daily functioning and the role of sleep difficulties should be incorporated. These insights can inform the development of more patient-centred HRQoL measures for mental health populations, potentially leading to more accurate evaluation of mental health interventions.

• Nguyen, Huong Thu; Moger, Tron Anders; Valberg, Morten; Degerud, Eirik; Page, Christian Magnus & Leblanc, Marissa [Show all 7 contributors for this article] (2024). Individual heterogeneity, educational attainment and cardiovascular mortality: a pooled analysis of Norwegian health surveys. BMJ Public Health. 2. doi: 10.1136/bmjph-2023-000104. Full text in Research Archive Show summary

  Background: Smoking, physical inactivity, cholesterol level and systolic blood pressure are well-established risk factors for cardiovascular diseases (CVD). However, even among individuals with similar levels of these factors, a substantial degree of variation in risk may still remain. We investigated the variation in this unexplained risk across educational levels. Methods: The study population (N=451 800) was from Norwegian health surveys and linked to the National Education Database and the Norwegian Cause of Death Registry. We used survival analysis with frailty models to measure unobserved heterogeneity (frailty variation). Models were stratified by three educational levels. We highlight the degree of heterogeneity by presenting Gini coefficients and indicate how much the unobserved heterogeneity differed across levels of education from the estimated parameters of the frailty distributions. Lorenz curves were plotted for a graphical representation of inequalities in individual risk. Main results: The estimated frailty variances were 24.96, 34.12 and 42.37 in the low, middle and high education groups, respectively, before adjusting for risk factors and 3.76, 7.12 and 7.82 after adjusting for risk factors. The corresponding Gini coefficients were 0.75, 0.84 and 0.86 for low, middle and high education groups, respectively. Conclusion: A large share of the variation in CVD mortality was explained by the observed risk factors. However, a substantial individual unobserved variation in CVD mortality remained after adjusting for these risk factors. Our findings indicate that the unobserved variation in CVD mortality could vary somewhat between educational groups, but that education does not explain the major share of the remaining substantial heterogeneity.

• Aars, Ole Kristian; Godager, Geir; Kaarbøe, Oddvar Martin & Moger, Tron Anders (2024). Sending emails to reduce medical costs? The effect of feedback on general practitioners’ claiming of fees. Journal of Behavioral and Experimental Economics. ISSN 2214-8043. 109. doi: 10.1016/j.socec.2024.102178. Full text in Research Archive Show summary

  Audit and feedback is employed as a strategy to guide practices of health care professionals towards certain targets. The outcome of interest can be quality improvements, but also ensuring that health care workers adhere to relevant regulations. We conducted a nationwide field experiment in the Norwegian primary care sector to study the behavioral responses from giving general practitioners feedback (GPs) on their claiming of fees. The email-based feedback intervention targeted GPs who most frequently claimed fees for double consultations and provided them with a reminder of the formal regulations for double consultations. The intervention caused a 3–4 percentage point reduction in the use of the double-consultation fee, reducing the yearly health care spending of the Norwegian government by approximately €480 000 per year. This substantial and durable behavioral response found in our study sample comprising 15 % of Norwegian GPs, shows that low-cost interventions via email can have significant financial impact.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Døhl, Øystein & Bragstad, Line Kildal [Show all 9 contributors for this article] (2024). The in- and outpatient health care use of patients with COPD before and after initiation of home care: a registry study from Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(1). doi: 10.1080/02813432.2024.2404056. Full text in Research Archive Show summary

  Objective: Chronic obstructive pulmonary disease (COPD) is a common condition associated with age, multimorbidity and frequently involves the use of health care across levels. Understanding the factors associated with the initiation of long-term care is important when planning the future need for services. We describe healthcare use before and after the reception of any home care. We further studied the associations between healthcare use and first registered home care service and from first registered home care service to nursing home admission or death. Design and subjects: Patients residing in Oslo or Trondheim at the time of first contact with a COPD primary diagnosis, 2009–2018. Patient data were linked across national and municipal registries, covering healthcare and sociodemographics. The sample consisted of 16,738 individuals. Results: There was a marked increase in inpatient and outpatient hospital contacts in the years prior to and after the reception of any home care. Adjusted for comorbidities and sociodemographics, high numbers of GP consultations, and inpatient and outpatient hospital contacts for respiratory diagnoses were associated with a significantly higher likelihood of receiving home care the next year (hazard odds ratios > 1.3). Following the reception of home care, the type of home care service received (e.g. home nursing or short-term rehabilitation/treatment) was more important than outpatient services in predicting next-year nursing home admission or death. Conclusion: Including data on prior outpatient care when predicting future need for home care is beneficial. A high frequency (top 10%) of yearly GP, in- or outpatient hospital contacts can imply that the patient may be in need of home care in the near future.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Show all 8 contributors for this article] (2024). Patient characteristics and healthcare use for high-cost patients with musculoskeletal disorders in Norway: a cohort study. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-12051-3. Full text in Research Archive Show summary

  Background: A high proportion of healthcare costs can be attributed to musculoskeletal disorders (MSDs). A small proportion of patients account for most of the costs, and there is increasing focus on addressing service overuse and high costs. We aimed to estimate healthcare use contributing to high costs over a five-year period at the individual level and to examine if healthcare use for high-cost patients is in accordance with guidelines and recommendations. These findings contribute to the understanding of healthcare use for high-cost patients and help in planning future MSD-care. Methods: This study combined Norwegian registries on healthcare use, diagnoses, demographic, and socioeconomic factors. Patients (≥ 18 years) were included by their first MSD-contact in 2013–2015. We analysed healthcare use during the subsequent five years. Descriptive statistics were used to compare high-cost (≥ 95th percentile) and non-high-cost patients. Total healthcare contacts and costs for high-cost patients were examined stratified by number of hospitalisations and surgical treatments. Healthcare use of General Practitioners (GPs), physiotherapy, chiropractor and Physical Medicine and Rehabilitation physicians prior to the first hospitalisation or surgical treatment for a non-traumatic MSD was registered. Results: High-cost patients were responsible for 61% of all costs. Ninety-four percent of their costs were related to hospital treatment. Ninety-nine percent of high-cost patients had at least one hospitalisation or surgical procedure. Out of the high-cost patients, 44% had one registered hospitalisation or surgical procedure, 52% had two to four and 4% had five or more. Approximately 30–50% of patients had seen any healthcare personnel delivering conservative treatment other than GPs the year prior to their first hospitalisation/surgical treatment for a non-traumatic MSD. Conclusion: Most healthcare costs were concentrated among a small proportion of patients. In contrast to guidelines and recommendations, less than half had been to a healthcare service focused on conservative management prior to their first hospitalisation or surgical treatment for a non-traumatic MSD. This could indicate that there is room for improvement in management of patients before hospitalisation and surgical treatment, and that ensuring sufficient capacity for conservative care and rehabilitation can be beneficial for reducing overall costs.

• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2024). Patient experiences and clinical outcomes of admissions to municipal acute wards versus a hospital: A multicentre randomised controlled trial in Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(4), p. 659–667. doi: 10.1080/02813432.2024.2377727. Full text in Research Archive Show summary

  Background: In Norway, municipal acute wards (MAWs) were implemented as alternatives to hospitalisation. Evaluations of the quality of MAW services are lacking. The primary objective of this study was to compare patient experiences after admission to a MAW versus to a hospital. The secondary objective was to compare ‘readmissions’, ‘length of stay’, ‘self-assessed health-related quality of life’ as measured by the EuroQol 5 items 5 level (EQ-5D-5L) index, and ‘health status’ measured by the RAND-12, in patients admitted to a MAW versus a hospital. Methods: A multicentre randomised controlled trial (RCT), randomising patients to either MAW or hospital. Results: In total, 164 patients were enrolled in the study; 115 were randomised to MAW and 49 to hospital. There were no significant differences between the MAW and hospital groups regarding patient experience, which was rated positively in both groups. Patients in the MAW group reported significantly better physical health status as measured by the RAND-12 four to six weeks after admittance than those randomised to hospital (physical component summary score, 31.7 versus 27.1, p=0.04). The change in EQ-5D index score from baseline to four to six weeks after admittance was significantly greater among patients randomised to MAWs versus hospitals (0.20 versus 0.02, p=0.03). There were no other significant differences between the MAW and hospital groups. Conclusions: In this study, patient experiences and readmissions were similar, whether patients were admitted to a MAW or a hospital. The significant differences in health status and quality of life favouring the MAWs suggest that these healthcare services may be better for elderly patients. However, unfortunately we did not reach the planned sample size due to challenges in the data collection posed by the Covid-19 pandemic.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Edvardsen, Anne & Bragstad, Line Kildal [Show all 9 contributors for this article] (2024). Associations between outpatient care and later hospital admissions for patients with chronic obstructive pulmonary disease - a registry study from Norway. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10975-4. Full text in Research Archive Show summary

  Background Although chronic obstructive pulmonary disease (COPD) admissions put a substantial burden on hospitals, most of the patients’ contacts with health services are in outpatient care. Traditionally, outpatient care has been difficult to capture in population-based samples. In this study we describe outpatient service use in COPD patients and assess associations between outpatient care (contact frequency and specific factors) and next-year COPD hospital admissions or 90-day readmissions. Methods Patients over 40 years of age residing in Oslo or Trondheim at the time of contact in the period 2009–2018 were identified from the Norwegian Patient Registry (in- and outpatient hospital contacts, rehabilitation) and the KUHR registry (contacts with GPs, contract specialists and physiotherapists). These were linked to the Regular General Practitioner registry (characteristics of the GP practice), long-term care data (home and institutional care, need for assistance), socioeconomic and–demographic data from Statistics Norway and the Cause of Death registry. Negative binomial models were applied to study associations between combinations of outpatient care, specific care factors and next-year COPD hospital admissions and 90-day readmissions. The sample consisted of 24,074 individuals. Results A large variation in the frequency and combination of outpatient service use for respiratory diagnoses (GP, emergency room, physiotherapy, contract specialist and outpatient hospital contacts) was apparent. GP and outpatient hospital contact frequency were strongly associated to an increased number of next-year hospital admissions (1.2–3.2 times higher by increasing GP frequency when no outpatient hospital contacts, 2.4-5 times higher in combination with outpatient hospital contacts). Adjusted for healthcare use, comorbidities and sociodemographics, outpatient care factors associated with lower numbers of next-year hospitalisations were fees indicating interaction between providers (7% reduction), spirometry with GP or specialist (7%), continuity of care with GP (15%), and GP follow-up (8%) or rehabilitation (18%) within 30 days vs. later following any current year hospitalisations. For 90-day readmissions results were less evident, and most variables were non-significant. Conclusion As increased use of outpatient care was strongly associated with future hospitalisations, this further stresses the need for good communication between providers when coordinating care for COPD patients. The results indicated possible benefits of care continuity within and interaction between providers.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Show all 8 contributors for this article] (2023). Combination of health care service use and the relation to demographic and socioeconomic factors for patients with musculoskeletal disorders: a descriptive cohort study. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09852-3. Full text in Research Archive Show summary

  Background Patients with musculoskeletal disorders (MSDs) access health care in different ways. Despite the high prevalence and significant costs, we know little about the different ways patients use health care. We aim to fill this gap by identifying which combinations of health care services patients use for new MSDs, and its relation to clinical characteristics, demographic and socioeconomic factors, long-term use and costs, and discuss what the implications of this variation are. Methods The study combines Norwegian registers on health care use, diagnoses, comorbidities, demographic and socioeconomic factors. Patients (≥ 18 years) are included by their first health consultation for MSD in 2013–2015. Latent class analysis (LCA) with count data of first year consultations for General Practitioners (GPs), hospital consultants, physiotherapists and chiropractors are used to identify combinations of health care use. Long-term high-cost patients are defined as total cost year 1–5 above 95th percentile (≥ 3 744€). Results We identified seven latent classes: 1: GP, low use; 2: GP, high use; 3: GP and hospital; 4: GP and physiotherapy, low use; 5: GP, hospital and physiotherapy, high use; 6: Chiropractor, low use; 7: GP and chiropractor, high use. Median first year health care contacts varied between classes from 1–30 and costs from 20€-838€. Eighty-seven percent belonged to class 1, 4 or 6, characterised by few consultations and treatment in primary care. Classes with high first year use were characterised by higher age, lower education and more comorbidities and were overrepresented among the long-term high-cost users. Conclusion There was a large variation in first year health care service use, and we identified seven latent classes based on frequency of consultations. A small proportion of patients accounted for a high proportion of total resource use. This can indicate the potential for more efficient resource use. However, the effect of demographic and socioeconomic variables for determining combinations of service use can be interpreted as the health care system transforming unobserved patient needs into variations in use. These findings contribute to the understanding of clinical pathways and can help in the planning of future care, reduction in disparities and improvement in health outcomes for patients with MSDs.

• Choi, Hye Jung; Leblanc, Marissa Erin; Moger, Tron Anders; Valberg, Morten; Page, Christian Magnus & Aamodt, Geir [Show all 7 contributors for this article] (2023). Geographical variation in cardiovascular disease mortality in Norway: The role of life course socioeconomic position and parental health. Health and Place. ISSN 1353-8292. 83. doi: 10.1016/j.healthplace.2023.103095. Full text in Research Archive Show summary

  Despite substantial geographical variation in cardiovascular (CVD) mortality within countries, little is known about whether this variation can be explained by individuals' life course socioeconomic position (SEP) or differences in family history of premature CVD deaths. Cox proportional hazards models were used to investigate the association between the county of residence at ages 50–59 and CVD death in Norwegians born between 1940 and 1959 and survived to at least age 60, using national data. Individual life course SEP and family history of premature CVD death reduced the geographical variation in CVD mortality across Norwegian counties, but some significant differences remained. Furthermore, CVD risk varied by residents' migration histories between two counties with distinct CVD and socioeconomic profiles.

• Ki, Yeu Jin; Mcaleavey, Andrew Athan; Moger, Tron Anders & Moltu, Christian (2023). Cost structure in specialist mental healthcare: what are the main drivers of the most expensive episodes? International Journal of Mental Health Systems. 17(1), p. 1–23. doi: 10.1186/s13033-023-00606-6. Full text in Research Archive Show summary

  Background: Mental disorders are among the costliest conditions to treat in Norway, and research into the costs of specialist mental healthcare are needed. The purpose of this article is to present a cost structure and to investigate the variables that have the greatest impact on high-cost episodes. Methods: Patient-level cost data and clinic information during 2018-2021 were analyzed (N=180,220). Cost structure was examined using two accounting approaches. A generalized linear model was used to explain major cost drivers of the 1%, 5%, and 10% most expensive episodes, adjusting for patients’ demographic characteristics [gender, age], clinical factors [length of stay (LOS), admission type, care type, diagnosis], and administrative information [number of planned consultations, first hospital visits, interval between two hospital episode]. Results: One percent of episodes utilized 57% of total resources. Labor costs accounted for 87% of total costs. The more expensive an episode was, the greater the ratio of the inpatient (ward) cost was. Among the top-10%, 5%, and 1% most expensive groups, ward costs accounted for, respectively, 89%, 93%, and 99% of the total cost, whereas the overall average was 67%. Longer LOS, ambulatory services, surgical interventions, organic disorders, and schizophrenia were identified as the major cost drivers of the total cost, in general. In particular, LOS, ambulatory services, and schizophrenia were the factors that increased costs in expensive subgroups. The “first hospital visit” and “a very short hospital re-visit” were associated with a cost increase, whereas “the number of planned consultations” was associated with a cost decrease. Conclusions: The specialist mental healthcare division has a unique cost structure. Given that resources are utilized intensively at the early stage of care, improving the initial flow of hospital care can contribute to efficient resource utilization. Our study found empirical evidence that planned outpatient consultations may be associated with a reduced health care burden in the long-term.

• Brathovde, Mari; Moger, Tron Anders; Aalen, Odd O.; Grotmol, Tom; Veierød, Marit Bragelien & Valberg, Morten (2023). A lean additive frailty model: With an application to clustering of melanoma in Norwegian families. Statistics in Medicine. ISSN 0277-6715. p. 1–29. doi: 10.1002/sim.9856. Full text in Research Archive Show summary

  Additive frailty models are used to model correlated survival data. However, the complexity of the models increases with cluster size to the extent that practical usage becomes increasingly challenging. We present a modification of the additive genetic gamma frailty (AGGF) model, the lean AGGF (L‐AGGF) model, which alleviates some of these challenges by using a leaner additive decomposition of the frailty. The performances of the models were compared and evaluated in a simulation study. The L‐AGGF model was used to analyze population‐wide data on clustering of melanoma in 2 391 125 two‐generational Norwegian families, 1960‐2015. Using this model, we could analyze the complete data set, while the original model limited the analysis to a restricted data set (with cluster sizes ). We found a substantial clustering of melanoma in Norwegian families and large heterogeneity in melanoma risk across the population, where 52% of the frailty was attributed to the 10% of the population at highest unobserved risk. Due to the improved scalability, the L‐AGGF model enables a wider range of analyses of population‐wide data compared to the AGGF model. Moreover, the methods outlined here make it possible to perform these analyses in a computationally efficient manner.

• Moger, Tron Anders; Amundsen, Olav; Tjerbo, Trond; Hellesø, Ragnhild; Holte, Jon Helgheim & Vøllestad, Nina Køpke (2023). Innovations in use of registry data (INOREG) - Design of a registry-based study analyzing care pathways and outcomes for chronic patients. Nordic Journal of Health Economics. ISSN 1892-9729. 6(1), p. 129–146. doi: 10.5617/njhe.10097. Full text in Research Archive Show summary

  In recent years there have been several political initiatives in Norway, requiring more research into how multimorbidity and health care pathways in the municipality affect outcomes such as work participation, hospital admissions, disability and quality of life for patients with chronic diseases. Most of the care is provided outside hospitals and has been difficult to capture in large, registry-based studies. Focusing on two important groups, patients with chronic obstructive pulmonary disease (COPD) and musculoskeletal disorders (MSD), the INOREG project aims to reduce these knowledge gaps. In the paper we present 1) the data that are used in the project, 2) the construction of samples, variables and possible methods for analysis and 3) an example on how the data and methods will be applied. The project database is constructed from a novel linkage of national health and welfare registries. The data cover social, primary and specialized care for all COPD and MSD patients in Norway, long-term care data from Oslo and Trondheim municipalities and functioning and quality of life for ca. 2,700 patients treated at physiotherapy clinics in the FYSIOPRIM project. This enables construction of care pathways and outcomes at the individual level from 2008 through 2019. The project will fill knowledge gaps regarding the patterns of care at different levels in the health care system, and the association to outcomes for chronic patient groups. If the project is successful, it will provide improved insight on how to further develop provision and coordination of services to the decision makers, and ideally reduce inequalities in health.

• Moger, Tron Anders; Holen, åsne Sørlien; Hanestad, Berit & Hofvind, Solveig Sand-Hanssen (2022). Costs and Effects of Implementing Digital Tomosynthesis in a Population-Based Breast Cancer Screening Program: Predictions Using Results from the To-Be Trial in Norway. PharmacoEconomics - Open. ISSN 2509-4262. 6, p. 495–507. doi: 10.1007/s41669-022-00343-5. Full text in Research Archive Show summary

  Background Although several studies from Europe and the US have shown promising screening results favoring digital breast tomosynthesis compared with standard digital mammography (DM), both costs and efects of implementing tomosynthesis in routine screening programs remain uncertain. The cost efectiveness of using tomosynthesis in routine screening is debated in the literature, and model inputs from randomized trials are lacking. Using parameters mainly from a randomized controlled trial (the To-Be trial), we simulated costs and efects of implementing tomosynthesis in the national screening program BreastScreen Norway.<p> <p>Methods The To-Be trial was performed in Bergen from 2016 to 2017 within BreastScreen Norway, where females were randomized to either digital breast tomosynthesis including synthetic mammograms (DBT) or DM. The trial was followed by a cohort study ofering all females DBT in 2018–2019. The trial included over 37,000 females, and allowed for estimation of short-term costs and efects related to screening, recall examinations and cancer detection. Using these and recent Norwegian estimates for 10-year stage-specifc survival and treatment costs, the cost efectiveness of replacing DM with DBT in BreastScreen Norway was simulated in a decision tree model with probabilistic sensitivity analyses. Outcomes included false-positive screening results, screen-detected and interval cancers, stage at diagnosis, all-cause deaths, life-years gained, costs at recall and treatment and incremental cost-efectiveness ratio. <p>Results The estimated additional cost of DBT was €8.10. Simulating ten rounds of screening from 2018 and 10-year survival and costs, 500 deaths were averted and 2300 life-years gained at an additional screening cost of €29 million for females screened with DBT versus DM. Taking over-diagnosis, recall and treatment costs into account, DBT was dominant in the deterministic analysis. The incremental cost-efectiveness ratio indicated cost savings of €1400 per life-year gained. Probabilistic sensitivity analyses showed that DBT was cost efective in over 50% of the simulations at all willingness-to-pay levels per life-year gained, and in 80% of the simulations at levels above €22,000. If willingness-to-pay levels up to €35,000 were assumed, DBT would be cost efective in over 50% of the simulations for additional costs of DBT of up to €32, almost four times the estimated additional cost of €8.10. <p>Conclusion DBT may be cost efective if implemented in BreastScreen Norway. However, generalizability of results could depend on factors varying between countries, such as recall rates, program sensitivity and specifcity, treatment cost and willingness-to-pay levels.

• Choi, Hye Jung; Leblanc, Marissa Erin; Moger, Tron Anders; Valberg, Morten; Aamodt, Geir & Page, Christian Magnus [Show all 8 contributors for this article] (2022). Stroke survival and the impact of geographic proximity to family members: A population-based cohort study. Social Science and Medicine. ISSN 0277-9536. 309. doi: 10.1016/j.socscimed.2022.115252. Full text in Research Archive Show summary

  Introduction Familial support may be important for post-stroke survival. Objective To determine if geographical proximity between stroke survivors and their family members, i.e having a spouse/partner or distance to a nearest first-degree relative (parents, siblings, and offspring), as a proxy for familial support, is related to survivor mortality. Methods This study included all stroke survivors (n=128,227) hospitalised in Norway from 1994 to 2009, who were 30 years or older at the time of the stroke (born before 1965). National registries and censuses were used to calculate the distance to the nearest first-degree relative in the hospitalisation year. Cox proportional hazards models estimated hazard ratios (HRs) of all-cause mortality from 1994 to 2014 (mean 6.4 years follow-up), adjusting for sociodemographic and clinical covariates. Results Living up to 30 km from the nearest first-degree relative was associated with a higher mortality (HR 1.04, 95% CI: 1.03 to 1.06) than those living in the same household or neighbourhood as their nearest first-degree relatives. The association was more pronounced (1.13, 1.08 to 1.19 for ≤30 km; 1.25, 1.16 to 1.35 for >30 km) in survivors hospitalised at age ≤65 years, compared to older survivors. Among familial care predictors, having a spouse/partner was the most prominent predictor of reduced mortality (0.80, 0.78 to 0.82) in stroke survivors. Conclusion Living close to first-degree relatives was weakly associated with better survival in stroke patients while having a spouse/partner exhibited a stronger association. Both associations were larger for survivors hospitalised at age ≤65 years. Our findings thus suggest that the impact of familial support on survival after stroke may differ by familial support condition and patient's age at a stroke hospitalisation.

• Meulman, Iris; Loef, Bette; Stadhouders, Niek; Moger, Tron Anders; Wong, Albert & Polder, Johan J. [Show all 7 contributors for this article] (2022). Estimating healthcare expenditures after becoming divorced or widowed using propensity score matching. European Journal of Health Economics. ISSN 1618-7598. doi: 10.1007/s10198-022-01532-z. Full text in Research Archive Show summary

  Abstract Becoming divorced or widowed are stressful life events experienced by a substantial part of the population. While marital status is a significant predictor in many studies on healthcare expenditures, effects of a change in marital status, specifically becoming divorced or widowed, are less investigated. This study combines individual health claims data and registered sociodemographic characteristics from all Dutch inhabitants (about 17 million) to estimate the differences in healthcare expenditure for individuals whose marital status changed ( n  = 469,901) compared to individuals who remained married, using propensity score matching and generalized linear models. We found that individuals who were (long-term) divorced or widowed had 12–27% higher healthcare expenditures (RR = 1.12, 95% CI 1.11–1.14; RR = 1.27, 95% CI 1.26–1.29) than individuals who remained married. Foremost, this could be attributed to higher spending on mental healthcare and home care. Higher healthcare expenditures are observed for both divorced and widowed individuals, both recently and long-term divorced/widowed individuals, and across all age groups, income levels and educational levels.

• Nymoen, Lisbeth Damlien; Flatebø, Trude Eline; Moger, Tron Anders; Øie, Erik; Molden, Espen & Viktil, Kirsten Kilvik (2022). Impact of systematic medication review in emergency department on patients’ postdischarge outcomes—A randomized controlled clinical trial. PLOS ONE. 17:e0274907(9), p. 1–19. doi: 10.1371/journal.pone.0274907. Full text in Research Archive Show summary

  Introduction The main objective of this study was to investigate whether systematic medication review conducted by clinical pharmacists can impact clinical outcomes and post-discharge outcomes for patients admitted to the emergency department. Method This parallel group, non-blinded, randomized controlled trial was conducted in the emergency department, Diakonhjemmet Hospital, Oslo, Norway. The study was registered in ClinicalTrials.gov, Identifier: NCT03123640 in April 2017. From April 2017 to May 2018, patients ≥18 years were included and randomized (1:1) to intervention- or control group. The control group received standard care from emergency department physicians and nurses. In addition to standard care, the intervention group received systematic medication review including medication reconciliation conducted by pharmacists, during the emergency department stay. The primary outcome was proportion of patients with an unplanned contact with hospital within 12 months from inclusion stay discharge. Results In total, 807 patients were included and randomized, 1:1, to intervention or control group. After excluding 8 patients dying during hospital stay and 10 patients lacking Norwegian personal identification number, the primary analysis comprised 789 patients: 394 intervention group patients and 395 control group patients. Regarding the primary outcome, there was no significant difference in proportion of patients with an unplanned contact with hospital within 12 months after inclusion stay discharge between groups (51.0% of intervention group patients vs. 53.2% of control group patients, p = 0.546). Conclusion As currently designed, emergency department pharmacist-led medication review did not significantly influence clinical- or post-discharge outcomes. This study did, however pinpoint important practical implementations, which can be used to design tailored pharmacist-led interventions and workflow regarding drug-related issues in the emergency department setting.

• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2022). Finding good alternatives to hospitalisation: a data register study in five municipal acute wards in Norway. BMC Health Services Research. 22, p. 1–12. doi: 10.1186/s12913-022-08066-3. Full text in Research Archive Show summary

  Background: In Norway, municipal acute wards (MAWs) have been implemented in primary healthcare since 2012. The MAWs were intended to offer decentralised acute medical care 24/7 for patients who otherwise would be admit‑ ted to hospital. The aim of this study was to assess whether the MAW represents the alternative to hospitalisation as intended, through 1) describing the characteristics of patients intended as candidates for MAWs by primary care physicians, 2) exploring the need for extended diagnostics prior to admission in MAWs, and 3) exploring factors asso‑ ciated with patients being transferred from the MAWs to hospital. Methods: The study was based on register data from five MAWs in Norway in the period 2014–2020. Results: In total, 16 786 admissions were included. The median age of the patients was 78 years, 60% were women, and the median length of stay was three days. Receiving oral medication (OR 1.23, 95% CI 1.09–1.40), and the MAW being located nearby the hospital (OR 2.29, 95% CI 1.92–2.72) were factors associated with patients admitted to MAW after extended diagnostics. Patients needing advanced treatment, such as oxygen therapy (OR 2.13, 95% CI 1.81–2.51), intravenous medication (OR 1.60, 95% CI 1.45–1.81), intravenous fluid therapy (OR 1.32, 95% CI 1.19–1.47) and MAWs with long travel distance from the MAW to the hospital (OR 1.46, 95% CI 1.22–1.74) had an increased odds for being transferred to hospital. Conclusions: Our findings indicate that MAWs do not represent the alternative to hospitalisation as intended. The results show that patients receiving extended diagnostics before admission to MAW got basic treatment, while patients in need of advanced medical treatment were transferred to hospital from a MAW. This indicates that there is still a potential to develop MAWs in order to fulfil the intended health service level

• Hsu, John; Iversen, Tor; Price, Mary; Moger, Tron Anders; Tevis, Delaney & Hagen, Terje P. [Show all 7 contributors for this article] (2021). Myocardial infarction care among the elderly: Declining treatment with increasing age in two countries. Health Affairs. ISSN 0278-2715. 40(9), p. 1483–1490. doi: 10.1377/hlthaff.2021.00108. Full text in Research Archive Show summary

  The elderly account for the majority of medical spending in many countries, raising concerns about potentially unnecessary spending, especially during the final months of life. Using a well-defined starting point (hospitalization for an initial acute myocardial infarction) with evidence-based postevent treatments, we examined age trends in treatments in the US and Norway, two countries with high levels of per capita medical spending. After accounting for comorbidities, we found marked decreases within both countries in the use of invasive treatments with age (for example, less use of percutaneous coronary interventions and surgery) and the use of relatively inexpensive medications (for example, less use of anticholesterol [statin] drugs for which generic versions are widely available). The treatment decreases with age were larger in Norway compared with those in the US. The less frequent treatment of the oldest of the old, without even use of basic medications, suggests potential age-related bias and a disconnect with the evidence on treatment value. Hospital organization and payment in both countries should incentivize greater equity in treatment use across ages.

• Fosse, Rina Moe; Ambugo, Eliva Atieno; Moger, Tron Anders; Hagen, Terje P. & Tjerbo, Trond (2021). Does rehabilitation setting influence risk of institutionalization? A register-based study of hip fracture patients in Oslo, Norway. BMC Health Services Research. 21(1), p. 1–14. doi: 10.1186/s12913-021-06703-x. Full text in Research Archive Show summary

  Background: Reducing the economic impact of hip fractures (HF) is a global issue. Some efforts aimed at curtailing costs associated with HF include rehabilitating patients within primary care. Little, however, is known about how different rehabilitation settings within primary care influence patients’ subsequent risk of institutionalization for long-term care (LTC). This study examines the association between rehabilitation setting (outside an institution versus short-term rehabilitation stay in an institution, both during 30 days post-discharge for HF) and risk of institutionalization in a nursing home (at 6–12 months from the index admission). Methods: Data were for 612 HF incidents across 611 patients aged 50 years and older, who were hospitalized between 2008 and 2013 in Oslo, Norway, and who lived at home prior to the incidence. We used logistic regression to examine the effect of rehabilitation setting on risk of institutionalization, and adjusted for patients’ age, gender, health characteristics, functional level, use of healthcare services, and socioeconomic characteristics. The models also included fixed-effects for Oslo’s boroughs to control for supply-side and unobserved effects. Results: The sample of HF patients had a mean age of 82.4 years, and 78.9 % were women. Within 30 days after hospital discharge, 49.0 % of patients received rehabilitation outside an institution, while the remaining 51.0 % received a short-term rehabilitation stay in an institution. Receiving rehabilitation outside an institution was associated with a 58 % lower odds (OR = 0.42, 95 % CI = 0.23–0.76) of living in a nursing home at 6–12 months after the index admission. The patients who were admitted to a nursing home for LTC were older, more dependent on help with their memory, and had a substantially greater increase in the use of municipal healthcare services after the HF. Conclusions: The setting in which HF patients receive rehabilitation is associated with their likelihood of institutionalization. In the current study, patients who received rehabilitation outside of an institution were less likely to be admitted to a nursing home for LTC, compared to those who received a short-term rehabilitation stay in an institution. These results suggest that providing rehabilitation at home may be favorable in terms of reducing risk of institutionalization for HF patients.

• Häkkinen, Unto; Goude, Fanny; Hagen, Terje P.; Kruse, Marie; Moger, Tron Anders & Peltola, Mikko [Show all 7 contributors for this article] (2020). A performance comparison of patient pathways in Nordic capital areas – a pilot study for ischaemic stroke patients. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/1403494819863523. Full text in Research Archive
• Støme, Linn Nathalie; Moger, Tron Anders; Kidholm, Kristian & Kvaerner, Kari Jorunn (2020). A Web-based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study. JMIR Formative Research. 4:e14780(1), p. 1–11. doi: 10.2196/14780. Full text in Research Archive
• Moger, Tron Anders; Swanson, Jayson O.; Holen, åsne Sørlien; Hanestad, Berit & Hofvind, Solveig (2019). Cost differences between digital tomosynthesis and standard digital mammography in a breast cancer screening programme: results from the To-Be trial in Norway. European Journal of Health Economics. ISSN 1618-7598. 20, p. 1261–1269. doi: 10.1007/s10198-019-01094-7. Full text in Research Archive Show summary

  Background: Several studies in Europe and the US have shown promising results favouring digital breast tomosynthesis compared to standard digital mammography (DM). However, the costs of implementing the technology in screening programmes are not yet known. Methods: A randomised controlled trial comparing the results from digital breast tomosynthesis including synthetic mammograms (DBT) vs. DM was performed in Bergen during 2016 and 2017 as a part of BreastScreen Norway. The trial included 29,453 women and allowed for a detailed comparison of procedure use and screening, recall and treatment costs estimated at the individual level. Results: The increased cost of equipment, examination and reading time with DBT vs. DM was €8.5 per screened woman (95% CI 8.4−8.6). Costs of DBT remained significantly higher after adding recall assessment costs, €6.2 (95% CI 4.6−7.9). Substantial reductions in either examination and reading times, price of DBT equipment or price of IT storage and connectivity did not change the conclusion. Adding treatment costs resulted in too wide confidence intervals to draw definitive conclusions (additional costs of tomosynthesis €9.8, 95% CI –56 to 74). Performing biopsy at recall, radiation therapy and chemotherapy was significantly more frequent among women screened with DBT. Conclusion: The results showed lower incremental costs of DBT vs. DM, compared to what is found in previous cost analyses of DBT and DM. However, the incremental costs were still higher for DBT compared with DM after including recall costs. Further studies with long-term treatment data are needed to understand the complete costs of implementing DBT in screening.

• Swanson, Jayson O. & Moger, Tron Anders (2019). Comparisons of readmissions and mortality based on post-discharge ambulatory follow-up services received by stroke patients discharged home: A register-based study 11 Medical and Health Sciences 1117 Public Health and Health Services. BMC Health Services Research. 19(4), p. 1–11. doi: 10.1186/s12913-018-3809-z. Full text in Research Archive
• Hofvind, Solveig; Holen, åsne Sørlien; Aase, Hildegunn Siv; Houssami, Nehmat; Sebuødegård, Sofie & Moger, Tron Anders [Show all 8 contributors for this article] (2019). Two-view digital breast tomosynthesis versus digital mammography in a population-based breast cancer screening programme (To-Be): a randomised, controlled trial. The Lancet Oncology. ISSN 1470-2045. 20(6), p. 795–805. doi: 10.1016/S1470-2045(19)30161-5. Full text in Research Archive Show summary

  Background: Digital breast tomosynthesis is an advancement of mammography, and has the potential to overcome limitations of standard digital mammography. This study aimed to compare first-generation digital breast tomo-synthesis including two-dimensional (2D) synthetic mammograms versus digital mammography in a population-based screening programme. Methods: BreastScreen Norway offers all women aged 50–69 years two-view (craniocaudal and mediolateral oblique) mammographic screening every 2 years and does independent double reading with consensus. We asked all 32 976 women who attended the programme in Bergen in 2016–17, to participate in this randomised, controlled trial with a parallel group design. A study-specific software was developed to allocate women to either digital breast tomosynthesis or digital mammography using a 1:1 simple randomisation method based on participants' unique national identity numbers. The interviewing radiographer did the randomisation by entering the number into the software. Randomisation was done after consent and was therefore concealed from both the women and the radiographer at the time of consent; the algorithm was not disclosed to radiographers during the recruitment period. All data needed for analyses were complete 12 months after the recruitment period ended. The primary outcome measure was screen-detected breast cancer, stratified by screening technique (ie, digital breast tomosynthesis and digital mammography). A log-binomial regression model was used to estimate the efficacy of digital breast tomosynthesis versus digital mammography, defined as the crude risk ratios (RRs) with 95% CIs for screen-detected breast cancer for women screened during the recruitment period. A per-protocol approach was used in the analyses. This trial is registered at ClinicalTrials.gov, number NCT02835625, and is closed to accrual. Findings: Between, Jan 14, 2016, and Dec 31, 2017, 44 266 women were invited to the screening programme in Bergen, and 32 976 (74·5%) attended. After excluding women with breast implants and women who did not consent to participate, 29 453 (89·3%) were eligible for electronic randomisation. 14 734 women were allocated to digital breast tomosynthesis and 14 719 to digital mammography. After randomisation, women with a previous breast cancer were excluded (digital breast tomosynthesis group n=314, digital mammography group n=316), women with metastases from melanoma (digital breast tomosynthesis group n=1), and women who informed the radiographer about breast symptoms after providing consent (digital breast tomosynthesis group n=39, digital mammography group n=34). After exclusions, information from 28 749 women were included in the analyses (digital breast tomosynthesis group n=14 380, digital mammography group n=14 369). The proportion of screen-detected breast cancer among the screened women did not differ between the two groups (95 [0·66%, 0·53–0·79] of 14 380 vs 87 [0·61%, 0·48–0·73] of 14 369; RR 1·09, 95% CI 0·82–1·46; p=0·56). Interpretation: This study indicated that digital breast tomosynthesis including synthetic 2D mammograms was not significantly different from standard digital mammography as a screening tool for the detection of breast cancer in a population-based screening programme. Economic analyses and follow-up studies on interval and consecutive round screen-detected breast cancers are needed to better understand the effect of digital breast tomosynthesis in population-based breast cancer screening.

• Støme, Linn Nathalie; Moger, Tron Anders; Kidholm, Kristian & Kvaerner, Kari Jorunn (2019). Early assessment of innovation in a healthcare setting. International Journal of Technology Assessment in Health Care. ISSN 0266-4623. 35(1), p. 17–26. doi: 10.1017/S0266462318003719. Full text in Research Archive Show summary

  Objectives Early assessment can assist in allocating resources for innovation effectively and produce the most beneficial technology for an institution. The aim of the present study was to identify methods and discuss the analytical approaches applied for the early assessment of innovation in a healthcare setting. Methods Knowledge synthesis based on a structured search (using the MEDLINE, Embase, and Cochrane databases) and thematic analysis was conducted. An analytical framework based on the stage of innovation (developmental, introduction, or early diffusion) was applied to assess whether methods vary according to stage. Themes (type of innovation, study, analysis, study design, method, and main target audience) were then decided among the authors. Identified methods and analysis were discussed according to the innovation stage. Results A total of 1,064 articles matched the search strategy. Overall, thirty-nine articles matched the inclusion criteria. The use of methods has a tendency to change according to the stage of innovation. Stakeholder analysis was a prominent method in the innovation stages and particularly in the developmental stage, as the introduction and early diffusion stage has more availability of data and may apply more complex methods. Barriers to the identified methods were also discussed as all of the innovation stages suffered from lack of data and substantial uncertainty. Conclusions Although this review has identified applicable approaches for early assessment in different innovation stages, research is required regarding the value of the available data and methods and tools to enhance interactions between different parties at different stages of innovation.

• Moger, Tron Anders; Häkkinen, Unto & Hagen, Terje P. (2018). Higher mortality among ACS patients in Finland than in Norway: Do differences in acute services and scale effects in hospital treatment explain the variation? Nordic Journal of Health Economics. ISSN 1892-9729. 7. doi: 10.5617/njhe.4834. Full text in Research Archive Show summary

  Mortality following hospital treatment in Finland and Norway is similar for major diseases, with acute coronary syndrome (ACS) as an important exception. For ACS, the mortality is significantly higher in Finland than in Norway. We study whether a decentralized structure with reduced emergency preparedness and smallscale production in Finland vs. a centralized structure with large percutaneous coronary intervention (PCI) departments performing acute services 24/7 in Norway explains the country differences in mortality. For patients discharged with acute myocardial infarction (International Classification of Diseases - ICD-10 I21 and I22) and unstable angina pectoris (ICD-10 I 20.0), data from the hospital discharge registers for 1 Jan. 2009–30 Nov. 2014 was linked with socio-demographic and regional variables, variables describing distances to hospitals, and with data from causes of death registers in Norway and Finland. Variables relating to hospital system and organization of care were included as independent variables in logistic regression analyses. Marginal mortality differences between the countries for different categories of the variables are presented separately for ST-segment elevation myocardial infarction (STEMI) and for other ACS patients. In Finland, 36% of STEMI patients and 25% of other ACS patients were admitted to hospitals having an emergency PCI service. The corresponding numbers for Norway were 77% and 66%. However, the percentage of patients receiving PCI within one day was similar (STEMI: Norway 54% vs. Finland 56%, p < 0.001), as was the distribution of PCIs performed during weekends (28% vs. 26%, p = 0.02). The short term mortality was a little lower in Norway for STEMI patients (30-day mortality: 10% vs. 12%, p < 0.001; 365-day mortality: 18% vs. 18%, p = 0.48), while markedly lower for other ACS (30-day mortality: 6% vs. 10%, p < 0.001; 365-day mortality: 14% vs. 20%, p < 0.001). After adjusting for individual and regional variables, the mortality was found to be 2–4% lower in Norway within most categories of the hospital system and organization of care variables in all analyses. As such, we were not able to explain the mortality differences by the hospital system and organization of care variables. Rather, the explanation seems to have other sources.

• Häkkinen, Unto; Hagen, Terje P. & Moger, Tron Anders (2018). Performance comparison of hip fracture pathways in two capital cities: Associations with level and change of integration. Nordic Journal of Health Economics. ISSN 1892-9729. 7. doi: 10.5617/njhe.4836. Full text in Research Archive Show summary

  Finland and Norway have health care systems that have a varying degree of vertical integration. In Finland the financial responsibility for all patient treatment is placed at the municipal level, while in Norway the responsibility for patients is divided between the municipalities (primary and long-term care) and state-owned hospitals. From 2012, the Norwegian system became more vertically integrated following the introduction of the Coordination Reform. The aim of the paper is to analyse the associations between different modes of integration and performance indicators. The data included operated hip fracture patients from the years 2009– 2014 residing in the cities of Oslo and Helsinki. Data from routinely collected national registers, also including data from primary health and long-term-care services, were linked. Performance indicators were compared at baseline (before the Coordination Reform, i.e., 2009–2011), and trends were described and analysed by difference-in-difference methods. The baseline study indicated that hip fracture patients in Oslo, compared with those in Helsinki, had longer stays in acute hospitals. They used less institutional care outside of hospitals as well as more GP services and fewer other outpatient services. Mortality was lower, and the probability of being discharged to home within 90 days from the index day was higher. After the Coordination Reform, the length of stay in hospital was shorter and the length of the first institutional episode in Oslo was longer than before the Reform, demonstrating that the shorter hospital stays were more than compensated for by longer stays in long-term-care institutions. The number of patients institutionalised 90 days from the index day increased and the number of patients discharged to home within 90 days from the index day decreased in Oslo after the Reform while the opposite trends were observed in Helsinki. After the Reform, the performance differences between the two regions had decreased.

• Williams, Linda J.; Fletcher, Eilidh; Douglas, Anne; Anderson, Elaine D.C.; McCallum, Alison & Simpson, Colin R. [Show all 14 contributors for this article] (2018). Retrospective cohort study of breast cancer incidence, health service use and outcomes in Europe: A study of feasibility. European Journal of Public Health. ISSN 1101-1262. 28(2), p. 327–332. doi: 10.1093/eurpub/ckx127. Full text in Research Archive
• Swanson, Jayson O.; Vogt, Verena; Sundmacher, Leonie; Hagen, Terje P. & Moger, Tron Anders (2018). Continuity of care and its effect on readmissions for COPD patients: A comparative study of Norway and Germany. Health Policy. ISSN 0168-8510. 122(7), p. 737–745. doi: 10.1016/j.healthpol.2018.05.013. Full text in Research Archive Show summary

  Background This study compares continuity of care between Germany – a social health insurance country, and Norway – a national health service country with gatekeeping and patient lists for COPD patients before and after initial hospitalization. We also investigate how subsequent readmissions are affected. Methods Continuity of Care Index (COCI), Usual Provider Index (UPC) and Sequential Continuity Index (SECON) were calculated using insurance claims and national register data (2009–14). These indices were used in negative binomial and logistic regressions to estimate incident rate ratios (IRR) and odds ratios (OR) for comparing readmissions. Results All continuity indices were significantly lower in Norway. One year readmissions were significantly higher in Germany, whereas 30-day rates were not. All indices measured one year after discharge were negatively associated with one-year readmissions for both countries. Significant associations between indices measured before hospitalization and readmissions were only observed in Norway – all indices for one-year readmissions and SECON for 30-day readmissions. Conclusion Our findings indicate higher continuity is associated with reductions in readmissions following initial COPD admission. This is observed both before and after hospitalization in a system with gatekeeping and patient lists, yet only after for a system lacking such arrangements. These results emphasize the need for policy strategies to further investigate and promote care continuity in order to reduce hospital readmission burden for COPD patients.

• Damlien, Lisbeth; Davidsen, Nina; Nilsen, Merethe; Godø, Aasmund; Moger, Tron Anders & Viktil, Kirsten Kilvik (2017). Drug safety at admission to emergency department: an innovative model for PRIOritizing patients for MEdication Reconciliation (PRIOMER). European journal of emergency medicine. ISSN 0969-9546. 24(5), p. 333–339. doi: 10.1097/MEJ.0000000000000355. Full text in Research Archive
• Moger, Tron Anders; Bjørnelv, Gudrun Maria Waaler & Aas, Eline (2016). Expected 10-year treatment cost of breast cancer detected within and outside a public screening program in Norway. European Journal of Health Economics. ISSN 1618-7598. 17(6), p. 745–754. doi: 10.1007/s10198-015-0719-4. Full text in Research Archive
• Valberg, Morten; Grotmol, Tom; Tretli, Steinar; Veierød, Marit Bragelien; Moger, Tron Anders & Devesa, Susan S. [Show all 7 contributors for this article] (2016). Prostate-specific antigen testing for prostate cancer: Depleting a limited pool of susceptible individuals? European Journal of Epidemiology (EJE). ISSN 0393-2990. 20(6), p. 511–520. doi: 10.1007/s10654-016-0185-z. Full text in Research Archive
• Hagen, Terje P.; Iversen, Tor & Moger, Tron Anders (2016). Risikojustering ved måling av predikert dødelighet etter hjerteinfarkt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(5), p. 423–427. doi: 10.4045/tidsskr.13.1292. Full text in Research Archive
• Ddidzonu, Daniel; Skrivarhaug, Torild; Joner, Geir & Moger, Tron Anders (2016). Ethnic differences in the incidence of type 1 diabetes in Norway: a register-based study using data from the period 2002-2009. Pediatric Diabetes. ISSN 1399-543X. 17(5), p. 337–341. doi: 10.1111/pedi.12294. Full text in Research Archive
• Haugen, Marion & Moger, Tron Anders (2016). Frailty modelling of time-to-lapse of single policies for customers holding multiple car contracts. Scandinavian Actuarial Journal. ISSN 0346-1238. 2016(6), p. 489–501. doi: 10.1080/03461238.2014.963886. Full text in Research Archive Show summary

  Corporate customers often hold multiple contracts and this might give dependence between the lapsing times of the single policies. We present a shared gamma frailty model in order to study the time-to-lapse of single car policies for customers holding multiple car contracts with the same insurance company, accounting for measured and time-dependent covariates. Customers with the highest frailty value tend to leave the company earlier than the others and finding these is a central aspect within a company’s customer relationship management strategy.We estimate conditional survival curves which illustrate the decreased survival probability of a customer after a lapse in a single car insurance policy. The individual survival curves are overestimated if the underlying association for cars with the same customer is ignored. Fitting misspecified Cox’s proportional hazards model also results in an underestimation of the standard error of the parameter estimates.

• Tangen, Gro Gujord; Engedal, Knut; Bergland, Astrid; Moger, Tron Anders; Hansson, Oskar & Mengshoel, Anne Marit (2015). Spatial navigation measured by the Floor Maze Test in patients with subjective cognitive impairment, mild cognitive impairment, and mild Alzheimer's disease. International Psychogeriatrics. ISSN 1041-6102. 27(8), p. 1401–1409. doi: 10.1017/S1041610215000022. Full text in Research Archive Show summary

  Background: Impaired spatial navigation is an early sign of Alzheimer's disease (AD), but this can be difficult to assess in clinical practice. We examined how the performance on the Floor Maze Test (FMT), which combines navigation with walking, differed between patients with subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and mild AD. We also explored if there was a significant relationship between the FMT and the cognitive tests or sociodemographic factors. Methods: The study included 128 patients from a memory clinic classified as having SCI (n = 19), MCI (n = 20), and mild AD (n = 89). Spatial navigation was assessed by having the patients walk through the FMT, a two-dimensional maze. Both timed measures and number of errors were recorded. Cognitive function was assessed by the Word List Memory test, the Clock Drawing test, the Trail Making tests (TMT) A and B, and the Mini Mental Status Examination (MMSE). Results: The patients with MCI were slower than those with SCI, while the patients with mild AD more frequently completed the FMT with errors or gave up than the patients with MCI. Performance on the FMT was significantly associated with executive function (measured by TMT-B). Conclusions: The performances on the FMT worsened with increasing severity of cognitive impairment, and the FMT was primarily associated with executive function. The explained variance was relatively low, which may indicate that the standard cognitive test battery does not capture impairments of spatial navigation.

• Hagen, Terje P.; Iversen, Tor; Klitkou, Søren Toksvig; Moger, Tron Anders & Häkkinen, Unto (2015). Socio-economic inequality in the use of procedures and mortality among AMI patients: Quantifying the effects along different paths. Health Economics. ISSN 1057-9230. 24, p. 102–115. doi: 10.1002/hec.3269. Full text in Research Archive Show summary

  SOCIO-ECONOMIC INEQUALITY IN THE USE OF PROCEDURES AND MORTALITY AMONG AMI PATIENTS: QUANTIFYING THE EFFECTS ALONG DIFFERENT PATHS TERJE P. HAGEN a, * , UNTO HÄKKINEN a,b , TOR IVERSEN a , SØREN TOKSVIG KLITKOU a , TRON ANDERS MOGER a ON BEHALF OF THE EUROHOPE STUDY GROUP a Department of Health Management and Health Economics, University of Oslo, Oslo, Norway b Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare (THL), Helsinki, Finland ABSTRACT

• Smith, Joel; Banks, Helen; Campbell, Harry; Douglas, Anne; Fletcher, Eilidh & McCallum, Alison [Show all 12 contributors for this article] (2015). Parameter heterogeneity in breast cancer cost regressions - Evidence from five European countries. Health Economics. ISSN 1057-9230. 24, p. 23–37. doi: 10.1002/hec.3274. Full text in Research Archive
• Kvamme, Maria Knoph; Lie, Elisabeth; Uhlig, Till; Moger, Tron Anders; Kvien, Tore Kristian & Kristiansen, Ivar Sønbø (2015). Cost-effectiveness of TNF inhibitors vs synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: A Markov model study based on two longitudinal observational studies. Rheumatology. ISSN 1462-0324. 54(7), p. 1226–1235. doi: 10.1093/rheumatology/keu460. Full text in Research Archive
• Burger, Emily; Nygård, Mari; Gyrd-Hansen, Dorte; Moger, Tron Anders & Kristiansen, Ivar Sønbø (2014). Does the primary screening test influence women's anxiety and intention to screen for cervical cancer? A randomized survey of Norwegian women. BMC Public Health. 14:360. doi: 10.1186/1471-2458-14-360. Full text in Research Archive Show summary

  Background Countries must decide whether or not to replace primary cytology-based screening with primary human papillomavirus (HPV)-based screening. We aimed to assess how primary screening for an HPV infection, a sexually transmitted infection (STI), and the type of information included in the invitation letter, will affect screening intention. Methods We randomized a representative sample of Norwegian women to one of three invitation letters: 1) Pap smear, 2) HPV testing or 3) HPV testing with additional information about the nature of the infection. Intention to participate, anxiety level and whether women intend to follow-up abnormal results were measured between groups using chi-squared and nonparametric Kruskal-Wallis tests. Determinants of intention were explored using logistic regression. Results Responses from 3540 women were representative of the Norwegian population with respect to age, civil status and geographic location. No significant difference across invitation letters was found in women’s stated intention to participate (range: 91.8-92.3%), anxiety (39-42% were either quite or very worried) or to follow-up after an abnormal result (range: 97.1-97.6%). Strength of intention to participate was only marginally lower for HPV-based invitation letters, albeit significant (p-value?=?0.008), when measured on a scale. Only 36–40% of respondents given the HPV invitations correctly understood that they likely had an STI. Conclusions We found that switching to primary HPV screening, independent of additional information about HPV infections, is not likely to reduce screening participation rates or increase anxiety; however, women lacked the ability to interpret the meaning of an HPV-test result.

• Tangen, Gro Gujord; Engedal, Knut; Bergland, Astrid; Moger, Tron Anders & Mengshoel, Anne Marit (2014). Relationships between balance and cognition in patients with subjective cognitive impairment, mild cognitive impairment, and Alzheimer disease. Physical Therapy. ISSN 0031-9023. 94(8), p. 1123–1134. doi: 10.2522/ptj.20130298. Full text in Research Archive Show summary

  Background Balance impairments are common in patients with Alzheimer disease (AD), but which aspects of balance are affected, at which stage of cognitive impairment, and their associations with cognitive domains remain unexplored. Objectives The aims of this study were: (1) to explore differences in balance abilities among patients with subjective cognitive impairment (SCI) or mild cognitive impairment (MCI), mild AD, and moderate AD and (2) to examine the relationship between the various aspects of balance and cognitive domains. Design This was a cross-sectional study. Methods Home-dwelling patients with SCI or MCI (n=33), mild AD (n=99), and moderate AD (n=38) participated in this study. The Balance Evaluation Systems Test (BESTest), comprising 6 subscales—“Biomechanical Constraints,” “Stability Limits/Verticality,” “Anticipatory Postural Adjustments,” “Postural Responses,” “Sensory Orientation,” and “Stability in Gait”—was used to assess balance. Cognitive domains were assessed using the following measures: Mini-Mental Status Examination, Word-List Learning Test from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Verbal Fluency Test, Clock Drawing Test, and Trail Making Test, parts A and B (TMT-A and TMT-B, respectively). Two-way between-group analyses of variance, adjusted for age, were used to analyze differences among the groups. Multiple linear regression analysis was used to explore the associations between balance and cognition. Results Differences were found between the groups on all BESTest subscales; the moderate AD group had the worst scores. The TMT-B (measuring executive function) was associated with all of the BESTest subscales after controlling for demographic factors. Limitations The cross-sectional design hampered interpretation of the development of balance impairments. Conclusions The study findings indicate that all aspects of balance control deteriorate with increasing severity of cognitive impairment and that executive function plays an important role in balance control. Physical therapists should pay attention to these findings both in clinical practice and in future research.

• Valberg, Morten; Grotmol, Tom; Tretli, Steinar; Veierød, Marit Bragelien; Moger, Tron Anders & Aalen, Odd O. (2014). A hierarchical frailty model for familial testicular germ-cell tumors. American Journal of Epidemiology. ISSN 0002-9262. 179(4), p. 499–506. doi: 10.1093/aje/kwt267. Full text in Research Archive
• Moger, Tron Anders & Peltola, Mikko (2014). Risk adjustment of health-care performance measures in a multinational register-based study: A pragmatic approach to a complicated topic. SAGE Open Medicine. doi: 10.1177/2050312114526589. Full text in Research Archive
• Andelic, Nada; Ye, Jiajia; Tornås, Sveinung; Røe, Cecilie; Lu, Juan & Bautz-Holter, Erik [Show all 10 contributors for this article] (2014). Cost-effectiveness analysis of an early-initiated, continuous chain of rehabilitation after severe traumatic brain injury. Journal of Neurotrauma. ISSN 0897-7151. 31(14), p. 1313–1320. doi: 10.1089/neu.2013.3292. Full text in Research Archive
• Viktil, Kirsten Kilvik; Frøyland, Hilde; Rogvin, Maria Beite & Moger, Tron Anders (2013). Beliefs about medicines among Norwegian outpatients with chronic cardiovascular disease. European Journal of Hospital Pharmacy Practice (EJHP Practice). ISSN 1781-9989. 21, p. 118–120. doi: 10.1136/ejhpharm-2013-000346. Full text in Research Archive
• Svensson, Karin Elisabeth; Rogvin, Maria Beite; Hultman, Christina M; Reichborn-Kjennerud, Ted; Sandin, Sven & Moger, Tron Anders (2013). Schizophrenia susceptibility and age of diagnosis - A frailty approach. Schizophrenia Research. ISSN 0920-9964. 147(1), p. 140–146. doi: 10.1016/j.schres.2013.03.004. Full text in Research Archive
• Viktil, Kirsten Kilvik; Blix, Hege Salvesen; Eek, Anne Katrine; Davies, Maren Nordsveen; Moger, Tron Anders & Reikvam, Åsmund (2012). How are drug regimen changes during hospitalisation handled after discharge: a cohort study. BMJ Open. 2(6). doi: 10.1136/bmjopen-2012-001461. Full text in Research Archive
• Hartvig, Pål; Roaldset, John Olav; Moger, Tron Anders; Østberg, Bjørn & Bjørkly, Stål (2011). The first step in the validation of a new screen for violence risk in acute psychiatry: The inpatient context. European psychiatry. ISSN 0924-9338. 26(2), p. 92–99. doi: 10.1016/j.eurpsy.2010.01.003. Full text in Research Archive Show summary

  BACKGROUND: Instruments for evaluating the risk of violence towards others have mostly been developed for assessment of risk for recidivism into violent crime in forensic psychiatry. In general psychiatry there is a considerable need for specialised, brief and structured assessment tools to inform risk decisions. METHOD: The study aimed to validate a brief structured clinical risk assessment screen of inpatient violence (V-RISK-10), a 10-item structured clinical checklist with a good vignette-based interrater reliability (ICC=0.87). In this study it was used for risk assessment of a one-year sample of patients (N=1.017) admitted to two acute psychiatric units. Risk assessments at admission were compared to prospective records of aggressive and violent acts during the hospital stay. RESULTS: Results showed a base rate for aggression of 9%. The predictive validity of the V-RISK-10 was estimated by Receiver Operating Characteristics (ROC). It yielded an area under the curve (AUC) of 0.83, with sensitivity/specificity of 0.81/0.73 and corresponding positive and negative predictive values (PPV/NPV) of 0.24/0.97. The screen was easy-to-use and showed a short completion time. CONCLUSION: Despite promising results further validation studies are required before the V-RISK-10 is adopted into routine clinical practise.

• Moger, Tron Anders; Haugen, Marion; Yip, Benjamin H. K.; Gjessing, Håkon & Borgan, Ørnulf (2011). A hierarchical frailty model applied to two-generation melanoma data. Lifetime Data Analysis. ISSN 1380-7870. 17(3), p. 445–460. doi: 10.1007/s10985-010-9188-3. Full text in Research Archive Show summary

  We present a hierarchical frailty model based on distributions derived from non-negative Lévy processes. The model may be applied to data with several levels of dependence, such as family data or other general clusters, and is an alternative to additive frailty models. We present several parametric examples of the model, and properties such as expected values, variance and covariance. The model is applied to a case-cohort sample of age at onset for melanoma from the Swedish Multi-Generation Register,organized in nuclear families of parents and one or two children. We compare the genetic component of the total frailty variance to the common environmental term, and estimate the effect of birth cohort and gender.

• Grotmol, Tom; Bray, Freddie Ian; Holte, Harald; Haugen, Marion; Kunz, Lauren & Tretli, Steinar [Show all 8 contributors for this article] (2011). Frailty Modeling of the Bimodal Age-Incidence of Hodgkin Lymphoma in the Nordic Countries. Cancer Epidemiology, Biomarkers and Prevention. ISSN 1055-9965. 20(7), p. 1350–1357. doi: 10.1158/1055-9965.EPI-10-1014. Full text in Research Archive
• Blix, Hege Salvesen; Viktil, Kirsten K; Moger, Tron Anders & Reikvam, Åsmund (2010). Drugs with narrow therapeutic index as indicators in the risk management of hospitalised patients. Pharmacy Practice. ISSN 1885-642X. 8(1), p. 50–55. Full text in Research Archive
• Yip, Benjamin H. K.; Moger, Tron Anders & Pawitan, Yudi (2010). Genetic analysis of age-at-onset traits based on case-control family data. Statistics in Medicine. ISSN 0277-6715. 29(30), p. 3258–3266. doi: 10.1002/sim.3907. Full text in Research Archive

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• Berg, Ole Trond; Hagen, Terje P.; Gjefsen, Hege Marie; Godager, Geir; Hart, Rannveig Kaldager & Kinge, Jonas Minet [Show all 13 contributors for this article] (2026). Organisering og finansering av helsetjenester. Fagbokforlaget. ISBN 9788245061505. 414 p. doi: 10.55669/oa1809. Full text in Research Archive Show summary

  Boken gir en bred innføring i organisering og finansiering av helsetjenester, med vekt på norske forhold. Den innledende bolken omfatter kapitler om helsetjenestesystemer og forsikringsordninger, betalingssystemer og demografiske endringer. I de følgende bolkene brukes de grunnleggende begrepene til å beskrive og analysere kommunehelsetjenesten og spesialisthelsetjenesten, samt samhandlingen mellom de to nivåene. Enkelte policy-orienterte temaer, som effektivitet og likhet i tilbudet, analyseres i egne kapitler. Den avsluttende bolken er viet komparativ helsepolitikk, med beskrivelser av land med sosialforsikringsordninger og private helseforsikringer. Utviklingen av EUs helsepolitikk beskrives i et eget kapittel. Bokens underliggende perspektiv er at organisering og finansiering er virkemidler i offentlig helsepolitikk. Dette er instrumenter som kan brukes til å redusere ulikhet i tjenestetilbudet, øke effektiviteten og heve kvaliteten. Boken inneholder oppdatert kunnskap om reformer og piloter fra de siste tiårene, også reformer i andre land som har relevans for norske forhold.

• Aalen, Odd O.; Frigessi, Arnoldo; Moger, Tron Anders; Scheel, Ida; Skovlund, Eva & Veierød, Marit Bragelien (2018). Statistiske metoder i medisin og helsefag. 2. utgave. Gyldendal Akademisk. ISBN 9788205507647. 351 p. Full text in Research Archive

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• Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Amundsen, Olav; Holte, Jon Helgheim & Haavaag, Silje Bjørnsen [Show all 8 contributors for this article] (2025). Bruk av registerdata i analyse av tjenesteforløp for muskelskjelett- og KOLS-pasienter – et sammendrag av INOREG prosjektet. Full text in Research Archive Show summary

  Bakgrunn: Muskel-/skjelettlidelser (MSK) og kronisk obstruktiv lungesykdom (KOLS) representerer to betydelige typer av kroniske sykdommer. I et tverrfaglig forskningsprosjekt ved Institutt for Helse og Samfunn, UiO, som ble introdusert på Helsetjenestekonferansen 2022, har vi analysert tjenesteforløpene for disse pasientgruppene ved hjelp av koblede registerdata. Formål: Beskrive pasientforløpene for de to pasientgruppene, finne faktorer i forløpene assosiert med utfall som sykehusinnleggelser, hjemmetjenester, høy fremtidig tjenestebruk og uførhet. Metode: Kvantitative og kvalitative analyser av pasientforløp. Kvantitative analyser baseres på data fra nasjonale registre, fra registre i pleie- og omsorgstjenestene i Oslo og Trondheim, samt internt fysioterapiregister. Resultater: Flere viktige avvik fra anbefalt oppfølging for pasientgruppene ble oppdaget i analysene. Noen eksempler er at mer enn 50 % av MSK-pasienter fikk kirurgi, uten å ha forsøkt konservativ behandling først, og at mer enn 10 % av KOLS-pasienter ikke mottar oppfølging for luftveisdiagnoser i året før en sykehusinnleggelse med KOLS. Samtidig hadde mange av pasientene med gjentatte KOLS-innleggelser begrenset oppfølging i primærhelsetjenesten i årene etter indeksinnleggelsen. For KOLS-pasienter observerer man videre en sterk økning i fastlegekontakter i året før man mottar hjemmetjenester, som har betydning for å predikere fremtidig tjenestebruk. På den positive siden fant vi at MSK-pasienter med dårlig prognose hadde fire ganger høyere sjanse for å rapportere et godt klinisk utfall dersom de hadde høy bruk av fysioterapi, som videre var assosiert med lavere sjanse for fremtidig uførhet. For pasienter med god/middels prognose var det ingen sammenheng mellom klinisk utfall og høy frekvens av fysioterapi. For KOLS-pasienter fant vi at bruk av samhandlingstakster, kontinuitet i fastlegeoppfølging, og psykososial støtte for særlig sårbare grupper var assosiert med lavere sannsynlighet for fremtidige akutte sykehusinnleggelser for KOLS. Konklusjon: Prosjektet illustrerer mulighetene ved bruk av administrative helseregisterdata. Samtidig finnes det flere begrensninger dersom man ikke har data på tvers av tjenestene, mer detaljerte kliniske data, samt pasientrapporterte utfallsmål

• Moger, Tron Anders; Hellesø, Ragnhild; Tjerbo, Trond; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen & Bragstad, Line Kildal [Show all 8 contributors for this article] (2025). INOREG workshop, perspective paper. Full text in Research Archive
• Moger, Tron Anders; Haavaag, Silje Bjørnsen; Vøllestad, Nina Køpke; Tjerbo, Trond; Holte, Jon Helgheim & Hellesø, Ragnhild [Show all 8 contributors for this article] (2025). INOREG workshop 2025. Full text in Research Archive
• Ki, Yeu Jin; Mcaleavey, Andrew Athan; Øien, Janne-Merete Torset; Moger, Tron Anders & Moltu, Christian (2025). Listening to Patient Voices: Qualitative Insights for Improving Health Economic Measures in Mental Health. doi: https:/cdn.ymaws.com/www.psychotherapyresearch.org/resource/resmgr/spr2025/spr_meeting_boa_2025.pdf. Full text in Research Archive Show summary

  Abstract Background: Existing instruments used in health economics to measure health-related quality of life (HRQoL) have been criticized for not sufficiently reflecting the HRQoL impacts of mental health problems. These shortcomings can lead to significant discounting of the burden of these conditions and consequently to undervaluation of mental health treatment, compounding the stigma already associated with psychiatric disorders. It is therefore crucial to investigate mental health patients’ experiences of such impacts with a view to identifying potential domains that conventional HRQoL instruments might overlook. Methods: Semi-structured in-depth interviews 49 were conducted with 16 participants receiving treatment in specialist mental health services in Norway. Participants had diverse diagnoses, including anxiety, depression, post-traumatic stress disorder, bipolar disorder, and personality disorders. Interviews were analyzed using reflexive thematic analysis. Results: The analysis identified five themes describing the impact of mental disorders on patients’ HRQoL: ‘reduced functioning impacts’, ‘mental process impacts’, ‘social impacts’, ‘fragility’, and ‘sleep difficulties’. The findings indicates areas of overlap between these themes and conventional HRQoL instruments, while also identifying dimensions distinct from current measurement frameworks. Notably, the concept of ‘fragility,’ encompassing unpredictability and inflexibility in daily life, emerged as a distinct theme. Conclusions: The findings suggest that comprehensive assessment should consider a broader range of mental phenomena beyond anxiety and depression, including cognitive difficulties, obstructive self-perception and feelings of meaninglessness. Additionally, the impact of unpredictability on daily functioning and the role of sleep difficulties should be incorporated. These insights can inform the development of more patient-centered HRQoL measures for mental health populations, potentially leading to more accurate evaluation of mental health interventions

• Moger, Tron Anders (2024). En forskers perspektiv på mulighetene for bedre helsetjenester og virksomhetsstyring gjennom analyser av kommunale data. Full text in Research Archive
• Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Hellesø, Ragnhild; Bragstad, Line Kildal & Holte, Jon Helgheim [Show all 8 contributors for this article] (2024). INOREG workshop 2024. Full text in Research Archive
• Amundsen, Olav; Moger, Tron Anders & Vøllestad, Nina Køpke (2024). Arbeid med registerdata - Erfaringer fra INOREG-prosjektet. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist; Nystrøm, Vivian; Moger, Tron Anders & Lurås, Hilde (2024). Kommunale akuttavdelinger skulle bli et alternativ til sykehusinnleggelse- men legene stoler ikke på tilbudet. Full text in Research Archive
• Amundsen, Olav; Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Hellesø, Ragnhild & Bragstad, Line Kildal [Show all 8 contributors for this article] (2023). INOREG workshop 2023. Full text in Research Archive
• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2023). Finding good alternatives to hospitalisation.A data register study in five municipal acute wards in Norway​. Full text in Research Archive
• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2023). Patient experiences and clinical outcomes of admissions to municipal acute wards versus a hospital.A multicenter randomised controlled trial in Norway. Full text in Research Archive
• Moger, Tron Anders (2022). Predicting risk of future hospital episodes for COPD patients – Associations to outpatient care, patient comorbidities, socioeconomic and –demographic factors. Full text in Research Archive Show summary

  Background Although chronic obstructive pulmonary disorder (COPD) admissions puts a substantial burden on hospitals, most of the patients’ contacts with health services are in primary care. Traditionally, primary care has been difficult to capture in population-based samples. Aim The aim is to assess associations between hospitalizations with a respiratory or COPD diagnosis and previous primary care/outpatient contacts, continuity and compliance to recommendations in guidelines. In addition, associations to comorbidities and sociodemographic and –economic variables are studied. Methods Patients were identified from the Norwegian Patient Register (in- and outpatient contacts, rehabilitation) and the KUHR register (consultations with GPs, contract specialists and physiotherapists), 2010-2019. Data also included the Regular General Practitioner register (characteristics of the GP and practice), long-term care data from Oslo and Trondheim (e.g. home nursing, nursing homes, need for assistance), socioeconomic and –demographic data from Statistics Norway and the Cause of Death register. At least three COPD consultations with GP or contract specialists in Oslo and Trondheim and a follow-up of one year was required. This resulted in a sample of 17,431 individuals. Results The number of current year primary and outpatient contacts was strongly associated to next year hospitalizations with COPD or respiratory diagnoses (10-60% more hospitalizations for categories with increasing contact numbers). Effects were relatively large compared to most comorbidities and socio demographic and –economic variables. Fees indicating interaction between providers, regular spirometries, greater continuity of care with GP, and rehabilitation within a month of previous hospitalizations as opposed to later, were associated with lower numbers of next year hospitalizations, although these effects were modest. Conclusion In a population-based sample of COPD patients, a huge variation in number of primary and specialist health care contacts is evident. An increasing number of contacts with any type of primary care provider was strongly associated with future hospitalizations, thus stressing the need for communication and coordination of care between providers for these patients.

• Amundsen, Olav; Vøllestad, Nina Køpke; Moger, Tron Anders; Tjerbo, Trond & Holte, Jon Helgheim (2022). Is future disability benefit associated with specific combinations of health care use for musculoskeletal disorders? Full text in Research Archive Show summary

  Background Musculoskeletal disorders (MSD) are one of the highest contributors to disability benefit in Norway and other OECD-countries. This is an increasing problem in most OECD countries and is a major challenge for welfare states. To be able to prevent people from falling out of the work force it is important to identify combinations of care associated with poorer outcomes and increased risk of future disability pension. Objective Examine how combinations of health care use relate to future disability benefit, controlling for demographic, socioeconomic and clinical factors. Methods The study combines Norwegian data registers with information on health care use, diagnosis, comorbidities, demographic, education, socioeconomic factors and disability benefits. Patients are included at the time of their first health care visit for MSD in 2013-2015 and are followed until end of 2020. Patients between 18-62 years and registered in the work force at index are included. The outcome is being registered with disability benefit minimum 12 months after index. Multivariable regression analysis is used with combinations of health care use for the first 12 months as the main explanatory variables. Combinations of health care use are identified by variables for having used GP, physiotherapy and specialist health care for MSD and creating combinations of these dichotomous variables. Other variables were included as covariates. Results/conclusion Using specialist health care for MSD in combination with GP (OR 1.91, 95%CI 1.36-2.68) or in combination with both GP and physiotherapy services (OR 2.38, 95%CI 1.53-3.71) was associated with increased risk of future disability pension compared to seeing GP alone. Seeing physiotherapist only or in combination with GP was not associated with increased risk of future disability pension. Reasons for these associations remain to be explored.

• Amundsen, Olav; Holte, Jon Helgheim; Vøllestad, Nina Køpke & Moger, Tron Anders (2022). INOREG-prosjektet - drøfting av resultater. Full text in Research Archive
• Moger, Tron Anders; Vøllestad, Nina Køpke; Hellesø, Ragnhild; Tjerbo, Trond; Holte, Jon Helgheim & Amundsen, Olav (2022). INOREG workshop 2022. Full text in Research Archive
• Moger, Tron Anders; Amundsen, Olav & Holte, Jon Helgheim (2022). Innovations in use of register data (INOREG) – Design of a register-based study analysing care pathways and outcomes for chronic patients. Full text in Research Archive Show summary

  Abstract: In recent years there have been several political initiatives in Norway, requiring increased research into how multimorbidity and health services in the municipality affect outcomes such as work participation, disability, quality of life and hospital admissions for patients with chronic diseases. Most of this care happens outside hospitals and has been difficult to capture in large, register-based studies. Focusing on two important chronic groups, patients with chronic obstructive pulmonary disease (COPD) and musculoskeletal disorders (MSD), the INOREG project will meet this need. In the paper we present the study design utilizing register data at the individual level for patients in Oslo and Trondheim, covering specialized care, primary care, home-based and long-term care, sociodemographic and –economic data and functioning. The database is constructed from a novel linkage of national health registers to care data from Oslo and Trondheim municipalities, capturing the entire population of COPD and MSD patients in the cities, and functioning and quality of life for ca. 3800 patients treated at physiotherapy clinics in the FYSIOPRIM project. This enables construction of complete care pathways and outcomes at the individual level during 2008-2020. The results from the project will fill knowledge gaps regarding patterns of care at different levels in the health care system and the association to outcomes for these patient groups. This will help inform decision makers about how services could be organized to improve provisions and coordination of services, as well as reduce inequalities in health.

• Moger, Tron Anders; Tjerbo, Trond; Hellesø, Ragnhild & Vøllestad, Nina Køpke (2021). INOREG opening seminar. Full text in Research Archive
• Nguyen, Huong Thu; Næss, Øyvind Erik; Valberg, Morten; Page, Christian Magnus; Leblanc, Marissa Erin & Moger, Tron Anders (2021). Modelling unobserved heterogeneity by education level in cardiovascular disease mortality - A frailty analysis of Norwegian population-based health surveys. Full text in Research Archive
• Moger, Tron Anders (2020). When should patients be transferred from hospital to municipal care? Full text in Research Archive
• Kvamme, Maria Knoph; Lie, Elisabeth; Uhlig, Till; Moger, Tron Anders; Kvien, Tore Kristian & Kristiansen, Ivar Sønbø (2020). Erratum: Cost-effectiveness of TNF inhibitors vs synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: A Markov model study based on two longitudinal observational studies (Rheumatology (2015 54 (1226-1235) DOI: 10.1093/rheumatology/keu460). Rheumatology. ISSN 1462-0324. 59(4), p. 917–917. doi: 10.1093/rheumatology/kez609. Full text in Research Archive
• Moger, Tron Anders; Häkkinen, Unto & Hagen, Terje P. (2017). Higher mortality among ACS patients in Finland than in Norway: Do differences in acute preparedness and scale effects in hospital treatment explain the variation? Full text in Research Archive Show summary

  Background: Mortality differences following hospital treatment in Finland and Norway are similar for major diseases with acute coronary syndrome (ACS) as an important exception. For ACS, mortality in Finland is significantly higher than in Norway. Objective: To study whether the differences in the organization of the PCI facilities, a decentralized structure with reduced emergency preparedness and small scale production in Finland vs. a centralized structure with large PCI departments performing acute services 24/7 in Norway, add to the explanations of country differences in 30 and 365 day all-cause mortality for patients hospitalized with ACS (acute myocardial infarction or unstable angina pectoris). Data and methods: Data for patients discharged with acute myocardial infarction (ICD 10 I21 and I22) and unstable angina pectoris (ICD 10 I 20.0) from the hospital discharge registers in 2009-2014 was linked with socio-demographic variables, variables describing distances to hospitals and causes of death registers in Norway and Finland. The variables of main interest, emergency preparedness of PCI and the volume of ACS patients at hospital level were included as independent variables in logistic regression analyses. Preliminary results: Across all years combined, Norway had lower 30 and 365 days mortality (7% vs 11%, p<0.001 and 14% vs 20%, p<0.001). However, differences for STEMI patients were smaller (30 days: 10% vs 12%, p<0.001, 365 days: 17% vs 18%, p=0.01) than for non-STEMI, undefined and unstable angina patients (30 days: 6% vs 10%, p<0.001, 365 days: 13% vs 20%, p<0.001). The average Finnish patient was first admitted to a hospital treating 540 ACS patients per year (average travel time by car: 40 min), increasing to 590 patients (travel time: 43 min) during the first episode including transfers to higher level hospitals. Corresponding numbers for Norway were 630 ACS patients per year for the first admission (travel time: 60 min) and 1240 patients (!) for the first episode (travel time: 96 min). In Finland, 48% of STEMI and 39% of non-STEMI, undefined and unstable angina patients were admitted to hospitals with an emergency PCI service during the episode. The corresponding numbers for Norway were 77% and 66%. However, more patients received PCI within 2 days in Finland than Norway (38% vs. 33%, p<0.001), and the distribution of PCIs performed during weekends was similar (23% vs. 23%, p=0.55). Both in Norway and Finland non-STEMI patients who not receive PCI have a significantly lower mortality if they are treated at hospital with PCI facility than at other hospitals (OR 0.65 in Norway and 0.73 in Finland for 365 days mortality, p<0.001). This may indicate better quality at high volume centers. Further work: Multilevel logistic models with individual level risk adjustment and hospital level variables and random effects are going to be used to study if the reduced preparedness for PCI at some of the Finnish hospitals and differences in organization of care for ACS patients add to our understanding of mortality differences between Finland and Norway.

• Swanson, Jayson O. J; Vogt, Verena; Sundmacher, Leonie; Hagen, Terje P. & Moger, Tron Anders (2017). Continuity of care and its effect on readmissions for COPD patients: A comparative study of Norway and Germany. Full text in Research Archive
• Moger, Tron Anders & Swanson, Jayson O. J (2017). Effects of municipal care and early follow-up on readmissions and mortality for stroke patients. Full text in Research Archive
• Moger, Tron Anders & Swanson, Jayson O. J (2017). Effekt av omsorgstjenester hos slagpasienter i Oslo. Full text in Research Archive
• Häkkinen, Unto; Hagen, Terje P. & Moger, Tron Anders (2017). Performance comparison of hip fracture pathways in two metropolitan areas - does the level of integration matter? Full text in Research Archive
• Moger, Tron Anders; Häkkinen, Unto & Hagen, Terje P. (2017). Higher mortality among ACS patients in Finland than in Norway: Do differences in acute services and scale effects in hospital treatment explain the variation? Full text in Research Archive
• Hagen, Terje P.; Iversen, Tor & Moger, Tron Anders (2016). T.P. Hagen og medarbeidere svarer:. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(8), p. 690–690. doi: 10.4045/tidsskr.16.0331. Full text in Research Archive
• Viktil, Kirsten; Blix, Hege Salvesen; Eek, Anne Katrine; Moger, Tron Anders & Reikvam, Åsmund (2011). Changes in drug regimen during hospital stay and after discharge. Full text in Research Archive
• Eek, Anne Katrine; Blix, Hege Salvesen; Viktil, Kirsten; Moger, Tron Anders & Reikvam, Åsmund (2011). General practioner`s experience with hospital discharge notes. Full text in Research Archive
• Viktil, Kirsten Kilvik; Blix, Hege Salvesen; Eek, Anne Katrine; Moger, Tron Anders & Reikvam, Åsmund (2010). The challenge of changes in drug regimen when changing level of care. Pharmacoepidemiology and Drug Safety. ISSN 1053-8569. 19, p. 58–58. Full text in Research Archive
• Viktil, Kirsten Kilvik; Blix, Hege Salvesen; Eek, Anne Katrine; Moger, Tron Anders & Reikvam, Åsmund (2010). The challenge of drug regimen surveillance when changing level of care. P14, Norsk Farmasøytisk Selskap. Programhefte fra Farmasidagene, Oslo 2010. Full text in Research Archive
• Eek, Anne Katrine; Blix, Hege Salvesen; Viktil, Kirsten Kilvik; Moger, Tron Anders & Reikvam, Åsmund (2010). GPs’ opinions of the hospital discharge notes – a survey among GPs. Full text in Research Archive
• Eek, Anne Katrine; Blix, Hege Salvesen; Viktil, Kirsten Kilvik; Moger, Tron Anders & Reikvam, Åsmund (2010). GP’s Opinions of the Hospital Discharge Notes – A Survey among GPs. Pharmacoepidemiology and Drug Safety. ISSN 1053-8569. 19, p. 290–291. doi: 10.1002/pds. Full text in Research Archive
• Aars, Ole Kristian; Godager, Geir; Kaarbøe, Oddvar Martin & Moger, Tron Anders (2022). Sending emails to reduce medical costs? The effect of feedback on general practitioners’ claiming of fees. Universitetet i Oslo. Full text in Research Archive Show summary

  Audit and feedback is used as a strategy to guide practices of health care professionals towards certain targets. The outcome of interest can be quality improvements, but also ensuring that health care workers adhere to relevant regulations. We conducted a nationwide field experiment in the Norwegian primary care sector to study the behavioral responses from giving general practitioners feedback (GPs) on their claiming of fees. The email-based feedback intervention targeted GPs who most frequently claimed fees for double consultations and provided them with a reminder of the formal regulations for double consultations. The intervention caused a 2-5 percentage point reduction in the use of the double-consultation fee, reducing the yearly health care spending of the Norwegian government by approximately €877 000 (or €1 270 per GP).

• Häkkinen, Unto; Engel-Andreasen, Christopher; Hagen, Terje P.; Goude, Fanny; Moger, Tron Anders & Kruse, Marie [Show all 8 contributors for this article] (2018). Performance comparison of patient pathways in Nordic capital areas. A pilot study. THL. ISSN 9789523431348. Full text in Research Archive
• Haugen, Marion & Moger, Tron Anders (2011). Using frailty models to account for heterogeneity and associations in cancer epidemiology and insurance. Faculty of medicine, University of Oslo. ISSN 9788282641609. Full text in Research Archive

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