Trial Lecture – time and place
See Trial Lecture.
- First opponent: Assistant Professor Ulrika Winblad, Uppsala University
- Second opponent: Associate Professor Viola Burau, Aarhus University
- Third member and chair of the evaluation committee: Associate Professor Øyvind Næss, University of Oslo
Chair of the Defence
Professor Magne Thoresen, University Of Oslo
Professor Tron Anders Moger, University of Oslo
Epidemiological and demographic changes combined with technological advancement are dictating an ongoing paradigm shift from short-term acute, episodic care to long-term, comprehensive, coordinated care that is continuous and longitudinal. These changes have been met with largely under-evaluated experimentation with different approaches to reorganization and shifting care traditionally provided in the specialist sector away from hospitals and into the community.
In this thesis three different empirical studies focused on the primary-secondary care interface using uniquely linkable register data to perform a variety of regression analyses and risk adjustment techniques. The aim was to fill noted real-world evidence gaps and add to existing literature by evaluating utilization outcomes associated with efforts to shift the balance of care including: secondary care substitutive services, in the form of intermediate local acute units; the existence of gatekeeping and patient lists related to GP provided continuity of care; and post-hospital community-based primary care services.
Introducing intermediate care facilities were associated with reduced hospital admission rates. The largest decrease was noted for the elderly, who were also affected by specific institutional characteristics. Differences in continuity were found between countries with and without gatekeeping or patient lists, yet an overall association between improving primary care continuity and reduced readmissions was observed, with different results based on when continuity was measured. No differences in short and long-term readmissions and mortality were associated with early post-discharge GP follow-up, whereas differences associated with different post-discharge community care compared to no services were mixed, primarily with rehabilitation associated with increased outcome measures. Overall, the thesis adds to understanding reforms at the primary-secondary care interface.
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