INOREG – INnovations in use Of REGister data

• 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.

• 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.

• 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; 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.

• 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.

• 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.

• 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.

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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
• 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
• 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
• Amundsen, Olav (2023). Variation in use of services and patient outcome for musculoskeletal disorders. Full text in Research Archive
• Amundsen, Olav (2023). - Behandlingsmål og utfall for personer med muskelskjelettplager. 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.

• Holte, Jon Helgheim (2022). Modelling long term trajectories for primary and secondary health care utilization in COPD patients: A population-based study using Norwegian registry data. Full text in Research Archive Show summary

  Background Few studies examine how the use of health services for COPD patients develops over time. Objective This study aims to identify care trajectories - combinations of primary and secondary health services use – for COPD patients over a period of five years. We also seek to identify determinants for variations in care trajectories. Methods We use data from a wide range of administrative registers. This provides us with nearly complete information on health- and social service utilization, coupled with data on social background, for all COPD patients in Trondheim and Oslo in the period from 2008-2019. The data was analyzed using a groupbased multi trajectory model (GBMT) on a sample of 13 467 individuals who are followed from the time of first contact with COPD and five years onwards. Results Six distinct care trajectories for COPD-related health services use emerged in our analysis. The most common trajectory involves consistent (yearly) use of GP services with little use of other services (38%). The second most common trajectory involves little use of health services apart from contact in the first year, which usually take place in general practice (28%). Furthermore, two trajectories involves consistent use of GP services accompanied with either some use of hospital and physiotherapist services (21%) or consistent use of contract specialist (6%). The two last trajectories both involves consultations with specialist contractor, of which one involves consistent contact with a specialist contractor and little use of other services (4%), while the second only involves contact with specialist contractor in the first year and inconsistent use of GP services throughout the five years. Conclusion This study shows that COPD patients constitute a highly heterogeneous group in terms of health care services utilization. It seems that the current guidelines for COPD treatment is not complied with for many patients. More research on the effects of different types of care pathways is warranted.

• 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
• Amundsen, Olav & Vøllestad, Nina Køpke (2022). Registerforskning – et nyttig fugleperspektiv for klinikere? Full text in Research Archive
• Amundsen, Olav & Vøllestad, Nina Køpke (2022). Hvordan er første års helsetjenestebruk for pasienter med muskel-skjelettplager assosiert med bruk av spesialisthelsetjenesten 3 år senere? Full text in Research Archive Show summary

  Bakgrunn: Muskel-skjelettplager (MUSP) inkluderer noen av de mest prevalente lidelsene både internasjonalt og i Norge. I Norge er kostanden for helsetjenester relatert til MUSP beregnet til 14.3 mrd NOK, og den økonomiske byrden relatert til redusert arbeidsdeltakelse og sosiale ytelser er estimert til å være 69-73 mrd NOK. For å kunne håndtere den økende byrden av MUSP trengs forskning på hvordan vi kan bedre individuelle helserelaterte utfallsmål og gjøre de samfunnsmessige kostnadene bærekraftige. Dette inkluderer et behov for å identifisere og fremme behandlingsforløp som er effektive, og redusere bruken av ineffektive behandlingsforløp. Metode: Studien henter data fra offentlige konsultasjoner hos fysioterapeut og spesialisthelsetjenesten fra dataregistrene KUHR og NPR-somatikk. Studiepopulasjonen er pasienter registrert med MUSP for første gang hos fastlege/fysioterapeut i 2015. Ressursbruk hos fysioterapeut og spesialisthelsetjeneste kodes i kategoriene høy/lav/ingen. Kategoriene "høy" og "lav" kodes basert på 50-percentilen. Kategoriene brukes som hovedvariabel i logistisk regresjonsanalyse hvor utfallsmålet er høy/lav eller ingen spesialisthelsetjenestebruk 3 år senere. Det er kontrollert for alder, kjønn, utdanning, arbeidslivstilknytning og komorbiditeter. Analysene er foreløpige og under utvikling. Resultater: Høy og lav bruk av spesialisthelsetjeneste første år var assosiert med høy bruk av spesialisthelsetjeneste 3 år senere, sammenlignet med ingen bruk. (Høy: OR 1.98, 95%CI 1.60-2.46. Lav: OR 1.25 95%CI 1.01-1.57). For kombinasjoner mellom helsetjenestebruk første år har gruppene med høy spesialisthelsetjenestebruk økt risiko for høy bruk etter 3 år, men gruppen med samtidig høy bruk av fysioterapi har lavest risiko av disse (Høy spesialisthelsetjeneste ingen fysioterapi: OR 2.00, 95%CI 1.54-2.61. Høy spesialisthelsetjeneste lav fysioterapi: OR 3.00 95%CI 1.90-4.75. Høy spesialisthelsetjeneste høy fysioterapi: OR 1.47, 95%CI 1.04-2.07). Diskusjon/konklusjon Høy bruk av spesialisthelsetjeneste første år var assosiert med høy bruk 3 år senere. Samtidig høy bruk av fysioterapi kan redusere risikoen for høy bruk av spesialisthelsetjeneste i denne gruppen, noe som kan ha betydning for reduksjon i samfunnskostnad.

• 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.

• Amundsen, Olav & Vøllestad, Nina Køpke (2022). Smerter hos voksne og bruk av helsetjenester. Full text in Research Archive
• Amundsen, Olav & Vøllestad, Nina Køpke (2022). Is future disability benefit associated with specific combinations of health care use for musculoskeletal disorders? Full text in Research Archive Show summary

  Bakgrunn og formål 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. The study’s objective is to examine how combinations of health care use relate to future disability benefit, controlling for demographic, socioeconomic and clinical factors. Metode 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. Resultater 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. Konklusjon Using specialist health care for MSD was associated with increased risk of future disability pension, while 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.

• Moger, Tron Anders; Tjerbo, Trond; Hellesø, Ragnhild & Vøllestad, Nina Køpke (2021). INOREG opening seminar. Full text in Research Archive

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