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Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture over a chosen topic - time and place
See Trial Lecture
Trial Lecture over a given topic - time and place
See Trial Lecture
Adjudication committee
- First opponent: Professor Paul Aylin, Imperial College London, UK
- Second opponent: Professor Håkon K. Gjessing, University of Bergen,
- Third member and chair of the evaluation committee: Professor Anette Hjartåker, University of Oslo
Chair of the Defence
Professor Magne Thoresen, University of Oslo
Supervisor
Professor emeritus Petter Laake, University of Oslo
Summary
Quality indicators are useful for the general public and for the governing the hospital system, as well as for clinicians and practitioners aiming at maintaining and improving the results of their efforts. A prerequisite is that the indicator measures what it is intended to do, free from systematic error or bias and other sources of inaccuracy. It must also be possible to disentangle the inherent randomness in individual outcomes from systematic, underlying quality differences by appropriate statistical methods.
In administrative databases of hospital admissions, patients are selected according to codes for disease or conditions. The accuracy of the coding has been called into question. Direct information about frailty and case severity is seldom found in the databases, and must be inferred indirectly from e.g., patient age and comorbidities.
Two of the papers are based on a large medical record abstraction, collecting clinical data from a nationwide, representative sample of hospitals and patients. For two conditions, acute heart infarction and hip fracture, we found that any differences in coding could not explain differences in 30-day mortality after admission. The frailty and severity of the hip fracture patients were comparable across hospitals.
In the study of the heart infarction data, the existing statistical methodology was found unsatisfactory. One of the papers studies a statistical model for laboratory data.
One severe outcome after gastrointestinal surgery is wound dehiscence or rupture. Risk adjusted rates of wound dehiscence were computed for each hospital. With data from a five-year period, some hospitals were found to have higher rates than average.
The HARM score is a composite quality score for surgery, based on length of stay, mortality and readmissions. The score was adapted to Norwegian hospitals, and was found to differentiate strongly between hospitals, even when based on one-year data.
Additional information
Contact the research support staff.