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Reinventing the community hospital: a retrospective population-based cohort study of a natural experiment using register data
  1. Jayson O Swanson,
  2. Terje P Hagen
  1. Department of Health Economics and Health Management, Institute of Health and Society, University of Oslo, Oslo, Norway
  1. Correspondence to Jayson O Swanson; j.o.swanson{at}


Objectives To investigate whether implementation of municipal acute bed units (MAUs) resulting from the Norwegian Coordination Reform (2012) was associated with reductions in hospital admissions, particularly for the elderly.

Design A municipality-based retrospective comparative cohort study using monthly population-based registry data analysed with fixed-effects log–log regressions.

Setting Norwegian municipalities and hospitals.

Population All patients admitted to secondary hospital care in Norway between 2010 and 2014, excluding psychiatric admissions, with additional focus on admission type and elderly age subgroups.

Main outcome measures Monthly admission rates in total and by age group for all patients, patients admitted with acute conditions and with acute conditions at internal medicine departments.

Results The introduction of MAUs was associated with a small yet significant overall negative effect on hospital admissions. The reduction in all admissions was significant for the entire population (−1.2%, 95% CI −2.0% to −0.0%) and slightly stronger for those aged 80 years and above (−1.9%, 95% CI −3.0% to −1.0%). The more detailed analysis of the elderly population aged 80 years and above revealed that effects were affected by the institutional characteristics of the MAUs. The significant effects ranged between −1.6% and −8.6%, depending on the availability of physicians on duty at the MAUs, the MAUs location or combinations thereof.

Conclusions Introduction of MAUs following implementation of the Norwegian Coordination Reform in 2012 was associated with a significant reduction in hospital admissions primarily for the elderly. Our findings suggest that this type of intermediate care is a viable option in an effort to alleviate the burden on hospitals by reducing the acute secondary care admission volume. Further examinations focused on cost-effectiveness, health status of patients, number of patients treated at the MAUs and comparing other intermediate care alternatives would all add important perspectives to the issue.

  • intermediate care
  • hospital admission rates
  • healthcare reform
  • elderly
  • registry data

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  • Contributors TPH conceptualised and designed the study, as well as contributed to the background. JOS analysed the data and drafted the manuscript. Both authors reviewed drafts of the article.

  • Funding The paper is funded by the Norwegian Research Council through the evaluation programme for the Cooperation reform (NFR grant 220764—‘Prosessevaluering av Samhandlingsreformen: Statlige virkemidler, kommunale innovasjoner’).

  • Competing interests None declared.

  • Ethics approval Granted by the Regional Ethics Committee South-East, Norway; and the Norwegian Data Inspectorate.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Access to the restricted data can be sought from the Regional Committees for Medical and Health Research Ethics, South-East Norway; and the Norwegian Data Inspectorate.

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