Do institutional context and setting affect how much and how intermediate care services are used? A cross-sectional study from Norway

Background: Nationally as well as internationally, the issue of how to avoid emergency hospital admissions has gained urgency against the backdrop of ageing populations and an increasing burden of chronic diseases. In Europe, different forms of admission avoidance intermediate care (AAIC) schemes have been introduced in order to meet growing demands for sufficient, accessible, good quality and affordable health and long-term care services. In Norway, municipal in-patient acute care (MIPAC) was launched as part of the Coordination Reform in 2012 with the explicit aim of reducing pressure on expensive specialist care services and providing patients with services closer to home. Translation and implementation of the policy was left up to the municipalities, which resulted in substantial variation in both organisational and structural characteristics of MIPAC units across Norway. This is likely to affect utilisation as well as outcomes of these services. Objective: This paper aims to determine to what extent variation in the use of MIPAC, defined as the volume of admissions and age groups of patients, is associated with conditions at the MIPAC level, such as service setting, organisation, intermunicipal collaboration (IMC), staffing levels, nursing competence and physician services. Methods: We will use aggregated municipality-level data on MIPAC admissions and organisation from 2019, sourced from the Norwegian health authorities, as well as data on the municipalities’ structural characteristics from the national administrative database for Municipality-State Reporting, KOSTRA. These registry data will be merged with data on nursing competence and staffing from a nation-wide survey of MIPAC units from 2019. The final sample size is 185, which equals 82% of all MIPAC units in Norway. It will be the first time these data sources are combined to provide new insights into the relationship between organisational context and setting of the units and their volume of admissions divided into age groups. We will use descriptive statistics and multinomial regression analysis. Results: No results yet. Will be presented at the conference. Conclusion/impact: The paper will produce new, context-sensitive and applicable knowledge about the use of the MIPAC service and the intended and unintended outcomes of its organisation. This knowledge will be directly applicable for implementation in service planning, organisation and service delivery both at the level of national policy and at local, (inter)municipal levels in Norway and beyond.