Potentially preventable hospitalisations among citizens with multimorbidity – characteristics, trajectories, and potentials in municipal home care

The purpose of this PhD project is to generate evidence-based knowledge about potentially preventable hospitalisations that can support future municipal organisation and prioritisation of the work in municipal health care.

The project contains of two main parts. In synergy, the two parts of the project will create research-based knowledge and recommendations that can support future organisation and strategic focus areas in the municipal sector.

Part 1: Consists of registry-based studies that aim to characterise and compare preventable hospitalizations and the subsequent course for patients with and without multimorbidity, as well as investigate whether multimorbidity can be used to predict length of hospitalization, readmission or death. The data is obtained via Statistics Denmark and is based on the National Patient Register, the Prescription Database, the Elderly Documentation and a number of socio-demographic registers. In a historical cohort design, descriptive analyses of the patient population and comparative analyses of associations between multimorbidity and length of hospitalization, readmission or death are performed.

Part 2: Is an ethnographic field study in 2 Danish municipalities' home care and nursing units. Through observation of practice in outpatient home (nursing) care and emergency nursing care as well as triage meetings, barriers and promoting factors for preventive work are examined, especially among complex citizens, potentials for work to prevent emergency hospitalisations among older citizens over 65 are examined by gain insight into and understanding of the organisational, practical, and professional barriers that exist in the work of preventing hospitalizations in home care. Participants are employees in municipal home care (nurses, assistants, helpers) and emergency nurses. The collected material consists of field notes, photographic material, and quotes from go-along interviews. Data is analysed using qualitative methods.

According to recent Danish political health reform initiatives, non-complicated treatments of patients with chronic diseases must be moved from secondary care to primary care settings to take the pressure of hospitals. However, the research-based knowledge on how to construct care pathways for these patients with an increased risk of hospital admissions due to ACSCs is limited. Large-scale population-based studies rather than disease-specific studies are needed to fill out the knowledge gap in order to understand the who, why and when in acute hospital admissions and thereby be able to design and improve effective preventive interventions in primary care. Nurses are expected to handle the complexity in chronic disease management in primary care settings. Hopefully, results from this study can contribute to advances in the nurses’ role in early prevention.

Marianne Lisby, PhD MScH RN, Research Centre for Emergency Medicine, Aarhus University Hospital, Department of Clinical Medicine, Aarhus University

Sidsel Vinge,PhD MSc(Econ.), VIVE – The Danish Center of Social Science Research

Mette Geil Kollerup, PhD MScN RN, Clinical Nursing Research Unit, Aalborg University Hospital

Patricia Dykes, PhD MA RN, Harvard Medical School, Brigham and Women’s Center for Nursing Excellence, Boston, USA