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Health services research
Original research
Older high-cost patients in Norwegian somatic hospitals: a register-based study of patient characteristics
  1. Morten Lønhaug-Næss1,
  2. Monika Dybdahl Jakobsen1,2,
  3. Bodil Hansen Blix1,3,
  4. Trine Strand Bergmo4,5,
  5. Matthias Hoben6,7,
  6. Jill-Marit Moholt1,2
  1. 1Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
  2. 2Center for Care Research North, UiT The Arctic University of Norway, Tromso, Norway
  3. 3Western Norway University of Applied Sciences, Bergen, Norway
  4. 4Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
  5. 5Digital Health Services, Norwegian Center for E-health Research, Tromso, Norway
  6. 6Faculty of Health, School of Health Policy & Management, York University, Toronto, Ontario, Canada
  7. 7Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Morten Lønhaug-Næss; morten.loenhaug.naess{at}uit.no

Abstract

Objective Two-thirds of the economic resources in Norwegian hospitals are used on 10% of the patients. Most of these high-cost patients are older adults, which experience more unplanned hospital admissions, longer hospital stays and higher readmission rates than other patients. This study aims to examine the individual and clinical characteristics of older patients with unplanned admissions to Norwegian somatic hospitals and how these characteristics differ between high-cost and low-cost older patients.

Design Observational cross-sectional study.

Setting Norwegian somatic hospitals.

Participants National registry data of older Norwegian patients (≥65 years) with ≥1 unplanned contact with somatic hospitals in 2019 (n=2 11 738).

Primary outcome measure High-cost older patients were defined as those within the 10% of the highest diagnosis-related group weights in 2019 (n=21 179). We compared high-cost to low-cost older patients using bivariate analyses and logistic regression analysis.

Results Men were more likely to be high-cost older patients than women (OR=1.25, 95% CI 1.21 to 1.29) and the oldest (90+ years) compared with the youngest older adults (65–69 years) were less likely to cause high costs (OR=0.47, 95% CI 0.43 to 0.51). Those with the highest level of education were less likely to cause high costs than those with primary school degrees (OR=0.74, 95% CI 0.69 to 0.80). Main diagnosis group (OR=3.50, 95% CI 3.37 to 3.63) and dying (OR=4.13, 95% CI 3.96 to 4.30) were the clinical characteristics most strongly associated with the likelihood of being a high-cost older patient.

Conclusion Several of the observed patient characteristics in this study may warrant further investigation as they might contribute to high healthcare costs. For example, MDGs, reflecting comprehensive healthcare needs and lower education, which is associated with poorer health status, increase the likelihood of being high-cost older patients. Our results indicate that Norwegian hospitals function according to the intentions of those having the highest needs receiving most services.

  • Health Services for the Aged
  • Hospitals, Public
  • REGISTRIES

Data availability statement

Data may be obtained from a third party and are not publicly available. The dataset used in the current study is not publicly available due to the contractual arrangement with the Norwegian Directorate of Health, who is the data custodian.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2023-074411

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The dataset used in the current study is not publicly available due to the contractual arrangement with the Norwegian Directorate of Health, who is the data custodian.

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    Footnotes

    • Contributors ML-N designed the study, analysed the data, wrote the first draft of the manuscript and is responsible for the overall content as the guarantor. MDJ designed the study and was involved in the data analysis, interpretation of results and writing process. TSB contributed with the planning of data analyses, interpretation of results and editing of the manuscript. BHB and MH contributed to the writing of the article and discussion. J-MM designed the study, conducted data management and contributed to both the analyses and writing of the article. All authors have critically reviewed and edited the draft article. All authors read and approved the final version of the manuscript.

    • Funding This study was funded by UiT—The Arctic University of Tromsø. The project affiliated with this study is funded by the Northern Norway Regional Health Authority (Helse Nord RHF), project number HNF-1541-20, and had no role in study design, data collection, analysis or publishing of this study.

    • Disclaimer Data from the Norwegian Patient Registry have been used in this publication. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Norwegian Patient Registry is intended nor should be inferred.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.