Explaining Variation in the Percentage of Admissions for Patients Aged 80 and Over in Municipal InPatient Acute Care Services: A Cross-Sectional Analysis From Norway
Hanne Marie Rostad, Marianne Sundlisæter Skinner, Lisa Victoria Burrell, Fan Yang, Trond Tjerbo, Torunn Kitty VatnøyBackground
Municipal Inpatient Acute Care (MIPAC) units in Norway provide short-term inpatient services, but structural and contextual disparities, spanning resources, competence, and accessibility, may affect utilization patterns.
Objectives
To examine to what extent variation in the percentage of admissions involving patients aged ≥80 years across MIPAC units is associated with structural and contextual conditions.
Design
Cross-sectional study using aggregated register and survey data.
Methods
The analytical sample included 147 MIPAC units, corresponding to 68% of the 215 units in the administrative dataset. Descriptive statistics describe sample characteristics and admissions by age group. Pearson correlations assessed interrelationships and multicollinearity before regression analysis.
Results
The model explained 38% of the variance. Unit location, registered nurse coverage, and driving distance to the nearest emergency department were associated with the percentage of admissions involving patients aged ≥80 years. Units located in GP out-of-hours clinics had a lower percentage compared to nursing home–based units (B = -17.12, 95% CI [-23.51 to -10.73], β =-0.41, p < 0.001). Greater registered nurse coverage (B = -0.12, 95% CI [-0.22 to -0.02], β = -0.18, p = 0.021) and longer driving distance to the nearest emergency department (B = -0.07, 95% CI [-0.11 to -0.04], β = -0.31, p < 0.001) were also associated with lower percentages. The estimate for the proportion of adults ≥80 years in the MIPAC catchment area was positive, but uncertain, as the confidence interval included zero (B = 1.76, 95% CI [-0.06 to 3.57], β = 0.20, p = 0.057).
Conclusion
MIPAC admission patterns for the oldest patients were associated with both service configuration and local context. These findings highlight variation in the use of MIPAC services across different units. Future research should examine how structural and contextual factors are related to patterns of MIPAC utilization and explore the mechanisms underlying these associations.