Background The complexity of caring for patients with chronic conditions necessitates new models of integrated care to accommodate an increasing demand. To inform the development of integrated care models, it is essential to map patients’ use of healthcare resources. In this nationwide registry-based cohort study, we describe and compare patient characteristics and healthcare utilisation between Danish patients with chronic conditions in general practice follow-up and in hospital outpatient follow-up. Methods On 1 January 2016, we identified 250,402 patients registered in 2006–2015 with a hospital diagnosis of atrial fibrillation/flutter, congestive heart failure, chronic liver disease, inflammatory bowel disease or chronic obstructive pulmonary disease. By linkage to national social and health registries, patient characteristics and 12-month healthcare utilisation were extracted. Incidence rates of health care utilisation were compared between patients with chronic conditions in general practice follow-up and patients in hospital outpatient follow-up using negative binomial regression. Results Across all five conditions, the largest proportions of patients were in general practice follow-up (range = 59–87%). Patients in hospital outpatient follow-up had higher rates of exacerbation-related admissions (adjusted incidence rate ratio (IRR) range = 1.3 to 2.8) and total length of stay (IRR range = 1.2 to 2.2). For these five conditions, all-cause admissions and lengths of stay, general practice daytime and out-of-hours contacts, and municipal home nursing contacts were similar between follow-up groups or higher among patients in general practice follow-up. The exception was patients with chronic obstructive pulmonary disease, where patients in hospital outpatient follow-up had higher utilisation of healthcare resources. Conclusions Patients in general practice follow-up accounted for the largest proportion of total healthcare utilisation, but patients in hospital outpatient follow-up were characterised by high exacerbation rates. Enhanced integration of chronic care may be of most benefit if patients in general practice follow-up are targeted, but it is also likely to have an impact on exacerbation rates among patients in hospital outpatient follow-up.

Background With an extensive rise in the number of acute patients and increases in both admissions and readmissions, hospitals are at times overcrowded and under immense pressure and this may challenge patient safety. This study evaluated an innovative strategy converting acute internal medicine inpatient take to an outpatient take. Here, acute patients, following referral, underwent fast-track assessment to the needed level of medical care as outpatients, directly in internal medicine wards. Method The two internal medicine wards at Diagnostic Centre, Silkeborg, Denmark, changed their take of acute patients 1st of March 2017. The intervention consisted of acute medical patients being received in medical examination chairs, going through accelerated evaluation as outpatients with assessment within one hour for either admission or another form of treatment. A before-and-after study design was used to evaluate changes in activity. All referred patients for 10 months following implementation of the intervention were compared with patients referred in corresponding months the previous year. Results A total of 5339 contacts (3632 patients) who underwent acute medical assessment (2633 contacts before and 2706 after) were included. Median hospital length-of-stay decreased from 32.6 h to 22.3 h, and the proportion of referred acute patients admitted decreased with 36.3% points from 94.5 to 58.2%. The median length-of-admission time for the admitted patients increased as expected after the intervention. The risk of being admitted, being readmitted as well as having a hospital length-of-time longer than 24 h, 72 h or 7 days, respectively, were significantly lower during the after-period in comparison to the before-period. Adverse effects, unplanned re-contacts, total contacts to general practice and mortality did not change after the intervention. Conclusion Assessing referred acute patients in medical examination chairs as outpatients directly in internal medicine wards and promoting an accelerated trajectory, reduced inpatient admissions and total length-of-stay considerably. This strategy seems effective in everyday acute medical patients and has the potential to ease the increasing pressure on the acute take for wards receiving acute medical patients.

Background: In 2015, Regional Hospital Silkeborg in Denmark introduced a 24-h telephone access hospital outpatient clinic (24-h access clinic). The 24-h access clinic allowed patients to call the hospital outpatient clinic in case of an exacerbation of symptoms. The aim of this study was to evaluate the effectiveness of a 24-h access clinic in terms of healthcare utilisation and mortality in patients with chronic conditions.Methods: This study was designed as a registry-based controlled cohort study. The 24-h access clinic was established at Silkeborg Regional Hospital in Central Denmark Region, and the five other regional hospitals served as comparison hospitals. We included patients in hospital outpatient follow-up with chronic obstructive pulmonary disease, congestive heart failure, atrial fibrillation/flutter, inflammatory bowel disease and chronic liver disease. Outcomes were hospital admissions, length of stay (LOS), intensive care unit assistance and outpatient visits, contacts to general practice, municipal home nursing and all-cause mortality. Follow-up was 18 months.Results: The study included 992 24-h access patients and 3,878 usual care patients. For the five conditions combined, the 24-h access patients had fewer all-cause admissions (incidence rate ratio (IRR) = .81, 95% confidence interval (Cl) = .71 to .92), general practice out-of-hours contacts (IRR = .81, CI = .71 to .92) and shorter LOS (IRR = .71, CI = .57 to .88), but the rate of all-cause outpatient visits was higher (IRR = 1.07, CI = .99 to 1.15). General practice daytime contacts were similar between the groups, and there was no significant difference in mortality.Conclusions: A 24-h access clinic reduced acute admissions and LOS compared to usual outpatient care. Planned outpatient visits increased and substituted unplanned acute care, thus enhancing integration of care by allowing for access to the correct level of care and ensuring continuity of care.