Successful care model with virtual home hospital

Local care involves focusing on patient needs, and much of the care for the elderly can be provided in the home. The Borgholm Model is about using preventive care to keep patients who do not need it f

Photograph: Municipality of Borgholm

The Borgholm Model has received a lot of attention thanks to its good results in providing local care for the elderly and frail. The model, which centres around patient needs, is now being scientifically evaluated by researchers at Uppsala University.

Northern Öland has the oldest population in Sweden, with one in three people over the age of 65. In other words, there is a great need for care for the elderly, the frail and individuals with multiple long-term conditions. The Borgholm Healthcare Centre and Borgholm Municipality have been working for five years under a collaborative model linking primary care, municipal home healthcare and ambulance care.

"The Borgholm Model is about bringing together the entire chain of healthcare providers. The aim is for the elderly and the frail to have continuity in their care and to see the same doctors and nursing staff to the greatest extent possible. Through interdisciplinary work, we can increase the quality of care," says Anna Hasselbom Trofast, Head of Social Services in Borgholm Municipality.

Working in closed systems

One of the major challenges facing Swedish healthcare is the lack of cooperation between municipal home healthcare and regional primary care. The different types of healthcare providers often work in closed systems, which makes it difficult to get a holistic picture of the patient's health status and care history. Elderly and frail people often fall through the cracks in the system.

"Patients end up in emergency departments and specialist clinics when they really should be treated within primary care or municipal home healthcare. There are unnecessary patient transports and hospitalisations. All this causes greater suffering," says Anna Hasselbom Trofast.

Cooperation via digital platform

The Borgholm Model was developed in response to this problem. The model involves elderly and frail people with complex care needs being admitted to a virtual home hospital for their care. The aim is to digitally connect the patient, the municipality and the region via an IoT platform in a way where all parties can cooperate. The municipality's healthcare staff have access to the region's medical records system, and a large proportion of the tests and examinations are carried out from the patient's home. In Borgholm Municipality, the ambulance crew are also connected to this model.

"If the ambulance responds to an alarm that turns out to be a non-emergency, the ambulance crew can offer a doctor visit in the home as early as the very next day. Most elderly people would rather wait a day than go to the emergency department," explains Anna Hasselbom Trofast.

Scientific evaluation

Inna Feldman is Associate Professor of Health Economics at Uppsala University. She has over twenty years' experience in health economic evaluations, and is now leading a project to carry out a scientific evaluation of the Borgholm Model in collaboration with the healthcare centre.

The main thesis is that providing good quality and preventive care can make it possible to avoid admissions to inpatient and specialist care.

"We are focusing on the economic impact of working according to the Borgholm Model. Preliminary data already show that per capita consumption of inpatient care and related costs have decreased," says Inna Feldman.

Reduced emergency department admissions lead to reduced costs. One night in hospital costs about SEK 20,000, and a visit to the emergency department costs between SEK 6,000 and 10,000.

Increased staffing makes an impact

Åke Åkesson is Head of Operations at Borgholm Healthcare Centre. He is one of the driving forces behind the transition to local care that is organisationally seamless and centres around patient needs. The basic premise is that primary care is responsible for all healthcare that does not require hospital resources. The transition has required a major investment in staff. For example, district doctors at Borgholm Healthcare Centre are allowed to have a maximum of 1,000 patients listed per doctor. This has proved to be an important piece of the puzzle in creating a good and sustainable working environment.

Socioeconomic benefits

Working according to the Borgholm Model means taking a holistic approach to socioeconomic benefits. The benefit does not always appear in the same place where the cost is incurred. This is a challenge, according to Inna Feldman.

"If, for example, you employ more staff in primary care, this leads to increased costs there. But it may reduce costs in emergency and specialist care, and the investment in staff generally leads to increased socioeconomic benefits," she says.

Anna Hasselbom Trofast, Head of Social Services, thinks that Borgholm has succeeded in doing just that.

"We did not think along those lines when we started the work. However, the work needs to be evaluated from a socioeconomic perspective to ensure that the region and municipality can maintain it and that there are always enough resources," she says.

Maria Bergenheim