Frequent and recurring patients

Important results from the project

Common criteria for what we mean by a frequent patient has been established. The literature review has shown that there are two main subgroups within the patient group, which will be very useful in developing individualized care plans. A model has been developed for the joint management of patients. The issue of system support needs to be resolved so that nurses can access individualized care plans. The project has contributed to better understanding of the resources within the organizations.

Expected long term effects

The project is expected to provide earlier and more coordinated care for this patient group, which will lead to more efficient use of resources and increased patient safety. An important step now is to test the model and interventions in order to develop methodological support. In this way, other healthcare providers can more easily apply the method. The project can thus serve as a catalyst for a shift from reactive to proactive care. The project will also generate associated research.

Approach and implementation

The project has been carried out as a feasibility study in close collaboration between regional, municipal, and private stakeholders. The work has included data analysis to map the healthcare-seeking behavior of the patient group. The project has engaged in dialogue with experts to identify legal frameworks and technical possibilities for system support. Through anchoring and joint efforts, the project has developed a working model to establish a foundation for a future implementation project.