Marie Kruse

Aim: To investigate the effect of screening for anxiety and depression (AD) in patients with ischaemic heart disease (IHD) on the likelihood of receiving treatment for AD. Methods: We used a nationwide dataset of all Danish patients with an incident IHD diagnosis in the period 2015–2018 ( N = 80,701) of which 20,461 (25%) were exposed to screening for AD as part of cardiac rehabilitation. A binary composite indicator for the use of any AD treatment (prescriptions of AD drugs, general practitioner (GP) counselling or referral to a psychologist), was modelled as the dependent variable. The probability of receiving AD treatment was estimated using linear probability and instrumental variable regression models. Results: Exposure to AD screening was lower for patients with low income (change in probability −0.67, 95% CI −0.76; −0.59), low education (change in probability −0.16, 95% CI −0.20; −0.13), and a high comorbidity burden (change in probability −0.09, 95% CI −0.10; −0.07). Screene...

Supplemental material, SJP863523_Supplemental_material for A performance comparison of patient pathways in Nordic capital areas – a pilot study for ischaemic stroke patients by Unto Häkkinen, Fanny Goude, Terje P. Hagen, Marie Kruse, Tron Moger, Mikko Peltola and Clas Rehnberg in Scandinavian Journal of Public Health

Introduction: The aim of this paper is to provide an overview and a few examples of how national registers are used in analyses of healthcare costs in Denmark. Research topics: The paper focuses on health economic analyses based on register data. For the sake of simplicity, the studies are divided into three main categories: economic evaluations of healthcare interventions, cost-of-illness analyses, and other analyses such as assessments of healthcare productivity. Conclusion: We examined a number of studies using register-based data on healthcare costs. Use of register-based data renders a

The Danish Heart Registry (DHR) keeps track of all coronary angiographies (CATH), percutaneous coronary interventions (PCI), coronary artery bypass grafting (CABG), and adult heart valve surgery performed in Denmark. DHR is a clinical database established in order to follow the activity and quality of the procedures mentioned. Information concerning each procedure, age, gender, and co-morbidity of the patient was collected. Each patient was followed with respect to survival for 30 days by linkage to the central personal registry in Denmark. Mortality was estimated by the Kaplan-Meier method and comparisons of 30-day mortality between centres were carried out in Cox proportional hazard models. The mortality within 30 days after PCI was 3.2% and closely related to the indication for PCI: ST-elevation myocardial infarction (STEMI) 6.8%; non-STEMI & unstable angina pectoris 1.9% and stable angina pectoris 0.5%. The 30-day mortality after PCI on the indication STEMI did not differ betwee...

This study examined if acquiring a traumatic brain injury (TBI) increased the utilization of health care costs, risk of job loss for the patient and the closest relatives, and the risk of divorce 1 to 5 years following the injury. The study was conducted as a Danish national population-based register study with follow-up. Participants included a cohort of TBI patients (n=18,328) hospital admitted or treated in emergency departments and a matching control group (n=89,155). For both the TBI group and the matching controls, relatives were identified, using the national registers (TBI relatives: n=25,708 & control relatives: n=135,325). The outcome measures were utilization of health care costs (including hospital services, use of general practitioner and practicing specialists, and prescribed medication), risk of job loss and divorce among the TBI group and the control group and their relatives. TBI patients had significantly increased health care costs at baseline (e.g. the year before the injury) and the following four years. Furthermore, TBI relatives had a significantly higher use of health care costs the first and the third year after injury. The TBI group had a significant increased risk of job loss (OR=2.88; CI: 2.70-3. 07) and divorce (OR=1.44; CI: 1.27-1.64) during the first three years following injury. In conclusion, the TBI group had significantly higher use of health care costs, also premorbidly. Furthermore, increased risk of job loss and divorce were found emphasizing the socioeconomic consequences of TBI lasting years to come.

This study examined if acquiring a traumatic brain injury (TBI) increased the utilization of health care costs, risk of job loss for the patient and the closest relatives, and the risk of divorce 1 to 5 years following the injury. The study was conducted as a Danish national population-based register study with follow-up. Participants included a cohort of TBI patients (n=18,328) hospital admitted or treated in emergency departments and a matching control group (n=89,155). For both the TBI group and the matching controls, relatives were identified, using the national registers (TBI relatives: n=25,708 & control relatives: n=135,325). The outcome measures were utilization of health care costs (including hospital services, use of general practitioner and practicing specialists, and prescribed medication), risk of job loss and divorce among the TBI group and the control group and their relatives. TBI patients had significantly increased health care costs at baseline (e.g. the year befor...

This study explores health and social care consumption in two groups of patients with risk of alcohol use disorder (AUD), following a brief outreach alcohol intervention in a general hospital setting in Denmark. The Relay intervention aims to decrease health care contacts and thus primarily, in the long run, to reduce health care costs and secondarily to reduce labour market consequences and social costs for patients with alcohol problems. The study took place in somatic hospital departments with high prevalence of alcohol related injuries and illnesses. Patients admitted to the hospital between October 2013 and June 2016 were screened using the Alcohol Use Identification Test (AUDIT) and everyone scoring 8 points and above were randomised to either intervention (Relay group) or control group (TAU group). The patients (n=561) were followed for 12 months after discharge from the hospital. Data was gathered on somatic and psychiatric hospital admissions, GP visits and other primary he...

Objectives We aimed to investigate the cost-utility and cost-effectiveness of a modified Individual Placement and Support intervention for people with mood and anxiety disorders (IPS-MA). Methods Costs were assessed from a societal perspective. Health care costs were derived from registers and combined with data on use of IPS-MA services, municipal social care, and labour market services. EQ-5D was used to compute QALY. Missing data were imputed in a sensitivity analysis. We also computed the cost per gain in hours worked. Incremental cost-effectiveness ratios (ICER) were computed and bootstrapped to obtain confidence intervals for QALY and gain in hours worked. Results We found no difference in overall costs between groups. A significant saving was found in use of labour market services in the IPS-MA group. But the IPS-MA group had significantly lower wage earnings compared to the control group. The intervention group had a higher, though statistically in-significant, increase in Q...

INTRODUCTION The Danish Heart Registry (DHR) keeps track of all coronary angiographies (CATH), percutaneous coronary interventions (PCI), coronary artery bypass grafting (CABG), and adult heart valve surgery performed in Denmark. DHR is a clinical database established in order to follow the activity and quality of the procedures mentioned. MATERIALS AND METHODS Information concerning each procedure, age, gender, and co-morbidity of the patient was collected. Each patient was followed with respect to survival for 30 days by linkage to the central personal registry in Denmark. Mortality was estimated by the Kaplan-Meier method and comparisons of 30-day mortality between centres were carried out in Cox proportional hazard models. RESULTS The mortality within 30 days after PCI was 3.2% and closely related to the indication for PCI: ST-elevation myocardial infarction (STEMI) 6.8%; non-STEMI & unstable angina pectoris 1.9% and stable angina pectoris 0.5%. The 30-day mortality after PCI on...

ObjectivesFrailty is a major clinical geriatric syndrome associated with serious adverse events including functional disability, falls, hospitalisation, increased morbidity and mortality. The aim of this study was to study the associations between frailty defined as Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA-7) score ≥3 and use of healthcare resources in hospital and in the municipality as well as association between frailty and mortality.DesignRegister-based retrospective study.SettingThe target population consists of patients aged 75 years or above who, during hospital stay, were assessed by a physiotherapist, and at discharge from hospital were prescribed further physical training in the community.Participants973 individuals aged 75+ years were included.Outcome measuresWe examined associations between frailty and use of healthcare resources in hospital and in the municipality as well as the association between frailty and mortality.Results97...

Background Administrators and policymakers are increasingly interested in individual placement and support (IPS) as a way of helping people with severe mental illness (SMI) obtain employment or education. It is thus important to investigate the cost-effectiveness to secure that resources are being used properly. Methods In a randomized clinical trial, 720 people diagnosed with SMI were allocated into three groups; (a) IPS, (b) IPS supplemented with cognitive remediation a social skills training (IPSE), and (c) Service as usual (SAU). Health care costs, municipal social care costs, and labor market service costs were extracted from nationwide registers and combined with data on use of IPS services. Cost-utility and cost-effectiveness analyses were conducted with two primary outcomes: quality-adjusted life years (QALY) and hours in employment. Incremental cost-effectiveness ratios (ICER) were computed for both QALY, using participant’s responses to the EQ-5D questionnaire, and for hou...

This study examined the association between interpersonal violence and a range of psychiatric and physical health outcomes and assessed whether these associations changed when controlling for a stress-related diagnosis. An observational case–control study was conducted on a sample of 4,059 victims of violence. Using propensity score matching a number of risk factors (assessed five years prior assault) were used. Controls were matched 10:1 using the Danish Central Registry System. Outcomes were ICD-10 diagnoses of a range of psychiatric and physical health outcomes in the 15 years post-injury. Statistically significant associations were found for all psychiatric conditions and a diagnosis of a drug or substance misuse disorder. These findings remained even after controlling for a diagnosis of a stress-related disorder. Large scale case–control studies using the Danish nationwide registers enables a powerful way of assessing the relative impact of exposure to interpersonal violence on the development of psychiatric and physical health problems.

A bout 10% of obese patients experience surgical site infection after cesarean delivery, despite recognized interventions such as prophylactic antibiotics and antiseptic skin preparation to help reduce this maternal risk. An alternative to the standard postoperative dressing (SPD) that has been shown to reduce the risk of surgical site infections in nonobstetric patients is incisional negative pressure wound therapy (iNPWT). There are only a few studies that have focused on this intervention in obstetric patients undergoing cesarean delivery. This study aimed to assess the effectiveness of prophylactic iNPWT on obese patients after cesarean delivery. This study was an unblinded, pragmatic, randomized multicenter study conducted in 5 hospitals in Denmark between September 2013 and October 2016. Pregnant patients undergoing elective or emergency cesarean delivery, who were 18 years and older, who had a prepregnancy body mass index ≥ 30 kg/m2, and who read and understood Danish were recruited for the study. Patients were excluded if they had a vaginal delivery. Patients were randomly assigned to iNPWT (n= 432) or a SPD (n= 444) after cesarean delivery. Blinding was not possible due to the nature of the intervention. Patients were sent an electronic questionnaire designed to collect data on demographics, wound complications, contacts with the health care system, antibiotic treatment, and quality of life 30 days after surgery. Other individual health care data, including postpartum maternal antibiotic use and diagnostic codes related to postsurgical wound complications, were obtained through linked national registries. The primary outcome was surgical site infection, defined as an infection of the surgical site requiring antibiotics within 30 days of cesarean delivery. Of the 876 patients included in the study, 827 women completed the questionnaire. Surgical site infection was reported in 4.6% (20/432) in the iNPWT group and 9.2% (41/444) in the SPD group (relative risk: 0.50, 95% confidence intervals: 0.30–0.84; P= 0.007). There were similar numbers of deep surgical site infections that required surgery in both groups, 1.9% and 2.0% for the iNPWT group and the SPD group, respectively. In addition, 22.4% (92/410) of patients reported wound exudate in the iNPWT group, compared with 32.9% (137/417) in the control group (relative risk: 0.69, 95% confidence interval: 0.55-0.86; P= 0.001). There was no difference between groups for patients who reported minor wound dehiscence (15.1% in the iNPWT group and 16.6% in the SPD group). The overall self-rated health status did not differ between the 2 groups. In conclusion, iNPWT was shown to significantly reduce the relative risk of surgical site infection after cesarean delivery by 50% in obese patients. Wound exudate was also significantly reduced, but no effect was found for minor wound dehiscence or in self-reported quality of life measures.

Ó The Author(s) 2010. This article is published with open access at Springerlink.com Aim The aim of this study was to assess the impact on the cost-effectiveness ratio of including measures of production and consumption following a health care or health promotion intervention that improves survival. Data and methods We defined the net incremental consumption, or future costs, as the change in consumption minus change in production, while differentiating between health care and non-health care consumption. Based on 2005 register-based data for the entire Danish population, we estimated the average value of annual production and consumption for 1-year age groups. We computed the net consumption in the remaining expected lifetime and the net consumption per life year gained for different age groups. Results Age has a profound effect on the magnitude of net consumption. When including net incremental consumption

Background Internationally, older patients (≥65 years) account for more than 40% of acute admissions. Older patients admitted to the emergency department (ED) are frequently malnourished and exposed to inappropriate medication prescribing, due in part to the inaccuracy of creatinine-based equations for estimated glomerular filtration rate (eGFR). The overall aims of this trial are to investigate: (1) the efficacy of a medication review (MED intervention) independent of nutritional status, (2) the accuracy of eGFR equations based on various biomarkers compared to measured GFR (mGFR) based on 99mTechnetium–diethylenetriaminepentaacetic acid plasma clearance, and (3) the efficacy of an individualized multimodal and transitional nutritional intervention (MULTI-NUT-MED intervention) in older patients with or at risk of malnutrition in the ED. Methods The trial is a single-center block randomized, controlled, observer-blinded, superiority and explorative trial with two parallel groups. Th...

Background The course of coronavirus disease 2019 (COVID-19) seems to be aggravated by air pollution, and some industrial chemicals, such as the perfluorinated alkylate substances (PFASs), are immunotoxic and may contribute to an association with disease severity. Methods From Danish biobanks, we obtained plasma samples from 323 subjects aged 30–70 years with known SARS-CoV-2 infection. The PFAS concentrations measured at the background exposures included five PFASs known to be immunotoxic. Register data was obtained to classify disease status, other health information, and demographic variables. We used ordered logistic regression analyses to determine associations between PFAS concentrations and disease outcome. Results Plasma-PFAS concentrations were higher in males, in subjects with Western European background, and tended to increase with age, but were not associated with the presence of chronic disease. Of the study population, 108 (33%) had not been hospitalized, and of those ...

Aims: This article describes and discusses the extension of performance measurement using an episode-based approach so that the measurement includes primary care, and social and long-term-care services. By using data on incident stroke patients from the capital areas of four Nordic countries, this pilot study: (a) extended the disease-based performance analysis to include new indicators that better describe patient care pathways at different levels of care; (b) described and compared the performance of care given in the four areas; (c) evaluated how additional information changed the rankings of performance between the areas; and (d) described the trends in performance in the capital areas. Methods: The construction of data was based on a common protocol that used routinely collected national registers and statistics linked with local municipal registers. We created new variables describing the timing of discharge to home and institutionalisation, as well as describing the use and c...

Background: Being homeless entails higher mortality, morbidity, and prevalence of psychiatric diseases. This can lead to more frequent and expensive use of health care services. Medical respite care enables an opportunity to recuperate after a hospitalization and has shown a positive effect on readmissions, but little is known about the cost-effectiveness of medical respite care for homeless people discharged from acute hospitalization. Therefore, the aim of the present study was to investigate the cost-effectiveness of a 2-week stay in post-hospital medical respite care. Methods: A randomized controlled trial and cost-utility analysis, from a societal perspective, was conducted between April 2014 and December 2015. Homeless people aged >18 years with an acute admission were included from 10 different hospitals in the Capital Region of Denmark. The intervention group (n=53) was offered a 2-week medical respite care stay at a Red Cross facility and the control group (n=43) was dis...

Empirical analysis of hospitals in production economics often find little or no evidence of scale economies and quite small optimal sizes. Medical literature on the other hand provides evidence of better results for hospitals with a large volume of similar procedures. Based on a sample of Nordic hospitals and patients, we have examined whether the inclusion of quality variables in the production models changes estimates of scale elasticity. A sample of 58 million patient records from 2008 and 2009 in 149 hospitals in Denmark, Finland, Norway and Sweden were collected. Patient data DRG-points were aggregated into 3 outputs (medical inpatients, surgical inpatients and outpatients) and linked to operating costs for 292 observations. The patient data were used to calculate quality indicators on emergency readmissions and mortality within 30 days, adjusted for age, gender, comorbidities, hospital transfers and DRG using DRG-specific logistic regressions.The hypothesis that the elasticity...