Roadmap for developing acute community health care services - illustrated with the development in Danish municipalities

Introduction: Most Nordic countries have centralized the secondary health care sector within recent years, resulting in more complex treatment and health care services to be delivered by the primary health care sector. As a result, the political focus has been on improving collaboration and communication between the two health care sectors, in order to allow more patients to receive acute treatment and health care within their local community.

Acute community health care services have the potential to support continuity of care by bridging early recognition of acute disease, treatment, and care between the health care sectors.

Objectives: Our objective is to develop a conceptual roadmap supporting the development and comparison of acute community health care services in the primary health care sector. We illustrate the application of the roadmap on acute community health care services in Denmark with a status for implementation in 2022 meanwhile identifying gaps and potentials for learning.

Methods: The roadmap is structured and guided by policy documents about acute community health care services in Scandinavian countries and relevant scientific literature on integrated care and coordination in health care.

We then applied the roadmap to the Danish national framework for acute community health care services by analyzing survey data gathered by the Local Government Denmark.

Results: We identified two dimensions of main importance for the performance of acute community health care services: (1) capability & capacity, and (2) coordination & collaboration. These dimensions and the governance structure are of key importance to the acute community health care services performance.

All 98 Danish municipalities have implemented community acute health care services. However, regional differences exist between municipalities both in terms of capacity i.e., organizational model, staff composition, staff experience, tasks solved, and available diagnostic equipment, and in terms of capability, i.e. recruitment and availability of staff. Regarding choice of organizational model 56 % of municipalities have established stationary functions, 93 % outgoing functions and 69 % have established both. Variation also exists in terms of collaboration e.g., referrals and collaboration with other municipalities and coordination. In terms of the latter 60 % of municipalities have formalized their collaboration with regional hospitals in a written agreement, 7 % base their collaboration on an oral agreement and 33 % has no formalized agreement.

Conclusions: The roadmap for comparing acute community health care services is suited for highlighting the areas in need of further development in the acute community health care services. We illustrate the potentials for learning and improvement of these services in Denmark.

Implications: The roadmap can support the development, implementation, evaluation and monitoring of acute community health care services. It can be used by multiple actors on both national and local levels such as policy makers and allow researchers to do cross-country comparison.