Interregional clinical dashboard

In the dashboard, users can make a range of selections. The user's choices are highlighted with dark blue boxes and symbols.

The area (Somatics, Mental Health Services, Lab and Radiology, or Necessary Health Services) for which one wishes to obtain statistics is selected in the left margin. The chosen area is marked with dark blue highlighting.

Within the areas, there is statistics on sub-areas (for the Somatics area, the sub-areas are: Outpatient Clinics, Emergency Admissions, Focus Areas, and Procedure-related). The desired sub-area for which one wishes to obtain statistics is selected in the tabs at the top of the dashboard. The chosen sub-area is marked with dark blue highlighting.

Selection of Admission Areas:

Here, one selects the admission areas for which they wish to obtain statistics. Admission areas can be selected at three levels: RHF areas, HF areas, and hospital areas. Norway is always displayed. The number of selected admission areas will be shown in the selection button.

Selection of Year:

Here, the year for which one wishes to obtain statistics is selected. The choice is marked with dark blue highlighting.

Selection of Period:

Here, the period for which one wishes to obtain statistics is selected: 1st quarter, 2nd quarter, or for the entire year combined. The chosen period is marked with dark blue highlighting.

Other Choices:

Depending on what one is viewing, there are also other choices, such as Including/Excluding contracted specialists, Inpatients/Bed Days, Cost/Volume, etc. The choice is marked with dark blue highlighting.

Selection of Sample:

The sample for which one wishes to obtain statistics is selected in the right menu. The right menu can be a long list, and scrolling may be necessary. The chosen sample is marked with dark blue ticks, and the figure caption changes accordingly.

Illustrations

The statistics in the dashboard can be presented in various ways; as a Table, Bar Chart, Timeline, and for some sub-areas as Patient Flows. The choice of illustration is made by selecting one of the four symbols at the bottom left of the dashboard. The choice is marked with dark blue highlighting.

Tables, bar charts, and patient flows are displayed for the selected year and the selected period, while the timeline is shown for all the years to which the statistics in the dashboard apply.

In the bar charts, a blue scale is used to differentiate between the levels of admission areas, where the bar for Norway is light blue, bars for admission areas at the RHF level are slightly darker, bars for admission areas at the HF level are dark blue, and bars for admission areas at the hospital level are even darker blue.

The statistics are based on the data sources NPR – Somatic Specialist Health Services (NPR-SOM) and NPR – Contract Specialists in Somatic Specialist Health Services (NPR-AvtaleSOM). The sources contain information about patients and the healthcare they have received through the public specialist health service. Private and insurance-funded services are not included.

The data covers healthcare in the public specialist health service, namely:

• Contract specialists in somatic fields
• Somatic hospitals and departments within public health enterprises
• Somatic departments in publicly funded private institutions in the specialist health service (including breach-of-contract providers)
• Private rehabilitation institutions in the specialist health service

The statistics for Adult Mental Health Care (VOP) are based on the data sources NPR - Adult Mental Health Care (NPR-PHV) and NPR - Contract Specialists in Mental Health Care (NPR-AvtalePHV). These sources contain information about patients and the healthcare they have received in adult psychiatric departments and outpatient clinics in public health enterprises, in private institutions for mental health care, and from contract specialists with specialist training in psychology or psychiatry.

Healthcare provided to adults with mental disorders in child and adolescent psychiatric departments, in somatic departments, or in departments for specialised treatment of substance and addiction disorders is not included in the basis for the statistics for VOP.

The statistics for Child Mental Health Care (PHBU) are based on the data source NPR - Mental Health Care for Children and Young People (NPR-PHBU). This source contains information about patients and the healthcare they have received in child and adolescent psychiatric departments and outpatient clinics in public health enterprises and in private institutions for mental health care for children and young people.

Healthcare provided to children and young people with mental disorders by private contract specialists, in adult psychiatric departments, in somatic departments, or in departments for specialised treatment of substance and addiction disorders is not included in the basis for the statistics for PHBU.

The statistics for Interdisciplinary Specialised Substance Treatment (TSB) are based on the data source NPR - Interdisciplinary Specialised Substance Treatment (NPR-TSB). This source contains information about patients and the healthcare they have received in departments and outpatient clinics for specialised treatment of substance and addiction disorders in public health enterprises and in publicly funded private substance institutions within specialist healthcare.

Healthcare provided to young people and adults with substance and addiction disorders in mental health care, in somatic departments within specialist healthcare, or by contract specialists is not included in the basis for the statistics for TSB.

Privately and insurance-funded services are not included in the statistics, either for VOP, PHBU, or TSB.

Aggregated data files from NPR for analysis and management information are published on the FHI website (https://www.fhi.no/he/npr/styringsdata-for-rhf/).

Annual waiting list data are used to calculate waiting times and the number of new referrals. Therefore, the quarterly statistics for waiting times and new referrals will only be updated when the annual waiting list data are published.

These files do not contain information about gender, and age is defined in age groups (0-9 years, 10-19 years, 20-39 years, 40-59 years, 60-69 years, 70-79 years, and 80+). The rates for the number of new referrals are therefore only age-adjusted rates.

Due to the age group classification in the waiting list data, it may be that the samples do not correspond in terms of age. For example, the rates for outpatient consultations for Paediatrics are calculated for children aged 0-17 years, while the rates for new referrals for Paediatrics are calculated for children aged 0-19 years.

5-year relative survival is based on calculations and data provided by the Cancer Registry.

Disclaimer: The Cancer Registry is not responsible for the presentation or interpretation of the figures.

All contacts with the somatic specialist healthcare service have been counted based on reporting to the NPR from public hospitals, publicly funded private hospitals, and from privately practising specialists with agreements for publicly funded treatment.

Private contracted specialists are defined as all private hospitals with ISF funding and all privately practising specialists with agreements for publicly funded treatment on behalf of regional health enterprises. Private non-commercial hospitals, such as Diakonhjemmet Hospital, Haraldsplass Diaconal Hospital, and Lovisenberg Diaconal Hospital, are considered public hospitals in the Dashboard.

The rates are gender- and age-adjusted per 100,000 inhabitants in the relevant age and gender group using direct methods, with the population of Norway in 2024 as the reference population. The population figures are sourced from Statistics Norway (SSB). 

The rates for the number of new referrals are only age-adjusted rates. 

Rates for the 1st and 2nd quarter

To make the rates for the quarters comparable with the rates for the entire year, the population figures have been adjusted to reflect that the periods constitute 4/12 and 8/12 of the whole year. 

For the 1st quarter, the population figures have therefore been multiplied by 4/12, and for the 2nd quarter, the population figures have been multiplied by 8/12.

To analyse and characterise variation, Wennberg described three different groups of healthcare services with varying degrees of variation (Wennberg (2010), see figure below): necessary treatment, preference-sensitive healthcare services, and supply-sensitive healthcare services.

Necessary healthcare services

The first group consists of conditions with clear diagnostic criteria, where patients always seek medical help, where hospital treatment is the only treatment option, and where effective treatment is known. This group is characterised by treatment rates that reflect the actual morbidity of the population for these conditions. It is estimated that approximately 10–15% of all treatment provided in specialist healthcare services pertains to patients in this group. Surgery for hip fractures and colorectal cancer are examples. If greater variation is found between admission areas for conditions that fall under the category of necessary healthcare services, it is worth considering whether there are differences in morbidity or a genuine undercapacity. Alternatively, it may be due to patients not receiving necessary treatment or being mismanaged.

Preference-sensitive healthcare services

The second group is often described as preference-sensitive healthcare services. These are healthcare services where there are usually several possible treatment options and where the indication for, and health benefits of, the treatment may be disputed within the professional community or actually unclear. It is estimated that approximately 25% of all treatment provided in specialist healthcare services pertains to this group of services. This is particularly true within surgical fields where the surgeon's or department's preferences and subjective judgement can influence treatment choices, sometimes even contrary to good evidence-based practice. Here, one often sees greater variation than in the first group. Examples of this are well documented in the health atlas "Day Surgery in Norway 2011–2013" (Balteskard et al. 2015). It shows considerable variation between admission areas for, for example, tonsillectomy and cataract surgery, without underlying factors such as demographics and morbidity in the population being able to explain the variation.

Supply-sensitive healthcare services

The third group that Wennberg operates with is called supply-sensitive healthcare services and encompasses 50–60% of the activity in specialist healthcare services. Examples of such services may include correction of "droopy eyelids" or light treatment for skin disorders. Variation in the availability of these services is estimated to be the primary cause of variation in healthcare. It is characterised by the availability of healthcare services in the form of hospital beds, intensive care capacity, medical specialists, and capacity for imaging diagnostics affecting demand. With an increase in capacity, new patients are treated until the capacity is filled, without necessarily reflecting improved health at either the individual or population level.

The observed variation consists of random and systematic variation. There is no single measure that indicates whether the observed variation is large or small, or justified or unjustified (Ibáñez 2009). A common measure is the ratio between the extremes as an indication of whether the observed variation is large or small. If there are twice as many events in one recording area compared to another, it is often said that the variation is large or significant. At the same time, consideration must be given to the number of events and the size of the denominators. If the numbers are small, the contribution of random variation will be greater. For very small numbers, the random variation will be so dominant that it will be impossible to assess whether the observed variation contains a systematic component or is merely caused by chance. Generally, the proportion of the total variation that is due to chance will be smaller with larger denominators, more events, fewer recording areas, and smaller differences in the denominators across the various recording areas. In the dashboard, we have used *Relative ratio* as a measure of variation. *Relative ratio* is the rate in the recording area relative to the national rate, and therefore measures deviation from the national average. A weakness of this measure is that it implicitly assumes that the national average indicates the correct level of healthcare utilisation. We have no evidence to suggest that this is generally the case, and usually, one does not know what the correct level is. *Relative ratio* should therefore be used with caution, and there is greater uncertainty in the measure the fewer recording areas and events one considers.

Relevant publications related to the dashboard:

Balteskard, L., T. Deraas, O. H. Førde, T. Magnus, F. Olsen, and B. Uleberg (2015). Day Surgery in Norway 2011-2013, selected procedures. SKDE report, 1/15. ISBN: 978-82-93141-16-7.

Ibáñez, B., J. Librero, E. Bernal-Delgado, S. Peiró, B. López-Valcarcel, N. Martínez, and F. Aizpuru (2009). “Is there much variation in variation? Revisiting statistics of small area variation in health services research.” BMC Health Serv. Res. 9.1.