Informing an assistive living technology intervention to prevent hospitalisations for home-dwelling older persons


Martha Therese Gjestsen


elderly patients, eldre pasienter, eldreomsorg, assistive living technology


This thesis describes the process of planning an assistive living technology intervention for home-dwelling older persons receiving community care. The use of such technologies in the community care setting is heralded as one answer to address the challenges facing the health care system, as well as a mean for the health and care services to improve, simplify and enhance the efficiency of their activities. Although the implementation of assistive living technologies is complex, the implementation is informed basically in two ways—directly, based on empirical reports, or indirectly, through systematic or meta-analytic reviews. The main objective of this thesis is to provide a theory and evidence-based rationale for applying an assistive living technology intervention in community care to prevent hospitalisations for older persons. By using hospital admissions which may be prevented as a case, exploring health care personnel’s and managers’ perspectives, and furthermore using existing theories and research concerning implementation, we have applied both an empirical and theoretical approach to inform a future assistive living technology intervention in the defined context. A socio-technical perspective has been applied; the different stakeholders involved on different organisational levels and the framework conditions constitute the socio technical system in the study, implying that a multi-level approach is appropriate to help identify potential barriers and incentives for the implementation of assistive living technologies in community care. Furthermore, has the Model for Understanding Success in Quality (MUSIQ) provided guidance to identify contextual factors likely to influence a future implementation process.

Author Biography

Martha Therese Gjestsen

Stavanger University Hospital


Aarons, G. A., Fettes, D. L., Sommerfeld, D. H. & Palinkas, L. A. (2012). Mixed methods for implementation research: application to evidence-based practice implementation and staff turnover in community-based organizations providing child welfare services. Child Maltreat, 17(1), 67-79.

Aarts, J. & Gorman, P. (2007). IT in health care: sociotechnical approaches "To Err is System". Int J Med Inform, 76 Suppl 1, S1-3.

Andreassen, K. K. (2010). Befolkningens størrelse og aldersfordeling. Seniorer i Norge.

Bartholomew, L. K. (2011). Planning health promotion programs : an intervention mapping approach. San Francisco: Jossey-Bass.

Bartz, C. C. & Kouri, P. (2013). eHealth Programme of the International Council of Nurses Finnish Journal of eHealth and eWelfare, 5(1).

Bauer, M. S., Damschroder, L., Hagedorn, H., Smith, J. & Kilbourne, A. M. (2015). An introduction to implementation science for the non-specialist. BMC Psychology, 3(1), 32.

Berg, M., Aarts, J. & van der Lei, J. (2003). ICT in health care: sociotechnical approaches. Methods Inf Med, 42(4), 297-301.

Bloom, D. E., Chatterji, S., Kowal, P., Lloyd-Sherlock, P., McKee, M., Rechel, B., … Smith, J. P. (2015). Macroeconomic implications of population ageing and selected policy responses. The Lancet, 385(9968), 649-657.

Bowes, A. & McColgan, G. (2013). Telecare for Older People: Promoting Independence, Participation, and Identity. Research on Aging, 35(1), 32-49.

Breen, R. L. (2006). A Practical Guide to Focus-Group Research.

Journal of Geography in Higher Education, 30(3), 463-475.

Brewster, L., Mountain, G., Wessels, B., Kelly, C. & Hawley, M. (2014). Factors affecting front line staff acceptance of telehealth technologies: a mixed‐method systematic review. Journal of Advanced Nursing, 70(1), 21-33.

Broderick, A. & Lindeman, D. (2013). Scaling Telehealth Programs: Lessons from Early adopters (Case studies in Telehealth Adoption). The Commonwealth Fund. Hentet fra

Brooks, J., McCluskey, S., Turley, E. & King, N. (2015). The Utility of Template Analysis in Qualitative Psychology Research. Qual Res Psychol, 12(2), 202-222.

Browning, S. V., Tullai-McGuinness, S., Madigan, E. & Struk, C. (2009). Telehealth: is your staff ready to implement? A descriptive exploratory study of readiness for this technology in home health care. Home Healthc Nurse, 27(4), 242-248.

Campbell, M., Fitzpatrick, R., Haines, A., Kinmonth, A. L., Sandercock, P., Spiegelhalter, D. & Tyrer, P. (2000). Framework for design and evaluation of complex interventions to improve health. BMJ : British Medical Journal, 321(7262), 694-696.

Catwell, L. & Sheikh, A. (2009). Evaluating eHealth Interventions: The Need for Continuous Systemic Evaluation. PLoS Medicine, 6(8), e1000126.

Chandra, A., Crane, S. J., Tung, E. E., Hanson, G. J., North, F., Cha, S.S. & Takahashi, P. Y. (2015). Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits. Aging and Disease, 6(3), 188-195.

Clegg, A., Young, J., Iliffe, S., Rikkert, M. O. & Rockwood, K. (2013). Frailty in elderly people. The Lancet, 381(9868), 752-762.

Cohn, S., Clinch, M., Bunn, C. & Stronge, P. (2013). Entangled complexity: why complex interventions are just not complicated enough. J Health Serv Res Policy, 18(1), 40-43.

Coiera, E. (2004). Four rules for the reinvention of health care. BMJ, 328(7449), 1197-1199.

Corrao, S., Santalucia, P., Argano, C., Djade, C. D., Barone, E., Tettamanti, M., … Marengoni, A. (2014). Gender-differences in disease distribution and outcome in hospitalized elderly: data from the REPOSI study. Eur J Intern Med, 25.

Courtney, K. L., Demiris, G. & Alexander, G. L. (2005). Information Technology: Changing Nursing Processes at the Point-of-Care. Nursing Administration Quarterly, 29(4), 315-322.

Crabtree, B. F. & Miller, W. L. (1999). Doing qualitative research Sage Publications.

Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I. & Petticrew, M. (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ, 337.

Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I. & Petticrew, M. (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ, 337, a1655.

Crane, S. J., Tung, E. E., Hanson, G. J., Cha, S., Chaudhry, R. & Takahashi, P. Y. (2010). Use of an electronic administrative database to identify older community dwelling adults at high-risk for hospitalization or emergency department visits: the elders risk assessment index. BMC Health Serv Res, 10, 338.

Creswell, J. W. (1994). Research design: qualitative & quantitative approaches. Thousand Oaks, Calif.: Sage.

Creswell, J. W. (2009). Research design: qualitative, quantitative, and mixed methods approaches. Los Angeles: Sage

Creswell, J. W. & Plano Clark, V. L. (2011). Designing and conducting mixed methods research. Los Angeles: Sage.

Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A. & Sheikh, A. (2011). The case study approach. BMC Medical Research Methodology, 11, 100-100.

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A. & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci, 4.

Davies HTO, P. A., Nutley SM. (2015). Mobilising knowledge to improve UK health care: learning from other countries and other sectors - a multimethod mapping study. Health Services and Delivery Research, No. 3.27.

Deraas, T. S., Berntsen, G. R., Jones, A. P., Forde, O. H. & Sund, E. R. (2014). Associations between primary healthcare and unplanned medical admissions in Norway: a multilevel analysis of the entire elderly population. BMJ Open, 4(4), e004293.

Dixon-Woods, M., Bosk, C. L., Aveling, E. L., Goeschel, C. A. & Pronovost, P. J. (2011). Explaining Michigan: Developing an Ex Post Theory of a Quality Improvement Program. Milbank Q, 89(2), 167-205.

Dixon-Woods, M., Shaw, R. L., Agarwal, S. & Smith, J. A. (2004). The problem of appraising qualitative research, 13(3), 223-225.

Drzensky, F., Egold, N. & van Dick, R. (2012). Ready for a Change? A Longitudinal Study of Antecedents, Consequences and Contingencies of Readiness for Change. Journal of Change Management, 12(1), 95-111.

Ellis, G., Whitehead, M. A., Robinson, D., O'Neill, D. & Langhorne, P. (2011). Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ, 343.

Epstein, A. M., Jha, A. K. & Orav, E. J. (2011). The relationship between hospital admission rates and Rehospitalizations. N Engl J Med, 365.

Eron, L. (2010). Telemedicine: the future of outpatient therapy? Clin Infect Dis, 51.

European Commission (2014). The EU explained:Digital agenda for Europe. Brussels: Directorate-General for Communication Citizens information. Downloaded from:

Finch, T. L., Mair, F. S., O'Donnell, C., Murray, E. & May, C. R. (2012). From theory to 'measurement' in complex interventions: Methodological lessons from the development of an e-health normalisation instrument. BMC Medical Research Methodology, 12(1), 69.

Flottorp, S., Oxman, A., Krause, J., Musila, N., Wensing, M. & Godycki-Cwirko, M. (2013). A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci, 8.

Fortinsky, R. H., Madigan, E. A., Sheehan, T. J., Tullai-McGuinness, S. & Kleppinger, A. (2014). Risk factors for hospitalization in a National Sample of Medicare home health care patients. J Appl Gerontol, 33.

Galdas, P. M., Cheater, F. & Marshall, P. (2005). Men and health help- seeking behaviour: literature review. J Adv Nurs, 49.

Gamper, G., Wiedermann, W., Barisonzo, R., Stockner, I. & Wiedermann, C. (2011). Inappropriate hospital admission: interaction between patient age and co-morbidity. Internal and Emergency Medicine, 6(4), 361-367.

Gjestsen, M. T., Brønnick, K. & Testad, I. (2018). Characteristics and predictors for hospitalizations of home-dwelling older persons receiving community care: a cohort study from Norway. BMC Geriatrics, 18(1), 203.

Gjestsen, M. T., Wiig, S. & Testad, I. (2014). What does it take? Healthcare professional's perspective on incentives and obstacles related to implementing ICTs in home-based elderly care. BMC Health Services Research, 14(2), P45.

Gjestsen, M. T., Wiig, S. & Testad, I. (2017). What are the key contextual factors when preparing for successful implementation of ALT in primary elderly care? A case study from Norway. BMJ Open, 7(9).

Greenberg, M. E. (2009). A comprehensive model of the process of telephone nursing. Journal of Advanced Nursing, 65(12), 2621- 2629.

Greenberg, M. E. (2009). A comprehensive model of the process of telephone nursing. J Adv Nurs, 65(12), 2621-2629.

Greenhalgh, T., Procter, R., Wherton, J., Sugarhood, P., Hinder, S. & Rouncefield, M. (2015). What is quality in assisted living technology? The ARCHIE framework for effective telehealth and telecare services. BMC Med, 13, 91.

Greenhalgh, T., Procter, R., Wherton, J., Sugarhood, P. & Shaw, S. (2012). The organising vision for telehealth and telecare: discourse analysis. BMJ Open, 2(4).

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P. & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q, 82(4), 581-629.

Greenhalgh, T., Shaw, S., Wherton, J., Hughes, G., Lynch, J., A'Court, C., … Stones, R. (2016). SCALS: a fourth-generation study of assisted living technologies in their organisational, social, political and policy context. BMJ Open, 6(2).

Greenhalgh, T., Shaw, S., Wherton, J., Vijayaraghavan, S., Morris, J., Bhattacharya, S., … Hodkinson, I. (2018). Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study. Journal of Medical Internet Research, 20(4), e150.

Grol, R. P., Bosch, M. C., Hulscher, M. E., Eccles, M. P. & Wensing, M. (2007). Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q, 85(1), 93-138.

Guise, V. & Wiig, S. (2017). Perceptions of telecare training needs in home healthcare services: a focus group study. BMC Health Services Research, 17, 164.

Hammersley, M. (1990). Reading ethnographic research: A critical guide. London: Longman.

Hanlon, P., Daines, L., Campbell, C., McKinstry, B., Weller, D. & Pinnock, H. (2017). Telehealth Interventions to Support Self- Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer. Journal of Medical Internet Research, 19(5), e172.

Health, D. o. (2005). Supporting People with long term conditions. An NHS and Social Care Model to support local innovation and integration.

Hendy, J., Chrysanthaki, T., Barlow, J., Knapp, M., Rogers, A. & Sanders, C. (2012). An organisational analysis of the implementation of telecare and telehealth: The whole systems demonstrator. BMC Health Serv Res, 12.

Hesse-Biber, S. N., Johnson, R. B., Hunter, A. & Brewer, J. D. Designing Multimethod Research. I. Hentet fra

Hippisley-Cox, J. & Coupland, C. (2013). Predicting risk of emergency admission to hospital using primary care data: derivation and validation of QAdmissions score. BMJ Open, 3(8).

Hoffmann, T. C., Glasziou, P. P., Boutron, I., Milne, R., Perera, R., Moher, D., … Michie, S. (2014). Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide, 348.

Hofmann, B. (2012). Ethical Challenges with Welfare Technology: A Review of the Literature. Sci Eng Ethics.

Huseby, B. M. (2014). Samdata spesialisthelsetjenesten 2013. Hentet fra

Huseby, B. M. r. (2015). Samhandlingsstatistikk 2013-14. Directorate of Health. Hentet fra

International, U. a. H. (2012). Ageing in the Twenty-First Century. A Celebration and A Challenge (978-0-89714-981-5). Downloaded from:

Jennett, P., Gagnon, M. & Brandstadt, H. (2005). Preparing for success: readiness models for rural telehealth. J Postgrad Med, 51(4), 279 - 285.

Jick, T. D. (1979). Mixing Qualitative and Quantitative Methods: Triangulation in Action. Administrative Science Quarterly, 24(4), 602-611.

Joseph, V., West, R. M., Shickle, D., Keen, J. & Clamp, S. (2011). Key challenges in the development and implementation of telehealth projects. J Telemed Telecare, 17(2), 71-77.

Juel, K. & Christensen, K. (2008). Are men seeking medical advice too late? Contacts to general practitioners and hospital admissions in Denmark 2005. J Public Health (Oxf), 30.

Juhnke, C. (2012). Clinical and service integration. The route to improved outcomes. International Journal of Integrated Care, 12, e199.

Julia, C. & Marilyn, M. L. (2011). A stakeholder‐centred exploration of the current barriers to the uptake of home care technology in the UK. Journal of Assistive Technologies, 5(1), 12-25.

Kang, H. G., Mahoney, D. F., Hoenig, H., Hirth, V. A., Bonato, P., Hajjar, I., … Innovative Technology Working Group on Advanced Approaches to Physiologic Monitoring for the, A. (2010). In Situ Monitoring of Health in Older Adults: Technologies and Issues. Journal of the American Geriatrics Society, 58(8), 1579-1586.

Kaplan, H. C., Brady, P. W., Dritz, M. C., Hooper, D. K., Linam, W. M., Froehle, C. M. & Margolis, P. (2010). The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q, 88(4), 500-559.

Kaplan, H. C., Froehle, C. M., Cassedy, A., Provost, L. P. & Margolis, P. A. (2013). An exploratory analysis of the Model for Understanding Success in Quality. Health Care Management Review, 38(4), 325-338.

Kaplan, H. C., Provost, L. P., Froehle, C. M. & Margolis, P. A. (2012). The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement. BMJ Qual Saf, 21(1), 13-20.

Khosravi, P. & Ghapanchi, A. H. (2015). Investigating the effectiveness of technologies applied to assist seniors: A systematic literature review. Int J Med Inform, 85(1), 17-26.

Kilbourne, A. M., Neumann, M. S., Pincus, H. A., Bauer, M. S. & Stall, R. (2007). Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implement Sci, 2.

Klausen, H. H., Petersen, J., Bandholm, T., Juul-Larsen, H. G., Tavenier, J., Eugen-Olsen, J. & Andersen, O. (2017). Association between routine laboratory tests and long-term mortality among acutely admitted older medical patients: a cohort study. BMC Geriatrics, 17(1), 62.

Koch, S. & Hagglund, M. (2009). Health informatics and the delivery of care to older people. Maturitas, 63(3), 195-199.

Landi, F., Onder, G., Cesari, M., Barillaro, C., Lattanzio, F., Carbonin, P. U. & Bernabei, R. (2004). Comorbidity and social factors predicted hospitalization in frail elderly patients. J Clin Epidemiol, 57.

Landi, F., Onder, G., Cesari, M., Barillaro, C., Lattanzio, F., Carbonin, P. U. & Bernabei, R. (2004). Comorbidity and social factors predicted hospitalization in frail elderly patients. Journal of Clinical Epidemiology, 57(8), 832-836.

Larson-Dahn, M. L. (2000). Tel-eNurse Practice: a practice model for role expansion. J Nurs Adm, 30(11), 519-523.

Leung, L. (2015). Validity, reliability, and generalizability in qualitative research. Journal of Family Medicine and Primary Care, 4(3), 324-327.

Leveson, N. (2004). A new accident model for engineering safer systems. Safety Science, 42(4), 237-270.

Lewin, D., Adshead, S. & Glennon, B. (2010). Assisted living technologies for older and disabled people in 2030.

Lewin, K. ( 1951). Field theory in social science : selected theoretical papers New York : Harper.

Li, J. (2010). A Sociotechnical Approach to Evaluating the Impact of ICT on Clinical Care Environments. Open Med Inform J, 4, 202- 205.

Lie, S. S., Karlsen, B., Oord, E. R., Graue, M. & Oftedal, B. (2017). Dropout From an eHealth Intervention for Adults With Type 2 Diabetes: A Qualitative Study. Journal of Medical Internet Research, 19(5), e187.

Lillebo, B., Dyrstad, B. & Grimsmo, A. (2012). Avoidable emergency admissions? Emergency Medicine Journal.

Lincoln, Y. S. & Guba, E. G. (1985). Naturalistic Inquiry SAGE Publications.

Lindahl, A. K. (2015). The Norwegian Health Care System. Hentet 04.06.2018 fra

Lluch, M. (2011). Healthcare professionals' organisational barriers to health information technologies-A literature review. Int J Med Inform, 80(12), 849-862.

Locsin, R. (2016). Technological Competency as Caring in Nursing: Co-creating Moments in Nursing Occurring Within the Universal Technological Domain. Journal of Theory Construction & Testing, 20(1), 5-11. Hentet fra

Lovett, H. & Barland, M. (2014). The Future of Ageing. Report from Scenario Workshop in Norway (PACITA - Parliaments and Civil Society in Technology Assessment).

Lyon, D., Lancaster, G. A., Taylor, S., Dowrick, C. & Chellaswamy, H. (2007). Predicting the likelihood of emergency admission to hospital of older people: development and validation of the Emergency Admission Risk Likelihood Index (EARLI). Family Practice, 24(2), 158-167.

Mair, F. S., May, C., O'Donnell, C., Finch, T., Sullivan, F. & Murray, E. (2012). Factors that promote or inhibit the implementation of e- health systems: an explanatory systematic review. Bull World Health Organ, 90(5), 357-364.

Malterud, K. (2012). Systematic text condensation: A strategy for qualitative analysis. Scand J Pub Health, 40, 795 - 805.

March, S. T. & Smith, G. F. (1995). Design and natural science research on information technology. Decision Support Systems, 15(4), 251-266.

Martinsen, K. (2006). Care and vulnerability. Oslo. Akribe.

May, C., Finch, T., Cornford, J., Exley, C., Gately, C., Kirk, S., … Rogers, A. (2011). Integrating telecare for chronic disease management in the community: What needs to be done? BMC Heal Serv Res, 11(1), 131.

May, C., Finch, T., Cornford, J., Exley, C., Gately, C., Kirk, S., … Mair, F. (2011). Integrating telecare for chronic disease management in the community: What needs to be done? BMC Health Services Research, 11(1), 131.

May, C. R., Finch, T., Ballini, L., MacFarlane, A., Mair, F., Murray, E., … Rapley, T. (2011). Evaluating complex interventions and health technologies using normalization process theory: development of a simplified approach and web-enabled toolkit. BMC Health Serv Res, 11, 245.

McHugh, M. L. (2012). Interrater reliability: the kappa statistic. Biochemia Medica, 22(3), 276-282.

McLean, S., Protti, D. & Sheikh, A. (2011). Telehealthcare for long term conditions. BMJ, 342.

McLean, S., Sheikh, A., Cresswell, K., Nurmatov, U., Mukherjee, M., Hemmi, A. & Pagliari, C. (2013). The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview. PLoS One, 8(8), e71238.

Meetoo, D. & Temple, B. (2003). Issues in Multi-Method Research: Constructing Self-Care, 2(3), 1-12.

Mendel, P., Meredith, L. S., Schoenbaum, M., Sherbourne, C. D. & Wells, K. B. (2008). Interventions in organizational and community context: a framework for building evidence on dissemination and implementation in health services research. Adm Policy Ment Health, 35.

Milligan, C., Roberts, C. & Mort, M. (2011). Telecare and older people: Who cares where? Social Science & Medicine, 72(3), 347- 354.

Morgan, D. L. (1997). Focus groups as qualitative research (2nd ed.). Thousand Oaks, Calif: Sage Publications

Morse, J. M. & Niehaus, L. (2009). Mixed method design: principles and procedures. Walnut Creek, Calif: Left Coast Press.

Mossialos, E., Wenzl, M., Osborn, R. & Sarnak, D. e. (2016). 2015 International Profiles of Health Care Systems. Commonwealth Fund.

Moullin, J. C., Sabater-Hernández, D., Fernandez-Llimos, F. & Benrimoj, S. I. (2015). A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework. Health Research Policy and Systems, 13(1), 16.

Mytton, O. T., Oliver, D., Mirza, N., Lippett, J., Chatterjee, A., Ramcharitar, K. & Maxwell, J. (2012). Avoidable acute hospital admissions in older people. Br J Healthc Manag, 18.

Nagel, D. A. & Penner, J. L. (2016). Conceptualizing Telehealth in Nursing Practice:Advancing a Conceptual Model to Fill a Virtual Gap. Journal of Holistic Nursing, 34(1), 91-104.

Newman, I. & Benz, C. R. (1998). Qualitative - Quantitative Research Methodology. Exploring the Interactive Continuum. Southern Illinois University Press: Carbondale and Edwardsville.

Norwegian Board of Technology (2009). Ageing of the future and new technology.

Norwegian Nurses Organisation (2013). Political Platform for Innovation and service development 2013-2016.

Official Norwegian Reports NOU 2011:11. Innovation in the Care Services. (2011). Ministry of Health and Care Services

Onwuegbuzie, A. J., Dickinson, W. B., Leech, N. L. & Zoran, A. G. (2009). A qualitative framework for collecting and analyzing data in focus group research. International journal of qualitative methods, 8(3), 1-21.

Patton, M. Q. (2014). Qualitative Research & Evaluation Methods: Integrating Theory and Practice SAGE Publications.

Polit, D. & Beck, C. (2004). Nursing research : Principles and methods (7th ed. utg.). Philadelphia Pa: Lippincott Williams & Wilkins.

Pols, J. (2010). The Heart of the Matter. About Good Nursing and Telecare. Health Care Analysis, 18(4), 374-388.

Purdy, S. & Huntley, A. (2013). Predicting and Preventing Hospital admissions. A review. . J R Coll Physicians Edinb 2013; 43:340-4, (43), 4.

PwC. (2015). Ressursbruk i pleie- og omsorgssektoren Betydningen av organisering, edelse og kultur.

Rafferty, A. E., Jimmieson, N. L. & Armenakis, A. A. (2013). Change Readiness:A Multilevel Review. Journal of Management, 39(1), 110-135.

Rasmussen, J. (1997). Risk management in a dynamic society: a modelling problem. Safety Science, 27(2-3), 183-213.

Rechel, B., Doyle, Y., Grundy, E. & McKee, M. (2009). How can health sytems respond to population ageing? European Observatory on Health Systems and Policies, Policy Brief 10.

Rechel, B., Grundy, E., Robine, J.-M., Cylus, J., Mackenbach, J. P., Knai, C. & McKee, M. (2013). Ageing in the European union. The Lancet, 381(9874), 1312-1322.

Regitz-Zagrosek, V. (2012). Sex and gender differences in health: Science & Society Series on Sex and Science. EMBO Reports, 13(7), 596-603.

Report to Parliament no. 47 (2008-2009). Coordination reform; Right treatment the right place at the right time.

Report to Parliament no. 29 (2012-1013). Future Care.

Richards, D. E., Rahm Hallberg, I. (Ed.). . (2015 ). Complex Interventions in Health. An overview of research methods. London: Routledge.

Ringard, Å., Sagan, A., Saunes, I. S. & Lindahl, A. K. (2013). Norway. Health system review (Health Systems in Transistion). The European Observatory on Health Systems and Policies.

Roland, M. & Abel, G. (2012). Reducing emergency admissions: are we on the right track? BMJ, 345, e6017.

Roland, M., Dusheiko, M., Gravelle, H. & Parker, S. (2005). Follow up of people aged 65 and over with a history of emergency admissions: analysis of routine admission data. BMJ, 330.

Rossman, G. B. & Wilson, B. L. (1985). Numbers and Words:Combining Quantitative and Qualitative Methods in a Single Large-Scale Evaluation Study, 9(5), 627-643.

Salisbury, C., Thomas, C., O'Cathain, A., Rogers, A., Pope, C., Yardley, L., Montgomery, A. A. (2015). TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation. BMJ Open, 5(2).

Sandelowski, M. (2000). Devices and desires: Gender, Technology and American Nursing. The University of North Carolina Press: Chapel Hill and London.

Sinclair, H. S. A. & Furey, A. (2016). Reducing unplanned hospital admissions in Older people with high needs: a review of local practice in a small sample of primary care patients in an inner London borough. 2016, 6(2), 11.

Solli, H., Bjørk, I. T., Hvalvik, S. & Hellesø, R. (2012). Principle-based analysis of the concept of telecare. Journal of Advanced Nursing, 68(12), 2802-2815.

Soria-Aledo, V., Carrillo-Alcaraz, A., Campillo-Soto, A., Flores- Pastor, B., Leal-Llopis, J., Fernandez-Martin, M. P., … Aguayo- Albasini, J. L. (2009). Associated factors and cost of inappropriate hospital admissions and stays in a second-level hospital. Am J Med Qual, 24(4), 321-332.

Statistics Norway (2007). Health and health care utilization - gender differences (ISSN 0806-2056).

Statistics Norway (2015). January 1st 2015; table 09503 Statistics Norway. I. Downloaded from:

Statistics Norway (2017). Kommunale helse- og omsorgstjenester 2016. Statistikk om tjenester og tjenestemottakere.

Stavanger kommune. (2014). Selvstendig, trygg og aktiv. Strategi for implementering av velferdsteknologi 2014-2017. Downloaded from:

Steventon, A., Bardsley, M., Billings, J., Dixon, J., Doll, H., Hirani, S., Newman, S. (2012). Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ: British Medical Journal, 344.

Stroetmann, K. A. (2015). Patient-centric Care and Chronic Disease Management: A Stakeholder Perspective. Stud Health Technol Inform, 208, 324-330.

Strømgaard, S., Rasmussen, S. W. & Schmidt, T. A. (2014). Brief hospitalizations of elderly patients: a retrospective, observational study. Scand J Trauma Resusc Emerg Med, 22.

Syse, A. P., Dinh Q.; Keilman, Nico. (2016). Befolkningsframskrivinger 2016-2100: Statitics Norway: Dødelighet og levealder. Økonomiske analyser 3/2016. Befolkningsframskrivinger 2016-2100: Dødelighet og levealder. Hentet fra

Taylor, J., Coates, E., Brewster, L., Mountain, G., Wessels, B. & Hawley, M. S. (2015). Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption. Journal of Advanced Nursing, 71(2), 326-337.

Texmon, I. S., Nils Martin (2009). Rapporter 2009/9: Arbeidsmarkedet for helse- og sosialpersonell fram mot år 2030. Dokumentasjon av beregninger med HELSEMOD 2008 Statistics Norway. Hentet fra

United Nations. (2015). World Population Ageing United Nations, Department of Economic and Social Affairs, Population Division.

Van Dyk, L. (2014). A Review of Telehealth Service Implementation Frameworks. International Journal Of Environmental Research And Public Health, 11(2), 1279.

van Houwelingen, C. T. M., Moerman, A. H., Ettema, R. G. A., Kort, H. S. M. & ten Cate, O. (2016). Competencies required for nursing telehealth activities: A Delphi-study. Nurse Educ Today, 39, 50-62.

Wiig, S. (2008). Contributions to risk management in the public sector Faculty of Social Sciences, University of Stavanger, Stavanger.

Wilkinson, J. M. (2007). Nursing process and critical thinking (4th ed. utg.). Upper Saddle River, N.J: Pearson/Prentice Hall.

Winter, G. (2000). A Comparative Discussion of the Notion of 'Validity' in Qualitative and Quantitative Research. The Qualitative Report, 4(3)(1-14). Hentet fra

Wootton, R. (2012). Twenty years of telemedicine in chronic disease management - an evidence synthesis. J Telemed Telecare, 18(4), 211-220.

World Health Organization (2009). Global Standards for the Initial Education of Professional Nurses and Midwives. Geneva

Yackel, T. R. & Embi, P. J. (2010). Unintended errors with EHR-based result management: a case series. Journal of the American Medical Informatics Association, 17(1), 104-107.

Yin, R. K. (2014). Case study research : design and methods (5th ed. utg.). Los Angeles, Calif: SAGE.

Young, B. (2001). Postpositivism and Educational Research. 15(4), 206-206.

Øvretveit, J. (2011). Understanding the conditions for improvement: research to discover which context influences affect improvement success. BMJ Quality & Safety, 20(Suppl 1), i18-i23.

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