The HighHealthCare study: A new model of care for people who need it most
In Norway, one in ten patients accounts for almost two-thirds of all healthcare use. These are people with the most complex needs — often older adults living with several chronic conditions, frequent hospital stays, and heavy reliance on home care. Meeting their needs well, and sustainably, is one of the biggest challenges facing Norwegian healthcare in the years ahead.
The HighHealthCare study, led by Lovisenberg Diaconal Hospital (LDS) in Oslo, is developing and testing a new way of caring for this group: a tailored intervention that combines digital home follow-up with other coordinated healthcare services, delivered by health personnel with the right competence at the right time — bridging the gap between hospital and municipal care.
Why this matters
A pilot study by LDS and Oslo's Gamle Oslo district reviewed the records of around 200 patients with the highest healthcare use. Nearly two in five had a substance use or psychiatric disorder alongside their physical illness. More than a third died within a year. Six in ten lived alone. The findings pointed to a group of patients that the healthcare system, split between hospital and municipality, often struggles to follow up well — and who could
benefit from more joined-up, individually tailored care.
What the project is doing
The study follows Ophelia, an internationally recognised method for developing healthcare interventions together with the people who will use them, in three stages:
1. Understanding the need. Around 500 patients across four Oslo districts, Bodø municipality, and the two hospitals will complete surveys on their health, health literacy and quality of life, alongside in-depth interviews with a smaller group. This builds a detailed picture of who these patients are and what stands in the way of good care.
2. Designing the solution together. Patients, family carers, nurses, doctors, physiotherapists and other professionals will take part in workshops to shape the content of the new service — deciding, together, what tailored follow-up and digital home monitoring should actually look like in practice.
3. Putting it to the test. In the final and largest phase, 332 patients will be randomly assigned to either the new intervention or standard care, so the research team can measure, rigorously, whether it improves patients' health, quality of life and use of healthcare services — and whether it saves money.
A shared effort
The project brings together Lovisenberg Diaconal Hospital, the Oslo districts of Gamle Oslo, St. Hanshaugen, Grünerløkka and Sagene, Bodø Municipality and Nordland Hospital, together with researchers from VID Specialized University, Lovisenberg Diaconal University College, the University of Oslo, and La Trobe University in Australia. It runs from 2026 to 2029.
If successful, the HighHealthCare study won't just describe the problem of high healthcare utilisation — it will offer municipalities and hospitals a tested, ready-to-use model for caring for some of their most vulnerable patients, more safely, more humanely, and more sustainably.
Principal Investigator HighHealthCare-study