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The dataset includes data from the two studies reported in our 'Terror Management in a Multicultural Society' paper. The data was collected at the psychology lab at the Vrije Universiteit Amsterdam in 2013/2014 among Dutch-speaking student samples. The dataset consists of the measures described in the paper. The data can be used for replication purposes, meta-analyses, and exploratory analyses, as well as cross-cultural comparisons of mortality salience effects. The authors also welcome collaborative research based on re-analyses of the data. [ABSTRACT FROM AUTHOR]

Introduction: Stroke care is complex and often provided by various healthcare organisations. Integrated care solutions are needed to optimise stroke care. In this paper, we describe the development of integrated stroke care in the region of Maastricht during the last 15 years. Description of integrated care case: Located in the south of the Netherlands, the region of Maastricht developed integrated stroke care to serve a population of about 180,000 people. Integration was needed to improve the continuity, coordination and quality of stroke care. The development of integrated care in Maastricht was a phased process. The last phase emphasized early discharge from hospital and assessing the best individual rehabilitation track in a specialized nursing home setting. Discussion and lessons learned: The development and implementation of integrated stroke care in the region of Maastricht led to fewer days in hospital, more patients being directly admitted to the stroke unit and an earlier start of rehabilitation. The implementation of early discharge from the hospital and rehabilitation assessment in a nursing home led to some unforeseen problems and lessons learned. [ABSTRACT FROM AUTHOR]

Introduction: Observational data are increasingly seen as a valuable source for integrated care research. Especially since the growing availability of routinely collected data and quasi-experimental methods. The aim of this paper is to describe the potentials and challenges when using observational data for integrated maternity care research, based on our experience from developing and working with the Data-InfrAstructure for ParEnts and childRen (DIAPER). Methods and Results: We provide a description of DIAPER, which is a linked datainfrastructure on the individual level based on maternity care claims data, quality and utilization of maternity care and data from municipal registries, covering the life course from preconception to adulthood. We then discuss potentials and practical applications of DIAPER such as to evaluate alternative payment models for integrated maternity care, to set the policy agenda regarding postpartum care, to provide insights into value of care and into provider variation, and to evaluate (policy) interventions designed to promote and support integrated maternity care. This is relevant for several stakeholders: policy makers, payers, providers and clients/patients. Based on experiences with DIAPER, we identify remaining challenges: missing data sources (especially self-reported outcomes), suboptimal quality of data, privacy concerns and potential biases introduced during data linkage, and describe how these challenges were tackled within the applications of DIAPER. Conclusions: With DIAPER we demonstrated that using observational data can be of added value for integrated care research, but also that challenges remain. It is essential to keep exploring and developing the possibilities of observational data and continue the discussions in the scientific community. Learning from each other's successes and failures will be critical. [ABSTRACT FROM AUTHOR]

As European governments adopt new circular built environment policies to cope with the socio-ecological crisis, the need for evaluating such policies gains in urgency. Ex post evaluation is, however, difficult as these policies have not been in place long enough to have had significant effects. Nonetheless, ex ante policy evaluation may be possible by assessing policy coherence or the alignment and synergies of policy goals, instruments and implementation practices. This paper proposes a framework to analyse circular built environment policies. This framework is based on a combination of two existing analytical frameworks: circular city development and policy coherence analysis. The framework is tested for the case of a circular built environment in campus development at Delft University of Technology in the Netherlands, which is regarded as an urban development proxy. Policy documents and semi-structured interviews were analysed and coded. Results confirm previous findings about a prevailing focus on looping actions and indicates limited policy instrumentalisation across governance levels. Identified multilevel (in)coherence in circular city policy is pointed out as consequence of siloed-led and supply chain-based thinking and underdeveloped circular policy frameworks. Finally, the analytical benefits of circular city development and policy coherence frameworks are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Network platforms are interesting for integrated care governance as they seek solutions for the problem of competition and tensions between networks. In this paper, we analyse how a network platform functions for the actors involved, and how it is used in their work. Methods: We employed a case study in a Dutch urbanised hospital region, and conducted 17 interviews with hospital physicians, directors, and supporting staff who are involved in a network platform called “BeterKeten” (BK). Results: Actors assign different functions and purposes to BK: facilitating and legitimising professional (learning) communities; adapting to a changing policy context; enlarging professionals’ and the networks’ circle of influence; and extending governing possibilities. Network platform’ dynamics and frictions entail changing professional and managerial practices; embedding a BK network in a partner network; and alignment of (conflicting) network platforms. Discussion: Network platforms are a promising strategy to govern, facilitate, and nurture network-building actions to enhance integrated care, offering new ways of working to cope with its multi-level nature. Conclusion: BK is a dynamic actor with steering capacities that enables the coexistence of multiple purposes. Further research could pay attention to how network platforms are able to develop modalities of integrated care governance that suit healthcare system’s networked character. [ABSTRACT FROM AUTHOR]

Background: In Ireland, as in many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of chronic disease. Integrated care is an approach to healthcare systems delivery that aims to minimise fragmentation of patient services and improve care continuity. To this end, how best to integrate primary and secondary care is a challenge. This paper aims to undertake a scoping review of empirical work on the integration of primary and secondary care in relation to chronic disease management. Methods: A search was conducted of 'PubMed', 'Cochrane Library' and 'Google Scholar' for papers published between 2009-2019 using Arksey and O'Malley's framework for conducing scoping reviews. Results: Twenty-two studies were included. These reported research from a wide range of healthcare systems (most commonly UK, Australia, the Netherlands), adopted a range of methodologies (most commonly randomised/non-randomised controlled trials, case studies, qualitative studies) and among patients with a range of chronic conditions (most commonly diabetes, COPD, Parkinson's disease). No studies reported on interventions to address the needs of whole populations. Interventions to enhance integration included multidisciplinary teams, education of healthcare professionals, and e-health interventions. Among the effectiveness measures reported were improved disease specific outcomes, and cost effectiveness. Conclusion: With healthcare systems increasingly recognising that integrated approaches to patient care can enhance chronic disease management, considerable literature now informs how this can be done. However, most of the research published has focussed on specific diseases and their clinical outcomes. Future research should focus on how such approaches may improve health outcomes for populations as a whole. [ABSTRACT FROM AUTHOR]

New approaches are needed to achieve the scale and standard of building retrofit required to meet climate targets. Transition experiments are innovation projects that take a societal challenge as their starting point; they can be both top-down (government led) and bottom-up (civil society led). However, such experiments often remain isolated events that have little impact on delivering systemic change. There is limited knowledge on why this is so and what can be done to increase the success of experiments. The paper therefore compares the top-down approach to piloting Local Heat and Energy Efficiency Strategies (LHEES) in Scotland with the bottom-up strategy used for the Social Innovation Labs for a Zero Energy Housing Stock (SMILE) in the Netherlands. The different approaches are compared using three mechanisms to characterise systemic change: deepening, broadening and scaling up. Using data from interviews with local authority and citizen actors, the paper shows that neither top-down nor bottom-up experiments are sufficient in themselves to foster the new norms, information-sharing or legislative mechanisms needed to reach climate targets. The paper specifies elements of top-down and bottom-up experiments which can usefully be incorporated for achieving systemic change in energy retrofitting. [ABSTRACT FROM AUTHOR]

Background: Patient reported outcomes and experience measures (PROM and PREM) provide an opportunity to prioritize patients' health goals in care decisions and quality improvement. In perinatal care, the use of PROM and PREM is scarce and limited to research and quality purposes. The International Consortium of Health Outcomes Measurement (ICHOM) published an outcome set for pregnancy and childbirth (PCB set), including PROM and PREM. In the Netherlands, the PCB set was implemented in a pilot project with the primary goal to integrate its PROM and PREM in clinical practice over the full course of pregnancy and postpartum care. To ensure continuity of care, the project was explicitly organized within integrated obstetric care networks (OCN): collaborating with all care professionals and organizations involved. Objectives: This study aimed to report first outcomes, experiences, and practice insights of implementing the PCB set in clinical practice of perinatal care. We assessed compliance to the PROM and PREM questionnaires, outcomes per domain, and clinical use of threshold values. Methods: Seven OCN across the Netherlands, each consisting of one or two hospitals and multiple community midwifery practices (2 - 18), implemented the PROM and PREM of the PCB set as part of clinical routine. This observational study included all women participating in the clinical project who gave informed consent for research purposes. The PROM and PREM were assessed with questionnaires at five timepoints: two during pregnancy and three postnatally until six months postpartum. Clinical threshold values (alerts) supported physicians interpretating the answers, indicating worrisome outcomes per domain. Data collection took place from February 2020 till September 2021. Questionnaires were assessed mostly digital - in one site on paper. Data analysis included missing (pattern) analysis, sum scores, alert rates, and sensitivity analysis. Results: In total 1923 questionnaires were collected across the five timepoints: 816 at T1 (first trimester), 793 at T2 (third trimester), 125 at T3 (maternity week), 170 at T4 (6 weeks postpartum) and 19 at T5 (6 months postpartum). Of these, 84% were filled out completely. Missing items per domain ranged from 0 to 13%, with highest missing rates for depression, pain with intercourse and experience with pain relief at birth. No notable missing patterns were found. Relatively high alert rates were found for urine incontinence (27%), pain with intercourse (25%), breastfeeding selfefficacy (23%) and mother-child binding (45%). Regarding PREM domains, most alerts were found for birth experience (23%), shared decision making (11%) and discussing pain relief antepartum (41%). Some domains showed very little clinical variation: mother role and satisfaction with care. Conclusions: The PCB set is a useful and acceptable tool to assess patient reported outcomes that need to be addressed over the whole course of pregnancy and childbirth. Our findings reveal a window of opportunity to improve and personalize perinatal care. Furthermore, based on our findings we could propose several recommendations about the methods and timeline of PROM and PREM measurement based. This study supports further implementation of the PCB set in clinical practice and the transformation towards patient centred value driven care. [ABSTRACT FROM AUTHOR]

Taking many forms across contextually diverse and complex settings, models of health care delivery described as integrated, commonly share an assumption that the model will improve the individuals experience and enable the individual to be in a better position to self-manage their health and any related ongoing health care needs. Engaging with, and being focussed on, what is important to the individual patient is widely accepted as being foundational in realising the immediate and longer-term individual, population and health system benefits of an integrated model of health care delivery. However, the practice of co-designing person-level outcome measures, that reflect what matters and is valued at the individual patient level and applying these to shape and evaluate health care delivery, is not common practice. Objectives: To identify pragmatic approaches (that have been applied in real-life settings) to understanding how individuals construct their expectations and/or experiences of an integrated model of health care delivery across a range of settings. To identify how person-level outcomes, that describe issues and outcomes important to the individual, could shape the integrated model of health care delivery. To propose recommendations on the benefits and insights that person-level outcomes offer integrated model of health care delivery across a range of settings. Study selection: Peer-reviewed empirical studies published in English within the last 10 years from June 2018, set within the context of an integrated model of health care delivery, with participants being adults (18 years or greater) living in the community self-managing and/or having been exposed to the integrated model, the focus of inquiry was the perspective and/or experience of the participant and the data analysis explored the issues and outcomes important to that participant, rather than an attribute of or issues at the provider, service, or system level, were included. Search Strategy: The search of Ovid MEDLINE, EBSCO CINAHL, SCOPUS Elsevier and ProQuest Health & Medicine databases with selected key words, yielded 707 records. 38 records were added following review of reference lists. 61 duplicates removed, leaving 684 potentially relevant records. Initial screening excluded 490 records. Remaining 194 records were screened, excluding 121 records due to study design (68), participants (25), intervention (21) or not full text (7). Indepth review of the 73 records assessed as addressing the research question resulted in 19 records being omitted for study design and 49 for the phenomena of interest. A total of 5 papers were determined eligible and included in the review. Data Extraction: All eligible papers were qualitative studies, exploring the views of individuals using indepth interviews and focus groups. The studies originated from United Kingdom (2), Australia (1), Netherlands (1) and USA (1). Participants were all community living adults, with sample size ranging from 23 to 230. As the aim of the review was to capture how information was collected, how it was applied and the potential significance, a bespoke data extraction tool was developed. Data Synthesis and key findings: A descriptive synthesis was undertaken, and a detailed narrative summary of the key findings will be presented. [ABSTRACT FROM AUTHOR]

Introduction: Older people living at home may experience problems in the physical, cognitive, psychological, social and/or environmental life domains, leading to complex care needs. Integration of health and social care is widely acknowledged as an adequate way to address these complex needs. An important component of integrated care programs is a comprehensive geriatric assessment CGA which helps to identify older people's care needs and preferences. A CGA provides the basis for a tailored care plan, consisting of specific actions to support older people in their homes. In the wide range of integrated care programs for frail older people, different CGA tools are being used. To the best of our knowledge, a comprehensive overview of the characteristics of the different CGA tools is currently lacking. The aim of our study was therefore to describe and compare different CGA tools and procedures for conducting them. Methods: A systematic literature search in the electronic databases Embase/Medline and Scopus was conducted to search for papers describing CGAs in integrated care programs for older people living at home. Our search yielded 814 potentially relevant publications. Two researchers independently assessed eligibility based on title and abstract and full text screening. In total, 26 integrated care programs were included in our review. The identified integrated care programs were reviewed as to their main characteristics: country, program objective, target group, setting and involved professionals. Data extraction for information about the CGAs included: CGA tool/instruments, comprehensiveness i.e. life domains being addressed, multidisciplinarity i.e. extent to which professionals from different disciplines are involved, person-centredness i.e. extent to which older people and informal carers are involved and procedures to conduct a CGA. Results: Included studies shows a great variety of CGAs used in integrated care programs. Most integrated care programs were implemented in the Netherlands and the United States. The majority of CGAs seemed to address comprehensiveness, multidisciplinarity and personcentredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. Furthermore, some identified instruments are broadly used in different countries e.g. RAI-CHA, whereas others e.g. [G]OLD instrument are developed and used exclusively in one specific program. Discussion/conclusion: This study shows that integrated care programs, in different settings and for different target groups, have different ways of conducting a CGA. Due to this heterogeneity, older people's needs and preferences are being assessed and addressed in different ways. It is still unclear what works best in conducting a CGA in the context of integrated care and whether the existing range of CGAs is adequate. Limitations/suggestions for future research: We did not include the entire range of existing CGAs in this review, as several papers did not adequately describe the CGA tool and procedures used. A more thorough description of CGAs as a component of an integrated care program is recommended to complement the current overview of CGAs. Further research is recommended to develop guidance on how older people's problems and care needs should best be assessed and to prevent researchers and professionals from reinventing the wheel. [ABSTRACT FROM AUTHOR]

Introduction: Health care systems are struggling to deal with the increasing demands of an older population. In an attempt to find a solution to these demands, there has been a shift towards integrated care supported by information and communication technologies. However, little is understood about the role played by incentives and reimbursement schemes in the development of integrated care and information and communication technologies uptake. The objective of this paper is to investigate this question, specifically as regards telehealthcare. Methods: In order to identify the deployment of telehealthcare applications and their role in supporting integrated care, a case study approach was used. A clustering exercise was carried out and eight European countries were selected for in-depth study: Denmark, Estonia, Germany, France, Italy, the Netherlands, Spain and the UK. In total, 31 telehealthcare initiatives across eight countries involving over 20,000 patients were investigated. Results: Reflecting on specific examples in each initiative, drivers promoting integrated care delivery supported by telehealthcare mainstreaming and associated incentive mechanisms were identified. Attention was also paid to other factors which acted as barriers for widespread deployment. Discussion and conclusions: Trends towards telehealthcare mainstreaming were found in Denmark, the UK, and in some regions of Spain, Italy and France. Mainstreaming often went hand-in-hand with progress towards integrated care delivery and payment reforms. A general trend was found towards outcomes-based payments and bundled payment schemes, which aimed to promote integrated care supported by telehealthcare deployment. Their effectiveness in achieving these goals remains to be seen. In addition, a form of outpatient diagnostic-related group reimbursement for telehealthcare services was found to have emerged in a few countries. However, it is questionable how this incentive could promote integrated care delivery on its own. This research suggests that incentives which align social, primary and hospital care are rare and there is a need to design new payment paradigms. Finally, eHealth penetration, interoperability, governance, availability of evidence and reorganisation of services represent additional factors which can act as drivers or barriers for integrated care delivery. [ABSTRACT FROM AUTHOR]

Introduction: A remarkable difference in care delivery pathways for Chronic Obstructive Pulmonary Disease (COPD) is the presence of hospital- at-home for COPD exacerbations in England and its absence in the Netherlands. The objective of this paper is to explain this difference. Methods: Descriptive COPD statistics and care delivery pathways on all care levels within the institutional context, followed by a comparison of care delivery pathways and an explanation of the difference with regard to hospital-at-home. Results: The Netherlands and England show broad similarities in their care delivery pathways for COPD patients. A major difference is the presence of hospital-at-home for COPD exacerbations in England and its absence in the Netherlands. Three possible explanations for this difference are presented: differences in the urgency for alternatives (higher urgency for alternative treatment models in England), the differences in funding (funding in England facilitated the development of hospital-at-home) and the differences in the substitution of tasks to nurses (substitution to nurses has taken place to a larger extent in England). Discussion and Conclusion: The difference between the Netherlands and England regarding hospital-at-home for COPD exacerbations can be explained in three ways. Hospital-at-home has proved to be a safe alternative for hospital care for selected patients, and should be considered as a treatment option for COPD exacerbations in the Netherlands. [ABSTRACT FROM AUTHOR]

Introduction: Stepped care strategies are potentially effective to organise integrated care but unknown is whether they function well in practice. This paper evaluates the implementation of a stepped care programme for depression in primary care and secondary care. Theory and methods: We developed a stepped care algorithm for diagnostics and treatment of depression, supported by a liaison-consultation function. In a 21/2 year study with pre-post design in a pilot region, adherence to the protocol was assessed by interviewing 28 caregivers of 235 patients with mild, moderate, or severe major depression. Consultation and referral patterns between primary and secondary care were analysed. Results: Adherence of general practitioners and consultant caregivers to the stepped care protocol proved to be 96%. The percentage of patients referred for depression to secondary care decreased significantly from 26% to 21% (p=0.0180). In the post-period more patients received treatment in primary care and requests for consultation became more concordant with the stepped care protocol. Conclusions: Implementation of a stepped care programme is feasible in a primary and secondary care setting and is associated with less referrals. Discussion: Further research on all subsequent treatment steps in a standardised stepped care protocol is needed. [ABSTRACT FROM AUTHOR]

Objective: The objective of this policy paper is to put recent developments in Dutch mental health reform in an international perspective and draw conclusions for future directions in policy. Context of the case: The practice of Western psychiatry in the second half and particularly in the last decade of the 20th century has fundamentally changed. Dutch psychiatry has traditionally been prominently bed-based and various policies in the last ten years have been intended to reduce the influence of the mental hospitals. Until the mid-1990s, this had not resulted in reducing the psychiatric bed rate in comparison to other countries. Since then, there have been rapid, dramatic changes. Data sources: We summarised two recent national studies on this subject and placed them in a national and international context, using documents on psychiatric reforms, government and advisory board reports and reviews on deinstitutionalisation in different countries. Case description: The practice of psychiatry in the second half, and particularly in the last decade, of the 20th century has fundamentally changed. This has resulted in a spectacular decline in the number of beds in mental hospitals, increased admissions, decreased length of stay, closure of the large asylums and in community treatment away from asylums and in society, although this is a reform process. This article examines how the Dutch mental health care system has developed at the national level. The main topics cover the size, nature, aims and effects of the process of deinstitutionalisation and how alternative facilities have been developed to replace the old-fashioned institutes. Conclusions and discussion: There are two contrasting aspects of deinstitutionalisation in Dutch mental health care: the tendency towards rehospitalisation in relation to the sudden, late, but rapid reduction of the old mental hospitals and their premises; and a relatively large scale for community-based psychiatry in relation to building mental health care centres. Compared to other countries the bed rate in the Netherlands is still among the highest, although it is rapidly decreasing. Lessons from psychiatric reform in other countries emphasise the counterpart of deinstitutionalisation, especially issues such as the quality of alternative community treatment and increasing compulsory admission, while the closing down of old mental hospitals has caused a decrease in the availability of beds. In the Netherlands less attention has been paid to legislation, societal attitudes towards psychiatry, the roles of other care suppliers, the balancing and financing of care, the fate of psychiatric patients from old hospitals, the way to cope with the ever-increasing demand for psychiatric help and the actual quality of psychiatric help. A more integrative policy that includes all these aspects is desirable. [ABSTRACT FROM AUTHOR]

Introduction: change towards patients/citizens who have more information, are educated and active regarding their health process is an important part of the evolution that all health systems need to integrate in all aspects of their activities, management and design. In Europe, the White Paper reiterates the importance of participation in any individual or collective health process whether in local or regional contexts. In our country, the Basic Law on Patient Autonomy Regulation and Rights and Obligations Regarding Clinical information and Documentation recognizes the patients 'capacity to choose and influence the organisations that represent them. The active participation of patients represents a new way of understanding therapeutic relationships, one that is respectful of patients' rights and potentially beneficial for the therapeutic process. The main objective of this project is to promote patient involvement in order to help improve/design healthcare strategies; to achieve this goal, we will be implementing a patient group dynamic that is currently used in the Dutch health system. Short description: this project comprises the setting up of patient focus groups (named "mirror meetings" in The Netherlands) where patients' contacts with the health system will be discussed so health professionals can learn and improve from the experiences of these patients. This dynamic allows patients/citizens that have been in contact with health services/units/procedures... (COPD, surgical or Hospital at Homepatients...) to communicate their experiences, satisfaction, positive outcomes, to improve aspects... It's a patient focus group attended also by professionals so they can learn from patients ' opinions. These steps will be followed throughout the process: first the topic of debate will be chosen. Later, patients who have been in contact with that area/service will be contacted and consent obtained if they wish to take part. The next step will be group formation and debate; information from these debates will be gathered by witnessing professionals in situ; this information will be double checked with the patients that took part. Finally, the organisation will aim to implement, whenever suitable, those suggestions that are considered viable. For evaluation purposes, the utility of these groups will be measured based on patient/professional satisfaction and implemented suggestions. Targeted population and stakeholders: citizens from whom we, as health professionals, can learn after listening to their experiences as patients. We believe that society as a whole will be our stakeholder since this is a topic that will hopefully improve health provision. Timeline: this is a project aimed to be started in October of 2018 and that will run through the first semester of 2019 Transferability: the strategies will first be tested on a couple of units/health centers and the aim is to reach the whole OSI or even the whole of the Basque Health Service- Osakidetza once the pilot study is finished and its usefulness is confirmed. [ABSTRACT FROM AUTHOR]

Introduction: Home-living older peoples often use many medications and the majority routinely take more than five prescription drugs, and are therefore prone to drug-related problems DRPs. For the management of DRPs, integrated primary care by the homecare, general practice and pharmacy is desired. The Homecare Observation of Medication-related problems by homecare Employees HOME-instrument is paper-based and assists homecare workers in reporting potential DRPs. To facilitate integrated multi professional consultation in primary care a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between homecare and general practices and/or pharmacies is desired. The objective of this study was to develop and evaluate the usability of eHOME, a mobile version of the HOME-instrument consisting of a report, monitoring and consulting system for primary care and to evaluate the type of DRPs revealed by eHOME, integrated care activities and the impact of DRPs on discomfort and clinical deterioration in homecare patients. Theory/Methods: The development phase of the Medical Research Council Framework was followed in which an iterative human-centered design approach was applied. The approach involved a Delphi-round for context of use and user requirements analysis of eHOME, followed by two series of pilots for testing the usability and redesign. The study was performed in 18 homecare teams n18, general practices 7 and pharmacies n10 in several settings in the Netherlands. Subsequently, a pilot study with one-year follow up was carried out in one primary care setting in the Netherlands consisting of 7 home care teams, 7 general practices and 6 pharmacies. Outcomes are: 1 types of DRPs in homecare patients, 2 integrated care activities and 3 classification of the clinical impact of DRPs on patients' discomfort and deterioration unlikely to cause discomfort/clinical deterioration, potential to cause moderate discomfort/clinical deterioration and potential to result in severe discomfort/clinical deterioration. Results: The human-centered design study resulted in eHOME including a report, monitoring and consulting system for the primary care. The results of the pilot study will be expected in May 2018. Conclusion: The eHOME-instrument was found as convenient, clear and easy to use. eHOME can also be used by informal caregivers and professionals caregivers in other settings. Suggestions for future research: Future research on the cost-effectiveness of eHOME in primary care on patient related outcomes e.g. patient satisfaction, quality of life and care related outcomes e.g. changes in care program, consultation moments with the general practitioner, admission to nursing homes and hospitals is needed. [ABSTRACT FROM AUTHOR]

Background: In the western world, a growing number of the older people live at home. In the Netherlands, GPs are expected to play a pivotal role in the organization of integrated care for this patient group. However, little is known about how GPs can play this role best. Our aim for this study was to unravel how GPs can play a successful role in elderly care, in particular in multidisciplinary teams, and to define key concepts for success. Methods: A mixed qualitative research model in four multidisciplinary teams for elderly care in the Netherlands was used. With these four teams, consisting of 46 health care and social service professionals, we carried out two rounds of focus-group interviews. Moreover, we performed semi-structured interviews with four GPs. We analysed data using a hybrid inductive/deductive thematic analysis. Results: According to the health care and social service professionals in our study, the role of GPs in multidisciplinary teams for elderly care was characterized by the ability to 'see the bigger picture'. We identified five key activities that constitute a successful GP role: networking, facilitating, team building, integrating care elements, and showing leadership. Practice setting and phase of multidisciplinary team development influenced the way in which GPs fulfilled their roles. According to team members, GPs were the central professionals in care services for older people. The opinions of GPs about their own roles were diverse. Discussion: In the opinions of health care and social professionals in our study, GPs should not be hesitant to take the initiative to organize multidisciplinary teams for the care of older people with complex needs. In position papers, physicians are urged to reform health care to more sustainable systems. Some advocate that GPs should take the lead in reforming primary care. Limitations of this study are the nature and size of our sample and the local setting. GPs' key concepts for multidisciplinary elderly care teams will probably be relevant for countries where the GP has a similar pivotal position as in the Netherlands, such as in Scandinavian countries, the United Kingdom, and Canada. Our findings will gain strength by studying successful multidisciplinary teams in other western countries. Conclusions: GPs took an important role in successful care settings for older people. Five key concepts seemed to be important for best practices in care for frail older people. Team members from primary care and social services indicated that GPs had an indispensable role in such teams. It would be advantageous for GPs to be aware of this attributed role. Attention to leadership competencies and to the diversity of roles in multidisciplinary teams in GP training programmes seems useful. The challenge is to convince GPs to take a lead, also when they are not inclined to take this role in organizing multidisciplinary teams for older people. [ABSTRACT FROM AUTHOR]

Introduction: Integral obstetric care is currently being implemented in the Netherlands in various models of care. In the Netherlands pregnant women are primarily cared for by midwifes and depending on the obstetrical healthcare plan of the women the gynecologist has a larger or smaller involvement. Short description of practice change implemented: We developed an eHealth application to manage obstetrical healthcare plans based on local protocols. Targeted population and stakeholders: All women participating community and hospital based obstetrical healthcare can make use of this application, to facilitate coordinated protocolized care by multiple professionals and to empower patients to be a partner in deciding on and carrying out their healthcare plan. Aim: The aim of the app is to provide patients and health care providers assistance in administering obstetrical healthcare management plans based on over 50 regional protocols developed by a collaborative of primary and secondary obstetrical caregivers. The app offers an overview for patients and their health care providers. Specific individualized patient information is offered at an appropriate time in pregnancy, allowing patients to access information independently from health care visits. Moreover, healthcare providers receive reminders of appropriate steps in health management plans and have access to actions that previous providers have already discussed or completed. Thereby, the app enhances transfer of complete and up-to-date interdisciplinary patient information, resulting in improved situational awareness and the flexibility to adapt the individuals' healthcare plan accordingly during the pregnancy. Timeline & highlights: The application was implemented in the region Kennemerland in the Netherlands yearly 3000 pregnancies in October 2017. In the third quarter of 2017 we assessed patient and health care provider healthcare satisfaction with a questionnaire on paper. In February and March 2018 we will assess the usability of the app using patient focus groups. Furthermore, we will determine whether the eHealth application has improved the healthcare provider satisfaction and communication. Patient satisfaction cannot yet be reported since as only few women will have completed the full 9-month trajectory of the app. Results will be presented at the congress. [ABSTRACT FROM AUTHOR]

Background: Transfer of patient care information between organizations is usually done by means of a transfer by paper: the patient himself hands the information over from the multidisciplinary team from one organization to another. In 2012, a stroke care pilot project regarding transfer of nursing and paramedical patient information, Cross-enterprise Document Sharing XDS, was started. Organizations from the Rotterdam Stroke Service n=19 in the Netherlands started a collaboration with "Care-portal Rijnmond", a safe gateway where health care organizations can exchange information in an easy, safe and reliable way. The assumption is that health care will be delivered in a more efficient and effective manner when ICT is used, even when organizations have different electronical patient file systems. Methods: A panel of experts in stroke care stroke nurses, neurologists, rehabilitation specialists, elderly care physicians reached consensus about the content of patient information that is necessary for a qualitative good, timely and correct information transfer. They used the Delphi method, a structured communication technique to reach consensus. The national standards ICT institute in Healthcare, Nictiz, were integrated in the project. For the diverse parts of the project, different project leaders were installed. These project leaders developed detailed project-plans. The project leaders were also the ambassadors for the project and were seeking for funding. The involved professionals and project leaders had every week skype meetings or face to face meetings. They kept the project on the agenda in the health care organizations. Results: Already existing agreements concerning the collaboration in the integrated care service were adjusted and new agreements regarding the innovative project were made. The information about the project was shared with multiple stakeholders. The initial developed dataset was translated to the general information "building bricks" from Nictiz. Software was chosen and ICT systems were adjusted to the new working method. A viewer for viewing patient information was installed. Tests showed that information was received earlier and was more complete available for example for the rehabilitation unit after the patients' discharge. The professionals were able to develop a rehabilitation plan for an individual patient, even if the patient was not transferred yet. When the patient was admitted, they could start immediately with rehabilitating that patient. Discussion/conclusion: Information is quickly available and therefore treatment can start earlier. It may benefit for example the rehabilitation process positively. Furthermore, this is an uniform solution based on standards, and therefore useful for multiple patient groups. It is assumable that the patient will profit and have better rehabilitation outcomes. Limitations and lessons learned: There were multiple new parties and it was therefore a challenge to reach consensus. Furthermore, because the delay there was a change of professionals over time, which means that these professionals had to be informed and introduced in the project. And lastly, over time safety and privacy regulations changed and new interventions were needed to cope with the new regulations. This is an ongoing project, with the goal to connect all organizations by means of XDS. [ABSTRACT FROM AUTHOR]

Introduction: Recently, in Dutch health care the focus is shifting from a disease oriented approach to a more population based approach. Since in The Netherlands every inhabitant is listed with one general practice, this offers a unique possibility to perform PHM analyses based on these practice lists. The Adjusted Clinical Groups ACG model is a worldwide used method for both concurrent and prospective population based analyses. However, the ACG system is developed with non-Dutch data. Consequently, for wider implementation in Dutch general practice the system needs to be validated in the Dutch setting. In this paper we show the results of the first use of the ACG system in Dutch general practice. Methods: The population for this first analysis consists of 26 306 persons listed in five participating Dutch general practices. ACG analyses were performed based on primary care diagnosis and pharmaceutical historical data of 2014. Results: Six different resource utilization bands RUBs were identified, resulting in 226 persons in the highest band. The RUB classification corresponded to the number of GP contacts per person. The distribution of all persons according to the ACG was made. In the population, next to minor and major symptoms, the main ACG categories were persons with 2-3 other ADGs, > 34 years and 6-9 other ADG Combinations, 0-1 major ADG, > 34 years. The general practitioners did not expect this second main group and wanted more detail information. Next, a more in-depth analyses of the heavy users more than 40 consultations per year showed that almost all persons in this group were diagnosed with a depression. Conclusions and limitations: The results of this study show that the ACG model is a useful tool to stratify Dutch primary care populations. However, the available data were not fit to validate the risk functions of the ACG model. Further research to validate the model in a Dutch primary care setting is needed. Future research: Based on this first analysis more primary care organisations and the largest Dutch health care insurance company are interested in using the ACG system. A more thorough validity study is in preparation in which we focus on face validity, convergent validity and predictive validity using data on the population listed in the participating practice and corresponding claims data. We plan to have the first results in April 2018. [ABSTRACT FROM AUTHOR]

Integrated care means doing justice to life in all its facets and supporting it where that is necessary for the client. This advocates the coordination of different forms of care and support and the integrated use of data that is available on these different facets of life. It can be challenging to provide the necessary care, in particular when different people are involved and decisions need to be based on care plans, reports, and other types of information originating from different individuals. However, there is a common understanding that technology is an important facilitator in tackling this challenge. Technology already supports care processes and complements the role of people in many ways. For instance, it takes over tasks and helps to save time, obtain new insights and simplify complexity. Most of the time, using technology comes down to creating, collecting, analyzing and applying big data, or combinations of these. In fact, all our actions - in healthcare, as in society in general - are directed by subjective and objective data, which is often hidden in the minds of people, but also increasingly collected digitally. Until now, the use of different technologies and data is too often not integrated in the organization and put away in separate silos as the use of a technical instrument in care processes is often initiated for specific reasons that do not affect the entire organization or client population. Meanwhile though, more and more opportunities are coming up to connect the different data flows that exist in healthcare, and to utilize the data both organization-transcending as for the individual client. Developments in intelligent software systems AI, amongst others, offer the possibility to rapidly collect, integrate, exchange, edit and analyze large amounts of data. This allows people to respond more proactively to incidents, gain new insights about health, provide customized care and support and improve the cooperation between individuals and disciplines. However, many longterm care organizations in The Netherlands experience these opportunities as something elusive and find it hard to take advantage of them. Though many organizations in Dutch longterm care are interested in the exploration of data-driven healthcare, a common challenge is that enthusiastic innovators within care organizations often have limited time to invest in data-driven care, and do so alone or with the support of only few colleagues. Therefore, innovators from different organizations regularly come together within networks where they share experiences and experiment. At the same time, despite the promises of data-driven healthcare, there are many dilemmas around privacy, security, access to data, risk of stigmatization and medicalization and the increasing dependence on technology, for instance. When experimenting, the dilemmas should be taken seriously and in co-creation between multiple organizations, codes of conduct on these issues can be developed step-by-step. This paper will share some experiences and lessons learned, both by individual organizations and in workshops in which they collaborated. The approach is that by creating room for experimenting, starting small and sharing experiences with other parties, 'big data' can be made small. [ABSTRACT FROM AUTHOR]

In pursuing person-centredness and cost containment in long-term care, policy makers and academics stress the importance of public participation and co-production with communities. When citizen involvement is interpreted as increasing their ownership over local care arrangements - either meant literally or as a sense of being in control - it potentially affects the roles of professional and community actors beyond a mere redistribution of responsibilities. While the issue has become a core concern in both policy and academic debates, not much is known about what it means for professional care organizations when profound strategic influence of citizens is pursued. This paper draws on 18 months of ethnographic field work, studying representatives of a professional care organization negotiating the design and delivery of services with inhabitants of a small town in the north of the Netherlands. Looking at attempts to transform a 'traditional' professional care home into a joint initiative of professional and community actors, I focus on how the various actors involved draw different symbolic boundaries between what they see as 'professional' and 'community' domains and their corresponding roles. As such notions are malleable and change over time, I explore how their evolving meaning affects - and is affected by - the degree of actual ownership that citizens experience over local care service delivery. The case study reveals some of the complexities of attempting to achieve higher levels of community ownership over activities traditionally dominated by professional organizations. On one hand, a substantial boundary shift took place by opening up space for citizens to negotiate issues that were initially decided for them. Still, it was a common reflex for organizational representatives to impose barriers when citizens actually tried to exert influence. Although boundaries seemed to be shifting, they did not disappear; professional actors struggled to reconcile 'letting go' to enable meaningful participation, with 'staying in control' to meet organizational requirements. Some dealt with this tension by clearly demarcating the domain in which citizen involvement was deemed possible and desirable. Others instead engaged in blurring organizational boundaries by - actively or passively - involving citizens in adjusting 'internal' policies and processes to accommodate local needs or preferences. These two approaches resembled different ways in which the organization's relation to citizens was characterized. When emphasizing citizens' role as client-consumer or volunteer _for_ the organization, they were granted less strategic agency than when portraying them as 'equal partners' in designing and delivering local care services. This study sheds light on how different perspectives on community engagement evolve and interact when attempting to transform the relationship between professional care organizations and the communities they work with. It shows how such attempts can potentially lead to fundamental questions about who defines the boundaries of the professional organization and how far citizens' strategic agency can go. Whereas the current paper focuses on how actors redraw and give meaning to such boundaries during the start-up of a joint initiative, future research is required for investigating how such dynamics evolve as the initiative matures. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands, disease management programs (DMPs) are used to treat chronic diseases. Their aim is to improve care and to control the rising expenditures related to chronic diseases. A bundled payment was introduced to facilitate the implementation of DMPs. This payment is an all-inclusive price per patient per year for a pre-specified care package. However, it is unclear to which extent the costs of developing and implementing DMPs are included in this price. Consequently, the organizations providing DMPs bear financial risk because the development and implementation (D&I) costs may be substantial. The aim of this paper is to investigate the variability in and drivers of D&I costs among 22 DMPs and highlight characteristics that impact these. Methods: The data was analyzed using a mixed methods approach. Descriptive statistical analysis explored the variability in D&I costs as measured by a self-developed costing instrument and investigated the drivers. In addition, qualitative research, including document analysis and interviews, was conducted to explain the possible underlying reasons of cost variability. Results: The development costs varied from €5,891 to €274,783 and the implementation costs varied from €7,278 to €387,879 across DMPs. Personnel costs were the main component of development. Development costs were strongly correlated with the implementation costs (p = 0.55), development duration (p = 0.74), and number of FTEs dedicated DMP development. Organizations with large size and high level of care prior to the implementation of a DMP had relatively low development costs. These findings were in line with the cross-case qualitative comparison where programs with a longer history, more experienced project leadership, previously established ICT systems, and less complex patient populations had lower D&I costs. Conclusions: There is wide variation in D&I costs of DMPs, which is driven primarily by the duration of the development phase and the staff needed to develop and implement a DMP. These drivers are influenced by the attributes of the DMP, characteristics of the target population, project leadership, and ICT involved. There are indications of economies of scale and economies of scope, which may reduce D&I costs. Lessons learned for research development: D&I costs of DMPs are substantial and should be incorporated in economic evaluation studies. In addition, the case-mix of patients included in a DMP is associated with the D&I costs. Limitations: The costs that facilitated the DMP development and occurred prior to it were not available. Future research: should investigate whether the D&I costs per patient decrease in the longer term due to the broader inclusion of patients in DMPs. [ABSTRACT FROM AUTHOR]