82 results
Search Results
2. Towards a better integrated stroke care: the development of integrated stroke care in the southern part of the Netherlands during the last 15 years (Special 10th Anniversary Edition paper).
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Heijnen, Ron, Limburg, Martien, Evers, Silvia, Beusmans, George, Der Weijden, Trudy van, and Schols, Jos
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INTEGRATED health care delivery , *STROKE rehabilitation , *MEDICAL quality control , *RANDOMIZED controlled trials - Abstract
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]
- Published
- 2012
3. Observational Data for Integrated Maternity Care: Experiences with a Data-Infrastructure for Parents and Children in the Netherlands.
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SCHEEFHALS, ZOË T. M., DE VRIES, ELINE F., MOLENAAR, JOYCE M., NUMANS, MATTIJS E., and STRUIJS, JEROEN N.
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MATERNAL health services ,HEALTH policy ,DATABASES ,CONTENT mining ,DATABASE management ,INFORMATION retrieval ,INFORMATION resources ,INTEGRATED health care delivery ,POSTNATAL care ,PARENTS - Abstract
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]
- Published
- 2023
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4. Ex ante analysis of circular built environment policy coherence.
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Ancapi, Felipe Bucci
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BUILT environment ,URBAN sociology ,ENVIRONMENTAL policy - Abstract
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]
- Published
- 2023
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5. How does a Network Platform Work for Participating Actors Towards Integrated Care Governance? A Case Study of a Dutch Hospital Region.
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VAN DER WOERD, OEMAR, VAN VEEN-BERKX, ELIZABETH, VAN DER SCHEER, WILMA, and BAL, ROLAND
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PROFESSIONAL practice ,AFFINITY groups ,CLINICAL governance ,SCIENTIFIC observation ,ATTITUDES of medical personnel ,RESEARCH methodology ,INTERVIEWING ,EXECUTIVES ,COMMUNITIES ,BUSINESS networks ,URBAN hospitals ,LEARNING ,CONFLICT (Psychology) ,CASE studies ,DECISION making ,UNOBTRUSIVE measures ,INTERPROFESSIONAL relations ,RESEARCH funding ,INTEGRATED health care delivery ,PHYSICIANS ,OCCUPATIONAL adaptation ,MANAGEMENT ,DATA analysis software - Abstract
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]
- Published
- 2022
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6. Retrofitting at scale: comparing transition experiments in Scotland and the Netherlands.
- Author
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HOFMAN, PETRA, WADE, FAYE, WEBB, JANETTE, and GROENLEER, MARTIJN
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RETROFITTING of buildings ,ENERGY consumption of buildings ,GOVERNMENT policy - Abstract
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]
- Published
- 2021
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7. All About That Face (No Trouble?) An Analysis of the Dutch Ban on Face-Covering Garments in Light of the ECHR, ICCPR and CEDAW, together with Feminist Theory.
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BUERKERT, JOHANNA, SCHUT, MICHAËL, and SZUHAI, LILI
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FEMINIST theory ,SEX discrimination against women ,POLITICAL rights ,POLITICAL conventions ,HUMAN rights ,INTERNATIONAL law - Abstract
The Dutch ban on face-covering garments (BFG) has caused a considerable amount of debate in the Netherlands since its entry into force on August 1, 2019. Questions have been raised as to whether this law is discriminatory towards those who wear fullface veils for religious reasons, as these individuals, almost exclusively women, will be excluded from public life based on their religion. Inspired by this debate, this paper analyzes the Dutch BFG from a regional and international law perspective. More specifically, this paper seeks to analyze Dutch BFG in light of the European Convention on Human Rights, the International Covenant on Civil and Political Rights and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). Additionally, feminist theories play an auxiliary role in specifying CEDAW obligations from a feminist perspective. While the ban may be justified from the point of view of the European Convention on Human Rights, it is problematic from the perspectives of the International Covenant on Civil and Political Rights and the Convention on the Elimination of All Forms of Discrimination against Women. Further research should therefore investigate this tension to determine how these frameworks can be reconciled while considering that the standard set by the European Court of Human Rights only provides a minimum level of protection. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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8. Integrating Primary and Secondary Care to Enhance Chronic Disease Management: A Scoping Review.
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MURTAGH, SARA, MCCOMBE, GEOFF, BROUGHAN, JOHN, CARROLL, ÁINE, CASEY, MARY, HARROLD, ÁINE, DENNEHY, THOMAS, FAWSITT, RONAN, and CULLEN, WALTER
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DISEASE management ,SECONDARY care (Medicine) ,MEDICAL personnel ,PRIMARY care ,CHRONIC diseases - Abstract
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]
- Published
- 2021
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9. Help me understand what is important to you, co-designing outcome measures that matter to people: A systematic review of the literature.
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Patterson, Karen, Jackson, Debra, and Travaglia, Joanne
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INTEGRATED health care delivery ,META-analysis ,MEDICAL care ,MEDICAL databases ,PATIENTS' attitudes ,HEALTH outcome assessment - Abstract
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]
- Published
- 2019
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10. Comprehensive geriatric assessment in integrated care for older people living at home: a systematic review.
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Stoop, Annerieke, Lette, Manon, van Gils, Paul, Nijpels, Giel, Baan, Caroline, and de Bruin, Simone
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GERIATRIC care units ,HOME care of older people ,META-analysis - Abstract
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]
- Published
- 2018
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11. Patient reported outcomes and experience measures in perinatal care to guide clinical practice: the first results.
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Depla, Anne Louise, Lamain-Ruiter, Marije, Laureij, Lyzette L., Ernst-Smelt, Hiske, Hazelzet, Jan, Franx, Arie, and Bekker, Mireille N.
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MATERNAL health services ,CHILDBIRTH ,PROFESSIONS ,HEALTH outcome assessment ,CONFERENCES & conventions ,PATIENT-centered care ,PATIENTS' attitudes ,EXPERIENCE ,QUESTIONNAIRES ,LEGAL compliance ,EVALUATION - Abstract
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]
- Published
- 2022
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12. Identifying Differences in Frames of Reference That Are Hard to Reconcile During the Process of Normative Integration to Deliver Care for People with Multiple Problems: A Mixed-Method Delphi Study in the Netherlands.
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Reinhoudt-den Boer, Lieke, Huijsman, Robbert, and van Wijngaarden, Jeroen David Hendrikus
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CHRONIC disease treatment ,CONSENSUS (Social sciences) ,SOCIAL workers ,FOCUS groups ,INCOME ,MENTAL health ,COMPULSIVE behavior ,LEGAL procedure ,INTERVIEWING ,QUESTIONNAIRES ,RESIDENTIAL patterns ,DEBT ,UNEMPLOYMENT ,JUDGMENT sampling ,DESCRIPTIVE statistics ,PROBLEM solving ,PARENTING ,THEMATIC analysis ,RESEARCH methodology ,DOMESTIC violence ,SOCIAL networks ,CASE studies ,NEEDS assessment ,DELPHI method ,HOUSING ,INTEGRATED health care delivery ,ACTIVITIES of daily living ,PEOPLE with disabilities ,SOCIAL participation - Abstract
Background: Integrated care is enhanced by integration on system, organizational, professional, and clinical levels including functional and normative integration. Many studies have been done on functional integration on these different levels, less studies focus on how normative integration takes place. In this study, we focus on the question: what differences in frames of refence must be addressed to establish consensus on appropriate care for People with Multiple Problems? Methods: A mixed-method Delphi study was carried out in which professionals and managers regularly involved in care for people with multiple problems (PWMPs) worked towards consensus on appropriate care delivery through the assessment of 15 vignettes representing real trajectories of PWMPs. Results: No consensus on appropriate care delivery was reached on any of the 15 vignettes. Five differences in perspective explained the dissensus: 1) an individual versus a systemic perspective on the client; 2) a focus on self-expressed needs of clients or professionally assessed (normative) needs; 3) client-directed or caregiver-directed care; 4) client as victim of circumstances or responsible for circumstances; 5) a focus on barriers or opportunities. Conclusions: In general, panelists agreed that care for PWMPs should be integrated. However, the further integrated care was to be operationalized in practice the greater the dissensus between panelists emerged. To understand how these differences in perspectives may be overcome to provide care for PWMPs normative integration needs to be studied during actual processes of care delivery. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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13. Governing Integrated Health and Social Care: An Analysis of Experiences in Three European Countries.
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EXLEY, JOSEPHINE, GLOVER, REBECCA, MCCAREY, MARTHA, REED, SARAH, AHMED, ANAM, VRIJHOEF, HUBERTUS, MANACORDA, TOMMASO, VACCARO, CONCETTA, LONGO, FRANCESCO, STEWART, ELLEN, MAYS, NICHOLAS, and NOLTE, ELLEN
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MEDICAL care research ,RESEARCH funding ,INTERPROFESSIONAL relations ,ENDOWMENTS ,DIFFUSION of innovations ,CLINICAL governance ,RESPONSIBILITY ,INTERVIEWING ,LEADERSHIP ,SOCIAL case work ,THEMATIC analysis ,RESEARCH methodology ,CONCEPTUAL structures ,RESEARCH ,MEDICAL coding ,COMPARATIVE studies ,INTEGRATED health care delivery ,COVID-19 pandemic ,MEDICAL care costs - Abstract
Purpose: Achieving greater health and social care integration is a policy priority in many countries, but challenges remain. We focused on governance and accountability for integrated care and explored arrangements that shape more integrated delivery models or systems in Italy, the Netherlands and Scotland. We also examined how the COVID-19 pandemic affected existing governance arrangements. Design/methodology/approach: A case study approach involving document review and semi-structured interviews with 35 stakeholders in 10 study sites between February 2021 and April 2022. We used the Transparency, Accountability, Participation, Integrity and Capability (TAPIC) framework to guide our analytical enquiry. Findings: Study sites ranged from bottom-up voluntary agreements in the Netherlands to top-down mandated integration in Scotland. Interviews identified seven themes that were seen to have helped or hindered integration efforts locally. Participants described a disconnect between what national or regional governments aspire to achieve and their own efforts to implement this vision. This resulted in blurred, and sometimes contradictory, lines of accountability between the centre and local sites. Flexibility and time to allow for national policies to be adapted to local contexts, and engaged local leaders, were seen to be key to delivering the integration agenda. Health care, and in particular acute hospital care, was reported to dominate social care in terms of policies, resource allocation and national monitoring systems, thereby undermining better collaboration locally. The pandemic highlighted and exacerbated existing strengths and weaknesses but was not seen as a major disruptor to the overall vision for the health and social care system. Research limitations: We included a relatively small number of interviews per study site, limiting our ability to explore complexities within sites. Originality: This study highlights that governance is relatively neglected as a focus of attention in this context but addressing governance challenges is key for successful collaboration. [ABSTRACT FROM AUTHOR]
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- 2024
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14. Pursuing community ownership in local service design and delivery: challenging the boundaries of professional long-term care?
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Glimmerveen, Ludo
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MEDICAL care ,COMMUNITY involvement ,MEDICAL laws ,MEDICAL personnel ,CITIES & towns - Abstract
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]
- Published
- 2015
15. Participatory Action Research as a Driver for Health Promotion and Prevention: A Co-creation Process Between Professionals and Citizens in a Deprived Neighbourhood in the Hague.
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VAN DER VLEGEL-BROUWER, WILMA, EELDERINK, MADELON, and BUSSEMAKER, JET
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FOCUS groups ,BUILT environment ,ATTITUDES of medical personnel ,FOOD security ,MENTAL health ,ECOLOGY ,PREVENTIVE health services ,EXPERIENCE ,SOCIAL cohesion ,ACTION research ,HEALTH attitudes ,HEALTH behavior ,HEALTH equity ,THEMATIC analysis ,JUDGMENT sampling ,FINANCIAL management ,HEALTH promotion ,NEIGHBORHOOD characteristics ,PUBLIC opinion - Abstract
Introduction: Ignited by the persistent health inequalities many cities and neighbourhoods, the 'Healthy and Happy The Hague' network in the Netherlands wanted to gain insight in how prevention and health promotion could become successful in one deprived neighbourhood, Moerwijk. Methods: The cycle of Look-Think-Act of Participatory Action Research was used in which both citizens and professionals got involved from the start. Besides interviews, field notes were analysed, visualised and discussed in several rounds of focus groups. Results: Thematic analysis yielded seven themes: Healthy Eating and Exercise, Healthy Money, Healthy Mind, Healthy Relationships, Growing up healthy, Healthy Environment and Healthy Collaboration. During sessions around combination of themes, eight initiatives were co-created by citizens and professionals together, improving the feeling of ownership and interconnectedness. Discussion and conclusion: This PAR sheds a light on the mismatch between the system world's solutions for individuals and the living world's needs for solutions for the collective. Findings provides a better insight into the social, political, and cultural mechanisms and processes that influence clustering and interaction of health conditions. PAR is a promising process of citizens and professionals working together is an excellent way to learn about the conditions under which people experience health inequalities, and how to combat these inequalities. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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16. Incentives for telehealthcare deployment that support integrated care: a comparative analysis across eight European countries.
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Lluch, Maria
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MEDICAL care ,TELEMEDICINE ,INFORMATION & communication technologies ,PAYMENT - Abstract
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]
- Published
- 2013
17. Care delivery pathways for Chronic Obstructive Pulmonary Disease in England and the Netherlands: a comparative study.
- Author
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Utens, Cecile M. A., Maarse, J. A. M., Van Schayck, Onno C. P., Maesen, Boudewijn L. P., Rutten, Maureen P. M. H., and Smeenk, Frank W. J. M.
- Subjects
PUBLIC health administration ,OBSTRUCTIVE lung diseases patients ,COMPARATIVE studies ,PRIMARY care ,DISEASE exacerbation - Abstract
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]
- Published
- 2012
18. A stepped care programme for depression management: an uncontrolled pre-post study in primary and secondary care in The Netherlands.
- Author
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Meeuwissen, Jolanda A. C., van der Feltz-Cornelis, Christina M., van Marwijk, Harm W. J., Rijnders, Paul B. M., and Donker, Marianne C. H.
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MENTAL depression ,THERAPEUTICS ,PRIMARY care ,MEDICAL care ,DEPRESSED persons ,MEDICAL referrals ,MEDICAL protocols - Abstract
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]
- Published
- 2008
19. Deinstitutionalisation of mental health care in the Netherlands: towards an integrative approach.
- Author
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Ravelli, Dick P.
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MENTAL health services ,DEINSTITUTIONALIZATION ,MEDICAL laws ,HEALTH care reform ,PUBLIC welfare - Abstract
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]
- Published
- 2006
20. The e-Depot at the National Library of the Netherlands.
- Author
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Oltmans, Erik and Lemmen, Adriaan
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ELECTRONIC journals ,ELECTRONIC publications ,ELECTRONIC publishing ,METADATA ,ELECTRONIC information resources ,NATIONAL Library of the Netherlands (Hague, Netherlands) - Abstract
Electronic journals have come to dominate the field of academic literature, and it is of great importance to the international scientific community that this electronic intellectual output is preserved well and that it remains accessible in perpetuity. The traditional principles for the archiving of printed academic literature no longer suffice in the digital world. These are based on national frontiers: each national deposit library preserves its own national academic heritage. Regarding electronic publications, however, the geographical criterion is not very useful and the geographical provenance of material is irrelevant, since electronic data can exist independently of a geographic location. Most current journals of multinational publishers no longer have a fatherland that can be easily identified. New ways of co-operation in the field of long-term digital archiving of electronic publications and its metadata will emerge. This paper looks at the policy and ambitions of the National Library of the Netherlands (KB) regarding digital archiving of electronic publications. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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21. Factors Influencing the Introduction of Value-Based Payment in Integrated Stroke Care: Evidence from a Qualitative Case Study.
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SALET, NEWEL, BUIJCK, BIANCA I., VAN DAM-NOLEN, DIANNE H. K., HAZELZET, JAN A., DIPPEL, DIEDERIK W. J., GRAUWMEIJER, ERIK, SCHUT, F. T., ROOZENBEEK, BOB, and EIJKENAAR, FRANK
- Subjects
STROKE treatment ,MOTIVATION (Psychology) ,STAKEHOLDER analysis ,INTERVIEWING ,VALUE-based healthcare ,QUALITATIVE research ,DATABASE management ,RESEARCH funding ,INTEGRATED health care delivery ,COMMITMENT (Psychology) ,TRUST - Abstract
Background: To address issues related to suboptimal insight in outcomes, fragmentation, and increasing costs, stakeholders are experimenting with value-based payment (VBP) models, aiming to facilitate high-value integrated care. However, insight in how, why and under what circumstances such models can be successful is limited. Drawing upon realist evaluation principles, this study identifies context factors and associated mechanisms influencing the introduction of VBP in stroke care. Methods: Existing knowledge on context-mechanism relations impacting the introduction of VBP programs (in real-world settings) was summarized from literature. These relations were then tested, refined, and expanded based on a case study comprising interviews with representatives from organizations involved in the introduction of a VBP model for integrated stroke care in Rotterdam, the Netherlands. Results: Facilitating factors were pre-existing trust-based relations, shared dissatisfaction with the status quo, regulatory compatibility and simplicity of the payment contract, gradual introduction of down-side risk for providers, and involvement of a trusted third party for data management. Yet to be addressed barriers included friction between short- and long-term goals within and among organizations, unwillingness to forgo professional and organizational autonomy, discontinuity in resources, and limited access to real-time data for improving care delivery processes. Conclusions: Successful payment and delivery system reform require long-term commitment from all stakeholders stretching beyond the mere introduction of new models. Careful consideration of creating the 'right' contextual circumstances remains crucially important, which includes willingness among all involved providers to bear shared financial and clinical responsibility for the entire care chain, regardless of where care is provided. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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22. Dutch Parelsnoer Institute-Cerebrovascular Accident (CVA) Study: A Large Multicenter Clinical Biobank with Standardized Collection and Storage.
- Author
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Van Os, H. J. A., Ruigrok, Y. M., Manniën, J., Van Dijk, E. J., Koudstaal, P. J., Luijckx, G. J., Nederkoorn, P. J., Van Oostenbrugge, R. J., Visser, M. C., Kappelle, L. J., Verspaget, H. W., Algra, A., and Wermer, M. J. H.
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STROKE ,BIOBANKS ,ACADEMIC medical centers ,BIOMATERIALS ,BLOOD sampling - Abstract
The Dutch Parelsnoer Institute-Cerebrovascular accident (CVA) Study is part of the Parelsnoer Institute (PSI), initiated in 2007 by the Netherlands Federation of University Medical Centers (NFU). PSI is a cooperation of all eight Dutch University Medical Centers (UMCs) and aims at building large prospectively collected datasets with uniformly and standardized storage of biomaterials for complex diseases. Currently, PSI covers 18 disease-specific cohorts called 'Pearls', and this number is still growing. One of these cohorts is the Stroke or CVA Pearl. For each of the cohorts, PSI offers the UMCs an infrastructure and standard procedures for storing the specific biomaterials in their certified biobanks. Clinical data are stored in a central database after being pseudonymized to ensure patient privacy. For the Parelsnoer Institute-CVA Study, blood for genetic analysis, serum and plasma are collected according to nationally agreed standards. Currently (November 2017) the Stroke Pearl has stored blood samples with prospectively obtained clinical data of around 6000 patients in all UMCs combined. Blood samples and data are available for all researchers with a methodologically valid research proposal. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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23. Use of patient involvement to improve/design healthcare strategies.
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Zugazua, Jaione Sánchez, Dominguez, Estíbaliz Cristobal, Montalbán, Inma Laburu, Villagarcia, Coro Ruiz, Alejandre, Idoia Beistegui, Valero, Belen Jiménez, and Bartolomé, Nerea Gutierrez
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PATIENT participation ,PATIENT autonomy ,POPULATION health management ,GROUP formation ,MEDICAL care ,MEDICAL centers - Abstract
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]
- Published
- 2019
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- View/download PDF
24. eHOME for an integrated care approach for drug-related problems in homeliving older people.
- Author
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Dijkstra, Nienke, Hiddink, Eric, and Sino, Carolien
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NURSING home care ,OLDER people - Abstract
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]
- Published
- 2018
- Full Text
- View/download PDF
25. The role of the general practitioner in multidisciplinary teams: a qualitative study in elderly care.
- Author
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Grol, Sietske, Molleman, Gerard, and Schers, Henk
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GENERAL practitioners ,ELDER care ,TEAMS - Abstract
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]
- Published
- 2018
- Full Text
- View/download PDF
26. An ehealth application for the management of obstetric care.
- Author
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van Stralen, Karlijn Janneke, de Groot, Pieter-Kees, de Bruine, Martine, Schagen, Murielle, and Painter, Rebecca C.
- Subjects
POPULATION health management ,PREGNANT women ,MEDICAL care ,PATIENT satisfaction - Abstract
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]
- Published
- 2018
- Full Text
- View/download PDF
27. Integrated care issues: Transfer of patient care information.
- Author
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Buijck, Bianca
- Subjects
REHABILITATION nursing ,NEUROLOGISTS ,MEDICAL care - Abstract
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]
- Published
- 2018
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- View/download PDF
28. First Use of a Population Health Management Strategy in Dutch Primary Health Care.
- Author
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Girwar, Shelley-Ann and Bruijnzeels, Marc
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POPULATION health management ,PRIMARY care - Abstract
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]
- Published
- 2018
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- View/download PDF
29. Integrated care: only possible with the support of technology?
- Author
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Lukkien, Dirk, Timmer, Sabine, van der Sande, Ruby, Suijkerbuijk, Sandra, and Nap, Henk Herman
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MEDICALIZATION ,TECHNOLOGY - Abstract
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]
- Published
- 2018
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30. Using Design Thinking for Co-Creating an Integrated Care Pathway Including Hospital at Home for Older Adults with an Acute Moderate-Severe Respiratory Infection in the Netherlands.
- Author
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PEPPING, RIANNE M. C., VAN AKEN, MAARTEN O., VOS, RIMKE C., NUMANS, MATTIJS E., VAN DEN BERG, JOHANNA M. W., KROON, INGRID, and VAN NIEUWKOOP, CEES
- Subjects
INFLUENZA diagnosis ,C-reactive protein ,CEFTRIAXONE ,KIDNEY function tests ,HOSPITAL emergency services ,TRANSITIONAL care ,POINT-of-care testing ,SODIUM ,INFLAMMATION ,CONVALESCENCE ,ORAL drug administration ,RESPIRATORY infections ,POTASSIUM ,ACQUISITION of data ,PATIENTS ,MEDICAL protocols ,SEVERITY of illness index ,HOSPITAL admission & discharge ,INTRAMUSCULAR injections ,HEALTH care teams ,RESEARCH funding ,MICROBIOLOGICAL techniques ,MEDICAL records ,INDEPENDENT living ,QUESTIONNAIRES ,OXYGEN therapy ,INFLUENZA ,INTEGRATED health care delivery ,COVID-19 testing ,BLOOD testing ,COMMUNITY-acquired pneumonia ,OSELTAMIVIR ,OLD age - Abstract
Introduction: Acute respiratory infections are common in frail, community-dwelling older people and are accompanied by considerable diagnostic and prognostic uncertainties. Inadequately coordinated care is associated with unnecessary hospital referral and admission with potential iatrogenic harm. Therefore, we aimed to cocreate a regional integrated care pathway (ICP), including a hospital at home journey. Developing the ICP: Tasked with using design thinking methodology, stakeholders from regional healthcare facilities, together with patient representatives, were assigned to different focus groups based on their expertise. The focus of each session was to co-create ideal patient journeys suitable for embedding in the ICP. Results: Based on these sessions, a regional cross-domain ICP was developed that comprises three patient journeys. The first journey included a hospital at home track, the second a tailored visit, with priority assessment, to regional emergency departments, and the third concerned referral to readily available nursing home ‘recovery-beds’ under the supervision of an elderly care medicine specialist. Conclusion: Using design thinking and involving end-users during the whole process, we created an ICP for community-dwelling frail older people with moderate-severe acute respiratory infections. This resulted in three realistic patient journeys, including a hospital at home track, which will be implemented and evaluated in the near future. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
31. Implementation of EPRYouth, a Client-Accessible and Multidisciplinary Health Record; A Mixed-Methods Process Evaluation.
- Author
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BENJAMINS, JANINE, DUINKERKEN, JAN-GERRIT, HAMER-JORDAAN, GERLINDE DEN, CANFIJN, ROMAY, KOSTER, RIANNE, DE VET, EMELY, and HAVEMAN-NIES, ANNEMIEN
- Subjects
MEDICAL ethics laws ,RIGHT of privacy ,PARENT attitudes ,EVALUATION of human services programs ,MEDICAL care for teenagers ,FOCUS groups ,ATTITUDES of medical personnel ,RESEARCH methodology ,LEADERSHIP ,ONE-way analysis of variance ,PATIENT portals ,INTERVIEWING ,PATIENTS' attitudes ,HUMAN services programs ,HEALTH care teams ,CHILD health services ,CHILD welfare ,QUESTIONNAIRES ,ACCESS to information ,ELECTRONIC health records ,INTEGRATED health care delivery ,DATA analysis software ,MEDICAL record access control ,LEGAL status of patients ,PARENTS - Abstract
Introduction: Client-accessible interdisciplinary health records potentially contribute to integrated care by facilitating collaboration and enhancing clients’ involvement in care. To achieve this, three Dutch organizations providing ‘care for youth’ developed a fully client-accessible electronic patient record (EPR-Youth). Objective: To evaluate the implementation of EPR-Youth and to determine barriers and facilitators. Methods: A mixed methods design combined system data, process observations, questionnaires and focus group interviews. Target groups were parents, adolescents, professionals using EPR-Youth, and implementation stakeholders. Findings: Client-portal acceptability was high among all clients. Client-portal adoption rate was high and differed between age groups and educational levels. Professionals’ doubts about acceptability, appropriateness and fidelity were partly due to lack of system knowledge. Implementation barriers were the complexity of co-creation, lack of clear leadership, and concerns about legal issues. Facilitators were clarifying vision and legal context, setting deadlines, and a pioneering spirit. Conclusion: The early implementation of EPR-Youth, the first Dutch client-accessible interdisciplinary electronic health record in ‘care for youth’ was successful. To enhance adoption among clients, group-specific barriers for portal-use should be determined. Professionals need additional training. Further research is needed to gain insight into client-portal access barriers. To benefit more from co-creation, an organizational change towards situational leadership is necessary. [ABSTRACT FROM AUTHOR]
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- 2023
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32. Construct Validation of the Rainbow Model of Integrated Care Measurement Tool in Dutch Primary Care for Older Adults.
- Author
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OOSTRA, DORIEN L., NIEUWBOER, MINKE S., JANSSEN, JEROEN H. M., RIKKERT, MARCEL G. M. OLDE, VALENTIJN, PIM P., and PERRY, MARIEKE
- Subjects
TREATMENT of dementia ,COMMUNITY health nurses ,RESEARCH methodology evaluation ,RESEARCH methodology ,CROSS-sectional method ,GOODNESS-of-fit tests ,MULTITRAIT multimethod techniques ,PRIMARY health care ,DEMENTIA patients ,QUESTIONNAIRES ,FACTOR analysis ,CHI-squared test ,HEALTH care teams ,DESCRIPTIVE statistics ,RESEARCH funding ,INTEGRATED health care delivery ,STATISTICAL sampling ,DATA analysis software ,ELDER care - Abstract
Introduction: Care integration in primary elderly care is suboptimal. Validated instruments are needed to enable the implementation of integrated primary care. We aimed to assess construct validity of the Rainbow Model of Integrated Care measurement tool (RMIC-MT) for healthcare professionals working in an integrated primary elderly care setting in the Netherlands. Methods: In a cross-sectional study, the RMIC-MT, a 36-item questionnaire covering all domains of the Rainbow Model of Integrated Care (RMIC), was sent out to local networks of primary elderly care professionals. Confirmatory factor analysis with maximum likelihood estimation was used for the validation of the factor structure the RMIC-MT. Model fit was assessed by the chi-square test and fit indices. Results: The RMIC-MT was completed by 323 professionals, primarily general practitioners, community nurses, practice nurses, and case managers. Confirmatory factor analysis and corresponding fit indices showed moderate to good fit, thereby confirming a nine factor model with a total of 36 items. Conclusions: The RMIC-MT is promising for the primary elderly care setting in the Netherlands. It can be used for evaluating integrated care initiatives in a primary care setting, thereby contributing to implementation of integrated primary elderly care. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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33. Monitoring the Dutch Solid Start Program: Developing an Indicator Set for Municipalities to Monitor their First Thousand DaysApproach.
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MOLENAAR, JOYCE M., BOESVELD, INGE C., KIEFTE-DE JONG, JESSICA C., and STRUIJS, JEROEN N.
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HEALTH policy ,CULTURE ,EVALUATION of human services programs ,SOCIAL determinants of health ,RESEARCH methodology ,MEDICAL care ,SOCIOECONOMIC factors ,QUESTIONNAIRES ,INTEGRATED health care delivery ,HEALTH equity ,SOCIAL case work ,DELPHI method - Abstract
Introduction: The Dutch Solid Start program aims to improve the collaboration between the medical and social sector to offer every child the best start in life. Municipalities form local coalitions of partners within the medical and social sector to support parents and children during the first thousand days. The aim of this study was to develop an indicator set for coalitions to monitor their local Solid Start program. Methods: A modified Delphi study with three rounds was carried out among Dutch experts in Solid Start practice, policy and research (n = 39) to reach consensus. Results: The indicator set included 19 indicators covering the three phases of the Solid Start program: preconception, pregnancy and after birth (up to two years). Prioritized indicators included both social and medical topics, among which poverty, psychological/ psychiatric problems, stress, smoking, cumulation of risk factors, preconception care, low literacy, premature birth, and intellectual disability. Additionally, a development agenda was established with topics and indicators that lacked data or clear operationalization (e.g. stress, unintended pregnancy, loneliness). Discussion and conclusion: The developed indicator set enhances the conversation between policymakers, managers, professionals and other stakeholders about the local situation and developments in order to prioritize interventions and policies. Next, the indicator set needs evaluation to assess its usefulness. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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34. Benchmarking energy performance: indicators and models for Dutch housing associations.
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VAN DER BENT, HERMAN S., VISSCHER, HENK J., MEIJER, ARJEN, and MOUTER, NIEK
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BENCHMARKING (Management) ,ENERGY industries ,DATA quality ,DWELLING design & construction - Abstract
Benchmarking is a method that can be used to measure progress and create awareness about the performance of organisations. Benchmarking the housing stock energy performance of Dutch housing associations can be used to measure and assess progress towards the decarbonisation of the housing stock. A new national climate agreement was signed in 2019, and in 2021 a new method to determine the theoretical energy performance of dwellings came into force in the Netherlands. To benchmark energy performance, a set of indicators is created that adequately represents the performance of Dutch housing associations according to the changed policies. A process involving key stakeholders is presented here to identify, assess and combine possible indicators. These were then integrated into four integrated models, which led to a final benchmark model. A model was chosen that consists of three indicators covering the energy performance of Dutch housing associations. The process and arguments that led to this final model are presented. While applicable within the Dutch context, the method and research results provide generalisable insights for the creation of energy performance benchmarks for building stocks. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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35. Comparative Optimism, Self-Superiority, Egocentric Impact Perception and Health Information Seeking: A COVID-19 Study.
- Author
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HOORENS, VERA, SCAMBLER, SASHA, DESCHRIJVER, ELIANE, COULSON, NEIL S., SPEED, EWEN, and ASIMAKOPOULOU, KOULA
- Subjects
INFORMATION-seeking behavior ,OPTIMISM ,COVID-19 ,EGOCENTRIC bias ,TRUST ,SENSATION seeking - Abstract
We examined perceived self-other differences (self-uniqueness) in appraisals of one's risk of an infectious disease (COVID-19), one's adherence to behavioural precautionary measures against the disease, and the impact of these measures on one's life. We also examined the relationship of self-uniqueness with information seeking and trust in sources of information about the disease. We administered an online survey to a community sample (N = 8696) of Dutch-speaking individuals, mainly in Belgium and The Netherlands, during the first lockdown (late April-Mid June 2020). As a group, participants reported that they were less likely to get infected or infect others or to suffer severe outcomes than average (unrealistic optimism) and that they adhered better than average to behavioural precautionary measures (illusory superiority). Except for participants below 25, who reported that they were affected more than average by these measures (egocentric impact bias), participants also generally reported that they were less affected than average (allocentric impact bias). Individual differences in self-uniqueness were associated with differences in the number of information sources being used and trust on these sources. Higher comparative optimism for infection, selfsuperiority, and allocentric impact perception were associated with information being sought from fewer sources; higher self-superiority and egocentric impact perception were associated with lower trust. We discuss implications for health communication. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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- View/download PDF
36. Identifying and explaining the variability in development and implementation costs of disease management programs in the Netherlands.
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Tsiachristas, A., Waters, B. Hipple, Adams, S. A., Bal, R., and Mölken, M. P. M. M. Rutten-van
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DISEASE management ,MEDICAL care ,CHRONIC diseases ,FINANCIAL risk ,MIXED methods research ,MANAGEMENT ,COST effectiveness - Abstract
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]
- Published
- 2015
37. A Decade of Lessons Learned from Integration Strategies in the Netherlands.
- Author
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NIES, HENK, STEKELENBURG, DINY, MINKMAN, MIRELLA, and HUIJSMAN, ROBBERT
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ELDER care ,DISEASE management ,MATERNAL health services ,CARE of people - Abstract
Introduction: In the Netherlands multiple single, cross sector and cross governance level policy reforms were introduced to improve health and social care and decrease fragmentation. In addition to legislative and funding measures, the governmental strategy was to set up long-lasting improvement programs and supported by applied research. Description: Five national improvement programs on chronic disease management, maternity care, youth care, care for older people and dementia care were analysed. The Laws of integration of Leutz were used as an analytical framework. The programs demonstrated a mixture of employing policy, quality and financial measures to stimulate coherence and integration. Discussion: The Laws that Leutz formulated are to a large extent applicable in the Dutch context. However, the characteristics of the system of governance being corporatist in its structure and its culture imply that it is hard to distinguish single actors being in the lead. Integration is a more complex process and requires more dynamics, than the law 'keep it simple, stupid' suggests. Conclusions: In the Dutch context integration implies a permanent pursuit of aligning mechanisms for integration. Sustainable integration requires long-standing efforts of all relevant stakeholders and cannot be achieved quickly. It may take a decade of consistently applying a mix of policy instruments. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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38. Attributing Conduct in the Law of State Responsibility: Lessons from Dutch Courts Applying the Control Standard in the Context of International Military Operations.
- Author
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RYNGAERT, CEDRIC
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LEGAL liability ,GOVERNMENT liability ,STANDARDS ,STATE laws ,TORTS ,JUST war doctrine ,EXERCISE - Abstract
In two decisions of 2019, the Dutch courts have come up with novel interpretations of the 'control-based' standard of attribution in the international law of State responsibility. This is a standard of attribution that is laid down in Article 8 of the International Law Commission's (ILC) Articles on the Responsibility of States for Internationally Wrongful Acts (ARSIWA), which is, by and large, reflective of customary international law. The traditional understanding of Article 8 ARSIWA is that it applies to relations between States and private persons or entities, in particular armed groups: conduct of a non-State armed group is attributed to a State to the extent that the State exercises control over that group. However, the Dutch courts have extended the scope of application of Article 8 ARSIWA to conduct of organs of international organisations (the UN) as well as foreign States (i.e., States other than the Netherlands). Internationally speaking, this is a novel interpretation of Article 8 ARSIWA, for which there are no precedents. After introducing the Dutch courts' reasoning in these cases, the contribution zooms out and inquires what the Dutch evolutions imply for the development of the controlbased attribution standard in the international law of State responsibility. The author argues that the relatively peculiar interpretation of Article 8 ARSIWA, as applying to interactions between States and international organisations and between States inter se, is practically viable in a narrow range of scenarios characterised by relatively strong politico-military relations and hierarchies. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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39. Optimising Integrated Stroke Care in Regional Networks: A Nationwide Self-Assessment Study in 2012, 2015 and 2019.
- Author
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VOOGDT-PRUIS, HELENE R., ZONNEVELD, NICK, BERGSMA, MONIQUE, VAN WIJK, ELIZE, KERKHOFF, HENK, VAN DER DUSSEN, LUIKJE, KUIJPENS, MAARTJE, VRIJHOEF, HUBERTUS J. M., and MINKMAN, MIRELLA M. N.
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INTEGRATIVE medicine ,INTERPROFESSIONAL collaboration ,SELF-evaluation ,REGRESSION analysis ,QUESTIONNAIRES ,STROKE units - Abstract
Background: To help enhance the quality of integrated stroke care delivery, regional stroke services networks in the Netherlands participated in a self-assessment study in 2012, 2015 and 2019. Methods: Coordinators of the regional stroke services networks filled out an online selfassessment questionnaire in 2012, 2015 and 2019. The questionnaire, which was based on the Development Model for Integrated Care, consisted of 97 questions in nine clusters (themes). Cluster scores were calculated as proportions of the activities implemented. Associations between clusters and features of stroke services were assessed by regression analysis. Results: The response rate varied from 93.1% (2012) to 85.5% (2019). Over the years, the regional stroke services networks increased in 'size': the median number of organisations involved and the volume of patients per network increased (7 and 499 in 2019, compared to 5 and 364 in 2012). At the same time, fewer coordinators were appointed for more than 1 day a week in 2019 (35.1%) compared to 2012 (45.9%). Between 2012 and 2019, there were statistically significantly more elements implemented in four out of nine clusters: 'Transparent entrepreneurship' (MD = 18.0% F(1) = 10.693, p = 0.001), 'Roles and tasks' (MD = 14.0% F(1) = 9.255, p = 0.003), 'Patient-centeredness' (MD = 12.9% F(1) = 9.255, p = 0.003), and 'Commitment' (MD = 11.2%, F(1) = 4.982, p = 0.028). A statistically significant positive correlation was found for all clusters between implementation of activities and age of the network. In addition, the number of involved organisations is associated with better execution of implemented activities for 'Transparent entrepreneurship', 'Result-focused learning' and 'Quality of care'. Conversely, there are small but negative associations between the volume of patients and implementation rates for 'Interprofessional teamwork' and 'Patient-centredness'. Conclusion: This long-term analyses of stroke service development in the Netherlands, showed that between 2012 and 2019, integrated care activities within the regional stroke networks increased. Experience in collaboration between organisations within a network benefits the uptake of integrated care activities. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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- View/download PDF
40. A Scoping Review of Alternative Payment Models in Maternity Care: Insights in Key Design Elements and Effects on Health and Spending.
- Author
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DE VRIES, ELINE F., SCHEEFHALS, ZOË T. M., DE BRUIN-KOOISTRA, MIENEKE, BAAN, CAROLINE A., and STRUIJS, JEROEN N.
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MATERNAL health services ,DUTCH language ,FINANCIAL accountability ,PAYMENT ,HIGH-income countries ,HOSPITAL maternity services - Abstract
Introduction: Although effects of alternative payment models on health outcomes and health spending are unclear, they are increasingly implemented in maternity care. We aimed to provide an overview of alternative payment models implemented in maternity care, describing their key design elements among which the type of APM, the care providers that participate in the model, populations and care services that are included and the applied risk mitigation strategies. Next to that, we made an inventory of the empirical evidence on the effects of APMs on maternal and neonatal health outcomes and spending on maternity care. Methods: We searched PubMed, Embase and Scopus databases for articles published from January 2007 through October 2020. Search key words included 'alternative payment model', 'value based payment model', 'obstetric', 'maternity'. English or Dutch language articles were included if they described or empirically evaluated initiatives implementing alternative payment models in maternity care in high-income countries. Additional relevant documents were identified through reference tracking. We systematically analyzed the initiatives found and examined the evidence regarding health outcomes and health spending. The process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to ensure validity and reliability. Results: We identified 17 initiatives that implemented alternative payment models in maternity care. Thirteen in the United States, two in the United Kingdom, one in New Zealand and one in the Netherlands. Within these initiatives three types of alternative payment models were implemented; pay-for-performance (n = 2), shared savings models (n = 7) and bundled payment models (n = 8). Alternative payment models that shifted more financial accountability towards providers seemed to include more strategies that mitigated those risks. Risk mitigation strategies were applied to the included population, included services or at the level of total expenditures. Of these seventeen initiatives, we found four empirical effect studies published in peerreviewed journals. Three of them were of moderate quality and one weak. Two studies described an association of the alternative payment model with an improvement of specific health outcomes and two studies described a reduction in medical spending. Conclusions: This study shows that key design elements of alternative payment models including risk mitigation strategies vary highly. Risk mitigation strategies seem to be relevant tools to increase APM uptake and protect providers from (initially) bearing too much (perceived) financial risk. Empirical evidence on the effects of APMs on health outcomes and spending is still limited. A clear definition of key design elements and a further, indepth, understanding of key design elements and how they operate into different health settings is required to shape payment reform that aligns with its goals. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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- View/download PDF
41. Advancing open access in the Netherlands after 2020: from quantity to quality.
- Author
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BOSMAN, JEROEN, DE JONGE, HANS, KRAMER, BIANCA, and SONDERVAN, JEROEN
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METADATA ,PREPRINTS ,TEXTBOOKS ,GOAL programming - Abstract
The purpose of this article is to explore options to further open access in the Netherlands from 2021. Its premise is that there is a need to look at the qualitative aspects of open access, alongside quantitative ones. The article first takes stock of progress that has been made. Next, we suggest broadening the agenda by involving more types of actors and other scholarly formats (like books, chapters, proceedings, preprints and textbooks). At the same time we suggest deepening the open access agenda by including several open access dimensions: immediacy, diamond open access, open metadata, open peer review and open licences. To facilitate discussion, a framework is proposed that allows specifying these actions by the a) aspects of open access they address (what is made open access, how, when and where it is made open access, and copyright and rights retention), b) the actors that play a role (government, research institutions, funders) and c) the various levels at which these actions can be taken: state as goal, set as policy, legalize and promote, recognize and reward, finance, support with infrastructure. A template is provided to ease the use of the framework. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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- View/download PDF
42. Monitoring energy performance improvement: insights from Dutch housing association dwellings.
- Author
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VAN DER BENT, HERMAN S., VISSCHER, HENK J., MEIJER, ARJEN, and MOUTER, NIEK
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HOME energy use ,SUSTAINABLE development ,RETROFITTING of buildings - Abstract
The Energy Performance of Buildings Directive (EPBD) enhanced the sustainable improvement of dwellings in the European Union. Member states formulated measurable goals to improve the housing stock, and monitoring systems were developed to give insights into the improvements. In the Netherlands, non-profit housing associations agreed to improve the quality of their housing stock to an average Dutch energy label B (energy index (EI NV) = 1.40) by 2020. Research assessing this progress over time is presented using an annual monitoring system based on 2.0 million energy performance calculations of 264 Dutch non-profit housing associations between 2017 and 2020. The assessment includes: a detailed description of the development of the state of the stock over time; the effect of changes to the stock (construction and demolition) and changes within the stock (different types of retrofit measures); and the different characteristics of non-profit housing associations. Insights from this research show which specific retrofit and other measures are adopted and have substantial impact over time. This provides a useful frame of reference for building stock analysis and accelerating the improvement of the building stock. It also creates a baseline of information for the future sustainable development of this particular stock. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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- View/download PDF
43. Together for health: introducing the International Foundation for Integrated Care.
- Author
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Goodwin, Nick and Ferrer, Lourdes
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MEDICAL care societies ,HEALTH policy ,HEALTH care reform ,PUBLIC health administration ,RESEARCH & development - Abstract
The authors reflect on the establishment of the International Foundation for Integrated Care (IFIC), a not-for-profit foundation registered in the Netherlands. They say that the mission of the IFIC is to gather people to move forward the knowledge, science and adoption of integrated care policy and practice. They cite various activities of the IFIC for 2013 including the 13th edition of the Annual Conference, World Congress, and research and development.
- Published
- 2012
44. Integrated Care for Older Adults: A Struggle for Sustained Implementation in Northern Netherlands.
- Author
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Holterman, Sander, Lahr, Maarten, Wynia, Klaske, Hettinga, Marike, and Buskens, Erik
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OLDER people ,PREVENTIVE health services ,CHRONIC care model ,LONG-term health care ,PERCEIVED quality - Abstract
Introduction: Integrated care has been suggested as a promising solution to the disparities in access and sustained high quality long-term care emerging in Europe's ageing population. We aim to gain a better understanding of context-specific barriers to and facilitators of implementation of integrated care by doing a retrospective assessment of seven years of Embrace. This Dutch integrated person-centred health service for older adults was based on two evidence-based models (the Chronic Care Model and the Kaiser Permanente Triangle). Despite successful deployment the programme ended in 2018. In this case study we assess the impact of the programme based on past evaluations, reflect on why it ended, lessons learned and ideas to take forward. Discussion: The majority of health outcomes were positive and the perceived quality of care improved, albeit no clear-cut savings were observed, and the costs were not balanced across stakeholders. The Embrace payment model did not support the integration of health services, despite reforms in long-term care in 2015. Key lessons: Enabling policy and funding are crucial to the sustained implementation of integrated person-centred health services. The payment model should incentivize the integration of care before the necessary changes can be made at organizational and clinical levels towards providing proactive and preventive health services. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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- View/download PDF
45. Parelsnoer Institute Biobank Hereditary Colorectal Cancer: A Joint Infrastructure for Patient Data and Biomaterial on Hereditary Colorectal Cancer in the Netherlands.
- Author
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Manders, Peggy, Vos, Janet R., de Voer, Richarda M., van Hest, Liselot P., Sijmons, Rolf, Hoge, Chantal V., Terpstra, Fokke G., Spaander, Manon C., Mesker, Wilma E., Dekker, Evelien, and Hoogerbrugge, Nicoline
- Subjects
GENETICS of colon cancer ,COLON cancer diagnosis ,BIOBANKS ,MEDICAL databases ,BIOMATERIALS - Abstract
Each year approximately 15,000 patients are diagnosed with colorectal cancer (CRC) in the Netherlands, of whom 5-10% are associated with a hereditary syndrome. To enable future research into hereditary CRC, we established a collaborative biobank for hereditary CRC in all eight University Medical Centers (UMCs) in the Netherlands in 2009. This Biobank Hereditary CRC is part of the Parelsnoer Institute (PSI), which is funded by the Dutch Federation of UMCs and the Dutch Government. Besides the multicenter collaboration, the multidisciplinary nature of this biobank - involving Gastroenterology, Genetics and Surgery - is essential for its functionality and value. Patients at increased risk of hereditary CRC and/or Polyposis, or with a proven germline mutation causing CRC and/or Polyposis are included. Both clinical data (demographic data, details on medical and family history, information on surveillance, endoscopy and surgery, results of microsatellite instability and molecular genetic tests) and biomaterial (DNA, plasma, serum and tissue) are collected in a standardized manner. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
46. National Survey Integrated Primary Care Judith Booij, PhD, Netherlands Institute for health services research (NIVEL).
- Author
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Booij, Judith, Bruijnzeels, Marc, Bakker, Dinny de, Struijs, Jeroen N., and Verhaak, Peter
- Subjects
HEALTH surveys ,PRIMARY care ,MEDICAL care - Abstract
Introduction: Primary care is highly valued in commentaries on health care systems [1,2]. However, its surplus value has only been demonstrated on a highly abstract level (comparing health care systems as a whole) or on a local level for single, isolated aspect of primary care (e.g. the relationship between multidisciplinary cooperation and hospital referrals). It is thought that the surplus value of primary care can best be realized by an integrated care approach [3]. Elements of this approach (at the level of funding, organization, administration, service delivery and clinical cooperation) are assumed to be related to a more cost-effective health care with comparable quality of care. Empirical evidence for such relationships is scarce up till now. In this contribution we present the design of a large scale survey, to be carried out in the Netherlands the forthcoming years. In this survey, we will analyze several aspects of integrated care and their contribution to cost-effectiveness controlling for case mix. Method: Specifically for this survey, a new instrument will be developed for the assessment of the degree of integrated care provided by primary care practices. This instrument will cover a number of dimensions of integrated care, mentioned above. A large number of practices (we aim at 320) will be approached to participate in this study. The integrated care instrument will be assessed for all these practices. As most of the invited practices participate in existing networks of health care registrations of general practitioners, it is possible to collect data on quality of care indicators for these practices in an automated way. In cooperation with the Dutch Insurers organization we will collect data on the integrated health care costs of participating practices. In addition, we will collect data on patients' health status, socio-demographic characteristics and evaluation of the practice by a questionnaire, to be administered to random samples from participating practices Results: We expect information on the following topics: the degree in which distinguished dimension of integrated care are realized in the Netherlands International Journal of Integrated Care - Volume 13, 23 October - URN:NBN:NL:UI:10-1-114697- http://www.ijic.org/ the relationship between this degree of integration and costs generated by these practices the relationship between this degree of integration and quality of care the relationship between this degree of integration and cost-effectivity [ABSTRACT FROM AUTHOR]
- Published
- 2013
47. An Approach to measuring Integrated Care within a Maternity Care System: Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study.
- Author
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Boesveld, Inge C., Valentijn, Pim P., Hitzert, Marit, Hermus, Marieke A. A., Franx, Arie, de Vries, Raymond G., Wiegers, Therese A., and Bruijnzeels, Marc A.
- Subjects
INTEGRATED health care delivery ,MATERNAL health services ,MATERNAL & infant welfare ,WOMEN'S health services ,MEDICAL care - Abstract
Introduction: Integrated care is considered to be a means to reduce costs, improve the quality of care and generate better patient outcomes. At present, little is known about integrated care in maternity care systems. We developed questionnaires to examine integrated care in two different settings, using the taxonomy of the Rainbow Model of Integrated Care. The aim of this study was to explore the validity of these questionnaires. Methods: We used data collected between 2013 and 2015 from two studies: the Maternity Care Network Study (634 respondents) and the Dutch Birth Centre Study (56 respondents). We assessed the feasibility, discriminative validity, and reliability of the questionnaires. Results: Both questionnaires showed good feasibility (overall missing rate < 20%) and reliability (Cronbach's Alpha coefficient > 0.70). Between-subgroups post-hoc comparisons showed statistically significant differences on integration profiles between regional networks (on all items, dimensions of integration and total integration score) and birth centres (on 50% of the items and dimensions of integration). Discussion: Both questionnaires are feasible and can discriminate between sites with different integration profiles in The Netherlands. They offer an opportunity to better understand integrated care as one step in understanding the complexity of the concept. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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48. Public Health Citizen Science; Perceived Impacts on Citizen Scientists: A Case Study in a Low-Income Neighbourhood in the Netherlands.
- Author
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Broeder, Lea Den, Lemmens, Lidwien, Uysal, Serfanim, Kauw, Karin, Weekenborg, Jitske, Schönenberger, Michaela, Klooster-Kwakkelstein, Simone, Schoenmakers, Mieke, Scharwächter, Willie, Van de Weerd, Annemarije, El Baouchi, Samira, Schuit, Albertine Jantine, and Wagemakers, Annemarie
- Subjects
CITIZEN science ,SCIENTISTS ,PUBLIC health ,POOR people - Abstract
Citizen science - the active participation of lay people in research - may yield crucial local knowledge and increase research capacity. Recently, there is growing interest to understand benefits for citizen scientists themselves. We studied the perceived impacts of participation in a public health citizen science project on citizen scientists in a disadvantaged neighbourhood in the Netherlands. Local citizen scientists, characterised by low income and low educational level - many of whom were of migrant origin - were trained to interview fellow residents about health-enhancing and health-damaging neighbourhood features. Experiences of these citizen scientists were collected through focus groups and interviews and analysed using a theoretical model of potential citizen science benefits. The results show that the citizen scientists perceived participation in the project as a positive experience. They acquired a broader understanding of health and its determinants and knowledge about healthy lifestyles, and took action to change their own health behaviour. They reported improved self confidence and social skills, and expanded their network across cultural boundaries. Health was perceived as a topic that helped people with different backgrounds to relate to one another. The project also induced joint action to improve the neighbourhood's health. We conclude that citizen science benefits participants with low educational or literacy level. Moreover, it seems to be a promising approach that can help promote health in underprivileged communities by strengthening personal skills and social capital. However, embedding projects in broader health promotion strategies and long-term engagement of citizen scientists should be pursued to accomplish this. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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- View/download PDF
49. The Parelsnoer Institute: A National Network of Standardized Clinical Biobanks in the Netherlands.
- Author
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Manniën, Judith, Ledderhof, Tessa, Verspaget, Hein W., Snijder, Roger R., Flikkenschild, Erik F., van Scherrenburg, Nicole P. C., Stolk, Ronald P., and Zielhuis, Gerhard A.
- Subjects
BIOBANKS ,ACADEMIC medical centers ,BIOLOGICAL specimens ,BIOMATERIALS - Abstract
The Parelsnoer Institute (PSI) is a collaborative biobanking project of all eight University Medical Centers in the Netherlands which was launched in 2007. Basically, PSI consists of three dimensions: participating institutions, disease entities and a central organization. An executive board for operational management instigates collective strategic and tactic policies and a central team of PSI experts and advisors supports the researchers and the board in establishing and implementing standards and procedures. PSI offers researchers an infrastructure and standard procedures for the establishment, expansion and optimisation of clinical biobanks for scientific research. To ensure patient privacy clinical data is pseudomized and carefully stored in a central database. Human biomaterials are collected according to nationally agreed standards. Currently PSI covers fifteen large disease specific cohorts (the so-called 'Parels' or 'Pearls') and new 'Pearls' are being developed. The Parelsnoer Institute currently (December 2016) has stored more than 538,000 biospecimens with annotated clinical data of more than 30,000 patients. All these materials and data are available for anyone with a bona fide research proposal. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
50. The Development of Integrated Stroke Care in the Netherlands a Benchmark Study.
- Author
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Vat, Lidewij E., Middelkoop, Ingrid, Buijck, Bianca I., and Minkman, Mirella M. N.
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STROKE treatment ,SELF-evaluation ,ACQUISITION of data ,MEDICAL quality control ,INTEGRATED health care delivery - Abstract
Introduction: Integrated stroke care in the Netherlands is constantly changing to strive to better care for stroke patients. The aim of this study was to explore if and on what topics integrated stroke care has been improved in the past three years and if stroke services were further developed. Methods: A web based self-assessment instrument, based on the validated Development Model for Integrated Care, was used to collect data. In total 53 coordinators of stroke services completed the questionnaire with 98 elements and four phases of development concerning the organisation of the stroke service. Data were collected in 2012 and 2015. Descriptive-comparative statistics were used to analyse the data. Results: In 2012, stroke services on average had implemented 56 of the 89 elements of integrated care (range 15-88). In 2015 this was increased up to 70 elements on average (range 37-89). In total, stroke services showed development on all clusters of integrated care. In 2015, more stroke services were in further phases of development like in the consolidation and transformation phase and less were in the initiative and design phase. The results show large differences between individual stroke services. Priorities to further develop stroke services changed over the three years of data collection. Conclusions: Based on the assessment instrument, it was shown that stroke services in the Netherlands were further developed in terms of implemented elements of integrated care and their phase of development. This three year comparison showed unique first analyses over time of integrated stroke care in the Netherlands on a large scale. Interesting further questions are to research the outcomes of stroke care in relation to this development, and if benefits on patient level can be assessed. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
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