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3. Variation in Excess Mortality Across Nursing Homes in the Netherlands During the COVID-19 Pandemic

Author

Bar, Marlies, Bom, Judith, Bakx, Pieter, Hertogh, Cees M.P.M., Wouterse, Bram, Bar, Marlies, Bom, Judith, Bakx, Pieter, Hertogh, Cees M.P.M., and Wouterse, Bram

Abstract

Objectives Nursing home residents constituted a vulnerable population during the COVID-19 pandemic, and half of all cause-attributed COVID-19 deaths occurred within nursing homes. Yet, given the low life expectancy of nursing home residents, it is unclear to what extent COVID-19 mortality increased overall mortality within this population. Moreover, there might have been differences between nursing homes in their ability to protect residents against excess mortality. This article estimates the number of excess deaths among Dutch nursing home residents during the pandemic, the variation in excess deaths across nursing homes, and its relationship with nursing home characteristics. Design Retrospective, use of administrative register data. Setting and Participants All residents (N = 194,432) of Dutch nursing homes (n = 1463) in 2016-2021. Methods We estimated the difference between actual and predicted mortality, pooled at the nursing home level, which provided an estimate of nursing home–specific excess mortality corrected for resident case-mix differences. We show the variation in excess mortality across nursing homes and relate this to nursing home characteristics. Results In 2020 and 2021, the mortality probability among nursing home residents was 4.0 and 1.6 per 100 residents higher than expected. There was considerable variation in excess deaths across nursing homes, even after correcting for differences in resident case mix and regional factors. This variation was substantially larger than prepandemic mortality and was in 2020 related to prepandemic spending on external personnel and satisfaction with the building, and in 2021 to prepandemic staff absenteeism. Conclusions and Implications The variation in excess mortality across nursing homes was considerable during the COVID-19 pandemic, and larger compared with prepandemic years. The association of excess mortality with the quality of the bui

Published
2024

4. Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries

Author

HAG Infectieziekten, Infection & Immunity, HAG Zorginnovatieonderzoek, Biostatistiek Onderzoek, Other research (not in main researchprogram), Hartman, Esther A.R., van de Pol, Alma C., Heltveit-Olsen, Silje Rebekka, Lindbæk, Morten, Høye, Sigurd, Lithén, Sara Sofia, Sundvall, Pär Daniel, Sundvall, Sofia, Arnljots, Egill Snaebjörnsson, Gunnarsson, Ronny, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Platteel, Tamara N., Groen, Wim G., Monnier, Annelie A., Zuithoff, Nicolaas P., Verheij, Theo J.M., Hertogh, Cees M.P.M., HAG Infectieziekten, Infection & Immunity, HAG Zorginnovatieonderzoek, Biostatistiek Onderzoek, Other research (not in main researchprogram), Hartman, Esther A.R., van de Pol, Alma C., Heltveit-Olsen, Silje Rebekka, Lindbæk, Morten, Høye, Sigurd, Lithén, Sara Sofia, Sundvall, Pär Daniel, Sundvall, Sofia, Arnljots, Egill Snaebjörnsson, Gunnarsson, Ronny, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Platteel, Tamara N., Groen, Wim G., Monnier, Annelie A., Zuithoff, Nicolaas P., Verheij, Theo J.M., and Hertogh, Cees M.P.M.

Published
2023

6. Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU)

Author

HAG Infectieziekten, Infection & Immunity, UMC Utrecht Holding, Heltveit-Olsen, Silje Rebekka, Sundvall, Pär Daniel, Gunnarsson, Ronny, Snaebjörnsson Arnljots, Egill, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Platteel, Tamara N., Koning, Hilde A.M., Groen, Wim G., Åhrén, Christina, Grude, Nils, Verheij, Theo J.M., Hertogh, Cees M.P.M., Lindbaek, Morten, Hoye, Sigurd, HAG Infectieziekten, Infection & Immunity, UMC Utrecht Holding, Heltveit-Olsen, Silje Rebekka, Sundvall, Pär Daniel, Gunnarsson, Ronny, Snaebjörnsson Arnljots, Egill, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Platteel, Tamara N., Koning, Hilde A.M., Groen, Wim G., Åhrén, Christina, Grude, Nils, Verheij, Theo J.M., Hertogh, Cees M.P.M., Lindbaek, Morten, and Hoye, Sigurd

Published
2022

7. Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: A qualitative study in four European countries

Author

HAG Infectieziekten, Infection & Immunity, Huisartsopleiding, Hartman, Esther A.R., Groen, Wim G., Heltveit-Olsen, Silje Rebekka, Lindbæk, Morten, Høye, Sigurd, Sundvall, Pär Daniel, Skoglund, Ingmarie, Snaebjörnsson Arnljots, Egill, Gunnarsson, Ronny, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Kosiek, Katarzyna, Platteel, Tamara N., Van De Pol, Alma C., Verheij, Theo J.M., Monnier, Annelie A., Hertogh, Cees M.P.M., HAG Infectieziekten, Infection & Immunity, Huisartsopleiding, Hartman, Esther A.R., Groen, Wim G., Heltveit-Olsen, Silje Rebekka, Lindbæk, Morten, Høye, Sigurd, Sundvall, Pär Daniel, Skoglund, Ingmarie, Snaebjörnsson Arnljots, Egill, Gunnarsson, Ronny, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Kosiek, Katarzyna, Platteel, Tamara N., Van De Pol, Alma C., Verheij, Theo J.M., Monnier, Annelie A., and Hertogh, Cees M.P.M.

Published
2022

8. National point prevalence study on carriage of multidrug-resistant microorganisms in Dutch long-term care facilities in 2018

Author

Kleef, Esther van, Wielders, Cornelia C.H., Schouls, Leo M., Feenstra, Sabiena G., Hertogh, Cees M.P.M., Bonten, Marc J. M., Tostmann, A., Lubben, Mariken van der, Greeff, Sabine C. de, Kleef, Esther van, Wielders, Cornelia C.H., Schouls, Leo M., Feenstra, Sabiena G., Hertogh, Cees M.P.M., Bonten, Marc J. M., Tostmann, A., Lubben, Mariken van der, and Greeff, Sabine C. de

Abstract

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Published
2021

9. Are presymptomatic SARS-CoV-2 infections in nursing home residents unrecognised symptomatic infections? Sequence and metadata from weekly testing in an extensive nursing home outbreak

Author

van den Besselaar, Judith H., Sikkema, Reina S., Koene, Fleur M.H.P.A., van Buul, Laura W., Oude Munnink, Bas B., Frénay, Ine, Witt, René Te, Koopmans, Marion P.G., Hertogh, Cees M.P.M., Buurman, Bianca M., van den Besselaar, Judith H., Sikkema, Reina S., Koene, Fleur M.H.P.A., van Buul, Laura W., Oude Munnink, Bas B., Frénay, Ine, Witt, René Te, Koopmans, Marion P.G., Hertogh, Cees M.P.M., and Buurman, Bianca M.

Abstract

BACKGROUND: Sars-CoV-2 outbreaks resulted in a high case fatality rate in nursing homes (NH) worldwide. It is unknown to which extent presymptomatic residents and staff contribute to the spread of the virus. AIMS: To assess the contribution of asymptomatic and presymptomatic residents and staff in SARS-CoV-2 transmission during a large outbreak in a Dutch NH. METHODS: Observational study in a 185-bed NH with two consecutive testing strategies: testing of symptomatic cases only, followed by weekly facility-wide testing of staff and residents regardless of symptoms. Nasopharyngeal and oropharyngeal testing with RT-PCR for SARs-CoV-2, including sequencing of positive samples, was conducted with a standardised symptom assessment. RESULTS: 185 residents and 244 staff participated. Sequencing identified one cluster. In the symptom-based test strategy period, 3/39 residents were presymptomatic versus 38/74 residents in the period of weekly facility-wide testing (P-value < 0.001). In total, 51/59 (91.1%) of SARS-CoV-2 positive staff was symptomatic, with no difference between both testing strategies (P-value 0.763). Loss of smell and taste, sore throat, headache or myalga was hardly reported in residents compared to staff (P-value <0.001). Median Ct-value of presymptomatic residents was 21.3, which did not differ from symptomatic (20.8) or asymptomatic (20.5) residents (P-value 0.624). CONCLUSIONS: Symptoms in residents and staff are insufficiently recognised, reported or attributed to a possible SARS-CoV-2 infection. However, residents without (recognised) symptoms showed the same potential for viral shedding as residents with symptoms. Weekly testing was an effective strategy for early identification of SARS-Cov-2 cases, resulting in fast mitigation of the outbreak.

Published
2021

10. Multifaceted antibiotic stewardship intervention using a participatory-action-research approach to improve antibiotic prescribing for urinary tract infections in frail elderly (ImpresU): Study protocol for a European qualitative study followed by a pragmatic cluster randomised controlled trial

Author

HAG Infectieziekten, Infection & Immunity, Biostatistiek Onderzoek, Other research (not in main researchprogram), Huisartsopleiding, Hartman, Esther A.R., Groen, Wim G., Heltveit-Olsen, Silje Rebekka, Lindbaek, Morten, Hoye, Sigurd, Sundvall, Pär Daniel, Gunnarsson, Ronny, Skoglund, Ingmarie, Snaebjörnsson Arnljots, Egill, Godycki-Cwirko, MacIej, Kowalczyk, Anna, Platteel, Tamara N., Zuithoff, Nicolaas P.A., Monnier, Annelie A., Verheij, Theo J.M., Hertogh, Cees M.P.M., Van De Pol, Alma C., HAG Infectieziekten, Infection & Immunity, Biostatistiek Onderzoek, Other research (not in main researchprogram), Huisartsopleiding, Hartman, Esther A.R., Groen, Wim G., Heltveit-Olsen, Silje Rebekka, Lindbaek, Morten, Hoye, Sigurd, Sundvall, Pär Daniel, Gunnarsson, Ronny, Skoglund, Ingmarie, Snaebjörnsson Arnljots, Egill, Godycki-Cwirko, MacIej, Kowalczyk, Anna, Platteel, Tamara N., Zuithoff, Nicolaas P.A., Monnier, Annelie A., Verheij, Theo J.M., Hertogh, Cees M.P.M., and Van De Pol, Alma C.

Published
2021

11. Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial

Author

Postgraduate Huisartsgeneeskunde, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Boere, Tjarda M., Van Buul, Laura W., Hopstaken, Rogier M., Veenhuizen, Ruth B., Van Tulder, Maurits W., Cals, Jochen W.L., Verheij, Theo J.M., Hertogh, Cees M.P.M., Postgraduate Huisartsgeneeskunde, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Boere, Tjarda M., Van Buul, Laura W., Hopstaken, Rogier M., Veenhuizen, Ruth B., Van Tulder, Maurits W., Cals, Jochen W.L., Verheij, Theo J.M., and Hertogh, Cees M.P.M.

Published
2020

12. Self-Management Support and eHealth When Managing Changes in Behavior and Mood of a Relative With Dementia: An Asynchronous Online Focus Group Study of Family Caregivers’ Needs

Author

Huis in het Veld, Judith, Verkaik, Renate, Meijel,van, B.K.G. (Berno), Verkade, Paul-Jeroen, Werkman, Wendy, Hertogh, Cees M.P.M., and Francke, Anneke

Subjects
Artikel, family caregivers, dementia
Abstract

Artikel van Judith Huis in het Veld, docent onderzoeker van de Hogeschool Inholland verschenen in Research in Gerontological Nursing ABSTRACT The current article discusses how and by whom family caregivers want to be supported in selfmanagement when managing changes in behavior and mood of relatives with dementia and whether family caregivers consider eHealth a useful tool for self-management support. Four asynchronous online focus groups were held with 32 family caregivers of individuals with dementia. Transcripts of the online focus groups were analyzed using qualitative thematic analysis. Family caregivers need support from professionals or peers in the form of (a) information about dementia and its symptoms, (b) tips and advice on managing changes in behavior and mood, (c) opportunities to discuss experiences and feelings, and (d) appreciation and acknowledgement of caregiving. The opinions of family caregivers about self-management support through eHealth were also reported. Findings suggest a personal approach is essential to self-management support for family caregivers managing changes in behavior and mood of relatives with dementia. In addition, self-management support can be provided to some extent through eHealth, but this medium cannot replace personal contacts entirely.

Published
2018

14. Consensus-based cross-European recommendations for the identification, measurement and valuation of costs in health economic evaluations : a European Delphi study

Author

van Lier, Lisanne I., Bosmans, Judith E., van Hout, Hein P.J., Mokkink, Lidwine B., van den Hout, Wilbert B., de Wit, G. Ardine, Dirksen, Carmen D., Nies, Henk L.G.R., Hertogh, Cees M.P.M., van der Roest, Henriëtte G., van Lier, Lisanne I., Bosmans, Judith E., van Hout, Hein P.J., Mokkink, Lidwine B., van den Hout, Wilbert B., de Wit, G. Ardine, Dirksen, Carmen D., Nies, Henk L.G.R., Hertogh, Cees M.P.M., and van der Roest, Henriëtte G.

Published
2018

15. Consensus-based cross-European recommendations for the identification, measurement and valuation of costs in health economic evaluations: a European Delphi study

Author

HEE, Circulatory Health, JC onderzoeksprogramma Methodologie, van Lier, Lisanne I., Bosmans, Judith E., van Hout, Hein P.J., Mokkink, Lidwine B., van den Hout, Wilbert B., de Wit, G. Ardine, Dirksen, Carmen D., Nies, Henk L.G.R., Hertogh, Cees M.P.M., van der Roest, Henriëtte G., HEE, Circulatory Health, JC onderzoeksprogramma Methodologie, van Lier, Lisanne I., Bosmans, Judith E., van Hout, Hein P.J., Mokkink, Lidwine B., van den Hout, Wilbert B., de Wit, G. Ardine, Dirksen, Carmen D., Nies, Henk L.G.R., Hertogh, Cees M.P.M., and van der Roest, Henriëtte G.

Published
2018

16. The occurrence and persistence of thoughts of suicide, self-harm and death in family caregivers of people with dementia: a longitudinal data analysis over 2 years

Author

Joling, Karlijn J., O'Dwyer, Siobhan T., Hertogh, Cees M.P.M., and van Hout, Hein P.J.

Subjects
Data Analysis, Aged, 80 and over, Male, Attitude to Death, Middle Aged, Suicidal Ideation, Diagnostic and Statistical Manual of Mental Disorders, Suicide, Logistic Models, Caregivers, suicidal thoughts, self‐harm, Humans, Dementia, Female, Longitudinal Studies, family caregivers, Self-Injurious Behavior, Research Articles, Stress, Psychological, Research Article, Aged, Netherlands
Abstract

Objective Family caregivers of people with dementia often report high levels of stress and depression, but little is known about those who contemplate suicide or self‐harm. This study explores thoughts of suicide, self‐harm and death in dementia caregivers and investigates the characteristics that distinguish them from those without such thoughts. Methods Data were collected every 3 months, for 24 months, from 192 family caregivers of people with dementia living in the Netherlands. Caregivers did not have a clinical depression or anxiety disorder at baseline. Suicide‐related thoughts were measured with an item from the Mini International Neuropsychiatric Interview, a diagnostic instrument for DSM‐IV mental disorders. Fisher exact, analysis of variance or Kruskal–Wallis tests compared the characteristics of caregivers who had contemplated suicide with two comparison groups. Results Within 24 months, 76 caregivers reported symptoms of a potential depression and were further assessed for suicidal thoughts. Nine carers (11.8%, 4.7% of the total sample) reported suicidal thoughts with three of those at multiple points. Caregivers with suicidal thoughts had more severe depressive and anxious symptoms, had a lower sense of competence and mastery, felt less happy and experienced more health problems, less family support and more feelings of loneliness than caregivers who had not. Conclusion Suicidal thoughts are present in dementia caregivers and can persist across the care trajectory. Various psychological and social characteristics significantly distinguish caregivers with suicidal thoughts from those without. More research is needed to enable the identification of high‐risk caregivers and provide an evidence base for the development of preventive strategies and interventions. © 2017 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.

Published
2016

17. Changes in geriatric rehabilitation: national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study

Author

Holstege, Marije, Caljouw, Monique A.A., Zekveld, Ineke G., Balen,van, Romke, Groot,de, Aafke J., Haastregt,van, Jolanda C.M., Schols, Jos M.G.A., Hertogh, Cees M.P.M., Gussekloo, Jacobijn, and Achterberg, Wilco P.

Subjects
health service delivery, quality of care, geriatric rehabilitation, national programme, care process
Abstract

Objective: To describe changes in the health service delivery process experienced by professionals, patients and informal caregivers during implementation of a national programme to improve quality of care of geriatric rehabilitation by improving integration of health service delivery processes. Study setting: Sixteen skilled nursing facilities. Study design: Prospective study, comparing three consecutive cohorts. Data collection: Professionals (elderly care physicians, physiotherapists and nursing staff) rated four domains of health service delivery at admission and at discharge of 1075 patients. In addition, these patients [median age 79 (Interquartile range 71–85) years, 63% females] and their informal caregivers rated their experiences on these domains 4 weeks after discharge. Principal findings: During the three consecutive cohorts, professionals reported improvement on the domain team cooperation, including assessment for intensive treatment and information transfer among professionals. Fewer improvements were reported within the domains alignment with patients’ needs, care coordination and care quality. Between the cohorts, according to patients (n = 521) and informal caregivers (n = 319) there were no changes in the four domains of health service delivery. Conclusion: This national programme resulted in small improvements in team cooperation as reported by the professionals. No effects were found on patients’ and informal caregivers’ perceptions of health service delivery.

Published
2015

18. Changes in geriatric rehabilitation: a national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study

Author

Holstege, Marije S., primary, Caljouw, Monique A.A., additional, Zekveld, Ineke G., additional, Van Balen, Romke, additional, De Groot, Aafke J., additional, Van Haastregt, Jolanda C.M., additional, Schols, Jos M.G.A., additional, Hertogh, Cees M.P.M, additional, Gussekloo, Jacobijn, additional, and Achterberg, Wilco P., additional

Published
2015
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20. Grip on challenging behavior:Process evaluation of the implementation of a care program

Author

Zwijsen, Sandra A., Smalbrugge, Martin, Eefsting, Jan A., Gerritsen, Debby L., Hertogh, Cees M.P.M., Pot, Anne M., Zwijsen, Sandra A., Smalbrugge, Martin, Eefsting, Jan A., Gerritsen, Debby L., Hertogh, Cees M.P.M., and Pot, Anne M.

Abstract

Background: The Grip on Challenging Behavior care program for managing challenging behavior was implemented in the dementia special care units of 17 Dutch nursing homes. A process evaluation of the implementation of the care program was performed to determine the quality of the implementation and the lessons to be learned for future implementation.Methods: The care program was implemented according to a stepped wedge design. First-order data (data on recruitment, reach, relevance and feasibility) were used to determine the validity of the study, and second-order data (intervention quality and the barriers and facilitators for implementing the care program) were used to describe the implementation process. Two structured questionnaires were administered to care staff and key stakeholders and semi-structured interviews were held in the units.Results: University affiliated and non-affiliated nursing homes from different parts of the Netherlands participated. The resident participation rate was over 95% and the participation rate for the training sessions was 82%. Respondents considered the care program relevant and feasible. The degree of implementation was not optimal. The barriers and facilitators in implementing the care program could be divided into three categories: organizational aspects, culture on the unit and aspects of the care program itself.Conclusions: The recruitment, reach, relevance and feasibility are sufficient to allow for analysis and generalization of the effects of the care program, but the degree of implementation should be taken into account in further analysis. Future projects that involve implementation should consider the specific features of the organization and the cultural orientation of the unit to better adapt to specific needs.Trial registration: The Netherlands National Trial register under number NTR2141 registered on 11 December 2009. Randomization took place in November 2010, and the first intervention group started using the int

Published
2014

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