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ObjectiveTo examine trends in patient experiences in the period 2014-2019, describe improvement strategies implemented by hospitals in the same period, and study associations between patient experiences and implemented strategies.DesignMulti-center retrospective region-wide observational design.SettingFlanders, Belgium.Participants44 out of 46 Flemish acute-care hospitals publicly reporting patient experiences via the Flemish Patient Survey (FPS).Main outcome measure(s)Primary outcomes were the two global FPS ratings: percentage of patients rating the hospital 9 or 10 and percentage of patients definitely recommending the hospital. Secondary outcomes were the average top-box score percentages for each of the 8 remaining dimensions of the FPS.ResultsBetween 2014 and 2019, there was a significant improvement in patients scoring the hospital 9 or 10 (56% to 61%) and patients definitely recommending (67% to 70%) the hospital. Significant increases in patient experiences over time were also observed in other dimensions, except for the dimension discharge. Hospital key informants reported various improvement strategies related to patient experiences with care and the FPS. Feedback to nursing wards (n = 44, 100%) and clinicians (n = 39, 89%) were most common. Overall, most improvement strategies were not or only weakly associated with patient experience ratings in 2019 and changes in ratings over time. Still, positive associations were discovered between the strategies 'nursing ward interventions' and 'hospital wide education' and recommendation of the hospital.ConclusionsPatient experiences have improved modestly in Flemish acute-care hospitals. Hospitals report to have invested in patient experience improvement strategies but positive associations between such strategies and FPS scores are weak, although there is potential in further exploring nursing ward interventions and hospital wide education. Hospitals should continue their efforts to improve the patient's experience, but with a more targeted approach, taking the lessons learned on the efficacy of strategies into consideration.

Kris Vanhaecht,1,2 Cathy Lodewijckx,1 Walter Sermeus,1 Marc Decramer,3,4 Svin Deneckere,1,5 Fabrizio Leigheb,6 Paulo Boto,7 Seval Kul,8 Deborah Seys,1 Massimiliano Panella1,6 1Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven – University of Leuven, 2Department of Quality Management, University Hospitals Leuven, 3Department of Clinical and Experimental Medicine, KU Leuven – University of Leuven, 4University Hospitals Leuven, Leuven, 5Medical Department, Delta Hospitals Roeselare, Roeselare, Belgium; 6Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy; 7Department of Health Services Policy and Management, Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal; 8Department of Biostatistics, School of Medicine, University of Gaziantep, Gaziantep, Turkey Purpose: Current in-hospital management of exacerbations of COPD is suboptimal, and patient outcomes are poor. The primary aim of this study was to evaluate whether implementation of a care pathway (CP) for COPD improves the 6 months readmission rate. Secondary outcomes were the 30 days readmission rate, mortality, length of stay and adherence to guidelines. Patients and methods: An international cluster randomized controlled trial was performed in Belgium, Italy and Portugal. General hospitals were randomly assigned to an intervention group where a CP was implemented or a control group where usual care was provided. The targeted population included patients with COPD exacerbation. Results: Twenty-two hospitals were included, whereof 11 hospitals (n=174 patients) were randomized to the intervention group and 11 hospitals (n=168 patients) to the control group. The CP had no impact on the 6 months readmission rate. However, the 30 days readmission rate was significantly lower in the intervention group (9.7%; 15/155) compared to the control group (15.3%; 22/144) (odds ratio =0.427; 95% confidence interval 0.222–0.822; P=0.040). Performance on process indicators was significantly higher in the intervention group for 2 of 24 main indicators (8.3%). Conclusion: The implementation of this in-hospital CP for COPD exacerbation has no impact on the 6 months readmission rate, but it significantly reduces the 30 days readmission rate. Keywords: COPD, care pathway, readmission, quality improvement, cluster randomized controlled trial

The constitutional monarchy as an essential ‘modern’ state form of the restoration period was intended to restore order and stability in Europe. In this respect, there is more of a break than continuity between the constitutional model that William I introduced in 1814-1815 and the constitutional monarchy to which Leopold I, the first king of the Belgians, had to subject himself in 1831. The specific authoritarian interpretation that William I gave to his function was one of the factors that helps to explain the Belgian revolution. It is therefore logical that the revolution, as such, produced a constitution that firstly, in general was far more democratic and, secondly, specifically restricted the power of the king. The new Belgian constitutional monarchy of 1830-1831 did not keep William I’s ‘heritage’ intact: onthe contrary, the constitutional definition of kingship in Belgium, for that time, was an ultra-liberal, modern answer to the ‘William I system’. Continuïteit en discontinuïteit van de constitutionele monarchie vanuit een transnationaal perspectief. Nederland-België (1815-1831)De constitutionele monarchie moest als een essentieel ‘moderne’ staatsvorm in het restauratietijdperk voor een herstel van orde en stabiliteit zorgen in Europa. Er is op dit punt eerder sprake van een breuk dan van continuïteit tussen het grondwettelijk model dat Willem I in 1814-1815 invoerde in het Verenigd Koninkrijk der Nederlanden en de constitutionele monarchie waaraan Leopold I zich als eerste koning der Belgen in 1831 moest onderwerpen. De specifieke interpretatie en autoritaire invulling die Willem I aan zijn functie gaf, was één van de factoren die de Belgische revolutie mee helpt verklaren. Het is dus logisch dat de revolutie als zodanig een grondwet opleverde die ten eerste in het algemeen veel democratischer was, en ten tweede specifiek de macht van de koning sterk inperkte. De Belgische grondwettelijke monarchie die uit een revolutie werd geboren, hield de ‘erfenis’ van Willem I dus niet intact: de grondwettelijke omschrijving van het koningschap was integendeel een voor die tijd ultraliberaal en modern antwoord op het ‘systeem-Willem I’.