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Behandeling van ziekten en afwijkingen is niet de taak van de jeugdgezondheidszorg. Diagnostiek, verwijzen en behandeladviezen wel (zie paragraaf 6.1). Jeugdgezondheidszorg is collectieve preventie: wordt ongevraagd en systematisch aangeboden aan alle kinderen (zie paragraaf 6.2). Kernactiviteiten jeugdgezondheidszorg (zie paragraaf 6.2): monitoring en signalering: volgen van gezondheid, groei en ontwikkeling; screeningen en vaccinaties: hielprik, gehoor- en visusproblemen, niet-ingedaalde testis, aangeboren hartafwijkingen, dysplastische heupontwikkeling, spraak- en taalontwikkeling, vaccinaties infectieziekten; voorlichting en advies: op gebied van borstvoeding, vitamine D en K, roken, buikligging zuigelingen, voeding, opvoeding etc.; veiligheid bevorderen: preventie, signalering kindermishandeling, verbetering onveilige (verkeers)situaties; opvoedingsondersteuning: m.b.v. jeugdzorg, jeugd-ggz of maatschappelijk werk. Organisatie jeugdgezondheidszorg (zie paragraaf 6.3): 0-3-jarigen: consultatiebureaus; 4-19-jarigen: via school; gemeenten hebben Centrum voor Jeugd en Gezin (CJG). Sommige groepen meer zorgbehoeften: allochtone afkomst, speciaal onderwijs, asielzoekers (zie paragraaf 6.3.2).

Aim As part of a replication study after the randomized controlled trial (RCTs) in the Netherlands, the impact was assessed on health services utilization and expenditure of two self-management programmes for older adults with osteoarthritis (OA) of the knee and hip. Background Evidence-based patient education and exercise programmes, developed and tested in RCTs, are often insufficiently diffused among practitioners and primary healthcare providers and tend to have a modest reach in the population. Large-scale adoption in primary healthcare can be improved if programmes are feasible and effective in real life. Methods The programmes were conducted in real-life conditions by primary healthcare providers (local health centres, home-care providers, physical therapy centres). Pre-test/post-test data were collected for consultation of the general practitioner (GP), medical specialist, physical therapist, and for the use of OA medication, as well as for the expenditure for physical therapy and OA medication. Findings In total, 20 Knee and 20 Hip programmes were carried out by 18 providers. The Knee programmes were attended by 204 participants and the Hip programmes by 169 participants. Physical therapy and use of OA medication for both programmes and consultation of the medical specialist for the Hip programme decreased. No effect was observed for consultations of the GP. Expenditure for physical therapy and use of OA medication could not be assessed, due to difficulties to obtain sufficient reliable data from participating health insurers. Both programmes produced similar outcomes in real-life conditions compared to their RCTs. The implications are discussed as to accurate data collection on OA expenditure, future cost-utility and cost-effectiveness studies, and the large-scale implementation of the programmes in the Dutch primary healthcare system.

Different approaches to improve quality are used in organizations delivering health care. Donabedian introduced structure, process and outcome, from which other approaches like self‐assessment, accreditation, visitation, International Standards Organisation (ISO) and European Foundation for Quality Management (EFQM) can be aligned. The EFQM model is one such approach that has been adopted and adapted by the Dutch Institute for Quality Management. This article describes the background and progress relating to the use of the EFQM business excellence model within Dutch health care organizations. In addition the process for applying for the European Quality Award and the Dutch Quality Award are described in detail. Finally, the reader is enlightened regarding the work of the European ExPeRT research group who are promoting the use of quality models within health care.

Visitatie en deelname daaraan zijn vanaf 1 januari 2005 in het kader van herregistratie volgens de Wet op de beroepen in de individuele gezondheidszorg (big) wettelijk verplicht (Centraal College van Medische Specialisten, 2004). De Kwaliteitswet zorginstellingen en de Wet big eisen dat instellingen respectievelijk beroepsbeoefenaren ‘verantwoorde zorg’ leveren en daartoe voorzien in een kwaliteitssysteem. De normen voor verantwoorde zorg zijn in de wetgeving (bewust) globaal geformuleerd. De wetgever heeft het aan ‘het veld’ overgelaten zelf invulling te geven aan wat naar professionele maatstaven als verantwoorde zorg moet worden gezien. Dit biedt ruimte om bij de invulling van het begrip rekening te houden met nieuwe inzichten en ontwikkelingen. Het kwaliteitssysteem dat de Kwaliteitswet en de Wet big verplicht stellen is een publiekrechtelijke verplichting die beoogt te garanderen dat in elk geval aan randvoorwaarden voor het leveren van verantwoorde zorg wordt voldaan.

This paper reviews safety initiatives in the health systems of the UK, Canada, Australia, and the US. Initiatives to tackle safety shortcomings involve public-private collaborations. Patient safety agencies (to institute learning, action and safety culture), adverse event reporting and, to a lesser extent, safety related performance indicators are currently used to design safer health systems. Their benefits are mixed, but there is little debate as to their possible side effects. Foreseeable adverse effects of multiple safety organisations stem from them being too many, too vague, too narrowly focused, threatened by the medical practice environment, and too optimistic. Safety related performance indicators are most developed in the US but suffer from inadequacies of administrative data, underreporting, variable indicator definitions, "extended" use, and low sensitivity of the diagnosis coding system, and arguable preventability of the prescribed conditions. A critical appraisal of the implications of these deficiencies is important to assure the safety of current health system safety initiatives and to establish evidence based safety. It is necessary to embed health system safety (as well as patient safety) in the societal culture, structures, and policies which promote effective, user centred, high performance care while allowing for healthy innovation.

Item does not contain fulltext OBJECTIVE: To assess the appropriateness of and variation in intention-to-treat decisions in the management of depression in the Netherlands. DESIGN: Mailed survey with 22 paper cases (vignettes) based on a population study. SETTING: A random sample from four professional groups in the Dutch mental healthcare system. SUBJECTS: 264 general practitioners, psychiatrists, psychotherapists, and clinical psychologists. MAIN OUTCOME MEASURES: Each vignette contained information on a number of patient characteristics taken from three national depression guidelines. The distribution of patient characteristics was based on data from a population study. Respondents were asked to choose the best treatment option and the best treatment setting. For each vignette we examined which of the selected treatments was appropriate according to the recommendations of the three published Dutch clinical guidelines and a panel of experts. RESULTS: 31% of all intention-to-treat decisions were not consistent with the guidelines. Overall, less severe depression, alcohol abuse, psychotic features, and lack of social resources were related to more inappropriate judgements. There was considerable variation between the professional groups: psychiatrists made more appropriate choices than the other professions although they had the highest rate of overtreatment. CONCLUSIONS: There is sufficient variation in the intentions to treat depression to give it priority in quality assessment and guideline development. Efforts to achieve appropriate care should focus on treatment indications, referral patterns, and overtreatment.

Pre-operative assessment of patients for surgery is one of the most prevalent topics for quality assurance by peer-review in Dutch hospitals. This article describes the experiences with pre-operative assessment in nine hospitals. It is discussed why preoperative assessment is performed, what tests are performed (chest X-ray, ECG, laboratory tests), and how the pre-operative assessment procedure is organized. Hospital protocols are compared with literature findings and audit studies from two hospitals show the actual compliance to the protocols. It is concluded that peer-review committees and audit studies play a major part in the assurance of the quality of preoperative assessment.