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Stolwijk ML, van Nispen RMA, van der Pas SL, van Rens GHMB. Big data study using health insurance claims to predict multidisciplinary low vision service uptake. Optom Vis Sci 2024; 101:290-297. [PMID: 38856650 DOI: 10.1097/opx.0000000000002134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
SIGNIFICANCE There is a lack of research from high-income countries with various health care and funding systems regarding barriers and facilitators in low vision services (LVS) access. Furthermore, very few studies on LVS provision have used claims data. PURPOSE This study aimed to investigate which patient characteristics predict receiving multidisciplinary LVS (MLVS) in the Netherlands, a high-income country, based on health care claims data. METHODS Data from a Dutch national health insurance claims database (2015 to 2018) of patients with eye diseases causing potentially severe visual impairment were retrieved. Patients received MLVS (n = 8766) and/or ophthalmic treatment in 2018 (reference, n = 565,496). MLVS is provided by professionals from various clinical backgrounds, including nonprofit low vision optometry. Patient characteristics (sociodemographic, clinical, contextual, general health care utilization) were assessed as potential predictors using a multivariable logistic regression model, which was internally validated with bootstrapping. RESULTS Predictors for receiving MLVS included prescription of low vision aids (odds ratio [OR], 8.76; 95% confidence interval [CI], 7.99 to 9.61), having multiple ophthalmic diagnoses (OR, 3.49; 95% CI, 3.30 to 3.70), receiving occupational therapy (OR, 2.32; 95% CI, 2.15 to 2.51), mental comorbidity (OR, 1.17; 95% CI, 1.10 to 1.23), comorbid hearing disorder (OR, 1.98; 95% CI, 1.86 to 2.11), and receiving treatment in both a general hospital and a specialized ophthalmic center (OR, 1.23; 95% CI, 1.10 to 1.37), or by a general practitioner (OR, 1.23; 95% CI, 1.18 to 1.29). Characteristics associated with lower odds included older age (OR, 0.30; 95% CI, 0.28 to 0.32), having a low social economic status (OR, 0.91; 95% CI, 0.86 to 0.97), physical comorbidity (OR, 0.87; 95% CI, 0.82 to 0.92), and greater distance to an MLVS (OR, 0.95; 95% CI, 0.92 to 0.98). The area under the curve of the model was 0.75 (95% CI, 0.75 to 0.76; optimism = 0.0008). CONCLUSIONS Various sociodemographic, clinical, and contextual patient characteristics, as well as factors related to patients' general health care utilization, were found to influence MLVS receipt as barriers or facilitators. Eye care practitioners should have attention for socioeconomically disadvantaged older patients when considering MLVS referral.
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van Munster JJCM, Halperin IJY, Ardesch FH, van den Hout WB, van Benthem PPG, Moojen W, Peul WC. Practice variation in surgical treatment for lumbar degenerative disc disease: exploring regional and hospital factors influencing surgical rates. Sci Rep 2024; 14:9273. [PMID: 38653739 DOI: 10.1038/s41598-024-59629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
The presence of significant, unwarranted variation in treatment suggests that clinical decision making also depends on where patients live instead of what they need and prefer. Historically, high practice variation in surgical treatment for lumbar degenerative disc disease (LDDD) has been documented. This study aimed to investigate current regional variation in surgical treatment for sciatica resulting from LDDD. We conducted a retrospective, cross-sectional analysis of all Dutch adults (>18 years) between 2016 and 2019. Demographic data from Statistics Netherlands were merged with a nationwide claims database, covering over 99% of the population. Inclusion criteria comprised LDDD diagnosis codes and relevant surgical codes. Practice variation was assessed at the level of postal code areas and hospital service areas (HSAs). Multivariable logistic regression analysis was employed to identify variables associated with surgical treatment. Among the 119,148 hospital visitors with LDDD, 14,840 underwent surgical treatment. Practice variation for laminectomies and discectomies showed less than two-fold variation in both postal code and HSAs. However, instrumented fusion surgery demonstrated a five-fold variation in postal code areas and three-fold variation in HSAs. Predictors of receiving surgical treatment included opioid prescription and patient referral status. Gender differences were observed, with males more likely to undergo laminectomy or discectomy, and females more likely to receive instrumented fusion surgery. Our study revealed low variation rates for discectomies and laminectomies, while indicating a high variation rate for instrumented fusion surgery in LDDD patients. High-quality research is needed on the extent of guideline implementation and its influence on practice variation.
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Affiliation(s)
- Juliëtte J C M van Munster
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands.
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
- Department of Neurosurgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Ilan J Y Halperin
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Frank H Ardesch
- Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
| | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Wouter Moojen
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands
| | - Wilco C Peul
- University Neurosurgical Centre Holland (UNCH), LUMC | HMC | HAGA, Leiden & The Hague, the Netherlands
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Stolwijk ML, van Nispen RMA, van der Pas SL, van Rens GHMB. A retrospective big data study using healthcare insurance claims to investigate the role of comorbidities in receiving low vision services. FRONTIERS IN HEALTH SERVICES 2024; 4:1264838. [PMID: 38500632 PMCID: PMC10944930 DOI: 10.3389/frhs.2024.1264838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
Introduction The aim was to examine the association between physical and mental comorbidity with receiving low vision services (LVS). Methods A retrospective study based on Dutch claims data of health insurers was performed. We retrieved data (2015-2018) of patients (≥18 years) with eye diseases causing severe vision loss who received LVS at Dutch rehabilitation organizations in 2018 (target group) and patients who did not receive LVS, but who received ophthalmic medical specialist care for glaucoma, macular, diabetic retinal and/or retinal diseases in 2018 (reference group). For examining the association between the patients' comorbidities and receiving LVS, multivariable logistic regression was used. The relative quality of five different models was assessed with the Akaike Information Criterion (AIC). Results The study population consisted of 574,262 patients, of which 8,766 in the target group and 565,496 in the reference group. Physical comorbidity was found in 83% and 14% had mental comorbidity. After adjustment for all assumed confounders, both physical and mental comorbidity remained significantly associated with receiving LVS. In the adjusted model, which also included both comorbidity variables, the best relative quality was found to describe the association between mental and physical comorbidity and receiving LVS. Conclusions Mental comorbidity seemed to be independently associated with receiving LVS, implying that the odds for receiving a LVS referral are higher in patients who are vulnerable to mental comorbidity. Physical comorbidity was independently associated, however, the association with receiving LVS might not be that meaningful in terms of policy implications. Providing mental healthcare interventions for people with VI seems warranted.
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Affiliation(s)
- M. L. Stolwijk
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Quality of Care, Amsterdam Public Health, Amsterdam, Netherlands
| | - R. M. A. van Nispen
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Quality of Care, Amsterdam Public Health, Amsterdam, Netherlands
| | - S. L. van der Pas
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Methodology, Amsterdam Public Health, Amsterdam, Netherlands
| | - G. H. M. B. van Rens
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Quality of Care, Amsterdam Public Health, Amsterdam, Netherlands
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Hilt AD, Umans VAWM, Vossenberg TNE, Schalij MJ, Beeres SLMA. Myocardial infarction care in low and high socioeconomic environments: claims data analysis. Neth Heart J 2024; 32:118-124. [PMID: 37823980 PMCID: PMC10884367 DOI: 10.1007/s12471-023-01813-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND To date, claims data have not been used to study outcome differences between low and high socioeconomic status (SES) patients surviving ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in the Netherlands. AIM To evaluate STEMI and NSTEMI care among patients with low and high SES in the referral area of three Dutch percutaneous coronary intervention (PCI) centres, using claims data as a source. METHODS STEMI and NSTEMI patients treated in 2015-2017 were included. Patients' SES scores were collected based on their postal code via an open access government database. In patients with low (SES1) and high (SES4) status, revascularisation strategies and secondary prevention medication were compared. RESULTS A total of 2065 SES1 patients (age 68 ± 13 years, 58% NSTEMI) and 1639 SES4 patients (age 68 ± 13 years, 63% NSTEMI) were included. PCI use was lower in SES1 compared to SES4 in both STEMI (80% vs 84%, p < 0.012) and NSTEMI (42% vs 48%, p < 0.002) patients. Coronary artery bypass grafting was performed more often in SES1 than in SES4 in both STEMI (7% vs 4%, p = NS) and NSTEMI (11% vs 7%, p < 0.001) patients. Optimal medical therapy use in STEMI patients was higher in SES1 compared to SES4 (52% vs 46%, p = 0.01) but comparable among NSTEMI patients (39% vs 40%, p = NS). One-year mortality was comparable in SES1 and SES4 patients following STEMI (14% vs 16%, p = NS) and NSTEMI (10% vs 11%, p = NS). CONCLUSION Combined analysis of claims data and area-specific socioeconomic statistics can provide unique insight into how to improve myocardial infarction care for low and high SES patients.
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Affiliation(s)
- Alexander D Hilt
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victor A W M Umans
- Department of Cardiology, Noordwest Ziekenhuisgroep, location Alkmaar, Alkmaar, The Netherlands
| | | | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
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Baas DJH, Reitsma J, van Gerwen L, Vleghaar J, Gehlen JMLG, Ziedses des Plantes CMP, van Basten JPA, van den Bergh RCN, Bruins HM, Collette ERP, Hoekstra RJ, Knipscheer BC, van Leeuwen PJ, Luijendijk-de Bruin D, van Roermund JGH, Sedelaar JPM, Speel TGW, Stomps SP, Wijburg CJ, Wijn RPWF, de Jong IJ, Somford DM. Validation of Claims Data for Absorbing Pads as a Measure for Urinary Incontinence after Radical Prostatectomy, a National Cross-Sectional Analysis. Cancers (Basel) 2023; 15:5740. [PMID: 38136286 PMCID: PMC10742264 DOI: 10.3390/cancers15245740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
The use of healthcare insurance claims data for urinary incontinence (UI) pads has the potential to serve as an objective measure for assessing post-radical prostatectomy UI rates, but its validity for this purpose has not been established. The aim of this study is to correlate claims data with Patient Reported Outcome Measures (PROMs) for UI pad use. Patients who underwent RP in the Netherlands between September 2019 and February 2020 were included. Incontinence was defined as the daily use of ≥1 pad(s). Claims data for UI pads at 12-15 months after RP were extracted from a nationwide healthcare insurance database in the Netherlands. Participating hospitals provided PROMS data. In total, 1624 patients underwent RP. Corresponding data of 845 patients was provided by nine participating hospitals, of which 416 patients were matched with complete PROMs data. Claims data and PROMs showed 31% and 45% post-RP UI (≥1 pads). UI according to claims data compared with PROMs had a sensitivity of 62%, specificity of 96%, PPV of 92%, NPV of 75% and accuracy of 81%. The agreement between both methods was moderate (κ = 0.60). Claims data for pads moderately align with PROMs in assessing post-prostatectomy urinary incontinence and could be considered as a conservative quality indicator.
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Affiliation(s)
- Diederik J. H. Baas
- Department of Urology, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, 6532 SZ Nijmegen, The Netherlands
| | - Jan Reitsma
- Zorgverzekeraars Nederland, 3700 AM Zeist, The Netherlands
| | | | - Jaron Vleghaar
- Vektis Intelligence, Vektis, 3700 AS Zeist, The Netherlands
| | | | | | - Jean Paul A. van Basten
- Department of Urology, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, 6532 SZ Nijmegen, The Netherlands
| | | | - H. Max Bruins
- Department of Urology, Zuyderland Medical Center, 6419 PC Heerlen, The Netherlands
| | | | - Robert J. Hoekstra
- Prosper Prostate Cancer Clinics, 6532 SZ Nijmegen, The Netherlands
- Department of Urology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - Ben C. Knipscheer
- Department of Urology, Treant Zorggroep, 7824 AA Emmen, The Netherlands
| | - Pim J. van Leeuwen
- Department of Urology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | | | - Joep G. H. van Roermund
- Department of Urology, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - J. P. Michiel Sedelaar
- Prosper Prostate Cancer Clinics, 6532 SZ Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Tommy G. W. Speel
- Department of Urology, Leeuwarden Medical Center, 8934 AD Leeuwarden, The Netherlands
| | - Saskia P. Stomps
- Department of Urology, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands
| | - Carl J. Wijburg
- Department of Urology, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
| | - Rob P. W. F. Wijn
- Department of Urology, Jeroen Bosch Hospital, 5223 GZ Hertogenbosch, The Netherlands
| | - Igle Jan de Jong
- Department of Urology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Diederik M. Somford
- Department of Urology, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, 6532 SZ Nijmegen, The Netherlands
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van Steenbergen GJ, Demandt JPA, Schulz DN, Tonino PA, Dekker L, Vermeer‐Gerritzen I, Wijnbergen IF, Thijssen EJM, Theunissen LJHJ, Heijmen EPCM, Haest RJP, Vlaar P, van Veghel D. Direct admission versus interhospital transfer for revascularisation in non-ST-segment elevation myocardial infarction. Clin Cardiol 2023; 46:997-1006. [PMID: 37345218 PMCID: PMC10436781 DOI: 10.1002/clc.24060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The differences in outcomes and process parameters for NSTEMI patients who are directly admitted to an intervention centre and patients who are first admitted to a general centre are largely unknown. HYPOTHESIS There are differences in process indicators, but not for clinical outcomes, for NSTEMI who are directly admitted to an intervention centre and patients who are first admitted to a general centre. METHODS We aim to compare process indicators, costs and clinical outcomes of non-ST-segment elevation myocardial infarction (NSTEMI) patients stratified by center of first presentation and revascularisation strategy. Hospital claim data from patients admitted with a NSTEMI between 2017 and 2019 were used for this study. Included patients were stratified by center of admission (intervention vs. general center) and subdivided by revascularisation strategy (PCI, CABG, or no revascularisation [noRevasc]). The primary outcome was length of hospital stay. Secondary outcomes included: duration between admission and diagnostic angiography and revascularisation, number of intracoronary procedures, clinical outcomes at 30 days (MACE: all-cause mortality, recurrent myocardial infarction and cardiac readmission) and total costs (accumulation of costs for hospital claims and interhospital ambulance rides). RESULTS A total of 9641 NSTEMI events (9167 unique patients) were analyzed of which 5399 patients (56%) were admitted at an intervention center and 4242 patients to a general center. Duration of hospitalization was significantly shorter at direct presentation at an intervention centre for all study groups (5 days [2-11] vs. 7 days [4-12], p < 0.001). For PCI, direct presentation at an intervention center yielded shorter time to diagnostic angiography (1 day [0-2] vs. 1 day [1-2], p < 0.01) and revascularisation (1 day [0-3] vs. 4 days [1-7], p < 0.001) and less intracoronary procedures per patient (2 [1-2] vs. 2 [2-2], p < 0.001). For CABG, time to revascularisation was shorter (8 days [5-12] vs. 10 days [7-14], p < 0.001). Total costs were significantly lower in case of direct presentation in an intervention center for all treatment groups €10.211 (8750-18.192) versus €13.741 (11.588-19.381), p < 0.001) while MACE was similar 11.8% versus 12.4%, p = 0.344). CONCLUSION NSTEMI patients who were directly presented to an intervention center account for shorter duration of hospitalization, less time to revascularisation, less interhospital transfers, less intracoronary procedures and lower costs compared to patients who present at a general center.
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Affiliation(s)
| | | | | | - Pim A. Tonino
- Catharina Heart CentreCatharina HospitalEindhovenThe Netherlands
| | - Lukas Dekker
- Catharina Heart CentreCatharina HospitalEindhovenThe Netherlands
- Netherlands Heart Network (NHN)South‐East BrabantThe Netherlands
| | | | | | - Eric J. M. Thijssen
- Netherlands Heart Network (NHN)South‐East BrabantThe Netherlands
- Maxima Medical CenterVeldhovenThe Netherlands
| | - Luc J. H. J. Theunissen
- Netherlands Heart Network (NHN)South‐East BrabantThe Netherlands
- Maxima Medical CenterVeldhovenThe Netherlands
| | - Eric P. C. M. Heijmen
- Netherlands Heart Network (NHN)South‐East BrabantThe Netherlands
- Elkerliek HospitalHelmondThe Netherlands
| | - Rutger J. P. Haest
- Netherlands Heart Network (NHN)South‐East BrabantThe Netherlands
- St. Anna HospitalGeldropThe Netherlands
| | - Pieter‐Jan Vlaar
- Catharina Heart CentreCatharina HospitalEindhovenThe Netherlands
- Netherlands Heart Network (NHN)South‐East BrabantThe Netherlands
| | - Dennis van Veghel
- Catharina Heart CentreCatharina HospitalEindhovenThe Netherlands
- Netherlands Heart Network (NHN)South‐East BrabantThe Netherlands
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Krefting J, Sen P, David-Rus D, Güldener U, Hawe JS, Cassese S, von Scheidt M, Schunkert H. Use of big data from health insurance for assessment of cardiovascular outcomes. Front Artif Intell 2023; 6:1155404. [PMID: 37207237 PMCID: PMC10188985 DOI: 10.3389/frai.2023.1155404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023] Open
Abstract
Outcome research that supports guideline recommendations for primary and secondary preventions largely depends on the data obtained from clinical trials or selected hospital populations. The exponentially growing amount of real-world medical data could enable fundamental improvements in cardiovascular disease (CVD) prediction, prevention, and care. In this review we summarize how data from health insurance claims (HIC) may improve our understanding of current health provision and identify challenges of patient care by implementing the perspective of patients (providing data and contributing to society), physicians (identifying at-risk patients, optimizing diagnosis and therapy), health insurers (preventive education and economic aspects), and policy makers (data-driven legislation). HIC data has the potential to inform relevant aspects of the healthcare systems. Although HIC data inherit limitations, large sample sizes and long-term follow-up provides enormous predictive power. Herein, we highlight the benefits and limitations of HIC data and provide examples from the cardiovascular field, i.e. how HIC data is supporting healthcare, focusing on the demographical and epidemiological differences, pharmacotherapy, healthcare utilization, cost-effectiveness and outcomes of different treatments. As an outlook we discuss the potential of using HIC-based big data and modern artificial intelligence (AI) algorithms to guide patient education and care, which could lead to the development of a learning healthcare system and support a medically relevant legislation in the future.
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Affiliation(s)
- Johannes Krefting
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- *Correspondence: Johannes Krefting
| | - Partho Sen
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Diana David-Rus
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ulrich Güldener
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Johann S. Hawe
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Heribert Schunkert
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Alberga AJ, Stangenberger VA, de Bruin JL, Wever JJ, Wilschut JA, van den Brand CL, Verhagen HJM, W J M Wouters M. Administrative healthcare data as an addition to the Dutch surgaical aneurysm audit to evaluate mid-term reinterventions following abdominal aortic aneurysm repair: A pilot study. Int J Med Inform 2022; 164:104806. [PMID: 35671586 DOI: 10.1016/j.ijmedinf.2022.104806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/01/2022] [Accepted: 05/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Dutch Surgical Aneurysm Audit (DSAA) is a nationwide mandatory quality registry that evaluates the perioperative outcomes of abdominal aortic aneurysms (AAAs). The DSAA includes perioperative outcomes that occur up to 30 days, but various complications following AAA repair occur after this period. Administrative healthcare data yield the possibility to evaluate later occuring outcomes such as reinterventions, without increasing the registration burden. The aim of this study is to assess the feasibility and the potential benefit of administrative healthcare data to evaluate mid-term reinterventions following intact AAA repair. METHOD All patients that underwent primary endovascular aneurysm repair (EVAR) or open surgical repair (OSR) for an intact infrarenal AAA between January 2017 and December 2018 were selected from the DSAA. Subsequently, these patients were identified in a database containing reimbursement data. Healthcare activity codes that refer to reinterventions following AAA repair were examined to assess reinterventions within 12 and 15 months following EVAR and OSR. RESULTS We selected 4043 patients from the DSAA, and 2059 (51%) patients could be identified in the administrative healthcare database. Reintervention rates of 10.4% following EVAR and 9.5% following OSR within 12 months (p = 0.719), and 11.5% following EVAR and 10.8% following OSR within 15 months (p = 0.785) were reported. CONCLUSION Administrative healthcare data as an addition to the DSAA is potentially beneficial to evaluate mid-term reinterventions following intact AAA repair without increasing the registration burden for clinicians. Further validation is necessary before reliable implementation of this tool is warranted.
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Affiliation(s)
- Anna J Alberga
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | | | - Jorg L de Bruin
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan J Wever
- Department of Vascular Surgery, Haga Teaching Hospital, The Hague, The Netherlands
| | - Janneke A Wilschut
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | | | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Salet N, Stangenberger VA, Eijkenaar F, Schut FT, Schut MC, Bremmer RH, Abu-Hanna A. Identifying prognostic factors for clinical outcomes and costs in four high-volume surgical treatments using routinely collected hospital data. Sci Rep 2022; 12:5902. [PMID: 35393507 PMCID: PMC8989991 DOI: 10.1038/s41598-022-09972-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Identifying prognostic factors (PFs) is often costly and labor-intensive. Routinely collected hospital data provide opportunities to identify clinically relevant PFs and construct accurate prognostic models without additional data-collection costs. This multicenter (66 hospitals) study reports on associations various patient-level variables have with outcomes and costs. Outcomes were in-hospital mortality, intensive care unit (ICU) admission, length of stay, 30-day readmission, 30-day reintervention and in-hospital costs. Candidate PFs were age, sex, Elixhauser Comorbidity Score, prior hospitalizations, prior days spent in hospital, and socio-economic status. Included patients dealt with either colorectal carcinoma (CRC, n = 10,254), urinary bladder carcinoma (UBC, n = 17,385), acute percutaneous coronary intervention (aPCI, n = 25,818), or total knee arthroplasty (TKA, n = 39,214). Prior hospitalization significantly increased readmission risk in all treatments (OR between 2.15 and 25.50), whereas prior days spent in hospital decreased this risk (OR between 0.55 and 0.95). In CRC patients, women had lower risk of in-hospital mortality (OR 0.64), ICU admittance (OR 0.68) and 30-day reintervention (OR 0.70). Prior hospitalization was the strongest PF for higher costs across all treatments (31–64% costs increase/hospitalization). Prognostic model performance (c-statistic) ranged 0.67–0.92, with Brier scores below 0.08. R-squared ranged from 0.06–0.19 for LoS and 0.19–0.38 for costs. Identified PFs should be considered as building blocks for treatment-specific prognostic models and information for monitoring patients after surgery. Researchers and clinicians might benefit from gaining a better insight into the drivers behind (costs) prognosis.
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Affiliation(s)
- N Salet
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
| | - V A Stangenberger
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,LOGEX b.v., Amsterdam, The Netherlands
| | - F Eijkenaar
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - F T Schut
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - M C Schut
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - A Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Stolwijk ML, Nispen RMA, Verburg IWM, Gerwen L, Brug T, Rens GHMB. Trends in low vision service utilisation: A retrospective study based on general population healthcare claims. Ophthalmic Physiol Opt 2022; 42:828-838. [PMID: 35661209 PMCID: PMC9325458 DOI: 10.1111/opo.12982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
Purpose To identify parameters associated with the downward trend in the uptake of Low Vision Services (LVS) in the Netherlands. Methods A retrospective cohort study was conducted based on a Dutch national health insurance claims database (Vektis CV) of all adults (≥18 years) who received LVS from 2015 until 2018. Descriptive statistics were used to assess socio‐demographic, clinical and contextual characteristics and other healthcare utilisation of the study population. General estimating equations trends in characteristics and healthcare utilisation were determined over time. Results A total of 49,726 unique patients received LVS, but between 2015 and 2018, the number of patients decreased by 15%. The majority was aged 65 years or older (53%), female (54%), had a middle (38%) or low (24%) socio‐economic status and lived in urban areas (68%). Between 2015–2018, significant downward trends were found for treatment with intravitreal injections and lens‐related diseases for LVS patients. For physical comorbidity, utilisation of ophthalmic care, low vision aids and occupational therapy, a significant upward trend was found over time. Conclusion The decrease of Dutch LVS patients by 15% between 2015 and 2018 might be explained by a reduced distribution of patients treated with intravitreal injections and patients with lens‐related diseases within the LVS. Compared to 2015, patients were more likely to have physical comorbidity, to see an ophthalmologist and to use low vision aids and occupational therapy in 2016, 2017 and 2018. This might indicate enhanced access to LVS when treated by ophthalmologists or within other medical specialties, or the opposite, i.e., less access when not treated within one of these medical specialties. Future research is needed to examine differences in patterns between LVS users and non‐users further.
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Affiliation(s)
- Miriam L Stolwijk
- Ophthalmology Department Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | - Ruth M A Nispen
- Ophthalmology Department Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | | | - Lieke Gerwen
- Healthcare Information Center Vektis CV Zeist the Netherlands
| | - Tim Brug
- Epidemiology and Data Science Department Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | - Ger H M B Rens
- Ophthalmology Department Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute Amsterdam the Netherlands
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Morikubo H, Kobayashi T, Fukuda T, Nagahama T, Hisamatsu T, Hibi T. Development of algorithms for identifying patients with Crohn's disease in the Japanese health insurance claims database. PLoS One 2021; 16:e0258537. [PMID: 34644342 PMCID: PMC8513890 DOI: 10.1371/journal.pone.0258537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background Real-world big data studies using health insurance claims databases require extraction algorithms to accurately identify target population and outcome. However, no algorithm for Crohn’s disease (CD) has yet been validated. In this study we aim to develop an algorithm for identifying CD using the claims data of the insurance system. Methods A single-center retrospective study to develop a CD extraction algorithm from insurance claims data was conducted. Patients visiting the Kitasato University Kitasato Institute Hospital between January 2015–February 2019 were enrolled, and data were extracted according to inclusion criteria combining the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnosis codes with or without prescription or surgical codes. Hundred cases that met each inclusion criterion were randomly sampled and positive predictive values (PPVs) were calculated according to the diagnosis in the medical chart. Of all cases, 20% were reviewed in duplicate, and the inter-observer agreement (Kappa) was also calculated. Results From the 82,898 enrolled, 255 cases were extracted by diagnosis code alone, 197 by the combination of diagnosis and prescription codes, and 197 by the combination of diagnosis codes and prescription or surgical codes. The PPV for confirmed CD cases was 83% by diagnosis codes alone, but improved to 97% by combining with prescription codes. The inter-observer agreement was 0.9903. Conclusions Single ICD-code alone was insufficient to define CD; however, the algorithm that combined diagnosis codes with prescription codes indicated a sufficiently high PPV and will enable outcome-based research on CD using the Japanese claims database.
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Affiliation(s)
- Hiromu Morikubo
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Minato-ku, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Minato-ku, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Minato-ku, Tokyo, Japan
- * E-mail:
| | - Tomohiro Fukuda
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Minato-ku, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Minato-ku, Tokyo, Japan
| | - Takayoshi Nagahama
- Data Innovation Lab, Japan Medical Data Center Co., Ltd., Minato-ku, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Minato-ku, Tokyo, Japan
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12
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Enklaar RA, van IJsselmuiden MN, IntHout J, Haan SJH, Rijssenbeek OGAM, Bremmer RH, van Eijndhoven HWF. Practice pattern variation: treatment of pelvic organ prolapse in The Netherlands. Int Urogynecol J 2021; 33:1973-1980. [PMID: 34487194 PMCID: PMC9270291 DOI: 10.1007/s00192-021-04968-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Great variety in clinical management of pelvic organ prolapse (POP) has been described over the last years. Practice pattern variation (PPV) reflects differences in care that cannot be explained by the underlying condition. We aim to explore whether PPV in management of POP in The Netherlands has changed between 2011 and 2017. METHODS We conducted a multicenter cohort study, using prospective routinely collected benchmark data from LOGEX, a healthcare analytics company (Amsterdam, The Netherlands). Data of patients with a diagnosis POP from 50 hospitals (16 teaching and 34 non-teaching hospitals) were collected for the years 2011 and 2017. All treatments were categorized into three groups: conservative treatment, uterus-preserving or uterus-removing surgery. Using meta-analysis, we evaluated whether the proportions of conducted treatments changed over time and estimated the between-center variation (Cochran's Q), reflecting the PPV in 2011 and 2017. This variation was analyzed using F-tests. RESULTS Compared to 2011, referral for POP in 2017 decreased by 16.2% (-4505 patients), and the percentage of hysterectomies decreased by 33.6% (p < 0.0001). The PPV of POP surgery decreased significantly by 47.2% (p = 0.0137) and of hysterectomies by 41.5% (p = 0.0316). CONCLUSIONS We found a decline in PPV for POP surgery between 2011 and 2017. Furthermore, the number of surgical interventions decreased, which was mostly due to a decline of hysterectomies. This indicates a shift toward more conservative therapy and uterus preservation. A further reduction of PPV would be beneficial for the quality of health care.
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Affiliation(s)
- Rosa A Enklaar
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Groote plein Zuid 10, 6525, GA, Nijmegen, The Netherlands. .,Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands.
| | | | - Joanna IntHout
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Association between public media and trends in new acute coronary syndrome presentations during the first COVID‑19 wave in the Netherlands. Neth Heart J 2021; 29:577-583. [PMID: 34327671 PMCID: PMC8320720 DOI: 10.1007/s12471-021-01603-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We aimed to evaluate the association between public media and trends in new presentations of acute coronary syndrome (ACS) during the first wave of the coronavirus disease 2019 (COVID‑19) in the Netherlands. METHODS New ACS presentations per week in 73 hospitals during the first half of 2019 and 2020 were retrieved from the national organisation Dutch Hospital Data and incidence rates were calculated. Stratified analyses were performed by region, type of ACS and patient characteristics. RESULTS After the first confirmed COVID‑19 case and during lockdown, numbers declined by up to 41% (95% confidence interval (CI): 36-47%) compared to 2019. This reduction was more pronounced for non-ST-segment elevation myocardial infarction (NSTEMI) (48%; 95% CI: 39-55%) and unstable angina (UA; 50%; 95% CI: 40-59%) than for STEMI (34%; 95% CI: 23-43%). There was no association between ACS and COVID‑19 incidence rate per region. After the steep decline, a public campaign encouraged patients not to postpone hospital visits. Numbers then increased, without a rebound effect. Trends were similar irrespective of sex, age or socio-economic status. During the outbreak, compared to coronary artery bypass graft procedures, relatively more (acute) percutaneous coronary interventions for NSTEMI and UA were performed. CONCLUSION New ACS presentations decreased by up to 41%. Lockdown measures and public campaigns, rather than COVID‑19 incidence, were associated with significant changes in new ACS presentations. Even though causality cannot be established, this emphasises the role of the public media and healthcare organisations in informing patients to prevent underdiagnoses of ACS and associated health damage.
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Saunders-Hastings P, Heong SW, Srichaikul J, Wong HL, Shoaibi A, Chada K, Burrell TA, Dores GM. Acute myocardial infarction: Development and application of an ICD-10-CM-based algorithm to a large U.S. healthcare claims-based database. PLoS One 2021; 16:e0253580. [PMID: 34197488 PMCID: PMC8248590 DOI: 10.1371/journal.pone.0253580] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Healthcare administrative claims data hold value for monitoring drug safety and assessing drug effectiveness. The U.S. Food and Drug Administration Biologics Effectiveness and Safety Initiative (BEST) is expanding its analytical capacity by developing claims-based definitions—referred to as algorithms—for populations and outcomes of interest. Acute myocardial infarction (AMI) was of interest due to its potential association with select biologics and the lack of an externally validated International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) algorithm. Objective Develop and apply an ICD-10-CM-based algorithm in a U.S. administrative claims database to identify and characterize AMI populations. Methods A comprehensive literature review was conducted to identify validated AMI algorithms. Building on prior published methodology and consistent application of ICD-9-CM codes, an ICD-10-CM algorithm was developed via forward-backward mapping using General Equivalence Mappings and refined with clinical input. An AMI population was then identified in the IBM® MarketScan® Research Databases and characterized using descriptive statistics. Results and discussion Between 2014–2017, 2.83–3.16 individuals/1,000 enrollees/year received ≥1 AMI diagnosis in any healthcare setting. The 2015 transition to ICD-10-CM did not result in a substantial change in the proportion of patients identified. Average patient age at first AMI diagnosis was 64.9 years, and 61.4% of individuals were male. Unspecified chest pain, hypertension, and coronary atherosclerosis of native coronary vessel/artery were most commonly reported within one day of AMI diagnosis. Electrocardiograms were the most common medical procedure and beta-blockers were the most commonly ordered cardiac medication in the one day before to 14 days following AMI diagnosis. The mean length of inpatient stay was 5.6 days (median 3 days; standard deviation 7.9 days). Findings from this ICD-10-CM-based AMI study were internally consistent with ICD-9-CM-based findings and externally consistent with ICD-9-CM-based studies, suggesting that this algorithm is ready for validation in future studies.
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Affiliation(s)
| | | | | | - Hui-Lee Wong
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Azadeh Shoaibi
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Kinnera Chada
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | | | - Graça M. Dores
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
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van Munster JJCM, Wammes JJG, Bremmer RH, Zamanipoor Najafabadi AH, Hemler RJ, Peul WC, van den Hout WB, van Benthem PPG. Regional and hospital variation in commonly performed paediatric otolaryngology procedures in the Netherlands: a population-based study of healthcare utilisation between 2016 and 2019. BMJ Open 2021; 11:e046840. [PMID: 34210728 PMCID: PMC8252878 DOI: 10.1136/bmjopen-2020-046840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In the past few decades, there has been an increase in high-quality studies providing evidence on the effectiveness of commonly performed procedures in paediatric otolaryngology. We believe that now is the time to re-evaluate the care process. We aimed to analyse (1) the regional variation in incidence and referrals of adenoidectomies, tonsillectomies and ventilation tube insertions in children in the Netherlands between 2016 and 2019, (2) whether regional surgical rates, referral rates and in-hospital surgical rates were associated with one another, and (3) the hospital variation in healthcare costs, which indicates the utilisation of resources. DESIGN Repeated cross-sectional analysis. SETTING Four neighbouring Dutch provinces comprising 2.8 million inhabitants and 14 hospitals. PARTICIPANTS Children aged 0-15 years. OUTCOME MEASURES We analysed variation in regional surgical rates and referral rates per 1000 inhabitants and in-hospital surgical rates per 1000 clinic visitors, adjusted for age and socioeconomic status. Furthermore, the relationships between referral rates, regional surgical rates and in-hospital surgical rates were estimated. Lastly, variation in resource utilisation between hospitals was estimated. RESULTS Adenoidectomy rates differed sixfold between regions. Twofold differences were observed for adenotonsillectomy rates, ventilation tube insertion rates and referral rates. Referral rates were negatively associated with in-hospital surgical rates for adenotonsillectomies, but not for adenoidectomies and ventilation tube insertions. In-hospital surgical rates were positively associated with regional rates for adenoidectomies and adenotonsillectomies. Significant variation between hospitals was observed in costs for all resources. CONCLUSIONS We observed low variation in tonsillectomies and ventilation tube insertion and high variation in adenoidectomies. Indications for a tonsillectomy and ventilation tube insertion are well defined in Dutch guidelines, whereas this is not the case for an adenoidectomy. Lack of agreement on indications can be expected and high-quality effectiveness research is required to improve evidence-based guidelines on this topic.
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Affiliation(s)
- Juliëtte J C M van Munster
- Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
- University Neurosurgical Center Holland, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rolf H Bremmer
- Hospital & Health Care, LOGEX, Amsterdam, The Netherlands
| | | | - Raphael J Hemler
- Otorhinolaryngology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Peter Paul G van Benthem
- Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
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16
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van Egmond S, Hollestein LM, Uyl-de Groot CA, van Erkelens JA, Wakkee M, Nijsten TEC. Practice Variation in Skin Cancer Treatment and Follow-Up Care: A Dutch Claims Database Analysis. Dermatology 2021; 237:1000-1006. [PMID: 33503632 DOI: 10.1159/000513523] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Quality indicators are used to benchmark and subsequently improve quality of healthcare. However, defining good quality indicators and applying them to high-volume care such as skin cancer is not always feasible. OBJECTIVES To determine whether claims data could be used to benchmark high-volume skin cancer care and to assess clinical practice variation. METHODS All skin cancer care-related claims in dermatology in 2016 were extracted from a nationwide claims database (Vektis) in the Netherlands. RESULTS For over 220,000 patients, a skin cancer diagnosis-related group was reimbursed in 124 healthcare centres. Conventional excision reflected 75% of treatments for skin cancer but showed large variation between practices. Large practice variation was also found for 5-fluorouracil and imiquimod creams. The practice variation of Mohs micrographic surgery and photodynamic therapy was low under the 75th percentile, but outliers at the 100th percentile were detected, which indicates that few centres performed these therapies far more often than average. On average, patients received 1.8 follow-up visits in 2016. CONCLUSIONS Claims data demonstrated large practice variation in treatments and follow-up visits of skin cancer and may be a valid and feasible data set to extract quality indicators. The next step is to investigate whether detected practice variation is unwarranted and if a reduction improves quality and efficiency of care.
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Affiliation(s)
- Sven van Egmond
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands,
| | - Loes M Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | | | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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van Munster JJCM, Zamanipoor Najafabadi AH, van 't Hooft J, van Barneveld TA, Böhringer S, Visser JS, Bremmer RH, Peul WC, van den Hout WB, van Benthem PPG. Changes in healthcare utilisation for paediatric tonsillectomy and adenoidectomy in the Netherlands: a population-based study. Clin Otolaryngol 2020; 46:347-356. [PMID: 33253462 PMCID: PMC8247036 DOI: 10.1111/coa.13675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 01/31/2023]
Abstract
Objectives Tonsillectomy and adenoidectomy in children are controversial subjects with large regional variation in surgical rates, partly explained by cultural differences and lack of high‐quality evidence on indications for surgery. A quality of care cycle was executed on this topic in the Netherlands. The objective of this study was to estimate changes in healthcare utilisation for paediatric tonsil surgery in the Netherlands. Methods Population‐based data on tonsillectomies and adenoidectomies in children up to age 10 were retrieved retrospectively from Dutch administrative databases between 2005 and 2018. A change point analysis was performed to detect the most pivotal change point in surgical rates. We performed univariate analyses to compare surgical patients’ characteristics before and after the pivotalpoint . Impact on healthcare budget and societal costs were estimated using current prices and data from cost‐effectiveness analyses. Results The annual number of adenotonsillectomies reduced by 10 952 procedures (−39%; from 129 per 10 000 children to 87 per 10 000 children) between 2005 and 2018, and the number of adenoidectomies by 14 757 procedures (−49%; from 138 per 10 000 children to 78 per 10 000 children). The most pivotal change point was observed around 2012, accompanied by small changes in patient selection for surgery before and after 2012. An estimated €5.3 million per year was saved on the healthcare budget and €10.4 million per year on societal costs. Conclusion The quality of care cycle resulted in fewer operations, with a concomitant reduction of costs. We suggest that part of these savings be invested in new research to maintain the quality of care cycle.
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Affiliation(s)
- Juliëtte J C M van Munster
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.,University Neurosurgical Centre Holland (UNCH), Leiden University Medical Center and The Hague Medical Center (HMC), Leiden, the Netherlands
| | - Amir H Zamanipoor Najafabadi
- University Neurosurgical Centre Holland (UNCH), Leiden University Medical Center and The Hague Medical Center (HMC), Leiden, the Netherlands
| | - Janneke van 't Hooft
- Department of Obstetrics and Gynecology, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Teus A van Barneveld
- Dutch Association of Medical Specialists, Knowledge Institute, Domus Medica, Utrecht, the Netherlands
| | - Stefan Böhringer
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Jorrit S Visser
- Department of Hospital & Health Care, LOGEX, Amsterdam, the Netherlands
| | - Rolf H Bremmer
- Department of Hospital & Health Care, LOGEX, Amsterdam, the Netherlands
| | - Wilco C Peul
- University Neurosurgical Centre Holland (UNCH), Leiden University Medical Center and The Hague Medical Center (HMC), Leiden, the Netherlands
| | | | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Bak MAR, Blom MT, Koster RW, Ploem MC. Resuscitation with an AED: putting the data to use. Neth Heart J 2020; 29:179-185. [PMID: 33052579 PMCID: PMC7991012 DOI: 10.1007/s12471-020-01504-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 12/03/2022] Open
Abstract
The increased use of the automated external defibrillator (AED) contributes to the rising survival rate after sudden cardiac arrest in the Netherlands. When used, the AED records the unconscious person’s medical data (heart rhythm and information about cardiopulmonary resuscitation), which may be important for further diagnosis and treatment. In practice, ethical and legal questions arise about what can and should be done with these ‘AED data’. In this article, the authors advocate the development of national guidelines on the handling of AED data. These guidelines should serve two purposes: (1) to safeguard that data are handled carefully in accordance with data protection principles and the rules of medical confidentiality; and (2) to ensure nationwide availability of data for care of patients who survive resuscitation, as well as for quality monitoring of this care and for related scientific research. Given the medical ethical duties of beneficence and fairness, existing (sometimes lifesaving) information about AED use ought to be made available to clinicians and researchers on a structural basis. Creating a national AED data infrastructure, however, requires overcoming practical and organisational barriers. In addition, further legal study is warranted.
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Affiliation(s)
- M A R Bak
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - M T Blom
- ARREST Research Group, Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R W Koster
- ARREST Research Group, Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M C Ploem
- Section of Health Law, Department of Social Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Ten Have P, Hilt AD, Paalvast H, Eindhoven DC, Schalij MJ, Beeres SLMA. Non-ST-elevation myocardial infarction in the Netherlands: room for improvement! Neth Heart J 2020; 28:537-545. [PMID: 32495295 PMCID: PMC7494715 DOI: 10.1007/s12471-020-01433-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim To analyse non-ST-elevation myocardial infarction (NSTEMI) care in the Netherlands and to identify modifiable factors to improve NSTEMI healthcare. Methods This retrospective cohort study analysed hospital and pharmacy claims data of all NSTEMI patients in the Netherlands in 2015. The effect of percutaneous coronary intervention (PCI) during hospitalisation on 1‑year mortality was investigated in the subcohort alive 4 days after NSTEMI. The effect of medical treatment on 1‑year mortality was assessed in the subcohort alive 30 days after NSTEMI. The effect of age, gender and co-morbidities was evaluated. PCI during hospitalisation was defined as PCI within 72 h after NSTEMI and optimal medical treatment was defined as the combined use of an aspirin species, P2Y12 inhibitor, statin, beta-blocker and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker, started within 30 days after NSTEMI. Results Data from 17,997 NSTEMI patients (age 69.6 (SD = 12.8) years, 64% male) were analysed. Of the patients alive 4 days after NSTEMI, 43% had a PCI during hospitalisation and 1‑year mortality was 10%. In the subcohort alive 30 days after NSTEMI, 47% of patients were receiving optimal medical treatment at 30 days and 1‑year mortality was 7%. PCI during hospitalisation (odds ratio (OR) 0.42; 95% confidence interval (CI) 0.37–0.48) and optimal medical treatment (OR 0.59; 95% CI 0.51–0.67) were associated with a lower 1‑year mortality. Conclusion In Dutch NSTEMI patients, use of PCI during hospitalisation and prescription of optimal medical treatment are modest. As both are independently associated with a lower 1‑year mortality, this study provides direction on how to improve the quality of NSTEMI healthcare in the Netherlands. Electronic supplementary material The online version of this article (10.1007/s12471-020-01433-x) contains supplementary material, which is available to authorized users.
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Vester MPM, Eindhoven DC, Bonten TN, Wagenaar H, Holthuis HJ, Schalij MJ, de Grooth GJ, van Dijkman PRM. Utilization of diagnostic resources and costs in patients with suspected cardiac chest pain. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:583-590. [PMID: 32810201 PMCID: PMC9172873 DOI: 10.1093/ehjqcco/qcaa064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/10/2020] [Indexed: 02/03/2023]
Abstract
AIMS Non-acute chest pain is a common complaint and can be caused by various conditions. With the rising healthcare expenditures of today, it is necessary to use our healthcare resources effectively. This study aims to give insight into the diagnostic effort and costs for patients with non-acute chest pain. METHODS AND RESULTS Financial data of patients without a cardiac history from 4 hospitals (January 2012-October 2018), who were registered with the national diagnostic code 'No cardiac pathology' (ICD-10 Z13.6), 'Chest wall syndrome' (ICD-10 R07.4) or 'stable angina pectoris' (ICD-10 I20.9) were extracted. In total, 74.091 patients were included for analysis and divided into the following final diagnosis groups: No cardiac pathology: N = 19.688 (age 53±18), 46% male), Chest wall syndrome: N = 40.858 (age 56±15), 45% male), and stable angina pectoris: N = 13.545 (age 67±11), 61% male). A total of approximately €142,7 million was spent during diagnostic work-up. The total expenditure during diagnostic effort was €1.97, €8.13, and €10.7 million respectively for no cardiac pathology, chest wall syndrome, and stable AP per year. After 8 years follow up ≥ 95% of the patients diagnosed with no cardiac pathology or chest wall syndrome had an (cardiac) ischemic free survival. CONCLUSION The diagnostic expenditure and clinical effort to ascertain non-cardiac chest pain is high. We should define what we as society find acceptable as 'assurance costs' with an increasing pressure on the healthcare system and costs.
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Affiliation(s)
- M P M Vester
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - D C Eindhoven
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - T N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - H Wagenaar
- Performation-HOT flo, Bilthoven, The Netherlands
| | - H J Holthuis
- Performation-HOT flo, Bilthoven, The Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G J de Grooth
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - P R M van Dijkman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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21
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Piek JJ. NVVC/NHJ Durrer prizes 2018. Neth Heart J 2019; 27:229-230. [PMID: 30969395 PMCID: PMC6470225 DOI: 10.1007/s12471-019-1278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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García-Macías JA, Palazón-Bru A, Carbonell-Torregrosa MÁ, Navarro-Juan M, Gil-Guillén VF. Therapeutic inertia in anti-platelet therapy in patients with a cardiovascular event attended in an emergency department. Curr Med Res Opin 2019; 35:455-459. [PMID: 29690773 DOI: 10.1080/03007995.2018.1469480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective As very few studies have assessed therapeutic inertia (TI) in anti-platelet therapy in patients in secondary cardiovascular prevention, the authors designed a study in their hospital emergency department to quantify its magnitude and its associated factors. Methods This descriptive cross-sectional observational study involved a sample of 223 patients with a history of cardiovascular disease and recommendation for anti-platelet therapy who attended the emergency department in a Spanish region in 2016. The main variable was TI in platelet anti-aggregation (lack of a prescription when recommended by the clinical guidelines). The secondary variables were gender, age, educational level, stable partner, hypertension, dyslipidemia, diabetes, smoking, type and number of cardiovascular events, blood pressure, and glomerular filtration rate. The magnitude of TI was quantified and associated factors were studied using a binary logistic regression model. Results TI was present in 107 patients (48.0%). In the multifactorial analysis, the following factors were associated with a higher proportion of TI: female gender (p = .021), higher cultural level (p = .020), and having no previous diagnosis of hypertension (p = .003) or dyslipidemia (p = .002). Conclusions The magnitude of TI in anti-platelet therapy in patients who had already suffered a cardiovascular event was very high. TI was associated with being a woman, having a high cultural level, and not being diagnosed with hypertension or dyslipidemia. More studies are needed to corroborate these results to take the appropriate measures to reduce TI.
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Affiliation(s)
| | - Antonio Palazón-Bru
- b Department of Clinical Medicine , Miguel Hernández University , San Juan de Alicante , Alicante , Spain
| | | | - Miguel Navarro-Juan
- a Emergency Department , General University Hospital of Elda , Elda , Alicante , Spain
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23
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Eindhoven DC, Wu HW, Kremer SWF, van Erkelens JA, Cannegieter SC, Schalij MJ, Borleffs CJW. Mortality differences in acute myocardial infarction patients in the Netherlands: The weekend-effect. Am Heart J 2018; 205:70-76. [PMID: 30176441 DOI: 10.1016/j.ahj.2018.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 07/24/2018] [Indexed: 11/18/2022]
Abstract
Objective Several studies have shown that patients admitted with an acute myocardial infarction during the weekends have a higher mortality rate than those admitted during weekdays, possibly attributable to less trained personnel available and a lower use of medical procedures. The current study aimed to assess this ‘weekend-effect’ in a nationwide registry. Methods In the Netherlands, all inhabitants are, by law, obliged to have health insurance and all claim data are centrally registered. In 2012 and 2013, all national diagnose-codings of STEMI and NSTEMI patients were acquired. One-year mortality rates and treatment with percutaneous coronary intervention (PCI) were compared between weekdays and weekends (holidays included). Results In total, 59,534 patients (67 ± 13 years, 39,545(66%) male) were included of whom 33,904(57%) had a NSTEMI. Overall 6857(12%) patients died in the year following the acute myocardial infarction registration. In STEMI patients, no differences in one-year mortality rates were observed between admission on weekdays or weekends. In NSTEMI patients, one-year mortality was higher in those admitted during weekends (weekdays 11% versus weekends 13%, P < .001). Furthermore, STEMI patients admitted during weekends were more often treated with PCI (weekdays 77% versus weekends 81%, P < .001). Conversely, NSTEMI patients admitted during weekends were less often treated with PCI (weekdays 35% versus weekends 32%, P < .001). Conclusion Differences in treatment and mortality rates exist between acute myocardial infarction patients admitted during weekdays and weekends. NSTEMI patients admitted during weekends are less often treated with PCI and have a higher mortality rate than patients admitted during weekdays.
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Affiliation(s)
- Daniëlle C Eindhoven
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hoi W Wu
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stijn W F Kremer
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Suzanne C Cannegieter
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Salet N, Bremmer RH, Verhagen MAMT, Ekkelenkamp VE, Hansen BE, de Jonge PJF, de Man RA. Is Textbook Outcome a valuable composite measure for short-term outcomes of gastrointestinal treatments in the Netherlands using hospital information system data? A retrospective cohort study. BMJ Open 2018; 8:e019405. [PMID: 29496668 PMCID: PMC5855341 DOI: 10.1136/bmjopen-2017-019405] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To develop a feasible model for monitoring short-term outcome of clinical care trajectories for hospitals in the Netherlands using data obtained from hospital information systems for identifying hospital variation. STUDY DESIGN Retrospective analysis of collected data from hospital information systems combined with clinical indicator definitions to define and compare short-term outcomes for three gastrointestinal pathways using the concept of Textbook Outcome. SETTING 62 Dutch hospitals. PARTICIPANTS 45 848 unique gastrointestinal patients discharged in 2015. MAIN OUTCOME MEASURE A broad range of clinical outcomes including length of stay, reintervention, readmission and doctor-patient counselling. RESULTS Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for gallstone disease (n=4369), colonoscopy for inflammatory bowel disease (IBD; n=19 330) and colonoscopy for colorectal cancer screening (n=22 149) were submitted to five suitable clinical indicators per treatment. The percentage of all patients who met all five criteria was 54%±9% (SD) for ERCP treatment. For IBD this was 47%±7% of the patients, and for colon cancer screening this number was 85%±14%. CONCLUSION This study shows that reusing data obtained from hospital information systems combined with clinical indicator definitions can be used to express short-term outcomes using the concept of Textbook Outcome without any excess registration. This information can provide meaningful insight into the clinical care trajectory on the level of individual patient care. Furthermore, this concept can be applied to many clinical trajectories within gastroenterology and beyond for monitoring and improving the clinical pathway and outcome for patients.
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Affiliation(s)
- Nèwel Salet
- VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- LOGEX, Amsterdam, The Netherlands
| | | | - Marc A M T Verhagen
- Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Vivian E Ekkelenkamp
- Department of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Bettina E Hansen
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pieter J F de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rob A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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