1
|
Voorend CG, Berkhout-Byrne NC, van Bodegom-Vos L, Diepenbroek A, Franssen CF, Joosten H, Mooijaart SP, Bos WJW, van Buren M. Geriatric Assessment in CKD Care: An Implementation Study. Kidney Med 2024; 6:100809. [PMID: 38660344 PMCID: PMC11039322 DOI: 10.1016/j.xkme.2024.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Rationale & Objective Older people with progressive chronic kidney disease (CKD) have complex health care needs. Geriatric evaluation preceding decision making for kidney replacement is recommended in guidelines, but implementation is lacking in routine care. We aimed to evaluate implementation of geriatric assessment in CKD care. Study Design Mixed methods implementation study. Setting & Participants Dutch nephrology centers were approached for implementation of geriatric assessment in patients aged ≥70 years and with an estimated glomerular filtration rate of ≤20 mL/min/1.73 m2. Quality Improvement Activities/Exposure We implemented a consensus-based nephrology-tailored geriatric assessment: a patient questionnaire and professionally administered test set comprising 16 instruments covering functional, cognitive, psychosocial, and somatic domains and patient-reported outcome measures. Outcomes We aimed for implementation in 10 centers and 200 patients. Implementation was evaluated by (i) perceived enablers and barriers of implementation, including integration in work routines (Normalization Measure Development Tool) and (ii) relevance of the instruments to routine care for the target population. Analytical Approach Variations in implementation practices were described based on field notes. The postimplementation survey among health care professionals was analyzed descriptively, using an explanatory qualitative approach for open-ended questions. Results Geriatric assessment was implemented in 10 centers among 191 patients. Survey respondents (n = 71, 88% response rate) identified determinants that facilitated implementation, ie, multidisciplinary collaboration (with geriatricians) -meetings and reports and execution of assessments by nurses. Barriers to implementation were patient illiteracy or language barrier, time constraints, and patient burden. Professionals considered geriatric assessment sufficiently integrated into work routines (mean, 6.7/10 ± 2.0 [SD]) but also subject to improvement. Likewise, the relevance of geriatric assessment for routine care was scored as 7.8/10 ± 1.2. The Clinical Frailty Score and Montreal Cognitive Assessment were perceived as the most relevant instruments. Limitations Selection bias of interventions' early adopters may limit generalizability. Conclusions Geriatric assessment could successfully be integrated in CKD care and was perceived relevant to health care professionals.
Collapse
Affiliation(s)
- Carlijn G.N. Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Noeleen C. Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper F.M. Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W. Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolijn van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| |
Collapse
|
2
|
Ropers FG, van Bodegom-Vos L, Rietveld S, Bossuyt PM, Rings EHHM, Hillen MA. [Paediatricians report an increased demand for diagnostic tests for reassurance]. Ned Tijdschr Geneeskd 2024; 168:D7843. [PMID: 38375874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Test decisions depend on the context in which health care is delivered. We interviewed paediatricians about perceived societal developments and their influence on diagnostic testing. DESIGN Qualitative interview study. METHODS Semi-structured in-depth interviews with 20 practicing Dutch paediatricians. RESULTS Paediatricians associated societal developments, such as decreased risk acceptance, with perceived pressure from parents to perform tests. They were motivated to restrict unnecessary tests to avoid harming the child. CONCLUSION Besides motivation and effort of health care providers, appropriate testing requires system-level actions, such as counteracting a culture of blame and considering societal interests in guideline recommendations.
Collapse
Affiliation(s)
- Fabienne G Ropers
- LUMC, Leiden. Afd. Kindergeneeskunde, Willem-Alexander Kinderziekenhuis
- Contact:
| | | | - Sophie Rietveld
- LUMC, Leiden. Afd. Kindergeneeskunde, Willem-Alexander Kinderziekenhuis
| | - Patrick M Bossuyt
- Amsterdam UMC, locatie AMC, Amsterdam. Afd. Epidemiology & Data Science
| | | | - Marij A Hillen
- Amsterdam UMC, locatie AMC, Amsterdam. Afd. Medische Psychologie
| |
Collapse
|
3
|
Kuhrij LS, Marang-van de Mheen PJ, van Lier L, Alimahomed R, Nelissen RGHH, van Bodegom-Vos L. Reduction in use of MRI and arthroscopy among patients with degenerative knee disease in independent treatment centers versus general hospitals: a time series analysis. Int J Qual Health Care 2024; 36:mzae004. [PMID: 38252692 PMCID: PMC10849166 DOI: 10.1093/intqhc/mzae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/16/2023] [Accepted: 01/21/2024] [Indexed: 01/24/2024] Open
Abstract
The use of MRI and arthroscopy are considered low-value care in most patients with degenerative knee disease. To reduce these modalities, there have been multiple efforts to increase awareness. Reductions have been shown for general hospitals (GH), but it is unclear whether this may be partly explained by a shift of patients receiving these modalities in independent treatment centers (ITCs). The aims of this study were to assess (i) whether the trend in use of MRI and arthroscopy in patients with degenerative knee disease differs between ITCs and GH, and (ii) whether the Dutch efforts to raise awareness on these recommendations were associated with a change in the trend for both types of providers. All patients insured by a Dutch healthcare insurer aged ≥50 years with a degenerative knee disease who were treated in a GH or ITC between July 2014 and December 2019 were included. Linear regression was used with the quarterly percentage of patients receiving an MRI or knee arthroscopy weighted by center volume, as the primary outcome. Interrupted time-series analysis was used to evaluate the effect of the Dutch efforts to raise awareness. A total of 14 702 patients included were treated in 90 GHs (n = 13 303, 90.5%) and 29 ITCs (n = 1399, 9.5%). Across the study period, ITCs on an average had a 16% higher MRI use (P < .001) and 9% higher arthroscopy use (P = .003). MRI use did not change in both provider types, but arthroscopy use significantly decreased and became stronger in ITCs (P = .01). The Dutch efforts to increase awareness did not significantly influence either MRI or arthroscopy use in ITCs (P = .55 and P = .84) and GHs (P = .13 and P = .70). MRI and arthroscopy uses were higher in ITCs than GHs. MRI use did not change significantly among patients ≥ 50 years with degenerative knee disease in both provider types between 2014 and 2019. MRI- and arthroscopy use decreased with ITCs on average having higher rates for both modalities, but also showing a stronger decrease in arthroscopy use. The Dutch efforts to increase awareness did not accelerate the already declining trend in the Netherlands.
Collapse
Affiliation(s)
- Laurien S Kuhrij
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Lisanne van Lier
- Zorg & Zekerheid, Haagse Schouwweg 12, Leiden 2332 KG, the Netherlands
| | - Razia Alimahomed
- Zorg & Zekerheid, Haagse Schouwweg 12, Leiden 2332 KG, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| |
Collapse
|
4
|
Brouns B, Meesters JJL, de Kloet AJ, Vliet Vlieland TPM, Houdijk S, Arwert HJ, van Bodegom-Vos L. What works and why in the implementation of eRehabilitation after stroke - a process evaluation. Disabil Rehabil Assist Technol 2024; 19:345-359. [PMID: 35730242 DOI: 10.1080/17483107.2022.2088867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Implementation of an eRehabilitation intervention named Fit After Stroke @Home (Fast@home) - including cognitive/physical exercise applications, activity-tracking, psycho-education - after stroke resulted in health-related improvements. This study investigated what worked and why in the implementation. METHODS Implementation activities (information provision, integration of Fast@home, instruction and motivation) were performed for 14 months and evaluated, using the Medical Research Council framework for process evaluations which consists of three evaluation domains (implementation, mechanisms of impact and contextual factors). Implementation activities were evaluated by field notes/surveys/user data, it's mechanisms of impact by surveys and contextual factors by field notes/interviews among 11 professionals. Surveys were conducted among 51 professionals and 73 patients. User data (n = 165 patients) were extracted from the eRehabilitation applications. RESULTS Implementation activities were executed as planned. Of the professionals trained to deliver the intervention (33 of 51), 25 (75.8%) delivered it. Of the 165 patients, 82 (49.7%) were registered for Fast@home, with 54 patient (65.8%) using it. Mechanisms of impact showed that professionals and patients were equally satisfied with implementation activities (median score 7.0 [IQR 6.0-7.75] versus 7.0 [6.0-7.5]), but patients were more satisfied with the intervention (8.0 [IQR 7.0-8.0] versus 5.5 [4.0-7.0]). Guidance by professionals was seen as most impactful for implementation by patients and support of clinical champions and time given for training by professionals. Professionals rated the integration of Fast@home as insufficient. Contextual factors (financial cutbacks and technical setbacks) hampered the implementation. CONCLUSION Main improvements of the implementation of eRehabilitation are related to professionals' perceptions of the intervention, integration of eRehabilitation and contextual factors.Implication for rehabilitationTo increase the use of eRehabilitation by patients, patients should be supported by their healthcare professional in their first time use and during the rehabilitation process.To increase the use of eRehabilitation by healthcare professionals, healthcare professionals should be (1) supported by a clinical champion and (2) provided with sufficient time for learning to work and getting familiar with the eRehabilitation program.Integration of eRehabilitation in conventional stroke rehabilitation (optimal blended care) is an important challenge and a prerequisite for the implementation of eRehabilitation in the clinical setting.
Collapse
Affiliation(s)
- Berber Brouns
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, the Netherlands
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jorit J L Meesters
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, the Netherlands
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Arend J de Kloet
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, the Netherlands
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Sander Houdijk
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
| | - Henk J Arwert
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Rehabilitation, Haaglanden Medical Center, the Hague, the Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
5
|
Kruiswijk AA, van de Sande MAJ, Verhoef C, Schrage YM, Haas RL, Bemelmans MHA, van Ginkel RJ, Bonenkamp JJ, Witkamp AJ, van den Akker-van Marle ME, Marang-van de Mheen PJ, van Bodegom-Vos L. Changes in Health-Related Quality of Life following Surgery in Patients with High-Grade Extremity Soft-Tissue Sarcoma: A Prospective Longitudinal Study. Cancers (Basel) 2024; 16:547. [PMID: 38339298 PMCID: PMC10854952 DOI: 10.3390/cancers16030547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Changes in health-related quality of life (HRQoL) during the diagnostic and treatment trajectory of high-grade extremity soft-tissue sarcoma (eSTS) has rarely been investigated for adults (18-65 y) and the elderly (aged ≥65 y), despite a potential variation in challenges from diverse levels of physical, social, or work-related activities. This study assesses HRQoL from time of diagnosis to one year thereafter among adults and the elderly with eSTS. METHODS HRQoL of participants from the VALUE-PERSARC trial (n = 97) was assessed at diagnosis and 3, 6 and 12 months thereafter, utilizing the PROMIS Global Health (GH), PROMIS Physical Function (PF) and EQ-5D-5L. RESULTS Over time, similar patterns were observed in all HRQoL measures, i.e., lower HRQoL scores than the Dutch population at baseline (PROMIS-PF:46.8, PROMIS GH-Mental:47.3, GH-Physical:46.2, EQ-5D-5L:0.76, EQ-VAS:72.6), a decrease at 3 months, followed by an upward trend to reach similar scores as the general population at 12 months (PROMIS-PF:49.9, PROMIS GH-Physical:50.1, EQ-5D-5L:0.84, EQ-VAS:81.5), except for the PROMIS GH-Mental (47.5), where scores remained lower than the general population mean (T = 50). Except for the PROMIS-PF, no age-related differences were observed. CONCLUSIONS On average, eSTS patients recover well physically from surgery, yet the mental component demonstrates no progression, irrespective of age. These results underscore the importance of comprehensive care addressing both physical and mental health.
Collapse
Affiliation(s)
- Anouk A. Kruiswijk
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (L.v.B.-V.)
- Orthopedic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands;
| | - Yvonne M. Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Rick L. Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
- Department of Radiotherapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marc H. A. Bemelmans
- Department of Surgical Oncology, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Robert J. van Ginkel
- Department of Surgical Oncology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Johannes J. Bonenkamp
- Department of Surgery, Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands;
| | - Arjen J. Witkamp
- Department of Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - M. Elske van den Akker-van Marle
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (L.v.B.-V.)
| | - Perla J. Marang-van de Mheen
- Safety & Security Science and Centre for Safety in Healthcare, Delft University of Technology, 2826 CN Delft, The Netherlands;
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (L.v.B.-V.)
| |
Collapse
|
6
|
Riganti P, Kopitowski KS, McCaffery K, van Bodegom-Vos L. The paradox of using SDM for de-implementation of low-value care in the clinical encounter. BMJ Evid Based Med 2024; 29:14-16. [PMID: 37080738 DOI: 10.1136/bmjebm-2022-112201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Paula Riganti
- Family and Community Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Karin Silvana Kopitowski
- Family and Community Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Kirsten McCaffery
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leti van Bodegom-Vos
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| |
Collapse
|
7
|
Østerås N, Aas E, Moseng T, van Bodegom-Vos L, Dziedzic K, Natvig B, Røtterud JH, Vlieland TV, Furnes O, Fenstad AM, Hagen KB. Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: A cluster-randomized controlled trial. Osteoarthritis Cartilage 2024; 32:108-119. [PMID: 37839506 DOI: 10.1016/j.joca.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To assess the quality of care, effectiveness, and cost-effectiveness over 12 months after implementing a structured model of care for hip and knee osteoarthritis (OA) in primary healthcare as compared to usual care. DESIGN In this pragmatic cluster-randomized, controlled trial with a stepped-wedge cohort design, we recruited 40 general practitioners (GPs), 37 physiotherapists (PTs), and 393 patients with symptomatic hip or knee OA from six municipalities (clusters) in Norway. The model included the delivery of a 3-hour patient education and 8-12 weeks individually tailored exercise programs, and interactive workshops for GPs and PTs. At 12 months, the patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (16 items, pass rate 0-100%, 100%=best). Costs were obtained from patient-reported and national register data. Cost-effectiveness at the healthcare perspective was evaluated using incremental net monetary benefit (INMB). RESULTS Of 393 patients, 109 were recruited during the control periods (control group) and 284 were recruited during interventions periods (intervention group). At 12 months the intervention group reported statistically significant higher quality of care compared to the control group (59% vs. 40%; mean difference: 17.6 (95% confidence interval [CI] 11.1, 24.0)). Cost-effectiveness analyses showed that the model of care resulted in quality-adjusted life-years gained and cost-savings compared to usual care with mean INMB €2020 (95% CI 611, 3492) over 12 months. CONCLUSIONS This study showed that implementing the model of care for OA in primary healthcare, improved quality of care and showed cost-effectiveness over 12 months compared to usual care. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02333656.
Collapse
Affiliation(s)
- Nina Østerås
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
| | - Eline Aas
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway; Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | - Tuva Moseng
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Krysia Dziedzic
- Impact Accelerator Unit, Primary Care Centre Versus Arthritis, Keele University, United Kingdom.
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Jan Harald Røtterud
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway.
| | - Thea Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
| | - Kåre Birger Hagen
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| |
Collapse
|
8
|
Ropers FG, Rietveld S, Rings EHHM, Bossuyt PMM, van Bodegom-Vos L, Hillen MA. Diagnostic testing in children: A qualitative study of pediatricians' considerations. J Eval Clin Pract 2023; 29:1326-1337. [PMID: 37221991 DOI: 10.1111/jep.13867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023]
Abstract
AIMS AND OBJECTIVES Studies in adult medicine have shown that physicians base testing decisions on the patient's clinical condition but also consider other factors, including local practice or patient expectations. In pediatrics, physicians and parents jointly decide on behalf of a (young) child. This might demand more explicit and more complex deliberations, with sometimes conflicting interests. We explored pediatricians' considerations in diagnostic test ordering and the factors that influence their deliberation. METHOD We performed in-depth, semistructured interviews with a purposively selected heterogeneous sample of 20 Dutch pediatricians. We analyzed transcribed interviews inductively using a constant comparative approach, and clustered data across interviews to derive common themes. RESULTS Pediatricians perceived test-related burden in children higher compared with adults, and reported that avoiding an unjustified burden causes them to be more restrictive and deliberate in test ordering. They felt conflicted when parents desired testing or when guidelines recommended diagnostic tests pediatricians perceived as unnecessary. When parents demanded testing, they would explore parental concern, educate parents about harms and alternative explanations of symptoms, and advocate watchful waiting. Yet they reported sometimes performing tests to appease parents or to comply with guidelines, because of feared personal consequences in the case of adverse outcomes. CONCLUSION We obtained an overview of the considerations that are weighed in pediatric test decisions. The comparatively strong focus on prevention of harm motivates pediatricians to critically appraise the added value of testing and drivers of low-value testing. Pediatricians' relatively restrictive approach to testing could provide an example for other disciplines. Improved guidelines and physician and patient education could help to withstand the perceived pressure to test.
Collapse
Affiliation(s)
- Fabienne G Ropers
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie Rietveld
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Edmond H H M Rings
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Patrick M M Bossuyt
- Amsterdam University Medical Centers, University of Amsterdam, Epidemiology & Data Science, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Leti van Bodegom-Vos
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Marij A Hillen
- Amsterdam University Medical Centers, location AMC, Amsterdam Public Health, Medical Psychology, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Geurkink TH, Marang-van de Mheen PJ, Nagels J, Wessel RN, Poolman RW, Nelissen RG, van Bodegom-Vos L. Substantial Variation in Decision Making to Perform Subacromial Decompression Surgery for Subacromial Pain Syndrome Between Orthopaedic Shoulder Surgeons for Identical Clinical Scenarios: A Case-Vignette Study. Arthrosc Sports Med Rehabil 2023; 5:100819. [PMID: 38023445 PMCID: PMC10661501 DOI: 10.1016/j.asmr.2023.100819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To provide further insight into the variation in decision making to perform subacromial decompression (SAD) surgery in patients with subacromial pain syndrome (SAPS) and its influencing factors. Methods Between November 2021 and February 2022, we invited 202 Dutch Shoulder and Elbow Society members to participate in a cross-sectional Web-based survey including 4 clinical scenarios of SAPS patients. Scenarios varied in patient characteristics, clinical presentation, and other contextual factors. For each scenario, respondents were asked (1) to indicate whether they would perform SAD surgery, (2) to indicate the probability of benefit of SAD surgery (i.e., pain reduction), (3) to indicate the probability of harm (i.e., complications), and (4) to rank the 5 most important factors influencing their treatment decision. Results A total of 78 respondents (39%) participated. The percentage of respondents who would perform SAD surgery ranged from 4% to 25% among scenarios. The median probability of perceived benefit ranged between 70% and 79% across scenarios for respondents indicating to perform surgery compared with 15% to 29% for those indicating not to perform surgery. The difference in the median probability of perceived harm ranged from 3% to 9% for those indicating to perform surgery compared with 8% to 13% for those indicating not to perform surgery. Surgeons who would perform surgery mainly reported patient-related factors (e.g., complaint duration and response to physical therapy) as the most important factors to perform SAD surgery, whereas surgeons who would not perform surgery mainly reported guideline-related factors. Conclusions Overall, Dutch orthopaedic shoulder surgeons are reluctant to perform SAD surgery in SAPS patients. There is substantial variation among orthopaedic surgeons regarding decisions to perform SAD surgery for SAPS even when evaluating identical scenarios, where particularly the perceived benefit of surgery differed between those who would perform surgery and those who would not. Surgeons who would not perform SAD surgery mainly referred to guideline-related factors as influential factors for their decision, whereas those who would perform SAD surgery considered patient-related factors more important. Clinical Relevance There is substantial variation in decision making to perform SAD surgery for SAPS between individual orthopaedic surgeons for identical case scenarios.
Collapse
Affiliation(s)
- Timon H. Geurkink
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Perla J. Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ronald N. Wessel
- Department of Orthopaedics, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Rudolf W. Poolman
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rob G.H.H. Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
10
|
Kruiswijk AA, van de Sande MAJ, Haas RL, van den Akker-van Marle EM, Engelhardt EG, Marang-van de Mheen P, van Bodegom-Vos L. (Cost-)effectiveness of an individualised risk prediction tool (PERSARC) on patient's knowledge and decisional conflict among soft-tissue sarcomas patients: protocol for a parallel cluster randomised trial (the VALUE-PERSARC study). BMJ Open 2023; 13:e074853. [PMID: 37918933 PMCID: PMC10626817 DOI: 10.1136/bmjopen-2023-074853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Current treatment decision-making in high-grade soft-tissue sarcoma (STS) care is not informed by individualised risks for different treatment options and patients' preferences. Risk prediction tools may provide patients and professionals insight in personalised risks and benefits for different treatment options and thereby potentially increase patients' knowledge and reduce decisional conflict. The VALUE-PERSARC study aims to assess the (cost-)effectiveness of a personalised risk assessment tool (PERSARC) to increase patients' knowledge about risks and benefits of treatment options and to reduce decisional conflict in comparison with usual care in high-grade extremity STS patients. METHODS The VALUE-PERSARC study is a parallel cluster randomised control trial that aims to include at least 120 primarily diagnosed high-grade extremity STS patients in 6 Dutch hospitals. Eligible patients (≥18 years) are those without a treatment plan and treated with curative intent. Patients with sarcoma subtypes or treatment options not mentioned in PERSARC are unable to participate. Hospitals will be randomised between usual care (control) or care with the use of PERSARC (intervention). In the intervention condition, PERSARC will be used by STS professionals in multidisciplinary tumour boards to guide treatment advice and in patient consultations, where the oncological/orthopaedic surgeon informs the patient about his/her diagnosis and discusses benefits and harms of all relevant treatment options. The primary outcomes are patients' knowledge about risks and benefits of treatment options and decisional conflict (Decisional Conflict Scale) 1 week after the treatment decision has been made. Secondary outcomes will be evaluated using questionnaires, 1 week and 3, 6 and 12 months after the treatment decision. Data will be analysed following an intention-to-treat approach using a linear mixed model and taking into account clustering of patients within hospitals. ETHICS AND DISSEMINATION The Medical Ethical Committee Leiden-Den Haag-Delft (METC-LDD) approved this protocol (NL76563.058.21). The results of this study will be reported in a peer-review journal. TRIAL REGISTRATION NUMBER NL9160, NCT05741944.
Collapse
Affiliation(s)
- Anouk A Kruiswijk
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rick L Haas
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Ellen G Engelhardt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Perla Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
11
|
van Veen LEJ, van der Weijden BM, van Bodegom-Vos L, Hol J, Visser DH, Achten NB, Plötz FB. Barriers and Facilitators to the Implementation of the Early-Onset Sepsis Calculator: A Multicenter Survey Study. Children (Basel) 2023; 10:1682. [PMID: 37892345 PMCID: PMC10605684 DOI: 10.3390/children10101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Prior studies demonstrated the neonatal early-onset sepsis (EOS) calculator's potential in drastically reducing antibiotic prescriptions, and its international adoption is increasing rapidly. To optimize the EOS calculator's impact, successful implementation is crucial. This study aimed to identify key barriers and facilitators to inform an implementation strategy. A multicenter cross-sectional survey was carried out among physicians, residents, nurses and clinical obstetricians of thirteen Dutch hospitals. Survey development was prepared through a literature search and stakeholder interviews. Data collection and analysis were based on the Consolidated Framework for Implementation Research (CFIR). A total of 465 stakeholders completed the survey. The main barriers concerned the expectance of the department's capacity problems and the issues with maternal information transfer between departments. Facilitators concerned multiple relative advantages of the EOS calculator, including stakeholder education, EOS calculator integration in the electronic health record and existing positive expectations about the safety and effectivity of the calculator. Based on these findings, tailored implementation interventions can be developed, such as identifying early adopters and champions, conducting educational meetings tailored to the target group, creating ready-to-use educational materials, integrating the EOS calculator into electronic health records, creating a culture of collective responsibility among departments and collecting data to evaluate implementation success and innovation results.
Collapse
Affiliation(s)
- Liesanne E. J. van Veen
- Department of Paediatrics, Tergooi MC, Laan van Tergooi 2, 1212 VG Hilversum, The Netherlands; (L.E.J.v.V.); (B.M.v.d.W.)
- Department of Paediatrics, Franciscus Gasthuis en Vlietland, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands;
| | - Bo M. van der Weijden
- Department of Paediatrics, Tergooi MC, Laan van Tergooi 2, 1212 VG Hilversum, The Netherlands; (L.E.J.v.V.); (B.M.v.d.W.)
- Amsterdam UMC, Department of Paediatrics and Amsterdam Reproduction & Development Research Institute, Location University of Amsterdam, Emma Children’s Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Jeroen Hol
- Department of Paediatrics, Noord West Ziekenhuis, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands;
| | - Douwe H. Visser
- Amsterdam UMC, Department of Paediatrics and Amsterdam Reproduction & Development Research Institute, Location University of Amsterdam, Emma Children’s Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam UMC, Department of Neonatology, Emma Children’s Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Niek B. Achten
- Department of Paediatrics, Erasmus MC, Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands;
| | - Frans B. Plötz
- Department of Paediatrics, Tergooi MC, Laan van Tergooi 2, 1212 VG Hilversum, The Netherlands; (L.E.J.v.V.); (B.M.v.d.W.)
- Amsterdam UMC, Department of Paediatrics and Amsterdam Reproduction & Development Research Institute, Location University of Amsterdam, Emma Children’s Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| |
Collapse
|
12
|
Weller FS, Hamming JF, Repping S, van Bodegom-Vos L. What information sources do Dutch medical specialists use in medical decision-making: a qualitative interview study. BMJ Open 2023; 13:e073905. [PMID: 37798031 PMCID: PMC10565272 DOI: 10.1136/bmjopen-2023-073905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To explore what information sources medical specialists currently use to inform their medical decision-making. DESIGN Qualitative, semistructured interviews. SETTING AND PARTICIPANTS A total of 20 semistructured interviews were conducted with 10 surgeons and 10 internal medicine specialists who work in academic and/or regional hospitals in the Netherlands. RESULTS Medical specialists reported that they primarily rely on their general knowledge and experience, rather than actively using information sources. The sources they use to update their knowledge can be categorised into 'scientific publications', 'guidelines or protocols', and 'presentations and meetings'. When medical specialists feel their general knowledge and experience are insufficient, they use three different approaches to find answers in response to clinical questions: consulting a colleague, actively searching the literature and asking someone else to search the literature. CONCLUSION Medical specialists use information sources to update their general knowledge and to find answers to specific clinical questions when they feel their general knowledge and experience are insufficient. An important finding is that medical specialists prefer accessible information sources (eg, consulting colleagues) over existing evidence-based medicine tools.
Collapse
Affiliation(s)
- Floris S Weller
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Basic Data Siences-Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Sjoerd Repping
- Department of Health Evaluation and Appropriate Use, University of Amsterdam, Amsterdam, The Netherlands
| | - Leti van Bodegom-Vos
- Basic Data Siences-Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
13
|
Kruiswijk AA, Kuhrij LS, Dorleijn DMJ, van de Sande MAJ, van Bodegom-Vos L, Marang-van de Mheen PJ. Follow-Up after Curative Surgical Treatment of Soft-Tissue Sarcoma for Early Detection of Recurrence: Which Patients Have More or Fewer Visits than Advised in Guidelines? Cancers (Basel) 2023; 15:4617. [PMID: 37760585 PMCID: PMC10527323 DOI: 10.3390/cancers15184617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Follow-up (FU) in soft-tissue sarcoma (STS) patients is designed for early detection of disease recurrence. Current guidelines are not evidenced-based and not tailored to patient or tumor characteristics, so they remain debated, particularly given concerns about cost, radiation frequency, and over-testing. This study assesses the extent to which STS patients received guideline-concordant FU and to characterize which type of patients received more or fewer visits than advised. METHODS All STS patients surgically treated at the Leiden University Medical Center between 2000-2020 were included. For each patient, along with individual characteristics, all radiological examinations from FU start up to 5 years were included and compared to guidelines. Recurrence was defined as local/regional recurrence or metastasis. RESULTS A total of 394 patients was included, of whom 250 patients had a high-grade tumor (63.5%). Only 24% of patients received the advised three FU visits in the first year. More FU visits were observed in younger patients and those diagnosed with a high-grade tumor. Among patients with a recurrence, 10% received fewer visits than advised, while 28% of patients without a recurrence received more visits than advised. CONCLUSIONS A minority of STS patients received guideline-concordant FU visits, suggesting that clinicians seem to incorporate recurrence risk in decisions on FU frequency.
Collapse
Affiliation(s)
- Anouk A. Kruiswijk
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (P.J.M.-v.d.M.)
- Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Laurien S. Kuhrij
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (P.J.M.-v.d.M.)
| | - Desiree M. J. Dorleijn
- Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | | | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (P.J.M.-v.d.M.)
| | - Perla J. Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (P.J.M.-v.d.M.)
| |
Collapse
|
14
|
Geurkink TH, Marang-van de Mheen PJ, Nagels J, Poolman RW, Nelissen RG, van Bodegom-Vos L. Impact of Active Disinvestment on Decision-Making for Surgery in Patients With Subacromial Pain Syndrome: A Qualitative Semi-structured Interview Study Among Hospital Sales Managers and Orthopedic Surgeons. Int J Health Policy Manag 2023; 12:7710. [PMID: 38618816 PMCID: PMC10590240 DOI: 10.34172/ijhpm.2023.7710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/31/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Withdrawal of reimbursement for low-value care through a policy change, ie, active disinvestment, is considered a potentially effective de-implementation strategy. However, previous studies have shown conflicting results and the mechanism through which active disinvestment may be effective is unclear. This study explored how the active disinvestment initiative regarding subacromial decompression (SAD) surgery for subacromial pain syndrome (SAPS) in the Netherlands influenced clinical decision-making around surgery, including the perspectives of orthopedic surgeons and hospital sales managers. METHODS We performed 20 semi-structured interviews from November 2020 to October 2021 with ten hospital sales managers and ten orthopedic surgeons from twelve hospitals across the Netherlands as relevant stakeholders in the active disinvestment process. The interviews were video-recorded and transcribed verbatim. Inductive thematic analysis was used to analyse interview transcripts independently by two authors and discrepancies were resolved through discussion. RESULTS Two overarching themes were identified that negatively influenced the effect of the active disinvestment initiative for SAPS. The first theme was that the active disinvestment represented a "Too small piece of the pie" indicating little financial consequences for the hospital as it was merely used in negotiations with healthcare insurers to reduce costs, required a disproportionate amount of effort from hospital staff given the small saving-potential, and was not clearly defined nor enforced in the overall healthcare insurer agreements. The second theme was "They [healthcare insurer] got it wrong," as the evidence and guidelines had been incorrectly interpreted, the active disinvestment was at odds with clinician experiences and beliefs and was perceived as a reduction in their professional autonomy. CONCLUSION The two overarching themes and their underlying factors highlight the complexity for active disinvestment initiatives to be effective. Future de-implementation initiatives including active disinvestment should engage relevant stakeholders at an early stage to incorporate their different perspectives, gain support and increase the probability of success.
Collapse
Affiliation(s)
- Timon H. Geurkink
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Perla J. Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rudolf W. Poolman
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob G.H.H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
15
|
Geurkink TH, van Bodegom-Vos L, Nagels J, Liew S, Stijnen P, Nelissen RGHH, Marang-van de Mheen PJ. The relationship between publication of high-quality evidence and changes in the volume and trend of subacromial decompression surgery for patients with subacromial pain syndrome in hospitals across Australia, Europe and the United States: a controlled interrupted time series analysis. BMC Musculoskelet Disord 2023; 24:456. [PMID: 37270498 DOI: 10.1186/s12891-023-06577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/27/2023] [Indexed: 06/05/2023] Open
Abstract
AIMS To evaluate the extent to which publication of high-quality randomised controlled trials(RCTs) in 2018 was associated with a change in volume or trend of subacromial decompression(SAD) surgery in patients with subacromial pain syndrome(SAPS) treated in hospitals across various countries. METHODS Routinely collected administrative data of the Global Health Data@work collaborative were used to identify SAPS patients who underwent SAD surgery in six hospitals from five countries (Australia, Belgium, Netherlands, United Kingdom, United States) between 01/2016 and 02/2020. Following a controlled interrupted time series design, segmented Poisson regression was used to compare trends in monthly SAD surgeries before(01/2016-01/2018) and after(02/2018-02/2020) publication of the RCTs. The control group consisted of musculoskeletal patients undergoing other procedures. RESULTS A total of 3.046 SAD surgeries were performed among SAPS patients treated in five hospitals; one hospital did not perform any SAD surgeries. Overall, publication of trial results was associated with a significant reduction in the trend to use SAD surgery of 2% per month (Incidence rate ratio (IRR) 0.984[0.971-0.998]; P = 0.021), but with large variation between hospitals. No changes in the control group were observed. However, publication of trial results was also associated with a 2% monthly increased trend (IRR 1.019[1.004-1.034]; P = 0.014) towards other procedures performed in SAPS patients. CONCLUSION Publication of RCT results was associated with a significantly decreased trend in SAD surgery for SAPS patients, although large variation between participating hospitals existed and a possible shift in coding practices cannot be ruled out. This highlights the complexities of implementing recommendations to change routine clinical practice even if based on high-quality evidence.
Collapse
Affiliation(s)
- Timon H Geurkink
- Department of Orthopaedics, Leiden University Medical Centre, Postbus, Leiden, 9600, 2300 RC, the Netherlands.
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Centre, Postbus, Leiden, 9600, 2300 RC, the Netherlands
| | - Susan Liew
- Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, Australia
| | - Pieter Stijnen
- Department of Management Information and Reporting, University Hospital Leuven, Leuven, Belgium
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Postbus, Leiden, 9600, 2300 RC, the Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
16
|
Hoffstädt HE, Boogaard JA, Tam MC, van Bodegom-Vos L, Stoppelenburg A, Hartog ID, van der Linden YM, van der Steen JT. Practice of Supporting Family Caregivers of Patients with Life-Threatening Diseases: A Two-phase Study Among Healthcare Professionals. Am J Hosp Palliat Care 2023; 40:633-643. [PMID: 36436831 PMCID: PMC10240656 DOI: 10.1177/10499091221123006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background: Although support for family caregivers is an essential component of palliative care, routine provision of such support is often lacking. To improve support for family caregivers, we assessed current practice and influencing factors as perceived by healthcare professionals. Methods: A two-phase study was conducted including a survey exploring healthcare professionals' practice of supporting family caregivers in Western urbanized Netherlands in 2017, and focus groups exploring facilitators and barriers to supporting family caregivers in 2018. Focus group data were thematically analyzed with deductive coding based on the COM-B system. Results: Of the 379 survey respondents (response 11%), 374 were eligible (physicians, 28%; nurses, 64%; nurse assistants, 9%). The respondents practiced in academic hospitals (52%), general hospitals (31%), nursing homes (11%) and hospices (5%). They reported to always (38%), most of the time (37%), sometimes (21%) or never (5%) provide support to family caregivers during the illness trajectory. Respondents reported to always (28%), sometimes (39%), or never (33%) provide support after death. Four focus group discussions with 22 healthcare professionals elicited motivational facilitators and barriers to supporting family caregivers (e.g., relationship with family caregivers, deriving satisfaction from supporting them), and factors related to capability (e.g., (lacking) conversational skills, knowledge) and opportunity (e.g., (un)availability of protocols and time). Conclusions: Support for family caregivers, especially after the patient's death, is not systematically integrated in working procedures of healthcare professionals. The barriers and facilitators identified in this study can inform the development of an intervention aiming to enhance support for family caregivers.
Collapse
Affiliation(s)
- Hinke E. Hoffstädt
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jannie A. Boogaard
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcella C. Tam
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Arianne Stoppelenburg
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Iris D. Hartog
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Yvette M. van der Linden
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Jenny T. van der Steen
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| |
Collapse
|
17
|
Kruiswijk AA, Dorleijn DMJ, Marang-van de Mheen PJ, van de Sande MAJ, van Bodegom-Vos L. Health-Related Quality of Life of Bone and Soft-Tissue Tumor Patients around the Time of Diagnosis. Cancers (Basel) 2023; 15:2804. [PMID: 37345139 DOI: 10.3390/cancers15102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Bone and soft-tissue tumor patients experience long-lasting physical and psychological challenges. It is unknown to what extent Health-Related Quality of Life (HRQoL) is already affected during the diagnostic process. This study assesses the HRQoL of bone and soft-tissue tumor patients around time of diagnosis and explores which patient or tumor characteristics are associated with a reduced HRQoL. METHODS All patients with a suspected benign/malignant bone tumor (BT), benign soft-tissue tumor (STT), or malignant soft-tissue sarcoma (STS) visiting the Leiden University Medical Center between 2016 and 2020 were invited to complete the Patient-Reported Outcomes Measurement Information System (PROMIS) 29-item profile questionnaire. Mean scores of all included patients and per diagnosis group were compared to mean scores of the general population using one-sample t-tests. RESULTS Overall, patients (n = 637) reported statistically significantly worse HRQoL-scores on anxiety (51.3 ± 9.6), pain (55.3 ± 10.1), physical functioning (46.0 ± 9.7), and social functioning (48.1 ± 10.8) with the difference in pain and physical functioning being clinically relevant (based on a 3-point difference on t-metric). HRQoL-scores differed between diagnosis subgroups, i.e., patients with malignant tumors had higher anxiety levels and experienced more pain, where patients with bone tumors had worse physical functioning. CONCLUSION The HRQoL of patients with suspected bone and soft-tissue tumors is already affected during the diagnostic process.
Collapse
Affiliation(s)
- Anouk A Kruiswijk
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Desiree M J Dorleijn
- Orthopedic Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Michiel A J van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| |
Collapse
|
18
|
Ritschl V, Sperl L, Andrews MR, Björk M, Boström C, Cappon J, Davergne T, de la Torre-Aboki J, de Thurah A, Domján A, Dragoi RG, Estévez-López F, Ferreira RJO, Fragoulis GE, Grygielska J, Kõrve K, Kukkurainen ML, Madelaine-Bonjour C, Marques A, Meesters J, Moe RH, Moholt E, Mosor E, Naimer-Stach C, Ndosi M, Pchelnikova P, Primdahl J, Putrik P, Rausch Osthoff AK, Smucrova H, Testa M, van Bodegom-Vos L, Peter WF, Zangi HA, Zimba O, Vliet Vlieland TPM, Stamm TA. Educational readiness among health professionals in rheumatology: low awareness of EULAR offerings and unfamiliarity with the course content as major barriers-results of a EULAR-funded European survey. RMD Open 2023; 9:e003120. [PMID: 37230762 PMCID: PMC10230966 DOI: 10.1136/rmdopen-2023-003120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Ongoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings. METHODS AND PARTICIPANTS We developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed the Checklist for Reporting Results of Internet E-Surveys guideline. RESULTS The questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries were recorded. The highest educational needs were 'professional development', 'prevention and lifestyle intervention'. Older age, more working experience in rheumatology and higher education levels were positively associated with higher postgraduate educational readiness. While more than half of the HPR were familiar with EULAR as an association and the respondents reported an increased interest in the content of the educational offerings, the courses and the annual congress were poorly attended due to a lack of awareness, comparatively high costs and language barriers. CONCLUSIONS To promote the uptake of EULAR educational offerings, attention is needed to increase awareness among national organisations, offer accessible participation costs, and address language barriers.
Collapse
Affiliation(s)
- Valentin Ritschl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Lisa Sperl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Margaret Renn Andrews
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
| | - Mathilda Björk
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Carina Boström
- Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
| | - Jeannette Cappon
- Department of Pediatric Rehabillitation, Reade Centre for Rehabillitation and Rheumatology, Amsterdam, The Netherlands
| | - Thomas Davergne
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | | | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Århus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrea Domján
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Razvan Gabriel Dragoi
- Department of Balneology, Rehabilitation and Rheumatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Fernando Estévez-López
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Coimbra, Portugal
| | - George E Fragoulis
- Joint Rheumatology Programme, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Katti Kõrve
- Center of Rheumatology, East Tallinn Central Hospital, Tallinn, Estonia
| | | | | | - Andréa Marques
- Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Jorit Meesters
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Rikke Helene Moe
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ellen Moholt
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Erika Mosor
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
| | | | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Polina Putrik
- Department of Rheumatology, Internal Medicine, MUMC and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Anne-Kathrin Rausch Osthoff
- Institute of Physiotherapy, Zurich University of Applied Sciences; School of Health Professions, Winterthur, Switzerland
- Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Hana Smucrova
- Center of Medical Rehabilitation, Institute of Rheumatology, Prague, Czech Republic
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilfred F Peter
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
- Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Heidi A Zangi
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Department of Rheumatology and Research, VID Specialized University, Oslo, Norway
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Tanja A Stamm
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
| |
Collapse
|
19
|
Liem SIE, Vliet Vlieland TPM, van de Ende CH, Dittmar S, Schriemer MR, Bodegom-Vos LV, Peter WFH, Vries-Bouwstra JKD. Consensus-based recommendations on communication and education regarding primary care physical therapy for patients with systemic sclerosis. Musculoskeletal Care 2023; 21:45-55. [PMID: 35689435 DOI: 10.1002/msc.1664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to develop recommendations for communication and postgraduate education regarding primary care physical therapy for systemic sclerosis (SSc) patients. METHODS A virtual Nominal Group Technique was used with tasks forces for communication (n = 18) and education (n = 21). Both included rheumatologists, physical therapists (PTs) in primary, secondary or tertiary care, rheumatology nurses, advanced nurse practictioners and patient representatives. Three online meetings were organised for each task force to discuss (1) current bottlenecks; (2) potential solutions; and (3) the resulting draft recommendations. After the final adjustments, participants rated their level of agreement with each recommendation on a scale from 0 (not at all agree) to 100 (totally agree), using an online questionnaire. RESULTS 19 and 34 recommendations were formulated for communication and education, respectively. For communication the main recommendations concerned the provision of an overview of primary care physical therapists with expertise in rheumatic and musculoskeletal diseases to patients and rheumatologists, the inclusion of the indication by the rheumatologist in the referral to the physical therapist and low-threshold communication with the rheumatologist in case of questions or concerns of the physical therapist. For postgraduate education three types of "on demand" educational offerings were recommended with varying levels of content and duration, to match the competencies and preferences of individual primary care physical therapists. CONCLUSION Using a systematic qualitative approach, two multi-stakeholder task forces developed practical recommendations for primary care physical therapists' communication with hospital-based care providers and postgraduate education regarding the treatment of SSc patients.
Collapse
Affiliation(s)
- Sophie I E Liem
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Theodora P M Vliet Vlieland
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia H van de Ende
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Sonja Dittmar
- NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Marisca R Schriemer
- NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Wilfred F H Peter
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
20
|
van Schie P, van Bodegom-Vos L, Zijdeman TM, Nelissen RGHH, Marang-van de Mheen PJ. Effectiveness of a multifaceted quality improvement intervention to improve patient outcomes after total hip and knee arthroplasty: a registry nested cluster randomised controlled trial. BMJ Qual Saf 2023; 32:34-46. [PMID: 35732486 DOI: 10.1136/bmjqs-2021-014472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/20/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the effectiveness of a prospective multifaceted quality improvement intervention on patient outcomes after total hip and knee arthroplasty (THA and TKA). DESIGN Cluster randomised controlled trial nested in a national registry. From 1 January 2018 to 31 May 2020 routinely submitted registry data on revision and patient characteristics were used, supplemented with hospital data on readmission, complications and length of stay (LOS) for all patients. SETTING 20 orthopaedic departments across hospitals performing THA and TKA in The Netherlands. PARTICIPANTS 32 923 patients underwent THA and TKA, in 10 intervention and 10 control hospitals (usual care). INTERVENTION The intervention period lasted 8 months and consisted of the following components: (1) monthly updated feedback on 1-year revision, 30-day readmission, 30-day complications, long (upper quartile) LOS and these four indicators combined in a composite outcome; (2) interactive education; (3) an action toolbox including evidence-based quality improvement initiatives (QIIs) to facilitate improvement of above indicators; and (4) bimonthly surveys to report on QII undertaken. MAIN OUTCOME MEASURES The primary outcome was textbook outcome (TO), an all-or-none composite representing the best outcome on all performance indicators (ie, the absence of revision, readmissions, complications and long LOS). The individual indicators were analysed as secondary outcomes. Changes in outcomes from pre-intervention to intervention period were compared between intervention versus control hospitals, adjusted for case-mix and clustering of patients within hospitals using random effect binary logistic regression models. The same analyses were conducted for intervention hospitals that did and did not introduce QII. RESULTS 16,314 patients were analysed in intervention hospitals (12,475 before and 3,839 during intervention) versus 16,609 in control hospitals (12,853 versus 3,756). After the intervention period, the absolute probability to achieve TO increased by 4.32% (95% confidence interval (CI) 4.30-4.34) more in intervention than control hospitals, corresponding to 21.6 (95%CI 21.5-21.8), i.e., 22 patients treated in intervention hospitals to achieve one additional patient with TO. Intervention hospitals had a larger increase in patients achieving TO (ratio of adjusted odds ratios 1.24, 95%CI 1.05-1.48) than control hospitals, a larger reduction in patients with long LOS (0.74, 95%CI 0.61-0.90) but also a larger increase in patients with reported 30-day complications (1.34, 95%CI 1.00-1.78). Intervention hospitals that introduced QII increased more in TO (1.32, 95%CI 1.10-1.57) than control hospitals, with no effect shown for hospitals not introducing QII (0.93, 95%CI 0.67-1.30). CONCLUSION The multifaceted QI intervention including monthly feedback, education, and a toolbox to facilitate QII effectively improved patients achieving TO. The effect size was associated with the introduction of (evidence-based) QII, considered as the causal link to achieve better patient outcomes. TRIAL REGISTRATION NUMBER NCT04055103.
Collapse
Affiliation(s)
- Peter van Schie
- Orthopaedics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Leti van Bodegom-Vos
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Tristan M Zijdeman
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Rob G H H Nelissen
- Orthopaedics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Perla J Marang-van de Mheen
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| |
Collapse
|
21
|
Weller FS, van Bodegom-Vos L, Hamming JF. [The role of clinical guidelines in daily practice]. Ned Tijdschr Geneeskd 2022; 166:D6989. [PMID: 36300461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In a time of exponential growth of medical scientific knowledge medical specialists need all the help they can get in translating the vast amount of information to the best treatment for their patients. Evidence based guidelines in essence seem a useful tool in promoting this translation as they report an extensive evaluation of available evidence. In daily practice however, guidelines do not always find their way to the clinical encounter with patients. But how do the end users of clinical practice guidelines, the medical specialists, utilize these instruments and how can this potentially be improved?
Collapse
Affiliation(s)
- Floris S Weller
- LUMC, Leiden, afd. Biomedical Data Sciencesenafd. Heelkunde
- Contact: Floris S. Weller
| | | | | |
Collapse
|
22
|
Knol R, Brouwer E, van den Akker T, DeKoninck PLJ, Lopriore E, Onland W, Vermeulen MJ, van den Akker-van Marle ME, van Bodegom-Vos L, de Boode WP, van Kaam AH, Reiss IKM, Polglase GR, Hutten GJ, Prins SA, Mulder EEM, Hulzebos CV, van Sambeeck SJ, van der Putten ME, Zonnenberg IA, Hooper SB, Te Pas AB. Physiological-based cord clamping in very preterm infants: the Aeration, Breathing, Clamping 3 (ABC3) trial-study protocol for a multicentre randomised controlled trial. Trials 2022; 23:838. [PMID: 36183143 PMCID: PMC9526936 DOI: 10.1186/s13063-022-06789-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International guidelines recommend delayed umbilical cord clamping (DCC) up to 1 min in preterm infants, unless the condition of the infant requires immediate resuscitation. However, clamping the cord prior to lung aeration may severely limit circulatory adaptation resulting in a reduction in cardiac output and hypoxia. Delaying cord clamping until lung aeration and ventilation have been established (physiological-based cord clamping, PBCC) allows for an adequately established pulmonary circulation and results in a more stable circulatory transition. The decline in cardiac output following time-based delayed cord clamping (TBCC) may thus be avoided. We hypothesise that PBCC, compared to TBCC, results in a more stable transition in very preterm infants, leading to improved clinical outcomes. The primary objective is to compare the effect of PBCC on intact survival with TBCC. METHODS The Aeriation, Breathing, Clamping 3 (ABC3) trial is a multicentre randomised controlled clinical trial. In the interventional PBCC group, the umbilical cord is clamped after the infant is stabilised, defined as reaching heart rate > 100 bpm and SpO2 > 85% while using supplemental oxygen < 40%. In the control TBCC group, cord clamping is time based at 30-60 s. The primary outcome is survival without major cerebral and/or intestinal injury. Preterm infants born before 30 weeks of gestation are included after prenatal parental informed consent. The required sample size is 660 infants. DISCUSSION The findings of this trial will provide evidence for future clinical guidelines on optimal cord clamping management in very preterm infants at birth. TRIAL REGISTRATION ClinicalTrials.gov NCT03808051. First registered on January 17, 2019.
Collapse
Affiliation(s)
- Ronny Knol
- Division of Neonatology, Department of Paediatrics, Sophia Children's Hospital, Erasmus MC University Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. .,Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Emma Brouwer
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.,Athena Institute, VU University, Amsterdam, The Netherlands
| | - Philip L J DeKoninck
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Enrico Lopriore
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marijn J Vermeulen
- Division of Neonatology, Department of Paediatrics, Sophia Children's Hospital, Erasmus MC University Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | | | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem P de Boode
- Division of Neonatology, Department of Paediatrics, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Paediatrics, Sophia Children's Hospital, Erasmus MC University Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - G Jeroen Hutten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sandra A Prins
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Estelle E M Mulder
- Department of Neonatology, Isala Women and Children's Hospital, Zwolle, The Netherlands
| | - Christian V Hulzebos
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Sam J van Sambeeck
- Department of Paediatrics, Maxima Medical Center, Veldhoven, The Netherlands
| | - Mayke E van der Putten
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Inge A Zonnenberg
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
23
|
van Bodegom-Vos L, Marang-van de Mheen P. Reducing Low-Value Care: Uncertainty as Crucial Cross-Cutting Theme Comment on "Key Factors That Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands". Int J Health Policy Manag 2022; 11:1964-1966. [PMID: 35297239 PMCID: PMC9808241 DOI: 10.34172/ijhpm.2022.7027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/09/2022] [Indexed: 01/12/2023] Open
Abstract
Low-value care is increasingly recognized as a global problem that places strain on healthcare systems and has no quick fix. Verkerk et al have identified key factors promoting low-value care on a national level, proposed strategies to address these and create a healthcare system facilitating delivery of high-value care. In this commentary, we reflect on the results of Verkerk et al and argue that uncertainty has a crucial role when it comes to reducing low-value care. This uncertainty is reflected in lack of a shared view between stakeholders, with clear criteria and thresholds on what constitutes low-value care, and as cross-cutting theme related to the key factors identified. We suggest to work on such a shared view of low-value care and - different from implementation efforts - to explicitly address uncertainty and its driving cognitive biases grounded in human decision-making psychology, to reduce low-value care.
Collapse
Affiliation(s)
- Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | | |
Collapse
|
24
|
Knoop J, Dekker J, van Dongen JM, van der Leeden M, de Rooij M, Peter WF, de Joode W, van Bodegom-Vos L, Lopuhaä N, Bennell KL, Lems WF, van der Esch M, Vliet Vlieland TP, Ostelo RW. Stratified exercise therapy does not improve outcomes compared with usual exercise therapy in people with knee osteoarthritis (OCTOPuS study): a cluster randomised trial. J Physiother 2022; 68:182-190. [PMID: 35760724 DOI: 10.1016/j.jphys.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/28/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022] Open
Abstract
QUESTION In people with knee osteoarthritis, how much more effective is stratified exercise therapy that distinguishes three subgroups (high muscle strength subgroup, low muscle strength subgroup, obesity subgroup) in reducing knee pain and improving physical function than usual exercise therapy? DESIGN Pragmatic cluster randomised controlled trial in a primary care setting. PARTICIPANTS A total of 335 people with knee osteoarthritis: 153 in an experimental arm and 182 in a control arm. INTERVENTION Physiotherapy practices were randomised into an experimental arm providing stratified exercise therapy (supplemented by a dietary intervention from a dietician for the obesity subgroup) or a control arm providing usual, non-stratified exercise therapy. OUTCOME MEASURES Primary outcomes were knee pain severity (numerical rating scale for pain, 0 to 10) and physical function (Knee Injury and Osteoarthritis Outcome Score subscale activities of daily living, 0 to 100). Measurements were performed at baseline, 3 months (primary endpoint) and 6 and 12 months (follow-up). Intention-to-treat, multilevel, regression analysis was performed. RESULTS Negligible differences were found between the experimental and control groups in knee pain (mean adjusted difference 0.2, 95% CI -0.4 to 0.7) and physical function (-0.8, 95% CI -4.3 to 2.6) at 3 months. Similar effects between groups were also found for each subgroup separately, as well as at other time points and for nearly all secondary outcome measures. CONCLUSION This pragmatic trial demonstrated no added value regarding clinical outcomes of the model of stratified exercise therapy compared with usual exercise therapy. This could be attributed to the experimental arm therapists facing difficulty in effectively applying the model (especially in the obesity subgroup) and to elements of stratified exercise therapy possibly being applied in the control arm. REGISTRATION Netherlands National Trial Register NL7463.
Collapse
Affiliation(s)
- Jesper Knoop
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands; Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
| | - Mariette de Rooij
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
| | - Wilfred Fh Peter
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands; Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Willemijn de Joode
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | | | - Kim L Bennell
- Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Willem F Lems
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands; Amsterdam UMC, location VUmc, Department of Rheumatology, Amsterdam, Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands; Center of Expertise Urban Vitality, Health Faculty, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | | | - Raymond Wjg Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| |
Collapse
|
25
|
van Schie P, Hasan S, van Bodegom-Vos L, Schoones JW, Nelissen RGHH, Marang-van de Mheen PJ. International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports. EFORT Open Rev 2022; 7:247-263. [PMID: 35446260 PMCID: PMC9069858 DOI: 10.1530/eor-21-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In order to improve care for total hip and knee arthroplasties (THA/TKA), hospitals may want to compare their performance with hospitals in other countries. Pooling data across countries also enable early detection of infrequently occurring safety issues. We therefore aimed to assess the between-hospital variation and definitions used for revision, readmission, and complications across countries. PubMed, Embase, Web of Science, Cochrane library, Emcare, and Academic Search Premier were searched from January 2009 to August 2020 for studies reporting on: (i) primary THA/TKA; (ii) revision, readmission, or complications; and (iii) between-hospital variation. Most recent registry reports of Network of Orthopedic Registries of Europe members were also reviewed. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the Integrated quality Criteria for the Review Of Multiple Study designs tool for studies and relevant domains for registries. We assessed agreement for the following domains: (i) outcome definition; (ii) follow-up and starting point; (iii) case-mix adjustment; and (iv) type of patients and hospitals included. Between-hospital variation was reported in 33 (1 high-quality, 13 moderate-quality, and 19 low-quality) studies and 8 registry reports. The range of variation for revision was 0–33% for THA and 0–27% for TKA varying between assessment within hospital admission until 10 years of follow-up; for readmission, 0–40% and 0–32% for THA and TKA, respectively; and for complications, 0–75% and 0–50% for THA and TKA, respectively. Indicator definitions and methodological variables varied considerably across domains. The large heterogeneity in definitions and methods used likely explains the considerable variation in between-hospital variation reported for revision, readmission, and complications , making it impossible to benchmark hospitals across countries or pool data for earlier detection of safety issues. It is necessary to collaborate internationally and strive for more uniformity in indicator definitions and methods in order to achieve reliable international benchmarking in the future.
Collapse
Affiliation(s)
- Peter van Schie
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Shaho Hasan
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
26
|
Sijbom M, Braun KK, Büchner FL, van Bodegom-Vos L, Hendriks BJC, de Boer MGJ, Numans ME, Lambregts MMC. Cues to improve antibiotic-allergy registration: A mixed-method study. PLoS One 2022; 17:e0266473. [PMID: 35390063 PMCID: PMC8989191 DOI: 10.1371/journal.pone.0266473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/21/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Approximately 2% of patients in primary care practice and up to 25% of hospital patients are registered as being allergic to an antibiotic. However, up to 90% of these registrations are incorrect, leading to unnecessary prescription of 2nd choice antibiotics with the attendant loss of efficacy, increased toxicity and antibiotic resistance. To improve registration, a better understanding is needed of how incorrect labels are attributed. OBJECTIVE To investigate the quality of antibiotic allergy registration in primary care and identify determinants to improve registration of antibiotic allergies. DESIGN Registration of antibiotic allergies in primary care practices were analysed for 1) completeness and 2) correctness. To identify determinants for improvement, semi-structured interviews with healthcare providers from four healthcare domains were conducted. PARTICIPANTS A total of 300 antibiotic allergy registrations were analysed for completeness and correctness. Thirty-four healthcare providers were interviewed. MAIN MEASURES A registration was defined as complete when it included a description of all symptoms, time to onset of symptoms and the duration of symptoms. It was defined as correct when the conclusion was concordant with the Salden criteria. Determinants of correct antibiotic allergy registrations were divided into facilitators or obstructers. KEY RESULTS Rates of completeness and correctness of registrations were 0% and 29.3%, respectively. The main perceived barriers for correct antibiotic allergy registration were insufficient knowledge, lack of priority, limitations of registration features in electronic medical records (EMR), fear of medical liability and patients interpreting side-effects as allergies. CONCLUSIONS The quality of antibiotic allergy registrations can be improved. Potential interventions include raising awareness of the consequences of incomplete and the importance of correct registrations, by continued education, and above all simplifying registration in an EMR by adequate ICT support.
Collapse
Affiliation(s)
- Martijn Sijbom
- Department of Public Health and Primary Care Campus-Den Haag, Leiden University Medical Center, Leiden, The Netherlands
| | - Karolina K. Braun
- Department of Public Health and Primary Care Campus-Den Haag, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederike L. Büchner
- Department of Public Health and Primary Care Campus-Den Haag, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart J. C. Hendriks
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark G. J. de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E. Numans
- Department of Public Health and Primary Care Campus-Den Haag, Leiden University Medical Center, Leiden, The Netherlands
| | - Merel M. C. Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
27
|
Rausch Osthoff AK, Vliet Vlieland TPM, Meichtry A, van Bodegom-Vos L, Topalidis B, Büchi S, Nast I, Ciurea A, Niedermann K. Lessons learned from a pilot implementation of physical activity recommendations in axial spondyloarthritis exercise group therapy. BMC Rheumatol 2022; 6:12. [PMID: 35034652 PMCID: PMC8762948 DOI: 10.1186/s41927-021-00233-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/05/2021] [Indexed: 01/20/2023] Open
Abstract
Background The Ankylosing Spondylitis Association of Switzerland (SVMB) aimed to implement physical activity recommendations (PAR) within their exercise groups (EGs). The PAR promote exercise in all fitness dimensions at the correct dose. To implement the PAR within EGs, they were translated into a new EG concept with five key activities: (a) training for supervising physiotherapists (PTs), (b) correctly dosed exercises in all fitness dimensions, (c) exercise counselling, (d) bi-annual fitness assessments, and (e) individual exercise training, in addition to EG. All these activities were realized in close coordination with SVMB management. Objectives To analyse the implementation success by evaluating adherence/fidelity, feasibility, and satisfaction at the patient, PTs, and organisational level. Methods The five key activities of the new EG concept were developed, executed, and assessed after 6 months. The primary outcomes for implementation success were adherence of patients to the recommended exercise behaviour, self-reported by electronic diary; fidelity of PTs to the new concept, self-reported by diary; SVMB organisational changes. Secondary outcomes were feasibility and satisfaction with the new EG concept at all three levels. The tertiary outcome, to evaluate the effectiveness of PAR, was patient fitness, assessed through fitness assessments. Results 30 patients with axSpA (ten women, mean age 58 ± 9 years) and four PTs (three women, mean age 46 ± 9 years) participated. The patients' self-reporting of adherence to the PAR was insufficient (43%), possibly due to technical problems with the electronic dairy. The PTs' fidelity to the new EG concept was satisfactory. On all levels, the new concept was generally perceived as feasible and useful for supporting personalised exercise.The frequency of exercise counselling and the fitness assessments was found by patients and PTs to be too high and rigid. Patients' cardiorespiratory fitness [ES 1.21 (95%CI 0.59, 1.89)] and core strength [ES 0.61 (95%CI 0.18, 1.06)] improved over the 6 months. Conclusions The pilot implementation of PAR showed acceptance and satisfaction to be sufficient, thus confirming the need for evidence-based EGs, provided by a patient organisation in order to support active PA behaviour. However, adaptations are necessary to increase its feasibility for nationwide implementation. Trial Registration: SNCTP, SNCTP000002880. Registered 31 May 2018, https://www.kofam.ch/en/snctp-portal/search/0/study/42491. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00233-z.
Collapse
Affiliation(s)
- Anne-Kathrin Rausch Osthoff
- ZHAW, School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland. .,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands.
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - André Meichtry
- ZHAW, School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Stefan Büchi
- Clinic for Psychotherapy and Psychosomatics Hohenegg, Meilen, Switzerland
| | - Irina Nast
- ZHAW, School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, 8091, Zurich, Switzerland
| | - Karin Niedermann
- ZHAW, School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| |
Collapse
|
28
|
Kjelle E, Andersen ER, Soril LJJ, van Bodegom-Vos L, Hofmann BM. Interventions to reduce low-value imaging - a systematic review of interventions and outcomes. BMC Health Serv Res 2021; 21:983. [PMID: 34537051 PMCID: PMC8449221 DOI: 10.1186/s12913-021-07004-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is estimated that 20-50% of all radiological examinations are of low value. Many attempts have been made to reduce the use of low-value imaging. However, the comparative effectiveness of interventions to reduce low-value imaging is unclear. Thus, the objective of this systematic review was to provide an overview and evaluate the outcomes of interventions aimed at reducing low-value imaging. METHODS An electronic database search was completed in Medline - Ovid, Embase-Ovid, Scopus, and Cochrane Library for citations between 2010 and 2020. The search was built from medical subject headings for Diagnostic imaging/Radiology, Health service misuse or medical overuse, and Health planning. Keywords were used for the concept of reduction and avoidance. Reference lists of included articles were also hand-searched for relevant citations. Only articles written in English, German, Danish, Norwegian, Dutch, and Swedish were included. The Mixed Methods Appraisal Tool was used to appraise the quality of the included articles. A narrative synthesis of the final included articles was completed. RESULTS The search identified 15,659 records. After abstract and full-text screening, 95 studies of varying quality were included in the final analysis, containing 45 studies found through hand-searching techniques. Both controlled and uncontrolled before-and-after studies, time series, chart reviews, and cohort studies were included. Most interventions were aimed at referring physicians. Clinical practice guidelines (n = 28) and education (n = 28) were most commonly evaluated interventions, either alone or in combination with other components. Multi-component interventions were often more effective than single-component interventions showing a reduction in the use of low-value imaging in 94 and 74% of the studies, respectively. The most addressed types of imaging were musculoskeletal (n = 26), neurological (n = 23) and vascular (n = 16) imaging. Seventy-seven studies reported reduced low-value imaging, while 3 studies reported an increase. CONCLUSIONS Multi-component interventions that include education were often more effective than single-component interventions. The contextual and cultural factors in the health care systems seem to be vital for successful reduction of low-value imaging. Further research should focus on assessing the impact of the context in interventions reducing low-value imaging and how interventions can be adapted to different contexts.
Collapse
Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802 Gjøvik, Norway
| | - Eivind Richter Andersen
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802 Gjøvik, Norway
| | - Lesley J. J. Soril
- Department of Community Health Sciences and The Health Technology Assessment Unit, O’Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6 Canada
| | - Leti van Bodegom-Vos
- Medical Decision making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802 Gjøvik, Norway
- Centre of Medical Ethics, University of Oslo, Postbox 1130, Blindern, 0318 Oslo, Norway
| |
Collapse
|
29
|
Huijts DD, Dekker JWT, van Bodegom-Vos L, van Groningen JT, Bastiaannet E, Marang-van de Mheen PJ. Differences in organization of care are associated with mortality, severe complication and failure to rescue in emergency colon cancer surgery. Int J Qual Health Care 2021; 33:6156887. [PMID: 33677517 PMCID: PMC7948387 DOI: 10.1093/intqhc/mzab038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background Emergency colon cancer surgery is associated with increased mortality and complication risk, which can be due to differences in the organization of hospital care. This study aimed. Objective To explore which structural factors in the preoperative, perioperative and postoperative periods influence outcomes after emergency colon cancer surgery. Methods An observational study was performed in 30 Dutch hospitals. Medical records from 1738 patients operated in the period 2012 till 2015 were reviewed on the type of referral, intensive care unit (ICU) level, surgeon specialization and experience, duration of surgery and operating room time, blood loss, stay on specialized postoperative ward, complication occurrence, reintervention and day of surgery and linked to case-mix data available in the Dutch Colorectal Audit. Multivariate logistic regression analysis was used to estimate the influence of these factors on 30-day mortality, severe complication and failure to rescue (FTR), after adjustment for case-mix. Results Patients operated by a non-Gastro intestinal/oncology specialized surgeon have significantly increased mortality (Odds Ratio (OR) 2.28 [95% confidence interval (95% CI) 1.23–4.23]) and severe complication risk (OR 1.61 [95% CI 1.08–2.39]). Also, duration of stay in the operating room was significantly associated with increased risk on severe complication (OR 1.03 [95% CI 1.01–1.06]). Patients admitted to a non-specialized ward have significantly increased mortality (OR 2.25 [95% CI 1.46–3.47]) and FTR risk (OR 2.39 [95% CI 1.52–3.75]). A low ICU level (basic ICU) was associated with a lower severe complication risk (OR 0.72 [95% CI 0.52–1.00]). Surgery on Tuesday was associated with a higher mortality risk (OR 2.82 [95% CI 1.24–6.40]) and a severe complication risk (OR 1.77, [95% CI 1.19–2.65]). Conclusion This study identified a non-specialized surgeon and ward, operating room, time and day of surgery to be risk factors for worse outcomes in emergency colon cancer surgery.
Collapse
Affiliation(s)
- Daniëlle D Huijts
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Jan Willem T Dekker
- Department of Surgery, Reinier de Graaf Group, Reinier de Graafweg 5, Delft 2600 GA, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Julia T van Groningen
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden 2333 ZA, The Netherlands.,Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| |
Collapse
|
30
|
Brouns B, van Bodegom-Vos L, de Kloet AJ, Tamminga SJ, Volker G, Berger MAM, Fiocco M, Goossens PH, Vliet Vlieland TPM, Meesters JJL. Effect of a comprehensive eRehabilitation intervention alongside conventional stroke rehabilitation on disability and health-related quality of life: A pre-post comparison. J Rehabil Med 2021; 53:jrm00161. [PMID: 33369683 PMCID: PMC8814840 DOI: 10.2340/16501977-2785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To compare the effect on disability and quality of life, of conventional rehabilitation (control group) with individualized, tailored eRehabilitation intervention alongside conventional rehabilitation (Fast@home; intervention group), for people with stroke. METHODS Pre–post design. The intervention comprised cognitive (Braingymmer®) and physical (Telerevalidatie®/Physitrack®) exercises, activity-tracking (Activ8®) and psycho-education. Assessments were made at admission (T0) and after 3 (T3) and 6 months (T6). The primary outcome concerned disability (Stroke Impact Scale; SIS). Secondary outcomes were: health-related quality of life, fatigue, self-management, participation and physical activity. Changes in scores between T0–T3, T3–T6, and T0–T6 were compared by analysis of variance and linear mixed models. Results The study included 153 and 165 people with stroke in the control and intervention groups, respectively. In the intervention group, 82 (50%) people received the intervention, of whom 54 (66%) used it. Between T3 and T6, the change in scores for the SIS subscales Communication (control group/intervention group –1.7/–0.3) and Physical strength (–5.7/3.3) were significantly greater in the total intervention group (all mean differences< minimally clinically important differences). No significant differences were found for other SIS subscales or secondary outcomes, or between T0–T3 and T0–T6. Conclusion eRehabilitation alongside conventional stroke rehabilitation had a small positive effect on communication and physical strength on the longer term, compared to conventional rehabilitation only.
Collapse
Affiliation(s)
- Berber Brouns
- Basalt Rehabilitation Centre, The Hague and Leiden, Department of Innovation, Quality + Research, Haag, The Netherlands. ,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
van Schie P, van Bodegom-Vos L, van Steenbergen LN, Nelissen RGHH, Marang-van de Mheen PJ. Monitoring Hospital Performance with Statistical Process Control After Total Hip and Knee Arthroplasty: A Study to Determine How Much Earlier Worsening Performance Can Be Detected. J Bone Joint Surg Am 2020; 102:2087-2094. [PMID: 33264217 DOI: 10.2106/jbjs.20.00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Given the low early revision rate after total hip arthroplasty (THA) and total knee arthroplasty (TKA), hospital performance is typically compared using 3 years of data. The purpose of this study was to assess how much earlier worsening hospital performance in 1-year revision rates after THA and TKA can be detected. METHODS All 86,468 THA and 73,077 TKA procedures performed from 2014 to 2016 and recorded in the Dutch Arthroplasty Register were included. Negative outlier hospitals were identified by significantly higher O/E (observed divided by expected) 1-year revision rates in a funnel plot. Monthly Shewhart p-charts (with 2 and 3-sigma control limits) and cumulative sum (CUSUM) charts (with 3.5 and 5 control limits) were constructed to detect a doubling of revisions (odds ratio of 2), generating a signal when the control limit was reached. The median number of months until generation of a first signal for negative outliers and the number of false signals for non-negative outliers were calculated. Sensitivity, specificity, and accuracy were calculated for all charts and control limit settings using outlier status in the funnel plot as the gold standard. RESULTS The funnel plot showed that 13 of 97 hospitals had significantly higher O/E 1-year revision rates and were negative outliers for THA and 7 of 98 hospitals had significantly higher O/E 1-year revision rates and were negative outliers for TKA. The Shewhart p-chart with the 3-sigma control limit generated 68 signals (34 false-positive) for THA and 85 signals (63 false-positive) for TKA. The sensitivity for THA and TKA was 92% and 100%, respectively; the specificity was 69% and 51%, respectively; and the accuracy was 72% and 54%, respectively. The CUSUM chart with a 5 control limit generated 18 signals (1 false-positive) for THA and 7 (1 false-positive) for TKA. The sensitivity was 85% and 71% for THA and TKA, respectively; the specificity was 99% for both; and the accuracy was 97% for both. The Shewhart p-chart with a 3-sigma control limit generated the first signal for negative outliers after a median of 10 months (interquartile range [IQR] = 2 to 18) for THA and 13 months (IQR = 5 to 18) for TKA. The CUSUM chart with a 5 control limit generated the first signal after a median of 18 months (IQR = 7 to 22) for THA and 21 months (IQR = 9 to 25) for TKA. CONCLUSIONS Monthly monitoring using CUSUM charts with a 5 control limit enables earlier detection of worsening 1-year revision rates with accuracy so that initiatives to improve care can start earlier.
Collapse
Affiliation(s)
- Peter van Schie
- Departments of Orthopaedic Surgery (P.v.S. and R.G.H.H.N.) and Biomedical Data Sciences and Medical Decision Making (L.v.B.-V. and P.J.M.-v.d.M.), Leiden University Medical Centre, Leiden, the Netherlands
| | - Leti van Bodegom-Vos
- Departments of Orthopaedic Surgery (P.v.S. and R.G.H.H.N.) and Biomedical Data Sciences and Medical Decision Making (L.v.B.-V. and P.J.M.-v.d.M.), Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Rob G H H Nelissen
- Departments of Orthopaedic Surgery (P.v.S. and R.G.H.H.N.) and Biomedical Data Sciences and Medical Decision Making (L.v.B.-V. and P.J.M.-v.d.M.), Leiden University Medical Centre, Leiden, the Netherlands
| | - Perla J Marang-van de Mheen
- Departments of Orthopaedic Surgery (P.v.S. and R.G.H.H.N.) and Biomedical Data Sciences and Medical Decision Making (L.v.B.-V. and P.J.M.-v.d.M.), Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
32
|
Huijts DD, Guicherit OR, Dekker JWT, van Groningen JT, van Bodegom-Vos L, Bastiaannet E, Govaert JA, Wouters MW, Marang-van de Mheen PJ. Do Outcomes in Elective Colon and Rectal Cancer Surgery Differ by Weekday? An Observational Study Using Data From the Dutch ColoRectal Audit. J Natl Compr Canc Netw 2020; 17:821-828. [PMID: 31319385 DOI: 10.6004/jnccn.2018.7282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/06/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies showing higher mortality after elective surgery performed on a Friday were based on administrative data, known for insufficient case-mix adjustment. The goal of this study was to investigate the risk of adverse events for patients with colon and rectal cancer by day of elective surgery using clinical data from the Dutch ColoRectal Audit. PATIENTS AND METHODS Prospectively collected data from the 2012-2015 Dutch ColoRectal Audit (n=36,616) were used to examine differences in mortality, severe complications, and failure to rescue by day of elective surgery (Monday through Friday). Monday was used as a reference, analyses were stratified for colon and rectal cancer, and case-mix adjustments were made for previously identified variables. RESULTS For both colon and rectal cancer, crude mortality, severe complications, and failure-to-rescue rates varied by day of elective surgery. After case-mix adjustment, lower severe complication risk was found for rectal cancer surgery performed on a Friday (odds ratio, 0.84; 95% CI, 0.72-0.97) versus Monday. No significant differences were found for colon cancer surgery performed on different weekdays. CONCLUSIONS No weekday effect was found for elective colon and rectal cancer surgery in the Netherlands. Lower severe complication risk for elective rectal cancer surgery performed on a Friday may be caused by patient selection.
Collapse
Affiliation(s)
- Daniëlle D Huijts
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden
| | - Onno R Guicherit
- Department of Surgery, University Cancer Center Leiden
- The Hague, The Hague
| | | | | | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden
| | | | | | - Michel W Wouters
- Dutch Institute for Clinical Auditing, Leiden.,Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | | |
Collapse
|
33
|
Spoon D, Rietbergen T, Huis A, Heinen M, van Dijk M, van Bodegom-Vos L, Ista E. Implementation strategies used to implement nursing guidelines in daily practice: A systematic review. Int J Nurs Stud 2020; 111:103748. [PMID: 32961463 DOI: 10.1016/j.ijnurstu.2020.103748] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Research specifically addressing implementation strategies regarding nursing guidelines is limited. The objective of this review was to provide an overview of strategies used to implement nursing guidelines in all nursing fields, as well as the effects of these strategies on patient-related nursing outcomes and guideline adherence. Ideally, the findings would help guideline developers, healthcare professionals and organizations to implement nursing guidelines in practice. DESIGN Systematic review. PROSPERO registration number: CRD42018104615. DATA SOURCES We searched the Embase, Medline, PsycINFO, Web of Science, Cochrane, CINAHL and Google Scholar databases until August 2019 as well as the reference lists of relevant articles. REVIEW METHODS Studies were included that described quantitative data on the effect of implementation strategies and implementation outcomes of any type of a nursing guideline in any setting. No language or date of publication restriction was used. The Cochrane Effective Practice and Organisation of Care taxonomy was used to categorize the implementation strategies. Studies were classified as effective if a significant change in either patient-related nursing outcomes or guideline adherence was described. Strength of the evidence was evaluated using the 'Cochrane risk of bias tool' for controlled studies, and the 'Newcastle-Ottawa Quality Assessment form' for cohort studies. RESULTS A total of 54 articles regarding 53 different guideline implementation studies were included. Fifteen were (cluster) Randomized Controlled Trials or controlled before-after studies and 38 studies had a before-after design. The topics of the implemented guidelines were diverse, mostly concerning skin care (n = 9) and infection prevention (n = 7). Studies were predominantly performed in hospitals (n = 34) and nursing homes (n = 11). Thirty studies showed a positive significant effect in either patient-related nursing outcomes or guideline adherence (68%, n = 36). The median number of implementation strategies used was 6 (IQR 4-8) per study. Educational strategies were used in nearly all studies (98.1%, n = 52), followed by deployment of local opinion leaders (54.7%, n = 29) and audit and feedback (41.5%, n = 22). Twenty-three (43.4%) studies performed a barrier assessment, nineteen used tailored strategies. CONCLUSIONS A wide variety of implementation strategies are used to implement nursing guidelines. Not one single strategy, or combination of strategies, can be linked directly to successful implementation of nursing guidelines. Overall, thirty-six studies (68%) reported a positive significant effect of the implementation of guidelines on patient-related nursing outcomes or guideline adherence. Future studies should use a standardized reporting checklist to ensure a detailed description of the used implementation strategies to increase reproducibility and understanding of outcomes.
Collapse
Affiliation(s)
- Denise Spoon
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Tessa Rietbergen
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anita Huis
- Radboud university medical centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Maud Heinen
- Radboud university medical centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands; Department of Paediatric Surgery and Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands; Department of Paediatric Surgery and Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
34
|
Brouns B, van Bodegom-Vos L, de Kloet AJ, Vliet Vlieland TPM, Gil ILC, Souza LMN, Braga LW, Meesters JJL. Correction to: Differences in factors influencing the use of eRehabilitation after stroke; a cross-sectional comparison between Brazilian and Dutch healthcare professionals. BMC Health Serv Res 2020; 20:607. [PMID: 32611341 PMCID: PMC7329422 DOI: 10.1186/s12913-020-05457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Berber Brouns
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands. .,Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, The Netherlands. .,Basalt Rehabilitation, The Hague/ Leiden, The Netherlands.
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Arend J de Kloet
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, The Netherlands.,Basalt Rehabilitation, The Hague/ Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.,Basalt Rehabilitation, The Hague/ Leiden, The Netherlands
| | - Ingrid L C Gil
- The SARAH Network of Rehabilitation Hospitals, Brasilia, Brazil
| | - Lígia M N Souza
- The SARAH Network of Rehabilitation Hospitals, Brasilia, Brazil
| | - Lucia W Braga
- The SARAH Network of Rehabilitation Hospitals, Brasilia, Brazil
| | - Jorit J L Meesters
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.,Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, The Netherlands.,Basalt Rehabilitation, The Hague/ Leiden, The Netherlands
| |
Collapse
|
35
|
Brouns B, van Bodegom-Vos L, de Kloet AJ, Vliet Vlieland TPM, Gil ILC, Souza LMN, Braga LW, Meesters JJL. Differences in factors influencing the use of eRehabilitation after stroke; a cross-sectional comparison between Brazilian and Dutch healthcare professionals. BMC Health Serv Res 2020; 20:488. [PMID: 32487255 PMCID: PMC7268386 DOI: 10.1186/s12913-020-05339-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 05/19/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To improve the use of eRehabilitation after stroke, the identification of barriers and facilitators influencing this use in different healthcare contexts around the world is needed. Therefore, this study aims to investigate differences and similarities in factors influencing the use of eRehabilitation after stroke among Brazilian Healthcare Professionals (BHP) and Dutch Healthcare Professionals (DHP). METHOD A cross-sectional survey study including 88 statements about factors related to the use of eRehabilitation (4-point Likert scale; 1-4; unimportant-important/disagree-agree). The survey was conducted among BHP and DHP (physical therapists, rehabilitating physicians and psychologists). Descriptive statistics were used to analyse differences and similarities in factors influencing the use of eRehabilitation. RESULTS ninety-nine (response rate 30%) BHP and 105 (response rate 37%) DHP participated. Differences were found in the top-10 most influencing statements between BHP and DHP BHP rated the following factors as most important: sufficient support from the organisation (e.g. the rehabilitation centre) concerning resources and time, and potential benefits of the use of eRehabilitation for the patient. DHP rated the feasibility of the use of eRehabilitation for the patient (e.g. a helpdesk and good instructions) as most important for effective uptake. Top-10 least important statements were mostly similar; both BHP and DHP rated problems caused by stroke (e.g. aphasia or cognitive problems) or problems with resources (e.g. hardware and software) as least important for the uptake of eRehabilitation. CONCLUSION The results indicate that the use of eRehabilitation after stroke by BHP and DHP is influenced by different factors. A tailored implementation strategy for both countries needs to be developed.
Collapse
Affiliation(s)
- Berber Brouns
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands. .,Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, The Netherlands. .,Basalt Rehabilitation, The Hague, /Leiden, The Netherlands.
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Arend J de Kloet
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, The Netherlands.,Basalt Rehabilitation, The Hague, /Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.,Basalt Rehabilitation, The Hague, /Leiden, The Netherlands
| | - Ingrid L C Gil
- The SARAH Network of Rehabilitation Hospitals, Brasilia, Brazil
| | - Lígia M N Souza
- The SARAH Network of Rehabilitation Hospitals, Brasilia, Brazil
| | - Lucia W Braga
- The SARAH Network of Rehabilitation Hospitals, Brasilia, Brazil
| | - Jorit J L Meesters
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.,Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, The Netherlands.,Basalt Rehabilitation, The Hague, /Leiden, The Netherlands
| |
Collapse
|
36
|
Rietbergen T, Spoon D, Brunsveld-Reinders AH, Schoones JW, Huis A, Heinen M, Persoon A, van Dijk M, Vermeulen H, Ista E, van Bodegom-Vos L. Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis. Implement Sci 2020; 15:38. [PMID: 32450898 PMCID: PMC7249362 DOI: 10.1186/s13012-020-00995-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/29/2020] [Indexed: 11/11/2022] Open
Abstract
Background In the last decade, there is an increasing focus on detecting and compiling lists of low-value nursing procedures. However, less is known about effective de-implementation strategies for these procedures. Therefore, the aim of this systematic review was to summarize the evidence of effective strategies to de-implement low-value nursing procedures. Methods PubMed, Embase, Emcare, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched till January 2020. Additionally, reference lists and citations of the included studies were searched. Studies were included that described de-implementation of low-value nursing procedures, i.e., procedures, test, or drug orders by nurses or nurse practitioners. PRISMA guideline was followed, and the ‘Cochrane Effective Practice and Organisation of Care’ (EPOC) taxonomy was used to categorize de-implementation strategies. A meta-analysis was performed for the volume of low-value nursing procedures in controlled studies, and Mantel–Haenszel risk ratios (95% CI) were calculated using a random effects model. Results Twenty-seven studies were included in this review. Studies used a (cluster) randomized design (n = 10), controlled before-after design (n = 5), and an uncontrolled before-after design (n = 12). Low-value nursing procedures performed by nurses and/or nurse specialists that were found in this study were restraint use (n = 20), inappropriate antibiotic prescribing (n = 3), indwelling or unnecessary urinary catheters use (n = 2), ordering unnecessary liver function tests (n = 1), and unnecessary antipsychotic prescribing (n = 1). Fourteen studies showed a significant reduction in low-value nursing procedures. Thirteen of these 14 studies included an educational component within their de-implementation strategy. Twelve controlled studies were included in the meta-analysis. Subgroup analyses for study design showed no statistically significant subgroup effect for the volume of low-value nursing procedures (p = 0.20). Conclusions The majority of the studies with a positive significant effect used a de-implementation strategy with an educational component. Unfortunately, no conclusions can be drawn about which strategy is most effective for reducing low-value nursing care due to a high level of heterogeneity and a lack of studies. We recommend that future studies better report the effects of de-implementation strategies and perform a process evaluation to determine to which extent the strategy has been used. Trial registration The review is registered in Prospero (CRD42018105100).
Collapse
Affiliation(s)
- Tessa Rietbergen
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Denise Spoon
- Department of Internal Medicine, Nursing Science, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Jan W Schoones
- Leiden University Medical Center, Walaeus Library, Leiden, The Netherlands
| | - Anita Huis
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maud Heinen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Nursing Science, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Hester Vermeulen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Nursing Science, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
37
|
Moseng T, Dagfinrud H, van Bodegom-Vos L, Dziedzic K, Hagen KB, Natvig B, Røtterud JH, Vlieland TV, Østerås N. Low adherence to exercise may have influenced the proportion of OMERACT-OARSI responders in an integrated osteoarthritis care model: secondary analyses from a cluster-randomised stepped-wedge trial. BMC Musculoskelet Disord 2020; 21:236. [PMID: 32284049 PMCID: PMC7155273 DOI: 10.1186/s12891-020-03235-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/25/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To address the well-documented gap between hip and knee osteoarthritis (OA) treatment recommendations and current clinical practice, a structured model for integrated OA care was developed and evaluated in a stepped-wedge cluster-randomised controlled trial. The current study used secondary outcomes to evaluate clinically important response to treatment through the Outcome Measures in Rheumatology Clinical Trials clinical responder criteria (OMERACT-OARSI responder criteria) after 3 and 6 months between patients receiving the structured OA care model vs. usual care. Secondly, the study aimed to investigate if the proportion of responders in the intervention group was influenced by adherence to the exercise program inherent in the model. METHODS The study was conducted in primary healthcare in six Norwegian municipalities. General practitioners and physiotherapists received training in OA treatment recommendations and use of the structured model. The intervention group attended a physiotherapist-led OA education program and performed individually tailored exercises for 8-12 weeks. The control group received usual care. Patient-reported pain, function and global assessment of disease activity during the last week were evaluated using 11-point numeric rating scales (NRS 0-10). These scores were used to calculate the proportion of OMERACT-OARSI responders. Two-level mixed logistic regression models were fitted to investigate differences in responders between the intervention and control group. RESULTS Two hundred eighty-four intervention and 109 control group participants with hip and knee OA recruited from primary care in six Norwegian municipalities. In total 47% of the intervention and 35% of the control group participants were responders at 3 or 6 months combined; showing an uncertain between-group difference (ORadjusted 1.38 (95% CI 0.41, 4.67). In the intervention group, 184 participants completed the exercise programme (exercised ≥2 times/week for ≥8 weeks) and 55% of these were classified as responders. In contrast, 28% of the 86 non-completers were classified as responders. CONCLUSIONS The difference in proportion of OMERACT-OARSI responders at 3 and 6 months between the intervention and control group was uncertain. In the intervention group, a larger proportion of responders were seen among the exercise completers compared to the non-completers. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02333656. Registered 7. January 2015.
Collapse
Affiliation(s)
- Tuva Moseng
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway.
| | - Hanne Dagfinrud
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Krysia Dziedzic
- School for Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Kåre Birger Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jan Harald Røtterud
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Thea Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway
| |
Collapse
|
38
|
van Schie P, van Steenbergen LN, van Bodegom-Vos L, Nelissen RGHH, Marang-van de Mheen PJ. Between-Hospital Variation in Revision Rates After Total Hip and Knee Arthroplasty in the Netherlands: Directing Quality-Improvement Initiatives. J Bone Joint Surg Am 2020; 102:315-324. [PMID: 31658206 DOI: 10.2106/jbjs.19.00312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Variation in 1-year revision rates between Dutch hospitals after primary total hip and knee arthroplasty (THA and TKA) may direct quality-improvement initiatives if this variation accurately reflects true hospital differences. The aim of the present study was to assess the extent of variation, both overall and for specific indications, as well as the statistical reliability of ranking hospitals. METHODS All primary THAs and TKAs that were performed between January 2014 and December 2016 were included. Observed/expected (O/E) ratios regarding 1-year revision rates were depicted in a funnel plot with 95% control limits to identify outliers based on 1 or 3 years of data, both overall and by specific indication for revision. The expected number was calculated on the basis of patient mix with use of logistic regression models. The statistical reliability of ranking hospitals (rankability) on these outcomes indicates the percentage of total variation that is explained by "true" hospital differences rather than chance. Rankability was evaluated using fixed and random effects models, for overall revisions and specific indications for revision, including 1 versus 3 years of data. RESULTS The present study included 86,468 THAs and 73,077 TKAs from 97 and 98 hospitals, respectively. Thirteen hospitals performing THAs were identified as negative outliers (median O/E ratio, 1.9; interquartile range [IQR], 1.5-2.5), with 5 hospitals as outliers in multiple years. Eight negative outliers were identified for periprosthetic joint infection; 4, for dislocation; and 2, for prosthesis loosening. Seven hospitals performing TKAs were identified as negative outliers (median O/E ratio, 2.3; IQR, 2.2-2.8), with 2 hospitals as outliers in multiple years. Two negative outlier hospitals were identified for periprosthetic joint infection and 1 was identified for technical failures. The rankability for overall revisions was 62% (moderate) for THA and 46% (low) for TKA. CONCLUSIONS There was large between-hospital variation in 1-year revision rates after primary THA and TKA. For most outlier hospitals, a specific indication for revision could be identified as contributing to worse performance, particularly for THA; these findings are starting points for quality-improvement initiatives.
Collapse
Affiliation(s)
- Peter van Schie
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
39
|
Brouns B, Meesters JJL, Wentink MM, de Kloet AJ, Arwert HJ, Boyce LW, Vliet Vlieland TPM, van Bodegom-Vos L. Factors associated with willingness to use eRehabilitation after stroke: A cross-sectional study among patients, informal caregivers and healthcare professionals. J Rehabil Med 2019; 51:665-674. [PMID: 31414140 DOI: 10.2340/16501977-2586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Despite the increasing availability of eRehabilitation, its use remains limited. The aim of this study was to assess factors associated with willingness to use eRehabilitation. DESIGN Cross-sectional survey. SUBJECTS Stroke patients, informal caregivers, health-care professionals. METHODS The survey included personal characteristics, willingness to use eRehabilitation (yes/no) and barri-ers/facilitators influencing this willingness (4-point scale). Barriers/facilitators were merged into factors. The association between these factors and willingness to use eRehabilitation was assessed using logistic regression analyses. RESULTS Overall, 125 patients, 43 informal caregivers and 105 healthcare professionals participated in the study. Willingness to use eRehabilitation was positively influenced by perceived patient benefits (e.g. reduced travel time, increased motivation, better outcomes), among patients (odds ratio (OR) 2.68; 95% confidence interval (95% CI) 1.34-5.33), informal caregivers (OR 8.98; 95% CI 1.70-47.33) and healthcare professionals (OR 6.25; 95% CI 1.17-10.48). Insufficient knowledge decreased willingness to use eRehabilitation among pa-tients (OR 0.36, 95% CI 0.17-0.74). Limitations of the study include low response rates and possible response bias. CONCLUSION Differences were found between patients/informal caregivers and healthcare professionals. Ho-wever, for both groups, perceived benefits of the use of eRehabilitation facilitated willingness to use eRehabili-tation. Further research is needed to determine the benefits of such programs, and inform all users about the potential benefits, and how to use eRehabilitation.
Collapse
Affiliation(s)
- Berber Brouns
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, , Leiden, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Østerås N, Moseng T, van Bodegom-Vos L, Dziedzic K, Mdala I, Natvig B, Røtterud JH, Schjervheim UB, Vlieland TV, Andreassen Ø, Hansen JN, Hagen KB. Correction: Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial. PLoS Med 2019; 16:e1002993. [PMID: 31856163 PMCID: PMC6922329 DOI: 10.1371/journal.pmed.1002993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1002949.].
Collapse
|
41
|
Knoop J, Dekker J, van der Leeden M, de Rooij M, Peter WFH, van Bodegom-Vos L, van Dongen JM, Lopuhäa N, Bennell KL, Lems WF, van der Esch M, Vliet Vlieland TPM, Ostelo RWJG. Stratified exercise therapy compared with usual care by physical therapists in patients with knee osteoarthritis: A randomized controlled trial protocol (OCTOPuS study). Physiother Res Int 2019; 25:e1819. [PMID: 31778291 PMCID: PMC7187154 DOI: 10.1002/pri.1819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/20/2019] [Accepted: 10/03/2019] [Indexed: 12/21/2022]
Abstract
Objectives Knee osteoarthritis (OA) is characterized by its heterogeneity, with large differences in clinical characteristics between patients. Therefore, a stratified approach to exercise therapy, whereby patients are allocated to homogeneous subgroups and receive a stratified, subgroup‐specific intervention, can be expected to optimize current clinical effects. Recently, we developed and pilot tested a model of stratified exercise therapy based on clinically relevant subgroups of knee OA patients that we previously identified. Based on the promising results, it is timely to evaluate the (cost‐)effectiveness of stratified exercise therapy compared with usual, “nonstratified” exercise therapy. Methods A pragmatic cluster randomized controlled trial including economic and process evaluation, comparing stratified exercise therapy with usual care by physical therapists (PTs) in primary care, in a total of 408 patients with clinically diagnosed knee OA. Eligible physical therapy practices are randomized in a 1:2 ratio to provide the experimental (in 204 patients) or control intervention (in 204 patients), respectively. The experimental intervention is a model of stratified exercise therapy consisting of (a) a stratification algorithm that allocates patients to a “high muscle strength subgroup,” “low muscle strength subgroup,” or “obesity subgroup” and (b) subgroup‐specific, protocolized exercise therapy (with an additional dietary intervention from a dietician for the obesity subgroup only). The control intervention will be usual best practice by PTs (i.e., nonstratified exercise therapy). Our primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score subscale daily living). Measurements will be performed at baseline, 3‐month (primary endpoint), 6‐month (questionnaires only), and 12‐month follow‐up, with an additional cost questionnaire at 9 months. Intention‐to‐treat, multilevel, regression analysis comparing stratified versus usual care will be performed. Conclusion This study will demonstrate whether stratified care provided by primary care PTs is effective and cost‐effective compared with usual best practice from PTs.
Collapse
Affiliation(s)
- Jesper Knoop
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joost Dekker
- VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marike van der Leeden
- VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Mariëtte de Rooij
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Wilfred F H Peter
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.,Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Kim L Bennell
- School of Health Sciences, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Willem F Lems
- VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.,Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
42
|
Østerås N, Moseng T, van Bodegom-Vos L, Dziedzic K, Mdala I, Natvig B, Røtterud JH, Schjervheim UB, Vlieland TV, Andreassen Ø, Hansen JN, Hagen KB. Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial. PLoS Med 2019; 16:e1002949. [PMID: 31613885 PMCID: PMC6793845 DOI: 10.1371/journal.pmed.1002949] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international recommendations. The objective of this study was to assess the effectiveness of this model in primary care. METHODS AND FINDINGS We conducted a cluster-randomised controlled trial with stepped-wedge cohort design in 6 Norwegian municipalities (clusters) between January 2015 and October 2017. The randomised order was concealed to the clusters until the time of crossover from the control to the intervention phase. The intervention was implementation of the SAMBA model, facilitated by interactive workshops for general practitioners and physiotherapists with an update on OA treatment recommendations. Patients in the intervention group attended a physiotherapist-led OA education and individually tailored exercise programme for 8-12 weeks. The primary outcome was patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire; 0-100, 100 = optimal quality) at 6 months. Secondary outcomes included patient-reported referrals to physiotherapy, magnetic resonance imaging (MRI), and orthopaedic surgeon consultation; patients' satisfaction with care; physical activity level; and proportion of patients who were overweight or obese (body mass index ≥ 25 kg/m2). In all, 40 of 80 general practitioners (mean age [SD] 50 [12] years, 42% females) and 37 of 64 physiotherapists (mean age [SD] 42 [8] years, 65% females) participated. They identified 531 patients, of which 393 patients (mean age [SD] 64 [10] years, 71% females) with symptomatic hip or knee OA were included. Among these, 109 patients were recruited during the control periods (control group), and 284 patients were recruited during interventions periods (intervention group). The patients in the intervention group reported significantly higher quality of care (score of 60 versus 41, mean difference 18.9; 95% CI 12.7, 25.1; p < 0.001) and higher satisfaction with OA care (odds ratio [OR] 12.1; 95% CI 6.44, 22.72; p < 0.001) compared to patients in the control group. The increase in quality of care was close to, but below, the pre-specified minimal important change. In the intervention group, a higher proportion was referred to physiotherapy (OR 2.5; 95% CI 1.08, 5.73; p = 0.03), a higher proportion fulfilled physical activity recommendations (OR 9.3; 95% CI 2.87, 30.37; p < 0.001), and a lower proportion was referred to an orthopaedic surgeon (OR 0.3; 95% CI 0.08, 0.80; p = 0.02), as compared to the control group. There were no significant group differences regarding referral to MRI (OR 0.6; 95% CI 0.13, 2.38; p = 0.42) and proportion of patients who were overweight or obese (OR 1.3; 95% CI 0.70, 2.51; p = 0.34). Study limitations include the imbalance in patient group size, which may have been due to an increased attention to OA patients among the health professionals during the intervention phase, and a potential recruitment bias as the patient participants were identified by their health professionals. CONCLUSIONS In this study, a structured model in primary care resulted in higher quality of OA care as compared to usual care. Future studies should explore ways to implement the structured model for integrated OA care on a larger scale. TRIAL REGISTRATION ClinicalTrials.gov NCT02333656.
Collapse
Affiliation(s)
- Nina Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- * E-mail:
| | - Tuva Moseng
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Krysia Dziedzic
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, United Kingdom
| | - Ibrahim Mdala
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jan Harald Røtterud
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | | | - Thea Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Øyvor Andreassen
- Patient Research Panel, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Jorun Nystuen Hansen
- Patient Research Panel, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kåre Birger Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
43
|
van Gerven P, van Bodegom-Vos L, Weil NL, van den Berg J, Rubinstein SM, Termaat MF, Krijnen P, van Tulder MW, Schipper IB. Reduction of routine radiographs in the follow-up of distal radius and ankle fractures: Barriers and facilitators perceived by orthopaedic trauma surgeons. J Eval Clin Pract 2019; 25:265-274. [PMID: 30484949 PMCID: PMC6587936 DOI: 10.1111/jep.13053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/12/2018] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Studies suggest that routine radiographs during follow-up of distal radius and ankle fractures result in increased radiation exposure and health care costs, without influencing treatment strategies. Encouraging clinicians to omit these routine radiographs is challenging, and little is known about barriers and facilitators that influence this omission. Therefore, this study aims to identify barriers and facilitators among orthopaedic trauma surgeons that might prove valuable towards the design of a deimplementation strategy. METHODS A mixed-method approach was used. First, interviews were conducted with orthopaedic trauma surgeons and patients (n = 16). Subsequently, a questionnaire was developed. This questionnaire was presented to 228 orthopaedic trauma surgeons in the Netherlands. Regression analyses were performed in order to identify which variables were independently associated to the decision to stop performing routine radiographs 6 and 12 weeks after trauma if proven not effective in a large randomized controlled trial. RESULTS In total, 130 (57%) respondents completed the questionnaire. Of these, 71% indicated they would stop ordering routine radiographs if they were proven not effective. Three facilitators were independent predictors for the intention to omit routine radiographs: This will "lead to lower health care costs" (Odds Ratio [OR]: 5.38 and 4.38), the need for "incorporation in the regional protocol" (OR: 3.66 and 2.66), and this will "result in time savings for the patient" (OR: 4.84). CONCLUSIONS We identified three facilitators that could provide backing for a deimplementation strategy aimed at a reduction of routine radiographs for patients with distal radius and ankle fractures.
Collapse
Affiliation(s)
- Pieter van Gerven
- Department of Traumasurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Nikki L Weil
- Department of Traumasurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jasper van den Berg
- Department of Traumasurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Sidney M Rubinstein
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marco F Termaat
- Department of Traumasurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieta Krijnen
- Department of Traumasurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Inger B Schipper
- Department of Traumasurgery, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
44
|
Voeten SC, van Bodegom-Vos L, Hegeman JH, Wouters MWJM, Krijnen P, Schipper IB. Hospital staff participation in a national hip fracture audit: facilitators and barriers. Arch Osteoporos 2019; 14:110. [PMID: 31754810 PMCID: PMC6872508 DOI: 10.1007/s11657-019-0652-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/05/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED To ensure meaningful results in a clinical audit, as many hospitals as possible should participate. To optimise participation, the data collection process should either be performed by additional staff or be automated. Active participation may be promoted by offering relevant external parties insight into the actual quality of care. PURPOSE The aim of the study was to identify which facilitators and barriers experienced by hospital staff are associated with participation in the ongoing nationwide multidisciplinary Dutch Hip Fracture Audit (DHFA). METHODS A survey including questions about the respondents' characteristics, hospital level of participation and factors of influence on DHFA participation was sent to hip fracture surgeons. The factors were based on results of semi-structured interviews held with hospital staff involved in hip fracture care. Univariable and multivariable logistic regression analyses were used to establish which respondent characteristics and factors were associated with participation and active participation (≥ 80% of patients registered) in the DHFA. Factors significantly increasing the (active) participation in the DHFA were classified as facilitators, and factors significantly decreasing the (active) participation in the DHFA as barriers. RESULTS One hundred nine surgeons filled out the questionnaire. The factors most agreed on were availability of staffing capacity for data collection and automated data import. A lower intention to participate was associated with being an academic surgeon (odds ratio, 0.15; 95% confidence interval, 0.04-0.52) and an orthopaedic surgeon (odds ratio, 0.30; 95% confidence interval, 0.10-0.90). Data sharing with relevant external parties was associated with active participation (odds ratio, 3.19; 95% confidence interval, 1.14-8.95). CONCLUSIONS To improve participation in a nationwide clinical audit, it seems that the data collection should either be performed by additional staff or be automated. Active participation is facilitated if audit data is made available to other parties, such as insurers, healthcare authorities or policymakers.
Collapse
Affiliation(s)
- Stijn C Voeten
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - J H Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Pieta Krijnen
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| |
Collapse
|
45
|
Huijts DD, van Groningen JT, Guicherit OR, Dekker JWT, van Bodegom-Vos L, Bastiaannet E, Govaert JA, Wouters MW, de Mheen PJMV. Weekend Effect in Emergency Colon and Rectal Cancer Surgery: A Prospective Study Using Data From the Dutch ColoRectal Audit. J Natl Compr Canc Netw 2018; 16:735-741. [DOI: 10.6004/jnccn.2018.7016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/20/2018] [Indexed: 11/17/2022]
|
46
|
Helfrich CD, Rose AJ, Hartmann CW, van Bodegom-Vos L, Graham ID, Wood SJ, Majerczyk BR, Good CB, Pogach LM, Ball SL, Au DH, Aron DC. How the dual process model of human cognition can inform efforts to de-implement ineffective and harmful clinical practices: A preliminary model of unlearning and substitution. J Eval Clin Pract 2018; 24:198-205. [PMID: 29314508 PMCID: PMC5900912 DOI: 10.1111/jep.12855] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/02/2017] [Accepted: 11/03/2017] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES One way to understand medical overuse at the clinician level is in terms of clinical decision-making processes that are normally adaptive but become maladaptive. In psychology, dual process models of cognition propose 2 decision-making processes. Reflective cognition is a conscious process of evaluating options based on some combination of utility, risk, capabilities, and/or social influences. Automatic cognition is a largely unconscious process occurring in response to environmental or emotive cues based on previously learned, ingrained heuristics. De-implementation strategies directed at clinicians may be conceptualized as corresponding to cognition: (1) a process of unlearning based on reflective cognition and (2) a process of substitution based on automatic cognition. RESULTS We define unlearning as a process in which clinicians consciously change their knowledge, beliefs, and intentions about an ineffective practice and alter their behaviour accordingly. Unlearning has been described as "the questioning of established knowledge, habits, beliefs and assumptions as a prerequisite to identifying inappropriate or obsolete knowledge underpinning and/or embedded in existing practices and routines." We hypothesize that as an unintended consequence of unlearning strategies clinicians may experience "reactance," ie, feel their professional prerogative is being violated and, consequently, increase their commitment to the ineffective practice. We define substitution as replacing the ineffective practice with one or more alternatives. A substitute is a specific alternative action or decision that either precludes the ineffective practice or makes it less likely to occur. Both approaches may work independently, eg, a substitute could displace an ineffective practice without changing clinicians' knowledge, and unlearning could occur even if no alternative exists. For some clinical practice, unlearning and substitution strategies may be most effectively used together. CONCLUSIONS By taking into account the dual process model of cognition, we may be able to design de-implementation strategies matched to clinicians' decision-making processes and avoid unintended consequence.
Collapse
Affiliation(s)
- Christian D Helfrich
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, USA
| | - Adam J Rose
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research (CHOIR) Bedford VA Medical Center, Bedford, USA.,Boston University School of Public Health, Boston, USA
| | - Leti van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Suzanne J Wood
- Graduate Program in Health Services Administration, Department of Health Sciences, School of Public Health, University of Washington, Seattle, USA
| | - Barbara R Majerczyk
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, USA
| | - Chester B Good
- Center for Health Equity Research and Promotion, VA Pittsburgh healthcare System, Department of Veterans Affairs, Pittsburgh, USA.,Medical Advisory Panel for Pharmacy Benefits Management, Department of Veterans Affairs, Washington, USA.,University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Leonard M Pogach
- Office of Specialty Care, Veterans Health Administration, Washington, USA.,VA New Jersey Health Care System, East Orange, USA
| | - Sherry L Ball
- Louis Stokes Cleveland VA Medical Center, Department of Veterans Affairs, Cleveland, USA
| | - David H Au
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, USA
| | - David C Aron
- Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, USA.,Division of Clinical and Molecular Endocrinology and Adjunct Professor Dept. of Organizational Behavior, Weatherhead School of Management, Case Western Reserve University, Cleveland, USA
| |
Collapse
|
47
|
Hofstede SN, van Bodegom-Vos L, Kringos DS, Steyerberg E, Marang-van de Mheen PJ. Mortality, readmission and length of stay have different relationships using hospital-level versus patient-level data: an example of the ecological fallacy affecting hospital performance indicators. BMJ Qual Saf 2017; 27:474-483. [PMID: 28986516 DOI: 10.1136/bmjqs-2017-006776] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ecological fallacy refers to an erroneous inference about individuals on the basis of findings for the group to which those individuals belong. Suppose analysis of a large database shows that hospitals with a high proportion of long length of stay (LOS) patients also have higher than average in-hospital mortality. This may prompt efforts to reduce mortality among patients with long LOS. But patients with long LOS may not be the ones at higher risk of death. It may be that hospitals with higher mortality (regardless of LOS) also have more long LOS patients-either because of quality problems on both counts or because of unaccounted differences in case mix. To provide more insight how the ecological fallacy influences the evaluation of hospital performance indicators, we assessed whether hospital-level associations between in-hospital mortality, readmission and long LOS reflect patient-level associations. METHODS Patient admissions from the Dutch National Medical Registration (2007-2012) for specific diseases (stroke, colorectal carcinoma, heart failure, acute myocardial infarction and hip/knee replacements in patients with osteoarthritis) were analysed, as well as all admissions. Logistic regression analysis was used to assess patient-level associations. Pearson correlation coefficients were used to quantify hospital-level associations. RESULTS Overall, we observed 2.2% in-hospital mortality, 8.1% readmissions and a mean LOS of 5.9 days among 8 478 884 admissions in 95 hospitals. Of the 10 disease-specific associations tested, 2 were reversed at hospital-level, 3 were consistent and 5 were only significant at either hospital-level or patient-level. A reversed association was found for stroke: patients with long LOS had 58% lower in-hospital mortality (OR 0.42 (95% CI 0.40 to 0.44)), whereas the hospital-level association was reversed (r=0.30, p<0.01). Similar negative patient-level associations were found for each hospital, but LOS varied across hospitals, thereby resulting in a positive hospital-level association. A similar effect was found for long LOS and readmission in patients with heart failure. CONCLUSIONS Hospital-level associations did not reflect the same patient-level associations in 7 of 10 associations, and were even reversed in 2 associations. Ecological fallacy thus potentially influences interpretation of hospital performance when patient-level associations are not taken into account.
Collapse
Affiliation(s)
- Stefanie N Hofstede
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Dionne S Kringos
- Department of Public Health, AMC, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Statistics and Bioinformatics, Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | | |
Collapse
|
48
|
Voorn VMA, Marang-van de Mheen PJ, van der Hout A, So-Osman C, van den Akker–van Marle ME, Koopman–van Gemert AWMM, Dahan A, Vliet Vlieland TPM, Nelissen RGHH, van Bodegom-Vos L. Hospital variation in allogeneic transfusion and extended length of stay in primary elective hip and knee arthroplasty: a cross-sectional study. BMJ Open 2017; 7:e014143. [PMID: 28729306 PMCID: PMC5541495 DOI: 10.1136/bmjopen-2016-014143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Outcomes in total hip and knee arthroplasty (THA and TKA), such as allogeneic transfusions or extended length of stay (LoS), can be used to compare the performance of hospitals. However, there is much variation in these outcomes. This study aims to rank hospitals and to assess hospital differences of two outcomes in THA and TKA: allogeneic transfusions and extended LoS, and to additionally identify factors associated with these differences. DESIGN Cross-sectional medical record review study. SETTING Data were gathered in 23 Dutch hospitals. PARTICIPANTS 1163 THA and 986 TKA patient admissions. OUTCOMES Hospitals were ranked based on their observed/expected (O/E) ratios regarding allogeneic transfusion and extended LoS percentages (extended LoS was defined by postoperative stay >4 days). To assess the reliability of these rankings, we calculated which percentage of the existing variation was based on differences between hospitals as compared with random variation (after adjustment for variation in patient characteristics). Associations between hospital-specific factors and O/E ratios were used to explore potential sources of differences. RESULTS The variation in O/E ratios between hospitals ranged from 0 to 4.4 for allogeneic transfusion, and from 0.08 to 2.7 for extended LoS. Variation in transfusion could in 21% be explained by hospital differences in THA and 34% in TKA. For extended LoS this was 71% in THA and 78% in TKA. Better performance (low O/E ratios) in transfusion was associated with more frequent tranexamic acid (TXA) use in TKA (R=-0.43, p=0.04). Better performance in extended LoS was associated with more frequent TXA use in THA (R=-0.45, p=0.03) and TKA (R=-0.65, p<0.001) and local infiltration analgesia (LIA) in TKA (R=-0.60, p=0.002). CONCLUSIONS Ranking hospitals based on allogeneic transfusion is unreliable due to small percentages of variation explained by hospital differences. Ranking based on extended LoS is more reliable. Hospitals using TXA and LIA have relatively fewer patients with transfusions and extended LoS.
Collapse
Affiliation(s)
- Veronique M A Voorn
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Anja van der Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Cynthia So-Osman
- Department of Transfusion Medicine, Sanquin Blood Supply, Leiden, The Netherlands
- Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
| | | | | | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rob G H H Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
49
|
Voorn VMA, Marang-van de Mheen PJ, van der Hout A, Hofstede SN, So-Osman C, van den Akker-van Marle ME, Kaptein AA, Stijnen T, Koopman-van Gemert AWMM, Dahan A, Vliet Vlieland TPMM, Nelissen RGHH, van Bodegom-Vos L. The effectiveness of a de-implementation strategy to reduce low-value blood management techniques in primary hip and knee arthroplasty: a pragmatic cluster-randomized controlled trial. Implement Sci 2017; 12:72. [PMID: 28558843 PMCID: PMC5450044 DOI: 10.1186/s13012-017-0601-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/16/2017] [Indexed: 01/07/2023] Open
Abstract
Background Perioperative autologous blood salvage and preoperative erythropoietin are not (cost) effective to reduce allogeneic transfusion in primary hip and knee arthroplasty, but are still used. This study aimed to evaluate the effectiveness of a theoretically informed multifaceted strategy to de-implement these low-value blood management techniques. Methods Twenty-one Dutch hospitals participated in this pragmatic cluster-randomized trial. At baseline, data were gathered for 924 patients from 10 intervention and 1040 patients from 11 control hospitals undergoing hip or knee arthroplasty. The intervention included a multifaceted de-implementation strategy which consisted of interactive education, feedback on blood management performance, and a comparison with benchmark hospitals, aimed at orthopedic surgeons and anesthesiologists. After the intervention, data were gathered for 997 patients from the intervention and 1096 patients from the control hospitals. The randomization outcome was revealed after the baseline measurement. Primary outcomes were use of blood salvage and erythropoietin. Secondary outcomes included postoperative hemoglobin, length of stay, allogeneic transfusions, and use of local infiltration analgesia (LIA) and tranexamic acid (TXA). Results The use of blood salvage (OR 0.08, 95% CI 0.02 to 0.30) and erythropoietin (OR 0.30, 95% CI 0.09 to 0.97) reduced significantly over time, but did not differ between intervention and control hospitals (blood salvage OR 1.74 95% CI 0.27 to 11.39, erythropoietin OR 1.33, 95% CI 0.26 to 6.84). Postoperative hemoglobin levels were significantly higher (β 0.21, 95% CI 0.08 to 0.34) and length of stay shorter (β −0.36, 95% CI −0.64 to −0.09) in hospitals receiving the multifaceted strategy, compared with control hospitals and after adjustment for baseline. Transfusions did not differ between the intervention and control hospitals (OR 1.06, 95% CI 0.63 to 1.78). Both LIA (OR 0.0, 95% CI 0.0 to 0.0) and TXA (OR 0.3, 95% CI 0.2 to 0.5) were significantly associated with the reduction in blood salvage over time. Conclusions Blood salvage and erythropoietin use reduced over time, but not differently between intervention and control hospitals. The reduction in blood salvage was associated with increased use of local infiltration analgesia and tranexamic acid, suggesting that de-implementation is assisted by the substitution of techniques. The reduction in blood salvage and erythropoietin did not lead to a deterioration in patient-related secondary outcomes. Trial registration www.trialregister.nl, NTR4044 Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0601-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Veronique M A Voorn
- Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300, RC, Leiden, The Netherlands.,Department of Orthopedic Surgery, Groene Hart Hospital, Bleulandweg 10, 2803, HH, Gouda, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Anja van der Hout
- Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300, RC, Leiden, The Netherlands.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1-3, 1081, BT, Amsterdam, The Netherlands
| | - Stefanie N Hofstede
- Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Cynthia So-Osman
- Department of Transfusion Medicine, Sanquin Blood Supply, Plesmanlaan 1a, 2333, BZ, Leiden, The Netherlands.,Department of Internal Medicine, Groene Hart Hospital, Bleulandweg 10, 2803, HH, Gouda, The Netherlands
| | - M Elske van den Akker-van Marle
- Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Theo Stijnen
- Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | | | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Thea P M M Vliet Vlieland
- Department of Orthopedics, Leiden University Medical Center, J11-R, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopedics, Leiden University Medical Center, J11-R, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300, RC, Leiden, The Netherlands.
| |
Collapse
|
50
|
van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016; 6:e010809. [PMID: 27566627 PMCID: PMC5013403 DOI: 10.1136/bmjopen-2015-010809] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES The aim of this study was to explore barriers among patients, general practitioners (GPs) and practice nurses to implement internet-based self-management support as provided by PatientCoach for asthma in primary care. SETTING Primary care within South Holland, the Netherlands. PARTICIPANTS Twenty-two patients (12 women, mean age 38 years), 21 GPs (6 women, mean age 52 years) and 13 practice nurses (all women, mean age 41 years). DESIGN A qualitative study using focus groups and interviews. OUTCOMES Barriers as perceived by patients, GPs and practice nurses to implementation of PatientCoach. METHODS 10 focus groups and 12 interviews were held to collect data: 4 patient focus groups, 4 GP focus groups, 2 practice nurse focus group, 2 patient interviews, 5 GP interviews and 5 practice nurse interviews. A prototype of PatientCoach that included modules for coaching, personalised information, asthma self-monitoring, medication treatment plan, feedback, e-consultations and a forum was demonstrated. A semistructured topic guide was used. Directed content analysis was used to analyse data. Reported barriers were classified according to a framework by Grol and Wensing. RESULTS A variety of barriers emerged among all participant groups. Barriers identified among patients include a lack of a patient-professional partnership in using PatientCoach and a lack of perceived benefit in improving asthma symptoms. Barriers identified among GPs include a low sense of urgency towards asthma care and current work routines. Practice nurses identified a low level of structured asthma care and a lack of support by colleagues as barriers. Among all participant groups, insufficient ease of use of PatientCoach, lack of financial arrangements and patient characteristics such as a lack of asthma symptoms were reported as barriers. CONCLUSIONS We identified a variety of barriers to implementation of PatientCoach. An effective implementation strategy for internet-based self-management support in asthma care should focus on these barriers.
Collapse
Affiliation(s)
- Johanna L van Gaalen
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Moira J Bakker
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jiska B Snoeck-Stroband
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacob K Sont
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|