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Kringos D, Carinci F, Barbazza E, Bos V, Gilmore K, Groene O, Gulácsi L, Ivankovic D, Jansen T, Johnsen SP, de Lusignan S, Mainz J, Nuti S, Klazinga N. Managing COVID-19 within and across health systems: why we need performance intelligence to coordinate a global response. Health Res Policy Syst 2020; 18:80. [PMID: 32664985 PMCID: PMC7358993 DOI: 10.1186/s12961-020-00593-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 04/29/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022] Open
Abstract
Background The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems’ decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. Discussion A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. Conclusion Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.
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Affiliation(s)
- D Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - F Carinci
- Department of Statistical Sciences, University of Bologna, Via Belle Arti 41, 40126, Bologna, Italy
| | - E Barbazza
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - V Bos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - K Gilmore
- Management and Health Laboratory (MeS), Institute of Management and EMbeDS, Scuola Superiore Sant'Anna, piazza Martiri della Libertà, 33, Pisa, Italy
| | - O Groene
- OptiMedis AG, Burchardstraße 17, 20095, Hamburg, Germany.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, 15-17, London, United Kingdom
| | - L Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - D Ivankovic
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - T Jansen
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - S P Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Fredrik Bajers Vej 5, 9100, Aalborg, Denmark
| | - S de Lusignan
- Nuffield Department of Primary Care and Health Sciences, University of Oxford, Woodstock Rd, OX2 6GG, Oxford, United Kingdom
| | - J Mainz
- Psychiatry Management, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark
| | - S Nuti
- Management and Health Laboratory (MeS), Institute of Management and EMbeDS, Scuola Superiore Sant'Anna, piazza Martiri della Libertà, 33, Pisa, Italy
| | - N Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Carinci F, Uccioli L, Carle F, Brownwood I, Klazinga N, Massi Benedetti M. Combination therapies and diabetes management new statistical models. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Groene O, Kristensen S, Arah OA, Thompson CA, Bartels P, Sunol R, Klazinga N. Feasibility of using administrative data to compare hospital performance in the EU. Int J Qual Health Care 2014; 26 Suppl 1:108-15. [PMID: 24554645 PMCID: PMC4001688 DOI: 10.1093/intqhc/mzu015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe hospitals' organizational arrangements relevant to the abstraction of administrative data, to report on the completeness of administrative data collected and to assess associations between organizational arrangements and completeness of data submission. DESIGN A cross-sectional STUDY DESIGN utilizing administrative data. SETTING AND PARTICIPANTS Randomly selected hospitals from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey). MAIN OUTCOME MEASURES Completeness of data submission for four quality indicators: mortality after acute myocardial infarction, stroke and hip fractures and complications after normal delivery. RESULTS In general, hospitals were able to produce data on the four indicators required for this research study. A substantial proportion had missing data on one or more data items. The proportion of hospitals that was able to produce more detailed indicators of relevance for quality monitoring and improvement was low and ranged from 40.1% for thrombolysis performed on patients with acute ischemic stroke to 63.8% for hip-fracture operations performed within 48 h after admission for patients aged 65 or older. National factors were strong predictors of data completeness on the studied indicators. CONCLUSIONS At present, hospital administrative databases do not seem to be an appropriate source of information for comparison of hospital performance across the countries of the EU. However, given that this is a dynamic field, changes to administrative databases may make this possible in the near future. Such changes could be accelerated by an in-depth comparative analysis of the issues of using administrative data for comparisons of hospital performances in EU countries.
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Affiliation(s)
- O Groene
- Health Services Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Januel JM, Couris CM, Luthi JC, Halfon P, Trombert-Paviot B, Quan H, Drosler S, Sundararajan V, Pradat E, Touzet S, Wen E, Shepheard J, Webster G, Romano P, So L, Moskal L, Tournay-Lewis L, Sundaresan L, Kelley E, Klazinga N, Ghali W, Colin C, Burnand B. Adaptation au codage CIM-10 de 15 indicateurs de la sécurité des patients proposés par l’Agence étasunienne pour la recherche et la qualité des soins de santé (AHRQ). Rev Epidemiol Sante Publique 2011; 59:341-50. [DOI: 10.1016/j.respe.2011.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 02/10/2011] [Accepted: 04/01/2011] [Indexed: 10/17/2022] Open
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Klazinga N. A tough tulip: the Dutch Journal of Health Sciences TSG. Eur J Public Health 2010; 20:246-7. [DOI: 10.1093/eurpub/ckq059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Groene O, Poletti P, Vallejo P, Cucic C, Klazinga N, Suñol R. Quality requirements for cross-border care in Europe: a qualitative study of patients', professionals' and healthcare financiers' views. Qual Saf Health Care 2009; 18 Suppl 1:i15-21. [PMID: 19188456 PMCID: PMC2629853 DOI: 10.1136/qshc.2008.028837] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the past decade the issue of patient mobility has emerged on the European health policy agenda. Although the volume of patients crossing borders to obtain healthcare is low, it is increasing continuously and, due to its legal, financial and medical implications, has generated considerable interest among health policy and other decision makers. However, there is little information available on the safety and patient-centredness of cross-border care and neither governments nor citizens have an explicit basis for comparing healthcare delivery in Europe. METHODS This study investigated the viewpoints of patients, professionals and healthcare financiers on the safety and patient-centredness of cross-border care. Qualitative interviews were carried out during 2005 and early 2006 with 40 patients, 30 professionals (doctors, nurses and managers) and 3 healthcare-financing bodies. RESULTS Although cross-border care has become a common issue in many European countries, there remain uncertainties on the side of each of the parties addressed--patients, professionals and financiers--with regard to the provision of cross-border care. One of the most striking results of this project is the current lack of research on systematic knowledge on the quality of cross-border care. CONCLUSION Many of the issues identified through this research may have a potential impact on the quality and safety of cross-border care and will support further investigation and help shape the health policy agenda on patients crossing borders in European Union countries.
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Affiliation(s)
- O Groene
- Avedis Donabedian Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Abstract
CONTEXT This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on patients crossing borders, a study to investigate quality improvement strategies in healthcare systems across the European Union (EU). AIM To explore the association between the implementation of quality improvement strategies in hospitals and hospitals' success in meeting defined quality requirements that are considered intermediate outputs of the care process. METHODS Data regarding the implementation of seven quality improvement strategies (accreditation, organisational quality management programmes, audit and internal assessment of clinical standards, patient safety systems, clinical practice guidelines, performance indicators and systems for obtaining patients' views) and four dimensions of outputs (clinical, safety, patient-centredness and cross-border patient-centredness) were collected from 389 acute care hospitals in eight EU countries using a web-based questionnaire. In a second phase, 89 of these hospitals participated in an on-site audit by independent surveyors. Pearson correlation and linear regression models were used to explore associations and relations between quality improvement strategies and achievement of outputs. RESULTS Positive associations were found between six internal quality improvement strategies and hospital outputs. The quality improvement strategies could be reasonably subsumed under one latent index which explained about half of their variation. The analysis of outputs concluded that the outputs can also be considered part of a single construct. The findings indicate that the implementation of internal as well as external quality improvement strategies in hospitals has beneficial effects on the hospital outputs studied here. CONCLUSION The implementation of internal quality improvement strategies as well as external assessment systems should be promoted.
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Affiliation(s)
- R Suñol
- Avedis Donabedian Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona 08037, Spain.
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Groene O, Lombarts MJMH, Klazinga N, Alonso J, Thompson A, Suñol R. Is patient-centredness in European hospitals related to existing quality improvement strategies? Analysis of a cross-sectional survey (MARQuIS study). Qual Saf Health Care 2009; 18 Suppl 1:i44-50. [PMID: 19188461 PMCID: PMC2629879 DOI: 10.1136/qshc.2008.029397] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2008] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is growing recognition of patients' contributions to setting objectives for their own care, improving health outcomes and evaluating care. OBJECTIVE To quantify the extent to which European hospitals have implemented strategies to promote a patient-centred approach, and to assess whether these strategies are associated with hospital characteristics and the development of the hospital's quality improvement system. DESIGN Cross-sectional survey of 351 European hospital managers and professionals. MAIN OUTCOME MEASURES Patients' rights, patient information and empowerment, patient involvement in quality management, learning from patients, and patient hotel services at the hospital and ward level were assessed. The hypothesis that the implementation of strategies to improve patient-centredness is associated with hospital characteristics, including maturity of the hospital's quality management system, was tested using binary logistic regression. RESULTS In general, hospitals reported high implementation of policies for patients' rights (85.5%) and informed consent (93%), whereas strategies to involve patients (71%) and learn from their experience (66%) were less frequently implemented. For 13 out of 18 hospital strategies, institutions with a more developed quality improvement system consistently reported better results (percentage differences within maturity classification ranged from 12.4% to 46.6%). The strength of association between implementation of patient-centredness strategies and the quality improvement system, however, seemed lower at the ward than at the hospital level. Some associations (OR 2.1 to 5.1) disappeared or were weaker after adjustment for potential confounding variables (OR 2.2 to 3.7). CONCLUSIONS Although quality improvement systems seem to be effective with regard to the implementation of selected patient-centredness strategies, they seem to be insufficient to ensure widespread implementation of patient-centredness throughout the organisation.
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Affiliation(s)
- O Groene
- Avedis Donabedian University Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Groene O, Klazinga N, Walshe K, Cucic C, Shaw CD, Suñol R. Learning from MARQuIS: future direction of quality and safety in hospital care in the European Union. Qual Saf Health Care 2009; 18 Suppl 1:i69-74. [PMID: 19188465 PMCID: PMC2629925 DOI: 10.1136/qshc.2008.029447] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This article summarises the significant lessons to be drawn from, and the policy implications of, the findings of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project--a part of the suite of research projects intended to support policy established by the European Commission through its Sixth Framework Programme. The article first reviews the findings of MARQuIS and their implications for healthcare providers (and particularly for hospitals), and then addresses the broader policy implications for member states of the European Union (EU) and for the commission itself. Against the background of the European Commission's Seventh Framework Programme, it then outlines a number of future areas for research to inform policy and practice in quality and safety in Europe. The article concludes that at this stage, a unique EU-wide quality improvement system for hospitals does not seem to be feasible or effective. Because of possible future community action in this field, attention should focus on the use of existing research on quality and safety strategies in healthcare, with the aim of combining soft measures to accelerate mutual learning. Concrete measures should be considered only in areas for which there is substantial evidence and effective implementation can be ensured.
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Affiliation(s)
- O Groene
- Avedis Donabedian University Institute, UAB, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Klazinga N. Benchmarking the quality of national health systems – the OECD indicators. Dtsch Med Wochenschr 2008. [DOI: 10.1055/s-0028-1085589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Januel JM, Couris CM, Quan H, Luthi JC, Drosler S, Sundararajan V, Trombert-Paviot B, Pradat E, Touzet S, Halfon P, Wen E, Shepheart J, Webster G, Romano P, So L, Moskal L, Tournay-Lewis L, Sundaresan L, Kelley E, Klazinga N, Ghali W, Burnand B, Colin C. Adaptation à la classification CIM-10 d’indicateurs de la sécurité des soins à l’hôpital développés à partir des données médico-administratives : le projet PSI. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Veillard J, Champagne F, Klazinga N, Kazandjian V, Arah OA, Guisset AL. A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. Int J Qual Health Care 2005; 17:487-96. [PMID: 16155049 DOI: 10.1093/intqhc/mzi072] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The World Health Organization (WHO) Regional Office for Europe launched in 2003 a project aiming to develop and disseminate a flexible and comprehensive tool for the assessment of hospital performance and referred to as the performance assessment tool for quality improvement in hospitals (PATH). This project aims at supporting hospitals in assessing their performance, questioning their own results, and translating them into actions for improvement, by providing hospitals with tools for performance assessment and by enabling collegial support and networking among participating hospitals. METHODS PATH was developed through a series of four workshops gathering experts representing most valuable experiences on hospital performance assessment worldwide. An extensive review of the literature on hospital performance projects was carried out, more than 100 performance indicators were scrutinized, and a survey was carried out in 20 European countries. RESULTS Six dimensions were identified for assessing hospital performance: clinical effectiveness, safety, patient centredness, production efficiency, staff orientation and responsive governance. The following outcomes were achieved: (i) definition of the concepts and identification of key dimensions of hospital performance; (ii) design of the architecture of PATH to enhance evidence-based management and quality improvement through performance assessment; (iii) selection of a core and a tailored set of performance indicators with detailed operational definitions; (iv) identification of trade-offs between indicators; (v) elaboration of descriptive sheets for each indicator to support hospitals in interpreting their results; (vi) design of a balanced dashboard; and (vii) strategies for implementation of the PATH framework. CONCLUSION PATH is currently being pilot implemented in eight countries to refine its framework before further expansion.
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Affiliation(s)
- J Veillard
- World Health Organization Regional Office for Europe, Barcelona, Spain.
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Tiemeier H, de Vries WJ, van het Loo M, Kahan JP, Klazinga N, Grol R, Rigter H. Guideline adherence rates and interprofessional variation in a vignette study of depression. Qual Saf Health Care 2002; 11:214-8. [PMID: 12486983 PMCID: PMC1743623 DOI: 10.1136/qhc.11.3.214] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the appropriateness of and variation in intention-to-treat decisions in the management of depression in the Netherlands. DESIGN Mailed survey with 22 paper cases (vignettes) based on a population study. SETTING A random sample from four professional groups in the Dutch mental healthcare system. SUBJECTS 264 general practitioners, psychiatrists, psychotherapists, and clinical psychologists. MAIN OUTCOME MEASURES Each vignette contained information on a number of patient characteristics taken from three national depression guidelines. The distribution of patient characteristics was based on data from a population study. Respondents were asked to choose the best treatment option and the best treatment setting. For each vignette we examined which of the selected treatments was appropriate according to the recommendations of the three published Dutch clinical guidelines and a panel of experts. RESULTS 31% of all intention-to-treat decisions were not consistent with the guidelines. Overall, less severe depression, alcohol abuse, psychotic features, and lack of social resources were related to more inappropriate judgements. There was considerable variation between the professional groups: psychiatrists made more appropriate choices than the other professions although they had the highest rate of overtreatment. CONCLUSIONS There is sufficient variation in the intentions to treat depression to give it priority in quality assessment and guideline development. Efforts to achieve appropriate care should focus on treatment indications, referral patterns, and overtreatment.
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Affiliation(s)
- H Tiemeier
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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Klazinga N, Stronks K, Delnoij D, Verhoeff A. Indicators without a cause. Reflections on the development and use of indicators in health care from a public health perspective. Int J Qual Health Care 2001; 13:433-8. [PMID: 11769744 DOI: 10.1093/intqhc/13.6.433] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Indicators have a long history in public health. Since the end of the 18th century information on the health of communities has been gathered on a health system level and public health indicators have become more sophisticated over the vears. However, in many modern health care systems there is a separation between public health and health services. This paper discusses the need for integration and promotes a stronger public health orientation of health services. This has consequences for the nature of indicators on the health services level. The methodological problems of turning epidemiological data into management information for health services are discussed. The key message is that the health of the community should be the ultimate cause of all indicators.
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Affiliation(s)
- N Klazinga
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Gross PA, Greenfield S, Cretin S, Ferguson J, Grimshaw J, Grol R, Klazinga N, Lorenz W, Meyer GS, Riccobono C, Schoenbaum SC, Schyve P, Shaw C. Optimal methods for guideline implementation: conclusions from Leeds Castle meeting. Med Care 2001; 39:II85-92. [PMID: 11583124] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND Quality problems in medical care are not a new finding. Variations in medical practice as well as actual medical errors have been pointed out for many decades. The current movement to write practice guidelines to attempt to correct these deviations from recommended medical practice has not solved the problem. OBJECTIVE In order to gain greater acceptance of these guidelines and to change the behavior of health care providers, the science of guideline implementation must be understood better. RESEARCH DESIGN A group of experts who have studied the problem of implementation in Europe and the United States was convened. This meeting summary enumerates the implementation methods studied to date, reviews the theories of behavioral change, and makes recommendation for effecting better implementation guidelines. RESULTS A research agenda was proposed to further our knowledge of effective evidence-based implementation.
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Affiliation(s)
- P A Gross
- Hackensack University Medical Center, New Jersey 07601, USA.
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Affiliation(s)
- N Klazinga
- University of Amsterdam, Institute of Social Medicine, The Netherlands
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Affiliation(s)
- N Klazinga
- Academic Medical Centre, University of Amsterdam
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Klazinga N. Re-engineering trust: the adoption and adaption of four models for external quality assurance of health care services in western European health care systems. Int J Qual Health Care 2000; 12:183-9. [PMID: 10894189 DOI: 10.1093/intqhc/12.3.183] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Accreditation, ISO, EFQLM and visitatie are, in essence, control mechanisms in health care systems. An analysis is provided of the way the four models have been adopted and adapted in European health care systems over the past decade. After a short discussion of the major reforms in the European health care systems in the direction of regulated markets, deregulation and decentralization, the features of the four models are highlighted and it is explained how each of them can help to fill the 'accountability gap' between health care providers on the one hand and patients, financiers and governments on the other. The quality system perspective of ISO, the quality management development perspective of EFQM, the health care organization perspective of accreditation and the professional perspective of visitatie can each be appropriate given the balance of power between parties in the health care system and the focus and scope of accountability. Although a general convergence between the four models can be observed, actual convergence will depend on their adoption in specific health system contexts. Potential pitfalls for further convergence are the differences in distribution of responsibilities for quality of care among the various European countries, the drift away from clinical decision making, bureaucratic tendencies and too much focus on efficiency and patient empowerment compared with attention to medical effectiveness.
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Affiliation(s)
- N Klazinga
- Department of Social Medicine, University of Amsterdam, The Netherlands.
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Nabitz U, Klazinga N, Walburg J. The EFQM excellence model: European and Dutch experiences with the EFQM approach in health care. European Foundation for Quality Management. Int J Qual Health Care 2000; 12:191-201. [PMID: 10894190 DOI: 10.1093/intqhc/12.3.191] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
One way to meet the challenges in creating a high performance organization in health care is the approach of the European Foundation for Quality Management (EFQM). The Foundation is in the tradition of the American Malcolm Baldrige Award and was initiated by the European Commission and 14 European multi-national organizations in 1988. The essence of the approach is the EFQM Model, which can be used as a self-assessment instrument on all levels of a health care organization and as an auditing instrument for the Quality Award. In 1999 the EFQM Model was revised but its principles remained the same. In The Netherlands many health care organizations apply the EFQM Model. In addition to improvement projects, peer review of professional practices, accreditation and certification, the EFQM Approach is used mainly as a framework for quality management and as a conceptualization for organizational excellence. The Dutch National Institute for Quality, the Instituut Nederlandse Kwaliteit, delivers training and supports self-assessment and runs the Dutch quality award programme. Two specific guidelines for health care organizations, 'Positioning and Improving' and 'Self-Assessment', have been developed and are used frequently. To illustrate the EFQM approach in The Netherlands, the improvement project of the Jellinek Centre is described. The Jellinek Centre conducted internal and external assessments and received in 1996, as the first health care organization, the Dutch Quality Prize.
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Affiliation(s)
- U Nabitz
- Amsterdam Institute of Addiction Research, The Netherlands.
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Klazinga N. From Chicago to Budapest, a tale of two cities. Int J Qual Health Care 1998; 10:187-9. [PMID: 9661056 DOI: 10.1093/intqhc/10.3.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Klazinga N, Lombarts K, van Everdingen J. Quality management in medical specialties: the use of channels and dikes in improving health care in The Netherlands. Jt Comm J Qual Improv 1998; 24:240-50. [PMID: 9626617 DOI: 10.1016/s1070-3241(16)30378-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 1989 a Dutch national policy was instituted to ensure that quality management is the responsibility of both health care professionals and management, with input from insurers and patients. In turn, quality management of medical specialists remained to a large extent self-regulatory, with accountability toward third-party payers and patients. Three programs for quality management-peer review, guidelines, and visitation-have sufficiently persuaded patient organizations and care insurers about medical specialists' ability to ensure the quality of the care they provide. PEER REVIEW Operational since 1976, the national program for peer review in hospitals has stressed the need for explicit evaluative mechanisms. This program led to the foundation of the National Organization for Quality Assurance in Hospitals (CBO), which conducts peer review activities but also support efforts aimed at quality assurance in hospitals. Once it is linked with the other two quality management programs, peer review will realize its full potential as a profession-based method for standardizing and rationalizing medical specialty practice. PRACTICE GUIDELINES Since 1982, more than 60 consensus guidelines have been developed for and by medical professionals, with input from patient organizations and third-party payers. Medical specialty associations have also created their own guidelines. Although the guidelines' impact has not been evaluated systematically, studies have shown effects on behavioral change and health outcomes. Solid, credible guidelines continue to be developed, although the successful implementation of these guidelines needs to be studied. VISITATION PROGRAM Visitation, or onsite assessment of specialty practice sites (in training and non-training hospitals), has been a hot issue in Dutch medical quality assurance. All 28 scientific societies have visitation programs, focusing on areas for improvement such as process management, use of guidelines, and evaluation of patient satisfaction and treatment outcomes. Closely linked to other medical quality assurance activities, visitation programs also incorporate clinical guidelines into evaluations. CONCLUSIONS Profession-driven peer review, practice guidelines, and visitation programs have been effective support tools for quality management in The Netherlands. Future challenges involve creating more synergy among these programs and between the profession-based quality management approaches and recently introduced hospital-based quality systems and maintaining the trust between third-party payers and patients.
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Affiliation(s)
- N Klazinga
- Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
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Klazinga N. Concerted action programme on quality assurance in hospitals 1990-1993 (COMAC/HSR/QA). Global results of the evaluation. Int J Qual Health Care 1994; 6:219-30. [PMID: 7795956 DOI: 10.1093/intqhc/6.3.219] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
This article describes the global results of the evaluation of a concerted action programme on quality assurance in hospitals that was executed between 1990 and 1993 in a total of 262 hospitals in 15 European countries. The programme aimed to introduce quality assurance notions into European hospitals and focused on four specific topics; record keeping, prophylactic antibiotic use in surgery, preoperative assessment and the prevention of bedsores. Evaluation took place on a national level (descriptive country reports), hospital level (questionnaire) and topic level (questionnaire and results of QA studies performed in the participating hospitals). Different situational and operational factors on national, hospital and topic level, that seem to influence the effectiveness of strategies for the implementation of quality assurance, are identified. The relative importance of these factors is discussed and supported with empirical evidence. Part of the analysis is based on quantitative data based on comparing the situation in 113 hospitals in 1990 and 1993, before and after the intervention.
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Affiliation(s)
- N Klazinga
- National Organization for Quality Assurance in Hospitals, Utrecht, The Netherlands
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Mertens R, Van den Berg JM, Veerman-Brenzikofer ML, Kurz X, Jans B, Klazinga N. International comparison of results of infection surveillance: The Netherlands versus Belgium. Infect Control Hosp Epidemiol 1994; 15:574-8. [PMID: 7989728 DOI: 10.1086/646984] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To explore the potential benefit of comparing results from two national surveillance networks. DESIGN Two prospective multicenter cohort studies of surgical wound infections (SWI). SETTING Thirty-five and 62 acute-care hospitals in The Netherlands (NL) and Belgium (B), respectively, from October 1, 1991, to June 30, 1992. RESULTS The participation was equivalent in the two countries: 27% (NL) and 28% (B) of all acute-care hospitals. Marked differences emerged between the Dutch and Belgian crude infection rates and the specific rates by wound class and other risk factors. Because the case-mix in the countries is quite different, comparisons can be made only by specific surgical category. The results for inguinal hernia repair and for appendectomy are compared as an example. In herniorrhaphies, the difference in infection rate (0.4% [NL] versus 1.2% [B]) is not explained by differences in the distribution of risk factors. The shorter hospital stay in The Netherlands (4 days [NL] versus 6 days [B]), the more effective postdischarge surveillance in Belgium, and the fact that more than two thirds of the detected infections occurred after the first postoperative week probably can account for most of the difference. There was a striking difference in prophylaxis use (3.7% [NL] versus 41.9% [B]). In appendectomies, the Dutch patient population shows on average a higher risk profile, and surgery is urgent much more often in The Netherlands (78.3%) than in Belgium (49.2%). The infection rate is higher in The Netherlands, especially among the patients without prophylaxis, which again is employed less frequently there. CONCLUSION We conclude that international comparisons yield interesting insights regarding quality of care, reaching beyond the field of nosocomial infection prevention. This is an argument in favor of more harmonization between surveillance networks.
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Affiliation(s)
- R Mertens
- Institute of Hygiene and Epidemiology, Brussels, Belgium
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Mertens R, Van den Berg JM, Veerman-Brenzikofer MLV, Kurz X, Jans B, Klazinga N. International Comparison of Results of Infection Surveillance: The Netherlands versus Belgium. Infect Control Hosp Epidemiol 1994. [DOI: 10.2307/30147431] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Affiliation(s)
| | - H. Giebing
- Head of the division on nursing audit, CBO, National Organization for Quality Assurance in Hospitals. Utrecht The Netherlands
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Abstract
The development of practice guidelines is gaining popularity in both North America and Europe. This review article explores the different reasons behind guideline development, the methodologies used and the effects assessed so far. Experience since 1982 with a guideline development programme at CBO is discussed in more detail. The consequences guidelines have for professional autonomy are discussed, and it is concluded that guidelines can enforce professionalization as well as accountability and efficiency when developed within the framework of a consistent goal-method-effect scheme and applied as an integral part of professional quality assurance activities.
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Affiliation(s)
- N Klazinga
- National Organization for Quality Assurance in Hospitals, Utrecht, Netherlands
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