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Ranchon F, Chanoine S, Lambert-Lacroix S, Bosson JL, Moreau-Gaudry A, Bedouch P. Development of Indirect Health Data Linkage on Health Product Use and Care Trajectories in France: Systematic Review. J Med Internet Res 2023; 25:e41048. [PMID: 37200084 DOI: 10.2196/41048] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND European national disparities in the integration of data linkage (ie, being able to match patient data between databases) into routine public health activities were recently highlighted. In France, the claims database covers almost the whole population from birth to death, offering a great research potential for data linkage. As the use of a common unique identifier to directly link personal data is often limited, linkage with a set of indirect key identifiers has been developed, which is associated with the linkage quality challenge to minimize errors in linked data. OBJECTIVE The aim of this systematic review is to analyze the type and quality of research publications on indirect data linkage on health product use and care trajectories in France. METHODS A comprehensive search for all papers published in PubMed/Medline and Embase databases up to December 31, 2022, involving linked French database focusing on health products use or care trajectories was realized. Only studies based on the use of indirect identifiers were included (ie, without a unique personal identifier available to easily link the databases). A descriptive analysis of data linkage with quality indicators and adherence to the Bohensky framework for evaluating data linkage studies was also realized. RESULTS In total, 16 papers were selected. Data linkage was performed at the national level in 7 (43.8%) cases or at the local level in 9 (56.2%) studies. The number of patients included in the different databases and resulting from data linkage varied greatly, respectively, from 713 to 75,000 patients and from 210 to 31,000 linked patients. The diseases studied were mainly chronic diseases and infections. The objectives of the data linkage were multiple: to estimate the risk of adverse drug reactions (ADRs; n=6, 37.5%), to reconstruct the patient's care trajectory (n=5, 31.3%), to describe therapeutic uses (n=2, 12.5%), to evaluate the benefits of treatments (n=2, 12.5%), and to evaluate treatment adherence (n=1, 6.3%). Registries are the most frequently linked databases with French claims data. No studies have looked at linking with a hospital data warehouse, a clinical trial database, or patient self-reported databases. The linkage approach was deterministic in 7 (43.8%) studies, probabilistic in 4 (25.0%) studies, and not specified in 5 (31.3%) studies. The linkage rate was mainly from 80% to 90% (reported in 11/15, 73.3%, studies). Adherence to the Bohensky framework for evaluating data linkage studies showed that the description of the source databases for the linkage was always performed but that the completion rate and accuracy of the variables to be linked were not systematically described. CONCLUSIONS This review highlights the growing interest in health data linkage in France. Nevertheless, regulatory, technical, and human constraints remain major obstacles to their deployment. The volume, variety, and validity of the data represent a real challenge, and advanced expertise and skills in statistical analysis and artificial intelligence are required to treat these big data.
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Affiliation(s)
- Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de pharmacie clinique oncologique, Pierre-Bénite, France
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
| | - Sébastien Chanoine
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
- Pôle Pharmacie, Centre hospitalo-Universitaire Grenoble Alpes, Grenoble, France
- Faculté de Pharmacie, Université Grenoble Alpes, Grenoble, France
| | - Sophie Lambert-Lacroix
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
| | - Jean-Luc Bosson
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
| | - Alexandre Moreau-Gaudry
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
| | - Pierrick Bedouch
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
- Pôle Pharmacie, Centre hospitalo-Universitaire Grenoble Alpes, Grenoble, France
- Faculté de Pharmacie, Université Grenoble Alpes, Grenoble, France
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Norlyk A, Burau V, Ledderer LK, Martinsen B. Who cares?-The unrecognised contribution of homecare nurses to care trajectories. Scand J Caring Sci 2023; 37:282-290. [PMID: 36085599 DOI: 10.1111/scs.13120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/25/2022] [Revised: 07/15/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Organisation of patients' trajectories is a critical element of nursing practice. However, nursing practice is mainly expressed in terms of direct patient care, while the practices through which care is organised have received little attention, are poorly acknowledged and lack formal recognition. AIM To examine the management of care trajectories as provided by homecare nurses. DESIGN We conducted focus group interviews with 29 Danish homecare nurses. The analysis drew on the evidence based and theoretically informed framework care trajectory management. Care trajectory management is conceptualised as comprising of three organisational components: (1) Trajectory awareness, (2) Trajectory working knowledge and (3) Trajectory articulation. FINDINGS The organising work of homecare nursing is both complex and unpredictable requiring advanced organisational, collaborative and clinical competences to secure concerted actions in alignment with the needs of the individual patient. Without having any formal obligation homecare nurses took on the responsibility for the coordination of the different activities of the professional actors, and for securing concerted actions. Care trajectory management as provided by homecare nurses reflected a high degree of commitment for patients and illustrated that this type of organising work was driven by the values of the humanistic ethos of nursing. CONCLUSION The study highlights the strength of the invisible and ongoing organising work of homecare nurses. Care trajectory management in homecare reflects the moral foundation of nursing. Consequently, the professional logic of nursing reflected as direct patient care alone is too narrow. We need to acknowledge the organising work of patients' trajectories as a core task equal to direct patient care. Our study highlights the need for articulating the organising work of homecare nurses and for presenting problematic organisational structures to policymakers and managers. If not, the important organisational work of homecare nurses is at the risk of remaining invisible.
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Affiliation(s)
- Annelise Norlyk
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,Faculty of Health and Sport Sciences, Agder University, Grimstad, Norway
| | - Viola Burau
- Department of Political Science, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Loni Kraus Ledderer
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Bente Martinsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
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Nguena Nguefack HL, Pagé MG, Choinière M, Vanasse A, Deslauriers S, Angarita-Fonseca A, Blanchette MA, Lacasse A. Distinct care trajectories among persons living with arthritic conditions: A two-year state sequence analysis. Front Pain Res (Lausanne) 2022; 3:1014793. [PMID: 36444387 PMCID: PMC9699830 DOI: 10.3389/fpain.2022.1014793] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/08/2022] [Accepted: 10/24/2022] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES Developing solutions to optimize care trajectories (CareTs) requires examining patient journeys through the health care system. This study aimed to describe CareTs among people living with arthritis and evaluate their association with self-reported health outcomes. METHODS Analyses were conducted using the TorSaDE Cohort (n = 102,148), which connects the 2007 to 2016 Canadian Community Health Surveys (CCHS) with Quebec administrative databases (longitudinal claims). CareTs of participants living with arthritis according to CCHS (n = 16,631), over the two years before CCHS completion, were clustered using state sequence analysis (months as a time unit). CareT group membership was then put in association with self-reported outcomes (pain intensity and interference, self-perceived general and mental health). RESULTS The analysis revealed five CareT groups characterized predominantly by: (1) arthritis-related visits to a specialist (n = 2,756; 16.6%), (2) arthritis-related emergency department visits (n = 2,928; 17.6%), (3) very high all-cause health care utilization and arthritis-related hospitalizations (n = 1,570; 9.4%), (4) arthritis-related medical visits to general practitioners and specialists (n = 2,708; 16.3%), (5) low all-cause health care utilization (n = 6,669; 40.1%). Multivariable results revealed that CareT group membership was associated with higher levels of pain interference (CareT group #3 vs. #5: OR: 1.4, 95%CI: 1.1-1.8) and fair/poor self-perceived general health (CareT group #1 vs. #5: OR: 1.551, 95%CI: 1.319-1.824; #2 vs. #5: OR: 1.244, 95%CI: 1.062-1.457; #3 vs. #5: OR: 1.771, 95%CI: 1.451-2.162; #4 vs. #5: OR: 1.481, 95%CI: 1.265-1.735). DISCUSSION Sate sequence analysis is an innovative method of studying CareTs and valuable for making evidence-based decisions taking into account inter- and intra-individual variability.
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Affiliation(s)
| | - M. Gabrielle Pagé
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Manon Choinière
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Centre, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Deslauriers
- VITAM – Centre de recherche en santé durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Adriana Angarita-Fonseca
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Marc-André Blanchette
- Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
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Rowaert S, De Pau M, De Meyer F, Nicaise P, Vander Laenen F, Vanderplasschen W. Voices to be heard: Understanding family perspectives in forensic care trajectories. Front Psychiatry 2022; 13:1022490. [PMID: 36590630 PMCID: PMC9798123 DOI: 10.3389/fpsyt.2022.1022490] [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: 08/18/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION De-institutionalization of psychiatric care has greatly increased the role of family members in the recovery pathways of Persons labeled as Not Criminally Responsible (PNCR). However, the role of family members in supporting PNCR in forensic psychiatric care remains understudied. Scarce evidence indicates that PNCR have to deal with stigma and endure specific burdens (i.e., symptom-specific, financial, social, and emotional). Recovery-focused research showed that recovery in both persons with a severe mental illness and family members develop in parallel with each other and are characterized by similar helpful principles (e.g., hope and coping skills). As such, the recovery pathways of PNCR often goes hand in hand with the recovery pathway of their family members. During the family recovery process, family members often experience not being listened to or being empowered by professionals or not being involved in the decision-making process in the care trajectory of their relative. Therefore, the aim of this study is to capture how family members experience the care trajectories of their relatives, more specifically by looking at family recovery aspects and personal advocacy of family members. METHODS Semi-structured interviews were conducted with 21 family members of PNCR from 14 families. A thematic analysis confirms that family members suffer from stigma and worry significantly about the future of their relative. RESULTS Regarding the care trajectory of PNCR, family members experienced barriers in multiple domains while trying to support their relative: involvement in care and information sharing, visiting procedures, transitions between wards, and the psychiatric and judicial reporting by professionals. In addition, family members emphasized the importance of (social) support for themselves during the forensic psychiatric care trajectories and of a shared partnership. DISCUSSION These findings tie in with procedural justice theory as a precondition for family support and family recovery within forensic psychiatric care.
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Affiliation(s)
- Sara Rowaert
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - Marjolein De Pau
- Department of Criminology, Criminal Law and Social Law, Institute for International Research on Criminal Policy (IRCP), Ghent University, Ghent, Belgium
| | - Florian De Meyer
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - Pablo Nicaise
- Faculty of Public Health, Institute of Health and Society (IRSS), Catholic University of Louvain, Brussels, Belgium
| | - Freya Vander Laenen
- Department of Criminology, Criminal Law and Social Law, Institute for International Research on Criminal Policy (IRCP), Ghent University, Ghent, Belgium
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Wodchis WP, Or Z, Blankart CR, Atsma F, Janlov N, Bai YQ, Penneau A, Arvin M, Knight H, Riley K, Figueroa JF, Papanicolas I. An international comparison of long-term care trajectories and spending following hip fracture. Health Serv Res 2021; 56 Suppl 3:1383-1393. [PMID: 34378190 PMCID: PMC8579202 DOI: 10.1111/1475-6773.13864] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/29/2021] [Revised: 07/10/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as follows: total expenditure, total days of care in different care settings, and overall longevity over a 1-year period following a hip fracture. DATA SOURCES We used administrative data from hospitals, institutional and home-based long-term care (LTC), physician visits, and medications compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) from five countries as follows: Canada, France, Germany, the Netherlands, and Sweden. DATA EXTRACTION METHODS Data were extracted from existing administrative data systems in each participating country. STUDY DESIGN This is a retrospective cohort study of all individuals admitted to acute care for hip fracture. Descriptive comparisons were used to examine aggregate institutional and home-based postacute care. Care trajectories were created to track sequential care settings after acute-care discharge through institutional and community-based care in three countries where detailed information allowed. Comparisons in patient characteristics, utilization, and costs were made across these trajectories and countries. PRINCIPAL FINDINGS Across five countries with complete LTC data, we found notable variations with Germany having the highest days of home-based services with relatively low costs, while Sweden incurred the highest overall expenditures. Comparisons of trajectories found that France had the highest use of inpatient rehabilitation. Germany was most likely to discharge hip fracture patients to home. Over 365 days, France averaged the highest number of days in institution with 104, Canada followed at 94, and Germany had just 87 days of institutional care on average. CONCLUSION In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional care, longevity, and total expenditures. There exist opportunities to organize postacute care differently to maximize independence and mitigate costs.
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Affiliation(s)
- Walter P. Wodchis
- Institute of Health Policy Management & EvaluationUniversity of TorontoTorontoOntarioCanada
- Institute for Better HealthTrillium Health PartnersMississaugaOntarioCanada
- ICESTorontoOntarioCanada
| | - Zeynep Or
- Institute for Research and Documentation in Health Economics (IRDES)ParisFrance
- Department of Economics (LEDa)University Dauphine PSLParisFrance
| | - Carl Rudolf Blankart
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
- Hamburg Center for Health EconomicsUniversität HamburgHamburgGermany
| | - Femke Atsma
- Radboud University Medical CenterRadboud Institute for Health Sciences, Scientific Center for Quality of HealthcareNijmegenThe Netherlands
| | - Nils Janlov
- The Swedish Agency for Health and Care Services AnalysisStockholmSweden
| | - Yu Qing Bai
- Institute of Health Policy Management & EvaluationUniversity of TorontoTorontoOntarioCanada
- ICESTorontoOntarioCanada
| | - Anne Penneau
- Institute for Research and Documentation in Health Economics (IRDES)ParisFrance
- Department of Economics (LEDa)University Dauphine PSLParisFrance
| | - Mina Arvin
- Radboud University Medical CenterRadboud Institute for Health Sciences, Scientific Center for Quality of HealthcareNijmegenThe Netherlands
| | | | - Kristen Riley
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Jose F. Figueroa
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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Raffray M, Vigneau C, Couchoud C, Bayat S. Predialysis Care Trajectories of Patients With ESKD Starting Dialysis in Emergency in France. Kidney Int Rep 2020; 6:156-167. [PMID: 33426395 PMCID: PMC7785414 DOI: 10.1016/j.ekir.2020.10.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 06/24/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Emergency dialysis start (EDS) is frequent for patients with chronic kidney disease (CKD). To improve CKD management, new trajectory-based care policies are currently being introduced both in France and in the United States. This study describes the different types of predialysis care trajectories and factors associated with EDS. Methods Adults patients who started dialysis in France in 2015 were included. Individual clinical and health care consumption data were retrieved from the French national end-stage kidney disease (ESKD) registry (Renal Epidemiology and Information Network [REIN]) and the French National Health Data system (SNDS), respectively. Hierarchical Clustering on Principal Component was used to identify groups of patients with the same health care consumption profile during the 2 years before dialysis start. Logistic regression analysis was used to identify factors associated with EDS. Results Among the 8856 patients included in the analysis, 2681 (30.3%) had EDS. The Hierarchical Clustering on Principal Component identified six types of predialysis care trajectories in which EDS rate ranged from 13.8% to 61.8%. After adjustment for the patients’ characteristics, less frequent or lack of follow-up with a nephrologist was associated with higher risk of EDS (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.17–1.50 and OR: 1.83; 95% CI: 1.58–2.12), but not follow-up with a general practitioner. Conclusions The care trajectories during the 2 years before dialysis start were heterogeneous and patients with a lesser or lack of follow-up with a nephrologist were more likely to start dialysis in emergency, regardless of the frequency of follow-up by a general practitioner (GP). New CKD policies should include actions to strengthen CKD screening and referral to nephrologists.
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Affiliation(s)
- Maxime Raffray
- University of Rennes, French School of Public Health (EHESP), Pharmaco-epidemiology and health Services Research, Rennes, France
- Correspondence: Maxime Raffray, French School of Public Health, 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France.
| | - Cécile Vigneau
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Cécile Couchoud
- REIN Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Sahar Bayat
- University of Rennes, French School of Public Health (EHESP), Pharmaco-epidemiology and health Services Research, Rennes, France
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Joling KJ, Janssen O, Francke AL, Verheij RA, Lissenberg-Witte BI, Visser PJ, van Hout HPJ. Time from diagnosis to institutionalization and death in people with dementia. Alzheimers Dement 2020; 16:662-671. [PMID: 32072728 PMCID: PMC7984226 DOI: 10.1002/alz.12063] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 06/18/2019] [Revised: 10/14/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Reliable estimates of time from diagnosis until institutionalization and death in people with dementia from routine nationally representative databases are lacking. METHODS We selected 9230 people with dementia and 24,624 matched controls from family physicians' electronic records linked with national administrative databases to analyze time until institutionalization and death and associated factors. RESULTS Median time from recorded diagnosis until institutionalization and until death for people with dementia was 3.9 and 5.0 years, respectively, which was considerably shorter than for controls. Once institutionalized, median time to death was longer for persons with dementia (2.5 years) than for controls (1.2 years). Older age and receiving home care were the strongest predictors of shorter time until institutionalization and death in people with dementia. Gender, cohabitation, migration status, frailty, polypharmacy, and dementia medication were other significant factors. DISCUSSION The estimates could help to inform patients, their families, and policymakers about probable trajectories.
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Affiliation(s)
- Karlijn J Joling
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Olin Janssen
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Anneke L Francke
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Robert A Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pieter-Jelle Visser
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Hein P J van Hout
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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