1
|
Brouwers J, Seys D, Claessens F, Van Wilder A, Bruyneel L, De Ridder D, Eeckloo K, Vanhaecht K. Effect on hospital incentive payments and quality performance of a hospital pay for performance (P4P) programme in Belgium. J Healthc Qual Res 2024; 39:147-154. [PMID: 38594161 DOI: 10.1016/j.jhqr.2024.02.005] [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: 09/14/2022] [Revised: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Belgium initiated a hospital pay for performance (P4P) programme after a decade of fixed bonus budgets for "quality and safety contracts". This study examined the effect of P4P on hospital incentive payments, performance on quality measures, and the association between changes in quality performance and incentive payments over time. METHODS The Belgian government provided information on fixed bonus budgets in 2013-2017 and hospital incentive payments as well as hospital performance on quality measures for the P4P programmes in 2018-2020. Descriptive analyses were conducted to map the financial repercussion between the two systems. A difference-in-difference analysis evaluated the association between quality indicator performance and received incentive payments over time. RESULTS Data from 87 acute-care hospitals were analyzed. In the transition to a P4P programme, 29% of hospitals received lower incentive payments per bed. During the P4P years, quality performance scores increased yearly for 55% of hospitals and decreased yearly for 5% of hospitals. There was a significant larger drop in incentive payments for hospitals that scored above median with the start of the P4P programme. CONCLUSIONS The transition from fixed bonus budgets for quality efforts to a new incentive payment in a P4P programme has led to more hospitals being financially impacted, although the effect is marginal given the small P4P budget. Quality indicators seem to improve over the years, but this does not correlate with an increase in reward per bed for all hospitals due to the closed nature of the budget.
Collapse
Affiliation(s)
- J Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Belgium.
| | - D Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - F Claessens
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - A Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - D De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
| | - K Eeckloo
- Department of Public Health and Primary Care, UGent & Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
| |
Collapse
|
2
|
Claessens F, Seys D, Van der Auwera C, Castro EM, Jans A, Schoenmakers B, De Ridder D, Bruyneel L, Van Wilder A, Vanhaecht K. The FlaQuM-Quickscan: A starting point to include primary care professionals' perspectives in the evaluation of hospital quality priorities. J Healthc Qual Res 2024; 39:89-99. [PMID: 38195377 DOI: 10.1016/j.jhqr.2023.12.002] [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: 07/26/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Today, primary care professionals' (PCPs) perspectives on hospital quality are unknown when evaluating hospital quality priorities. The aims of the present study were to identify key healthcare quality attributes from PCPs' perspective, to validate an instrument that measures PCPs' experiences of healthcare quality multidimensionally and to define hospital quality priorities based on PCPs' experiences. MATERIAL AND METHODS Focus groups with PCPs were conducted to identify quality attributes through a qualitative in-depth analysis. A multicentre study of 18 hospitals was used to quantitatively assess construct, discriminant and criterion validity of the FlaQuM-Quickscan, an instrument that measures 'Healthcare quality for patients and kin' (part 1) and 'Healthcare quality for professionals' (part 2). To set quality priorities, scores on quality domains were analyzed descriptively and between-hospital variation was examined by evaluating differences in hospitals' mean scores on the quality domains using one-way Analysis of Variance (ANOVA). RESULTS Identified key attributes largely corresponded with Lachman's multidimensional quality model. Including 'Communication' as a new quality domain was recommended. The FlaQuM-Quickscan was completed by 550 PCPs. Confirmatory factor analyses showed reasonable to good fit, except for the Root Mean Square Error of Approximation (RMSEA) in part 2. The 'Equity' domain scored the highest in parts 1 and 2. Domains 'Kin-centred care' and 'Accessibility and timeliness' scored the lowest in part 1 and 'Resilience' and 'Partnership and co-production' in part 2. Significant variation in hospitals' mean scores was observed for eleven domains in part 1 and sixteen domains in part 2. CONCLUSIONS The results gained a better understanding of PCPs' perspective on quality. The FlaQuM-Quickscan is a valid instrument to measure PCPs' experiences of hospital quality. Identified priorities indicate that hospital management should focus on multifaceted quality strategies, including technical domains, person-and kin-centredness, core values and catalysts.
Collapse
Affiliation(s)
- F Claessens
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium.
| | - D Seys
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - C Van der Auwera
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - E M Castro
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - A Jans
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - B Schoenmakers
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - D De Ridder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - A Van Wilder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
3
|
van Zelm R, Coeckelberghs E, Sermeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory. BMC Health Serv Res 2021; 21:11. [PMID: 33397382 PMCID: PMC7784254 DOI: 10.1186/s12913-020-06011-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/10/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Specific factors that facilitate or prevent the implementation of enhanced recovery protocols for colorectal cancer surgery have been described in previous qualitative studies. This study aims to perform a concurrent qualitative and quantitative evaluation of factors associated with successful implementation of a care pathway (CP) for patients undergoing surgery for colorectal cancer. METHODS This comparative mixed methods multiple case study was based on a sample of 10 hospitals in 4 European countries that implemented a specific CP and performed pre- and post-implementation measurements. In-depth post-implementation interviews were conducted with healthcare professionals who were directly involved. Primary outcomes included protocol adherence and improvement rate. Secondary outcomes included length of stay (LOS) and self-rated protocol adherence. The hospitals were ranked based on these quantitative findings, and those with the highest and lowest scores were included in this study. Qualitative data were summarized on a per-case basis using extended Normalization Process Theory (eNPT) as theoretical framework. The data were then combined and analyzed using joint display methodology. RESULTS Data from 381 patients and 30 healthcare professionals were included. Mean protocol adherence rate increased from 56 to 62% and mean LOS decreased by 2.1 days. Both measures varied greatly between hospitals. The two highest-ranking hospitals and the three lowest-ranking hospitals were included as cases. Factors which could explain the differences in pre- and post-implementation performance included the degree to which the CP was integrated into daily practice, the level of experience and support for CP methodology provided to the improvement team, the intrinsic motivation of the team, shared goals and the degree of management support, alignment of CP development and hospital strategy, and participation of relevant disciplines, most notably, physicians. CONCLUSIONS Overall improvement was achieved but was highly variable among the 5 hospitals evaluated. Specific factors involved in the implementation process that may be contributing to these differences were conceptualized using eNPT. Multidisciplinary teams intending to implement a CP should invest in shared goals and teamwork and focus on integration of the CP into daily processes. Support from hospital management directed specifically at quality improvement including audit may likewise facilitate the implementation process. TRIAL REGISTRATION NCT02965794 . US National Library of Medicine, ClinicalTrials.gov . Registered 4 August 2014.
Collapse
Affiliation(s)
- R van Zelm
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - E Coeckelberghs
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - W Sermeus
- Depertment of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Wolthuis
- Depertment of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - M Panella
- Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Quality, Academic Policy Advisor, University Hospital Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Tutolo M, Gandaglia G, Fossati N, Cannoletta D, Menean M, Stabile A, Bianchi M, Barletta F, Pellegrino F, Zaffuto E, Cucchiara V, Van Der AA F, Van Cleynenbreuguel B, Bruyneel L, Tasso G, De Ridder D, Joniau S, Everaerts W, Salonia A, De Cobelli F, Esposito A, Mirone V, Montorsi F, Briganti A. Anatomical prostate mpMRI features and continence recovery after robot assisted radical prostatectomy: is there something beyond membranous urethral length? results from a large, multi-institutional cohort. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35583-x] [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: 11/28/2022] Open
|
5
|
Seys D, Panella M, VanZelm R, Sermeus W, Aeyels D, Bruyneel L, Coeckelberghs E, Vanhaecht K. Care pathways are complex interventions in complex systems: New European Pathway Association framework. International Journal of Care Coordination 2019. [DOI: 10.1177/2053434519839195] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Care pathway implementation is characterised by a dual complexity. A care pathway itself represents a complex intervention with multiple interacting and interdependent intervention components and outcomes. The organisations in which care pathways are being implemented represent complex systems that need to be directed at change through an in-depth understanding of their external and internal context in which they are functioning in. This study sets out a new evidence-based and pragmatic framework that unpacks how intervention mechanisms, intervention fidelity and care context are converge and represent interacting processes that determine success or failure of the care pathway. We recommend researchers looking to increase the effectiveness of care pathway implementation and accelerate improvement of desired outcomes to adopt this framework from inception to implementation of the intervention.
Collapse
Affiliation(s)
- D Seys
- KU Leuven – University of Leuven, Belgium
| | - M Panella
- KU Leuven – University of Leuven, Belgium
- University of Eastern Piedmont ‘A. Avogadro’, Italy
| | - R VanZelm
- KU Leuven – University of Leuven, Belgium
| | - W Sermeus
- KU Leuven – University of Leuven, Belgium
| | - D Aeyels
- Universitair Ziekenhuis Brussel, Belgium
| | - L Bruyneel
- KU Leuven – University of Leuven, Belgium
- University Hospitals Leuven, Belgium
| | | | - K Vanhaecht
- KU Leuven – University of Leuven, Belgium
- University Hospitals Leuven, Belgium
| |
Collapse
|
6
|
Lamsens L, Peers K, Janssens L, Caluwé K, Kiekens C, Van Eldere J, Vandersmissen J, Vanhaecht K, Bruyneel L. Effect of supervised implementation of the international classification of functioning, disability and health on physiotherapeutic electronic patient records: A randomized controlled trial. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1169] [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: 11/16/2022]
|
7
|
Sermeus W, Cullum N, Balzer K, Schröder R, Junghans A, Stahl U, Träder JM, Köpke S, Dichter MN, Palm R, Halek M, Bartholomeyczik S, Meyer G, Holle D, Graf R, Rosier U, Reuther S, Roes M, Halek M, Gouveia BR, Jardim HG, Martins MM, Freitas DL, Maia JA, Rose DJ, Gouveia ÉR, Bruyneel L, Lesaffre E, Sermeus W, Ball JE, Bruyneel L, Aiken L, Tishelman C, Sermeus W, Griffiths P, Papastavrou E, Andreou P, Sasso L, Bagnasco A, Zanini MP, Catania G, Aleo G, Spandonaro F, Icardi G, Watson R, Sermeus W, Fleischer S, Burckhardt M, Meyer G, Berg A, Van Hecke A, Malfait S, Van Daele J, Eeckloo K, Deschodt M, Van Grootven B, Milisen K, Flamaing J, Rahn AC, Köpke S, Backhus I, Kasper J, Krützelmann A, Kleiter I, Mühlhauser I, Heesen C. European Academy of Nursing Science 2016 Summer Conference. BMC Nurs 2016. [PMCID: PMC5260782 DOI: 10.1186/s12912-016-0186-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
8
|
Bruyneel L, Nuyttens D. Effect of spray application technology on the biological control of aphids in Brussels sprouts. Commun Agric Appl Biol Sci 2010; 75:139-145. [PMID: 21542477] [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: 05/30/2023]
Abstract
A field trial was carried out to evaluate different application techniques for crop penetration and biological efficacy of aphid control in Brussels sprouts. Six different application techniques were tested at a pressure of 4.0 bar in a field trial in 3 parallels at the Provincial Vegetable Research Centre in Kruishoutem (PCG): a standard ISO 02 flat fan nozzle (at 200 l/ha), an ISO 04 twin air inclusion nozzle (at 800 l/ha), an ISO 03 drift reducing nozzle, an air injection nozzle (Airjet,) droplegs in combination with an ISO 03 drift reducing nozzle and an ISO 03 air inclusion nozzle (all at 400 l/ha). Best biological control of the aphids and spray distribution was found for the twin air inclusion nozzle, the air inclusion nozzle and the airjet-system. These are all drift reducing techniques because of their coarse droplet size spectrum or the effect of air support which makes the droplets faster. Both effects improve crop penetration. No added value was found for the droplegs for this type of spray treatments. Fine droplets, produced by a standard flat fan, did not give good results on biological control or penetration into the crop.
Collapse
Affiliation(s)
- L Bruyneel
- Provincial Vegetable Research Centre, Karreweg 6, BE-9770 Kruishoutem, Belgium.
| | | |
Collapse
|