Knowledge bank

2021

15 years of market forces in healthcare
In 2006 began the ambitious reform of the Dutch healthcare system based on principles of regulated competition or market forces. Can we now - 15 years on - consider those reforms a success? What has 15 years of market forces done to the accessibility, quality and affordability of our healthcare system? The book 'The market reform in Dutch health care; Results, lessons and prospects' provides a thorough review.
Download the book via this website.

2018

Betaalbare zorg (Affordable care)
The insights from the knowledge program 'Celsus, academy for affordable care' were compiled in the eponymous book 'Betaalbare zorg (Affordable Care)' edited by Patrick Jeurissen, Hans Maarse and Marit Tanke.

This core publication is part of a series of books on healthcare affordability that appeared simultaneously. The other titles in this series are also on this page
Available via SDU

Beleid en besturing in de zorg (Policy and management in health care)
Hans Maarse
Available via SDU

Vijftig jaar kostenbeheersing in de zorg (Fifty years of cost control in health care)
Part I: 1966-1995
Karel-Peter Companje, Ton Kappelhof, Robert Mouton and Patrick Jeurissen
Availablevia S DU - (Part II see 2021)

Waardevolle zorg, Kwaliteit en doelmatigheid voor verpleegkundigen (Valuable care, Quality and efficiency for nurses)
Henny van Lienden and Hiske Calsbeek
Available via Koninklijke van Gorcum

Current education requires nurses to be able to argue their own actions using theoretical principles and results of scientific research (evidence-based nursing). Effectief Verplegen provides students with the arguments for solving or making manageable a number of common nursing problems. This book elaborates nursing problems that can occur in many different patients/caregivers, focusing on somatics. As in Volume 2, these are self-contained nursing problems and interventions, such as malnutrition, pain, sleep problems, etc. The book opens with an introduction to ebp, followed by the nursing problems worked out. Each chapter forms a completed whole, which can be studied separately. The chapter structure follows a fixed pattern: each chapter begins with a brief introduction, followed by case histories and a description of the problem area, nursing diagnostics and nursing interventions, and concludes with a knowledge review and a literature review.

Editors: Prof. Dr. Th. van Achterberg, Dr. G.J.J.W. Bours, Drs. A.M. Eliens.
Publisher: Kavanah, Dwingeloo
ISBN: 9789057401244
Year of publication: 2012

This book discusses nursing problems that may occur in various patient categories and are located in the psychosocial domain. These nursing problems are clustered into a number of nursing problem areas (see below). The book opens with an introduction, which discusses the state of evidence-based nursing and explains the significance of some commonly used classification systems and the EAP formula.
The introduction is followed by the elaborated nursing problems: each chapter forms a rounded whole (problem area), which can be studied separately.
The chapter structure follows a fixed pattern: each chapter starts with a short introduction, followed by case histories and a description of respectively the problem area, nursing diagnostics and nursing interventions, after which it concludes with a knowledge review and a literature review.

Editors: Prof. Dr. Th. van Achterberg, Dr. G.J.J.W. Bours, Dr. A.M. Elien.
Publisher: Kavanah, Dwingeloo
ISBN: 9789057401176
Year of publication: 2011

Parts 1 and 2 in this series cover common nursing problems in somatic and psychosocial care. These are nursing problems that can occur in many different patients (general care).
Effectief Verplegen 3 and Effectief Verplegen 4 differ from this. Parts 3 and 4 highlight nursing problems in specific groups of patients or caregivers (complex care). By choosing target groups instead of nursing problems as an entry point, it becomes possible to describe the entire care of a group. The chapters therefore cover problems in every area of human functioning. When describing the nursing problems for a target group, the particular problems of the group in question were chosen. For general problems that may also occur in these groups, reference has been made to Parts 1 and 2 where possible (e.g., pressure ulcers in Part 1 or compliance in Part 2).
This book is provided with a personal access code that allows users to consult additional information (such as the latest insights, measurement tools and a knowledge test) at www.verpleegproblemen.nl.

Editors: Prof. Dr. Th. van Achterberg, Dr. G.J.J.W. Bours, Drs. A.M. Eliens.

Publisher: Kavanah, Dwingeloo
ISBN: 9789057401183
Year of publication: 2012

Effective communication is one of the most important competencies of the general practitioner. Yet this subfield sometimes remains underexposed in (continuing) education and is - wrongly - taken for granted. Optimal communication can make consultation and practice much more effective and enjoyable.

'Handboek effectieve communicatie in de huisartsenpraktijk'. Authors: Dielissen, P.W. / Jagt, E.J. van der / Timmerman, A.A. With contributions by W. Dekkers, S. Naber, P. Giesen (IQ Health).

Publisher: Prelum
ISBN:9789085621478
Year of publication: 2016

Implementation in healthcare is enjoying growing interest from science and practice. The book ‘Implementatie: Effectieve verbetering van de patiëntenzorg’ ('Implementation: Effective Improvement of Patient Care') edited by Michel Wensing and Richard Grol has for many years offered a practical and scientifically based overview of the knowledge in this field. It is widely used in education.

Recently, the eighth, revised edition was published, on which several scientists from the Radboudumc collaborated. The book covers clinical guidelines, implementation strategies, quality indicators, patient safety, patient empowerment, and process evaluation, among other topics. The new edition contains much new knowledge that has become available internationally in recent years.

Learn more at the BSL Web site.

The book Coaching Peer Learning in Healthcare by Marjo Maas and Anjo Markhorst was recently released. A Peer Learning (PL) Group is a group of professionals working together on professionalization, quality improvement and innovation. Central is learning from each other based on issues from practice or science. In this book, the authors focus primarily on coaching PL groups working toward good and responsible healthcare.

A critical reflection on current healthcare practice and the search together for alternative or new ways of doing things form the common thread. The authors of this book are experienced PL coaches in healthcare and trainers of PL coaches. They have compiled this book based on the available literature on learning and professionalization, their experience as trainers and their observational research using video recordings of PL sessions.

Coaching Peer Learning in Healthcare is intended for healthcare professionals who have experience with, or interest in, coaching professional learning groups. This book gives the (potential) coach tools to facilitate the process of Peer Learning and to act appropriately when it is necessary to adjust the process.

Marjo Maas is affiliated as senior lecturer at the Academy of Paramedical Studies of the HAN and as researcher at Radboudumc, IQ Health department. Anjo Markhorst is owner of Alinea Consult, organizational coach and researcher at Radboudumc, IQ Health department.

This book was created with support from the Stichting Keurmerk Fysiotherapie. Click here for more info:

 https://www.2010uitgevers.nl/product/het-coachen-van-peer-learning-in-de-gezondheidszorg/

New book, I Can See You. The healing power of empathy
The book with this title was recently released, edited by Prof. Dr. Maria van den Muijsenbergh and Dr. Hub Wollersheim. Dr. Wollersheim worked as a researcher and teacher at IQ Health until his retirement. At a time when polarization and individualism prevail, this book offers an essential look at the importance of empathy and humanity. It explores how declining empathy affects our relationships and social structures.
Through a series of essays by experts from various fields, including philosophy, medical science and technology, this book illuminates the multifaceted nature of empathy. It examines the impact of an empathetic attitude in the doctor-patient relationship, and how this translates to broader social and political issues.

Every year in healthcare, many valuable new insights, technologies, programs or best practices become available. Unfortunately, many of these innovations do not find their way into practice. Why is that? And how can effective improvement of patient care be achieved? In this - thoroughly revised - edition of Implementation: effectively improving patient care, you will find up-to-date information on implementing a variety of changes. The process of innovation in practice is carefully analyzed and discussed using a practical, step-by-step model. A large number of scientific findings and practical examples are presented to explain the model. In Implementation: effectively improving patient care, the emphasis is on improving the actions of physicians, paramedics and nurses and the teams in which they work. The patient is central to this effort. It is a practical book for healthcare providers, executives, quality officers, managers, policy makers and researchers involved in optimizing patient care in the Netherlands. Richard Grol is Emeritus Professor of Quality of Care at the Universities of Nijmegen and Maastricht, Michel Wensing is Professor of Implementation Science at Radboud University Nijmegen.

Editors: Richard Grol and Michel Wensing.
Publisher: Reed business, Amsterdam
ISBN: 9789035233966
Year of publication: 2011

Strategies for successfully updating and improving health care organizations of all kinds. 

Health care is always evolving and improving. However, the rapid speed of medical advancement can make the adoption of new technologies and practices a challenging process – particularly in large organizations and complex networks. Any projected impact upon quality and outcomes of care must be carefully evaluated so that changes may be implemented in the most efficacious and efficient manner possible.

Improving Patient Care equips professionals and policymakers with the knowledge required to successfully optimize health care practice. By integrating scientific evidence and practical experience, the text presents a cohesive and proven model for practice change and innovation, complete with analysis of innovation, target group and setting; selection and application of strategies; and evaluation of process, outcomes and costs.

This new third edition also includes:

• Newly written chapters on clinical performance feedback, patient engagement, patient safety, evaluation designs, and methods for process evaluation
• Increased emphasis on the role of contextual influences in implementation and improvement
• New research examples from across the world and updated scientific literature throughout

Designed to help promote safer and more efficient, patient-centered care and better outcomes, Improving Patient Care is an essential resource for healthcare providers, quality assessors, and students of health services research, health management, and health policy.

Editors: Michel Wensing, Richard Grol, Jeremy Grimshaw

More information can be found on the website of Wiley.

"Quality of care is determined by many factors, including the (personal and professional) qualities of professionals such as doctors and nurses. Those qualities include the personal qualities to be able to do your job ethically as a professional - virtues. This book includes a chapter on the virtues of doctors, the virtues of nurses and two "profiles" of healthcare professionals. One is Prof. Dr. Baziel van Engelen, a neurologist at the Radboudumc. The book combines two of IQ Health's research themes: 'professional development' and 'ethics.'"

According to virtue ethics, good action comes from attitudes you develop as you go through life, such as courage, justice and integrity. If you have character, you pursue such virtues. They make your own life and the lives of those around you good, even when you are at work.

'Those who are virtuous provide virtuosic custom.'

What virtues matter in professional practices such as education, healthcare, law and business, and how do you develop them? This book brings together answers to those questions and short interviews with professionals such as Robbert Dijkgraaf, Femke Cools and Jos de Blok. As an introduction, Paul van Tongeren wrote a brief history of virtue ethics.

Edited by Wouter Sanderse and Jos Kole
ISVW publishers NUR: 730 / ISBN: 978-94-91693-62-5

A new edition of the book Kwaliteit en veiligheid in patiëntenzorg (Quality and Safety in Patient Care) has been released. The book has now been made expressly suitable for nurses as well.
In health care education, increasing attention is being paid to quality improvement and the prevention of unsafety in patient care. The increased attention to quality of care is evident, for example, in the recent Framework Plan. The 2020 Framework Plan for Physician Education is based on the (updated) CanMEDS framework. Whereas in 2009 about half of the competencies were related to quality and safety, professional behavior and ethical moral thinking and acting, in 2020 this is more than three quarters. Moreover, many competencies are more explicitly elaborated toward patient safety, continuity of care, working on virtues and professional behavior, reflective capacity and lifelong learning, interprofessional collaboration, collaborative decision making and co-producing care. These topics are covered extensively in this textbook.
Quality and safety are such a high priority because of the important consequences for patients and society. But what exactly does it mean to provide quality and safe care in a transparent manner? What role does the healthcare organization play, and how can the physician, nurse or paramedic individually contribute to safe patient care? How are calamities prevented? But also: how to adequately deal with a mistake made and how to learn from it?
Quality and Safety in Patient Care clarifies what quality of care is and what are conditions for quality improvement. The various dimensions such as professional, organizational and patient-centered quality are discussed, as well as research on quality improvement and implementation in practice. Despite the pursuit of optimal patient care, incidents always continue to occur. A separate chapter is therefore devoted to how to deal with a calamity, keeping in mind patient, organization and one's own feelings and functioning. The possibilities of quality improvement are illustrated in this book with numerous examples from clinical practice.
Quality and Safety in Patient Care is written by leading Dutch quality researchers and improvers, -professionals and healthcare providers, who have already made many contributions to actual improvement of patient care. With this book they offer every (future) healthcare professional the knowledge and tools to pursue optimal patient care and to reflect on their own role in it.

Editors: Hub Wollersheim, Trudy van der Weijden, Cordula Wagner, Kees Ahaus, Jaap Hamming and Hester Vermeulen.

Quality of care is under pressure from high demand, complexity and high costs. The idea of 'appropriate care' helps address these issues. The updated edition of this book provides insight into theories (head), it encourages self-reflection (heart) and contains practical tips (hands). The book helps to deepen knowledge, and also to develop one's own view on quality of care. For (future) healthcare professionals who not only want to know what good care is, but also want to understand how they can really make a difference.

IQ Health colleagues Marlies Hulscher, Rosella Hermens, Hiske Calsbeek and Hester Vermeulen helped make this updated edition possible. The book can be ordered via:

BSL Shop | Kwaliteit en veiligheid in patiëntenzorg

On May 25, 2021, Kok Boekencentrum published the volume Leven met Euthanasie (Living with Euthanasia), by Theo Boer, Stef Groenewoud (health scientist and ethicist at IQ Health) and Wouter de Jonge. The book is a compilation of over forty stories of experience from people who are (or have been) involved in euthanasia in some way.
Approximately one in twenty deaths in the Netherlands involves euthanasia. In response to unplannable and unwanted suffering, people choose this planned death. But what does the "good death" mean for directly involved loved ones? How do they experience it? Living with Euthanasia provides an impressive, poignant look into the stories of 43 next of kin.

Medical Practice Variations © 2016

Editors: Johnson, Ana, Stukel, Thérèse A. (Eds.)

• Raises critical concerns about the quality, equity and efficiency of international health care resources  
• Raises critical concerns about the quality, equity and efficiency of international health care resources
• Synthesizes current research on variations in healthcare utilization, delivery and outcomes
• Outlines established concepts & frameworks involved in researching medical practice variations
• Examines systemic questions about healthcare spending, decision-making and service disparities

Medical Practice Variations Part of the series Health Services Research pp 113-122

Medical Practice Variations in Primary Care
Gert P. Westert Affiliated with Health Services Research, Scientific Institute for Quality of Healthcare (IQ Health), Radboud University Nijmegen Medical Centre Email author 

• Judith D. de Jong Affiliated with Health Care System and Governance, NIVEL (Netherlands Institute for Health Services Research)
• Philip da Silva Affiliated with NHS Right Care

In daily care, nurses, like other healthcare professionals, have many questions. What does a patient want to achieve? What are we going to work on? What are the effects of the care? Does treatment need to be adjusted?

The third, revised edition of the book Meten in de praktijk (Measuring in Practice) is now accessible to nurses. The book includes a roadmap for using measurement tools in health care.

Measuring clarifies and objectifies these issues. This benefits the healthcare professional, the patient and their loved ones, both in determining the diagnosis, predicting the course of recovery, and also jointly determining the goal and evaluating a treatment.

Hester Vermeulen, professor of nursing science at IQ Health, has been added to the editorial team. As a result, the nursing perspective is now well represented herein. Nurses regularly use measurement tools in all settings. Using a step-by-step plan, nurses can now also learn how to systematically and critically search for, select, and interpret the appropriate measurement instrument and integrate its outcomes into the treatment process.

So in this third edition, there is more focus on interpreting and using the results in the care process. In addition, it collaborates with the website https://meetinstrumentenzorg.nl/, making the measurement tools and user information freely available.

The book is now also accessible to nurses. Furthermore, it is intended for all healthcare professionals, students and teachers of healthcare courses in higher education. In addition, it is a useful guide for professionals and quality staff working in healthcare.

The editorial board members are Sandra Beurskens, Roland van Peppen, Raymond Swinkels, Hester Vermeulen and Harriët Wittink. The book can be ordered by: https://www.bsl.nl/shop/meten-in-de-praktijk-9789036824583.html

A new international book was released in 2020: "Occupational therapy for older people," in Dutch "Ergotherapie bij ouderen."  The book describes occupational therapy interventions with older people in primary care, intensive care, rehabilitation, nursing home, palliative care and future perspectives.
The editors of this book are IQ Health professor Maud Graff, Christian Pozzi, Alessandro Lanzoni and Alessandro Morandi. The book was published by Springer International Publishers, 2020.

Setting up clinical trials is a complicated business, and one of the more difficult questions is how many patients and centres to include in multi-centre trials.
Statistician Steven Teerensta from Radboud University Medical Center and Mirjam Moerbeek from Utrecht University have published the book 'Power Analysis of Trials with Multilevel Data' with Chapman and Hall  explaining exactly what the issues are and giving guidelines to researchers.

Nurses are critical to delivering quality care. By demonstrating leadership, they influence quality, safety, effectiveness and person-centeredness of care. After all, nurses influence key outcome measures such as reduced malnutrition, infection, pain, anxiety and increased participation, adherence and self-management.  Nurses influence their own development and professionalism as well as that of students and colleagues on their team or the organization.
The editors of this book, including three colleagues from Radboudumc, IQ Health, invite nurses to explore and make the topic of nursing leadership their own. In this book, they ask many questions in between, let them reflect on their own practice situations or give short assignments on leadership. Because leadership, like nursing, is a "practice," in other words, you have to do it, practice, learn and try.
This book is intended for all ambitious nurses who, in a variety of roles and functions, are engaged in the professionalization of their profession and serve as boosters. More specifically: nurses following a program to become nurse leaders, nurse advisory boards, nurse specialists in training, students in the final phase of undergraduate education.
Editors and authors: Hester Vermeulen, Monique van Dijk, Maud Heinen, Gerda Holleman, Anita Huis, Erwin Ista, Pieterbas Lalleman, Catharina van Oostveen and Marjolein Schouten.

Survey among GPs in 10 countries

The Dutch healthcare system is characterised by strong primary care. For most health problems, GP practices are the first place to turn for professional help. Specialist help usually requires a referral from a GP. This gives the GP the function of gatekeeper in healthcare. GP care is generalist medical care, accessible to all people close to home and thus fulfils a prominent place in healthcare. There are several challenges in healthcare, including an ageing population, rising healthcare costs and a more complex society and healthcare.

This report focuses on the quality of Dutch healthcare, as experienced by GPs in 2022. It focuses on, among other things, digitalisation, practice organisation, accessibility of care, coordination of care and care for chronic patients.

The results are from the 2022 Commonwealth Fund International Health Policy Survey (IHP 2022). Besides Dutch GPs, GPs from nine more Western countries participated. This provides a nuanced picture of the functioning of the Dutch healthcare system, as perceived by GPs. Every three years, this survey among GPs is repeated. In the intervening years, a similar study is conducted among citizens and the chronically ill.

The study was funded by the Commonwealth Fund, the Ministry of Health, Welfare and Sport, and IQ healthcare. The study was conducted with support from the Dutch General Practitioners Association.

Download the report

Is infection prevention covered in nursing courses? And if so: how? Anita Huis and Irma Maassen of IQ healthcare investigated this on behalf of GAIN (the Gelderland Care Network Infection Prevention). They did so following signals from various healthcare organisations that trainees are not always at home with the rules around infection prevention. The findings form the basis for a national project to give infection prevention a more prominent place in the curricula of mbo and hbo.

The study consisted of a survey and interviews. A total of 733 nurses-in-training from 37 educational institutions completed the questionnaire. Over 18% of the students reported that there was no focus on infection prevention within their education. More than a third of this group are lateral entrants or follow a shortened pathway. As infection prevention is mainly covered in the first year, non-regular students may miss out on the subject as a result. Anita and Irma also conducted interviews at 3 mbo and 3 hbo programmes.

Outcomes

Hand hygiene and personal hygiene are covered at most schools. Other topics scored only moderately. These include, for instance, antibiotic resistance and BRMOs or personal protective equipment. Topics that are really missed in the courses include attention to infectious diseases and approach behaviour.

Recommendations

The researchers make a number of recommendations in the report. More repetition in the curriculum is one of them. Other recommendations include: more depth and more attention to BRMOs.

National project

A national project will start soon to give infection prevention a more prominent place in education. All healthcare networks are cooperating in this. Anita and Irma's report forms the basis for the project. The aim is to formulate learning goals around infection prevention. These will then be submitted to the MBO Council and the Association of Universities of Applied Sciences.

Would you like to know more? Read the research report here.

Appropriate care has recently become the norm in the Netherlands. But appropriate care has existed much longer. As early as 1991, the Dunning Commission wrote about the need for choices in its report 'Choosing in Care'. In 2013, the American scientific societies presented their Choosing Wisely lists of examples of care in which doctors should exercise restraint. Dutch medical specialists followed with their 'Choosing Wisely'. But lists do not change care. That is why the Citrine Fund programme Doen of laten? launched an approach where healthcare professionals themselves were put in the lead to change healthcare. What did we achieve?

Open the desktop version
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Every year, the Netherlands participates in the Commonwealth Fund's International Health Policy (IHP) survey. Alternately, citizens, patients and GPs are surveyed in 11 Western countries. This makes it possible to compare the performance of the Dutch healthcare system with that of the 10 other participating countries. Researchers from IQ healthcare processed the results into reports.

This creates a differentiated picture of the functioning of the Dutch healthcare system, as perceived by the participants surveyed. With this monitoring, developments due to policy, but also other (external) factors, become visible and international comparisons are possible.

For the 2020 survey, citizens aged between 18 and 64 were interviewed on the themes. The focus was on the themes of participation - accessibility - care consumption - financial accessibility and costs and Functioning of the healthcare system. In 2021, these were citizens aged 65 and over with the themes of coordination and aftercare - Care wishes about end of life - (financial) accessibility and Corona crisis and social security.

At the time the 2020 survey was launched, the COVID-19 pandemic was presenting itself. In the 2020 edition, some questions were added to the survey on testing, treatment and consequences of COVID-19. In 2021, side effects of the corona crisis such as delayed care and effects on social security were collected.

The surveys show that on some aspects of care such as involvement in health and treatment decisions, social security and accessibility of care, the Netherlands scores very high compared to the other countries. On most other aspects of the IHP survey, the Netherlands scores average to good. As in previous editions, there remains room for improvement. Among others in the areas of lifestyle advice, coordination and aftercare and end-of-life care wishes. Also, as in previous years, aftercare and information transfer between the second and first line is a point of attention.

Both reports are available below:

Report IHP survey 2020

Report IHP survey 2021

The Healthcare and Youth Inspectorate (IGJ) monitors the quality of care provided by healthcare providers. Complex care, such as care for people in vulnerable situations, is increasingly organised in care networks. Cooperation is then needed to enable person-centred care. If only direct care is supervised, any problems in care networks remain underexposed, even though they affect direct care.

The inspectorate has therefore started developing supervision of care in care networks from the patient/client perspective and is now also working on supervision of collaborating organisations. Supervising cooperating parties (regional healthcare networks) is more complex than supervising individual healthcare providers.

Erasmus School Health Policy & Management (Erasmus University Rotterdam) and IQ healthcare (Radboudumc) were asked to provide building blocks for the further development of supervision of healthcare networks. To this end, the functioning of cooperation in care networks and initial experiences with the supervision of cooperation were investigated. The assignment focused on care networks for people in vulnerable situations. The building blocks produced are widely applicable in supervision. In the report, the researchers present 14 recommendations with which the inspectorate can further develop supervision of care networks.

Researchers Dr Jozé Braspenning and PhD student Rabab Chrifou were involved in the development of this report from IQ healthcare.

Read the report here.

This report is part of the Programming Study Development of Quality Standards 2019-2022. The aim of the study, set up by IQ healthcare in collaboration with NIVEL and Utrecht University of Applied Sciences, was to develop an agenda of activities to implement existing and future quality standards. Sub-goals here were: to provide an overview of quality standards where implementation activities are needed, an overview of implementation activities for future district nursing quality standards and to make recommendations to embed implementation in the quality cycle.

Several methods were used to unravel the implementation issues. First, an analysis from an implementation perspective of the results of the first two sub-studies (de Groot & Francke, 2021, Zuidema et al., 2021). Second, a further analysis of the topic of Advance Care Planning that was suggested from the field based on a request from the V&V Panel as a topic for the development of a new quality standard for district nursing. Third, an analysis of developments within V&VN regarding quality standards. This resulted in a number of core recommendations in addition to an overview of existing quality standards that may already answer some of the questions from practice but are not yet focused on district nursing. The core recommendations focus on 1) prioritisation based on the need from the field, 2) a pilot implementation as a regular part of the development process, 3) implementation-support tools summarised for practice, 4) a format for a dissemination plan, and 5) organising a system that monitors and/or evaluates the knowledge and use of quality standards at an aggregate level.

Partners involved

• IQ health, Radboudumc Nijmegen: Maud Heinen, Anita Huis and Hester Vermeulen
• Nivel, Utrecht: Anneke Francke, Kim de Groot
• University of Applied Sciences, Utrecht: Rixt Zuidema, Nienke Bleijenberg

Read the report here and view the infographic here.

To future-proof long-term care for the elderly in the Netherlands, the government must develop a realistic long-term vision, in dialogue with all stakeholders, as a precondition for stable public support. This is the main conclusion from the working paper 'Sustainable care for the elderly - Lessons and experiences from other countries' published today by the Scientific Council for Government Policy (WRR).

The country study was conducted by researchers from Leyden Academy on Vitality and Ageing, IQ Health Radboudumc and Erasmus School of Health Policy & Management (ESHPM), and forms a background study to the ongoing WRR advisory project Sustainable Care.

View the report here.

IQ Health was commissioned by the NTS Foundation to conduct a scientific study on the validity and reliability of the Dutch Triage Standard (NTS) in adults. In a nationwide study, 41 cases with real and common health complaints were assessed by 102 experienced triagists from the 3 partners in the emergency care chain: GP out-of-hours surgery (HAP), the Ambulance Dispatch Centre (MKA) and the Emergency Department (ED).

View the report here.

For people with a cochlear implant (CI), listening to music and enjoying music is a challenge. From her own experience, pianist Joke Veltman developed a training course that can bring music enjoyment back into the lives of people with cochlear implants. The report "Project Musi-CI ZonMw Project 'For Each Other!'" describes the further development of this training.

Open the report

New ways of working at the Beatrix Hospital in Gorinchem and hospital Bernhoven in Uden have improved the efficiency of care. The hospitals set up their organisations in such a way that the quality of care for the patient is more of a priority and that they are less focused on the number of treatments. Care providers' initiatives are given more space, there is more cooperation with GPs and organisational changes have been made. Also, agreements are no longer made with the insurer per treatment, but fixed amounts have been agreed for five years. This is according to the just-published evaluation of the new ways of working by the Netherlands Bureau for Economic Policy Analysis (CPB), IQ Health and the Dutch Healthcare Authority (NZa).

The hospitals each had their own strategy that suited their situation. In Bernhoven, for instance, all medical specialists went into salaried employment and in the Beatrix Hospital, a different distribution model for financing medical specialists was introduced. In Bernhoven, in addition, an organisational change was implemented in which the hospital was organised according to four types of care provision: acute care, diagnosis and indication, interventional care lines and chronic care.

The changes at both hospitals were made possible by five-year contractual agreements with the region's main health insurers (VGZ and CZ). This provided financial stability and reduced the incentive to treat as many patients as possible, and gave the hospitals room to make major organisational changes. Important for the outcome was the launch of over 50 initiatives from the shop floor to improve quality, as well as good cooperation with GPs and health insurers and the removal of unwanted incentives to treat among medical specialists.

Three years after implementation, treatment volume (the value of DBC treatments) decreased by 13% at Bernhoven and 7% at Beatrix Hospital, compared to other hospitals. This decrease came about through both less and less intensive treatment. For instance, both hospitals saw a stronger shift from inpatient care to day treatment and more care was done by GPs in the region than at comparable hospitals.

There is little evidence of negative effects. The study shows that there has been no shift of patients to other hospitals in the region. The quality of care at both hospitals did not change on average, according to the study.

More efficient care is an important first step towards lower healthcare spending. After all, it offers room for hospitals to (eventually) reduce healthcare spending and for health insurers to lower healthcare premiums for policyholders. However, a longer-term evaluation is needed to determine whether the change programmes will lead to lasting financial savings.

For more information:

View the report here.
Authors: Simone van Dulmen, Niek Stadhouders, Gert Westert, Erik Wackers, Patrick Jeurissen

Read the three parties' joint policy brief: Evaluation of Beatrix Hospital and Bernhoven programmes, CPB Policy Brief. CPB/IQHealth/NZa. (2020).

Read more in the background paper on the CPB and NZa study: CPB/NZa. (2020). Case study Beatrix hospital and Bernhoven.

The KNGF carried out a development project to modernise the quality system for first-line physiotherapy. IQ healthcare developed four intervision modules for this purpose: communication, file management, feedback on process and outcomes, and clinical reasoning. In this report, the researchers present the results of developing, testing and evaluating a generic module aimed at interprofessional cooperation and specifically for the benefit of patients with Parkinson's disease. The project was carried out in a partnership between IQ healthcare and ParkinsonNet.

Scientific Report KNGF Intervision - Module 5 Interprofessional learning and collaboration. Marjo Maas, Ron van Heerde, Philip van der Wees.

This report presents the results from the 2019 Commonwealth Fund International Health Policy Survey (IHP 2019). In addition to Dutch GPs, GPs from 10 more Western countries participated. This provides a nuanced picture of the functioning of the Dutch healthcare system as perceived by GPs. This survey is repeated among GPs every three years. In the intervening years, a similar study is conducted among citizens and the chronically ill. No questionnaire was administered in 2018. For this reason, it is now four years since the questionnaire was conducted among GPs.

The study was funded by the Commonwealth Fund, the Ministry of Health, Welfare and Sport, and IQ healthcare. The survey was conducted with support from the Dutch General Practitioners Association.

Read the full International Health Policy Survey 2019 | Commonwealth Fund - Survey of GPs in 11 countries.
Authors: Dr Simone van Dulmen, Florien Kruse and Prof Philip van der Wees.

This report provides insight into which factors nurses, carers and nursing specialists (V&V) experience when (de)implementing quality standards and which strategies lead to successful application of recommendations from quality standards by V&V. The recommendations from this study should contribute to optimal application of quality standards in V&V professional practice and education.

Partners involved

• Dr E. Ista, ErasmusMC,
• Dr L. van Bodegom-Vos, LUMC
• Prof. Dr M. van Dijk, ErasmusMC,
• Dr M. Heinen, Radboudumc, IQ healthcare
• Dr A. Huis, Radboudumc, IQ healthcare
• Dr. A. Persoon, UKON
• Prof. H. Vermeulen, Radboudumc, IQ healthcare

Download the entire final report WINK V&V: What Is Needed for Implementation of Quality Standards for Nurses, Caregivers & Nursing Specialists?

Publications published from this study:

Implementation strategies used to implement nursing guidelines in daily practice: A systematic review.
Denise Spoon, Tessa Rietbergen, Anita Huis, Maud Heinen, Monique van Dijk, Leti van Bodegom-Vos, Erwin Ista.

Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and metaanalysis.
Tessa Rietbergen, Denise Spoon, Anja H. Brunsveld-Reinders, Jan W. Schoones, Anita Huis, Maud Heinen,
Anke Persoon, Monique van Dijk, Hester Vermeulen, Erwin Ista and Leti van Bodegom-Vos

This bottleneck analysis investigated how family and client participation is currently implemented and what bottlenecks are experienced by clients, relatives and (district) nurses, caregivers and nursing specialists.

Bottleneck analysis family participation in district nursing care - Family and client participation: what makes it difficult and how can it be improved?
Drs Elise van Belle, Drs Benjamin Wendt, Dr Anita Huis, Dr Maud Heinen, Drs Mariëlle Blankestijn, Dr Alette de Jong, Dr Lilian Vloet, Prof Hester Vermeulen, Prof Sandra Zwakhalen.

In the period 2017-2019, Radboudumc's IQ healthcare department investigated practice variation within specialist medical care on behalf of the Patient Federation and in collaboration with the Dutch Healthcare Authority and the Netherlands Healthcare Institute. Practice variation analyses were performed and visualised for eight common conditions.

Report Practice variation eight conditions 2019
Femke Atsma, Mark Noordenbos, Philip de Reuver, Stef Groenewoud

Addendum report practice variation eight conditions 2019. Fenneke van Swigchum, Femke Atsma

The report 'Five Wise Choices in acute wound care' was released in 2015, making recommendations on situations where less wound care is actually better.

IQ healthcare evaluated the extent to which nurses and doctors are aware of and follow these recommendations. Although the majority of nurses and doctors are aware of the Wise Choices, not everyone follows them in practice and there is room for improvement.

The main barriers are lack of knowledge, the working environment and the assumed wishes of the patient. To improve care, it is important to improve knowledge about wound care among nurses and doctors, for example through the wound consultant.

Healthcare providers also need to become aware of patient trust in their choices. Furthermore, the Wise Choices and the potential harm if they are not followed should be brought to the patient's attention. Finally, it is important to design the work environment so that it facilitates following the Wise Choices.

Verkerk E, Huisman-de Waal G, Oude Bos A, Overtoom L, Kool T and Dulmen S van. Implementation of the Wise Choices in an acute wound. Nijmegen; IQ healthcare, 2018.

Download Final report 'Implementation of the Wise Choices in an acute wound'.

Using a combination of qualitative and quantitative research, researchers show that displacement is a diffuse process, and that the uptake of new costly treatments cannot be directly traced to displacement of valuable care.

Commissioned by Zorginstituut Nederland, IQ healthcare, together with the Health Evidence departments of Radboudumc, Ecorys Netherlands, Julius Centrum Utrecht and Maastricht University, conducted research into displacement effects in hospital care due to new costly treatments. A combination of qualitative and quantitative research shows that displacement is a diffuse process, and that the uptake of new costly treatments cannot be directly traced to displacement of valuable care. Qualitative research (6 case studies and 84 interviews) shows how healthcare providers, administrators and health insurers deal with the cost pressure associated with costly treatments, and what choices are made as a result. A quantitative study estimates how much health is lost on average in hospital care when care innovations are financed from the hospital budget.

Go to the final report Verdringing
Appendices to the final report displacement
Opportunity cost of Orkambi, an illustration for using POINT 1.0.

Using the tool POINT 1.0. which uses the results of this report to visualise displacement effects at a glance.
 

Go to the POINT 1.0 2018 user guide

An inventory of bottlenecks and solutions in the care of frail elderly people was commissioned by the Netherlands Healthcare Institute. A total of 125 documents were studied. With the help of all stakeholders (older people, informal care, care providers, health insurers, policymakers, researchers), a Think Tank and a Panel reached consensus on the most important bottlenecks and solutions were prioritised and elaborated. Our conclusion is that the solutions mentioned are often already part of projects in elderly care, but implementation leaves much to be desired.

The solutions require the active involvement of the frail elderly, their loved ones, the neighbourhood and care professionals. Agreements are needed on the organisation (tasks and roles), information exchange (e.g. digital sharing of care files) and consultation structures. These agreements may differ locally, but must fall within transparent laws and regulations.

An interpretation of the directing role is emphatically sought. The proposal is to place it with a Core Team, consisting of the vulnerable elderly person, the GP and the POH elderly care or a district nurse. Depending on the personal care and treatment plan, other care providers participate (temporarily) in the Core Team, which has cooperation agreements with a Specialist in Elderly Medicine (SO) or a framework GP in geriatrics and the district team.

Regional organisations can support implementation, among other things, through expertise promotion and information facilities. National umbrella organisations of healthcare providers are invited to set the quality standard for participation in an elderly care programme; and adjust the final attainment levels of professional training accordingly. For health insurers, the task is to work on appropriate costing, including for indirect care costs. They are asked to include in this the laws and regulations surrounding indication and to simplify them. These activities require coordination between patient organisations, care providers, health insurers and the government.

Inventory of bottlenecks and solution directions in care for frail elderly people living at home.
Mirjam Garvelink, Marianne Dees, Sander Ranke, Marieke Perry, Jozé Braspenning
Read the full report

International Health Policy Survey - Onderzoek onder 65 plussers in 11 landen. Joost Wammes, MSc, Dr. Philip van der Wees, Prof.dr. Gert Westert.

The International Health Policy (IHP) Survey 2017 was a comprehensive survey of 22,183 over-65s from 11 western countries. The results of this international survey were published in the journal Health Affairs on 15 November 2017.

To provide the best care, it is important that the actions of nurses and
carers are based on up-to-date knowledge and insights. For these professional groups, the Ministry of Health, Welfare and Sport (VWS) has requested ZonMw to develop quality standards for these professional groups. Professional organisation Verpleegkundigen & Verzorgenden Nederland (V&VN) prioritises the topics, of which healthcare-associated infections is one.

Healthcare-associated infections are relatively common. It was not yet clear, however, whether nurses and carers experience specific bottlenecks in their actions when dealing with this problem and whether these can best be addressed via a quality standard. For this reason, V&VN asked ZonMw to commission a bottleneck analysis. This bottleneck analysis was conducted by IQ healthcare (Radboudumc) and the Netherlands Institute for Healthcare Research (NIVEL).

To identify the bottlenecks with regard to nursing, several methods were used: a brief literature study, a questionnaire survey among participants of the Nursing & Care Panel, and three in-depth focus groups with nurses and carers from hospital care, intramural elderly care and home care.

This report describes the bottlenecks related to nursing and caregiving in the identification, prevention and treatment of healthcare-associated infections. Supplemented by an inventory of possible solutions.

Download the report.

This report identifies patients' and healthcare providers' experiences of using a healthcare portal. What hindering and promoting factors do they see and experience in practice. The researchers also identify areas for improvement of the patient portal and the implementation process.
Go to the report 'The patient portal
Go to the 'Patient portalreport supplement

Commissioned by the Ministry of Health, Welfare and Sport, the report 'First exploration of effects of outline agreements (hla's)' was written and included as appendix 4 of the Final Report 'Ensuring healthy growth' of the Technical Working Group on Health Care Expenditure Management Instruments.
In this exploration, interviews were conducted with managers and directors of healthcare providers. They stand, as it were, between all parties who jointly signed the hla's, and thus have a good picture of the effects of the hla's and the efforts made by parties. The purpose of this study was not to find out which specific agreements from the hla's were fulfilled or not, but to get a first impression of the effects.

Read the full report here.

How do you extract useful and meaningful management information for managers from the large amount of quality information available in an intensive care unit (ICU)? That was the main question of a collaborative project between IQ healthcare and the Intensive Care departments of Radboudumc and LUMC. This project was carried out as part of the Steering for Quality programme, led by the NFU consortium Quality of Care, funded by the Citrine Fund.

In the ICU, generic and department-specific quality information is collected. However, the large amount of information hampers the use of the information by healthcare providers, managers and administrators to promote quality of care. The need has therefore been expressed from the MUMCs to arrive at a compact set of indicators for administrators at the hospital level that can be deepened to the department and/or caregiver level where necessary.

By selecting the core set from already existing information, the registration burden does not increase further. To select a widely supported and useful core set of quality parameters, a modified Delphi method was chosen. This questionnaire survey of 48 stakeholders (administrators, intensivists, nurses and ex-IC patients and/or their relatives) yielded two core sets of ten quality parameters.

For both MUMCs, it yielded a (partly overlapping) core set of ten quality parameters. A striking finding is that the steering information selected contains relatively much qualitative information, such as 'points for improvement following complication discussions'. So people seem to be interested not only in figures, but rather in the story behind the figures.

The core sets were evaluated in two quarterly meetings between IC department management and the Executive Board and seem to add value to the dialogue on quality: the discussions actually focused on improving bottlenecks in care.

The method developed within this project forms a roadmap for other disciplines to distil a core set of quality parameters for directors from all the quality information collected.

The final report as well as more information on the Citrine Fund programme and the project can be found on the NFU website

In 2016, the Netherlands participated in the Commonwealth Fund's International Health Policy (IHP) Survey for the 11th year in a row. The 2016 survey was a comprehensive survey of 26,863 citizens from 11 western countries. In this report, we describe the Dutch results and compare our results with other countries and with the results of the survey in previous years.

The IHP-2016 survey shows that Dutch citizens' experiences with healthcare are good, although they also see room for improvement. The accessibility of care in the Netherlands is relatively good both in terms of GP care and medical specialist care. Compared to other countries, the Netherlands scores very high on several aspects of GP-patient communication in 2016. However, the Netherlands scores mediocre on respondents' assessment of the organisation of aftercare.

The study was produced with financial contributions from the Commonwealth Fund, the Ministry of Health, Welfare and Sport, and IQ healthcare. The report can be found here.

Quality, affordability and accessibility are the main issues of the healthcare system, and therefore also of physiotherapy care. Transparency plays an important role in this. An instrument for mapping practice variation in physical therapy care is the physical therapy treatment index. Cooperating health insurers have developed a uniform calculation method by which physiotherapy practices are no longer confronted with multiple, sometimes different, reports on their treatment intensity. This new method is examined in this report for validity, reliability and suitability for use.

The Physiotherapy Treatment Index uses claims data and compares the average number of sessions per client in a practice with the expected number of sessions per client based on client mix. This mirror information gives physiotherapy practices and health insurers insight into the (numerical) efficiency of the physiotherapy care provided.

The new calculation method for the uniform treatment index is valid and reliable. Use of the treatment index for the purpose: (1) 'mirror information' is possible, but still offers limited support for using it effectively in a Plan-Do-Check-Act (PDCA) cycle; (2) 'contracting' is possible, but drawing conclusions carefully is important; (3) 'choice information for clients' is currently not possible. An important next step is therefore to enrich the treatment index with quality information and patient experiences.

The study was commissioned by the SKMZ (Stichting Kwaliteits Monitoring Zorg) and conducted by Equalis in collaboration with researchers from the Talma Institute.

Read the full report or go to the final presentation treatment index physiotherapy.

In this policy briefing, we present the current state of the science on the effects of policies to control healthcare costs. We do this by first surveying all known literature on policy control options, and then we show which policies have been effectively implemented. A comparison between the two literature reviews shows where the blind spots are and where more research is needed, but also which measures offer opportunities for the Dutch context.

Read the full report here.

Task reallocation can improve the quality, accessibility and affordability of elderly care. However, the use of highly skilled healthcare professionals such as Nurse Specialists and Phyisician Assistants is still in its infancy. This is according to research by the Radboudumc and the Hogeschool van Arnhem en Nijmegen (HAN) funded by the Ministry of Health, Welfare and Sport. In this report, the researchers come up with recommendations with which organisations can better divide tasks.

Also read the article about this report on our website.

Download the report here.

The report 'Effective innovation in care' was commissioned by the Ministry of Finance to support the Interdepartmental Policy Research (IBO) 'Innovation in care'. The central question of the IBO was: what is the most effective government policy to promote the creation of effective innovations in healthcare and their implementation?

To support the IBO working group, we conducted a literature review on this topic. In the report, we examine the relationship between innovation and healthcare costs, and what role efficiency plays nationally and internationally in the admission of innovations to the insured package. We also look at the possible role of efficiency at the level of adoption by the healthcare provider. Finally, three case studies are discussed that illustrate the issues surrounding efficiency of innovation."
Our report forms an appendix to the IBO report. The full IBO report can be found on the government website.

When considering which care should and should not be reimbursed, great importance is attached to citizens' opinions. But how do you gain insight into citizens' opinions?
In this project, we investigated whether the Q-method is a suitable tool for this.
With the Q-method, you visualise the main opinions or attitudes on a certain topic . Our project focused on the reimbursement of infertility treatments: should they or should they not be reimbursed from the basic health insurance package?
This research shows that three value profiles can be distinguished: a group of people who advocate broad solidarity-based access to this care; a group who value more the emphasis on lifestyle and own risk and therefore find lower accessibility defensible, and finally ; people with a traditional attitude, who want to reserve this care for traditional couples and do not tolerate any interference from the government or insurer. The three profiles were found to have very limited correlation with characteristics of citizens.
Read the full report

The 2006 Health Insurance Act provides scope for selective healthcare purchasing but this is only applied to a limited extent in the Netherlands. In this report, we examine the limits and possibilities of selective purchasing. We do this by taking a closer look at the insurer-provider relationship within the contracting process of the US Medicare Advantage (MA) programme, a form of insurance with which there has been some 30 years of experience in the US.

Most studies on selective purchasing focus mainly on the efficiency gains to be achieved. However, the direct impact of selective purchasing on the quality of care is often not clear. With this study, we aim to contribute to the discussion on the potential impact of selective purchasing by analysing New York State's MA market and determining the extent to which healthcare purchasing is driven by quality purchasing.

Our results show that for selective purchasing to take full effect, a number of criteria must be met. The most important is that insurers have access to reliable performance information from healthcare providers. The use of quality-driven payment schemes (value-oriented payment schemes) can also contribute to improving the quality of care.
This leads to a number of policy recommendations, which you can read in the full report.

GPs and GP practices see training a VS or PA as an investment in the future of their practice or organisation. It is important that they first make a plan that includes a future vision for the practice before they start training. Now, it is still often the ambition of a POH or the demand of the post itself that is the reason.

Download the report.

Zinnige zorg in de laatste levensfase  van personen met darm- of longkanker: de 'praktijkfoto', September 2016.
This is a publication by IQ healthcare, Radboudumc, Integraal Kankercentrum Nederland (IKNL), Utrecht and VU medical centre (VUmc), Amsterdam. The study was commissioned by Zorginstituut Nederland, Diemen.

Rapport Zinnige zorg in de laatste levensfase van personen met darm- of longkanker: verdiepende analyses, September 2016
This is a publication by IQ healthcare, Radboudumc, Integraal Kankercentrum Nederland (IKNL), Utrecht and VU medical centre (VUmc), Amsterdam. The study was commissioned by Zorginstituut Nederland, Diemen.

Commissioned by the Healthcare Inspectorate (IGZ), this report offers tools to optimise the current surveillance strategy towards illegal drug trafficking via the internet. Specifically, it examined the possibilities for effective supervision of illegal drug trafficking via the internet and the measures the IGZ can take, as part of (inter)national agreements and legislation.

Read the full report
Read the report supplement

This report identifies the most prominent and noteworthy policy developments of the past five years in the Netherlands regarding "active and healthy ageing". It is an update of the Netherlands' RIS (Regional Implementation Strategy) of the MIPAA (Madrid International Plan of Action on Ageing) on national ageing policy, to the United Nations Economic Commission for Europe (UNECE).

Key messages
More and more countries are facing ageing and are implementing policies to manage this development appropriately. In this report, we chart the steps the Netherlands has taken in the past five years. The results that the Netherlands has achieved with its ageing policy are described according to the four goals of the Vienna Ministerial Declaration plan.

'Encouraging longer working lives'
In the Netherlands, this is encouraged by phasing out existing early retirement options and gradually raising the state pension age to 67. A link to life expectancy will follow after 2021.

'Participation of older persons and social inclusion'
The introduction of several national programmes supports the social participation of older persons. The most prominent developments are: the transition agenda 'living independently for longer', the action plan 'older people in safe hands' and the 'strengthening approach to loneliness'.

'Promoting, health and independence'
The main shift in policy on promoting health and independence is the reform of long-term care, more specifically the transition from the AWBZ to the Wmo, Wlz, Zvw and Youth Act. The other programmes under this heading facilitate and support this major reform.

'Intergenerational solidarity'
Intergenerational solidarity is formulated as a separate goal in the Vienna Ministerial Declaration plan, but in Dutch policy it is mainly considered an integrated part of the above goals.

• Partners involved are
• Client: VWS - Long-term care
• Sounding board group: representatives from the ministries of VWS, SZW, I&M, EZ, OCW and BZK
• Advice: NIDI, RIVM, SCP and CBS

Read the full report

Partners involved

Department of Social Medicine of the EMGO+ Institute/VUmc, IQ healthcare, Radboudumc, ParkinsonNet, Parkinson's Association, Consortium Quality of Care of the Dutch Federation of University Medical Centres (NFU) and the Care Institute of the Netherlands.

The project is part of NFU expert network Patient-reported outcomes.

Purpose of report

This report reports on an exploratory study among Parkinson's patients, neurologists, physiotherapists and PROM experts on the use of PROM information in the consulting room. Using PROMS in the consulting room seems possible and desirable under certain conditions.

Key message

Patients and healthcare providers are both positive about the use of PROMs in the consulting room. However, they differ on what should be discussed and who should take the initiative. Patients think PROMs should mainly be about choosing treatments and that the healthcare provider should take the initiative. On the contrary, healthcare providers are mostly positive about showing patients' own scores over time and about patients' use to compare healthcare facilities. Healthcare providers predominantly think that patients themselves should take the initiative to discuss this kind of information in the consulting room.

Opportunities for patient participation

The use of PROM information theoretically offers opportunities for improving patient participation in the consulting room. For instance, it can help facilitate choices about the treatment pathway or a healthcare facility and thus contribute to shared decision-making. Patients generally appear to understand PROM information well. Involved patients indicate that they want to discuss the outcomes with their healthcare provider.

Report

'PROMs voor de ziekte van Parkinson: van spreekkamer naar publiek en weer terug'

Last month, the Organisation for Economic Co-operation and Development (OECD, Paris) published the report "Better ways to pay for health care". This report describes nine alternative, future-proof financing models from seven different countries. Radboudumc' s Parkinson's care model is one of the examples presented. What makes this model so special?

In most countries, including the Netherlands, payments in healthcare rely on the so-called fee-for-service basis: a healthcare provider provides care, and that activity is then declared to the health insurer. This method results in healthcare providers having an incentive to provide as much care as possible. After all, those who provide more care can claim more. The method has thus helped tackle waiting lists, for example. However, there are also drawbacks to this payment method. For instance, it 'pays' for the healthcare provider to also provide unnecessary or undesirable care. Examples include unproven back surgery for low back pain or highly burdensome treatments for patients in the last stage of life. In Parkinson's care, this could include routine scans to confirm this clinical diagnosis. This ineffective care contributes to societal healthcare costs but not to patient health. For this reason, alternatives to the fee-for-service model are being widely experimented with worldwide.

Radboudumc, in collaboration with ParkinsonNet and two major insurers, has developed a new funding model for Parkinson's care. In this model, the hospital receives subscription fees per patient instead of payments per operation. Therefore, when Parkinson's care can be delivered at lower costs, the hospital keeps money. To prevent this savings incentive from eroding the quality of care, the hospital will make care outcomes transparent. These are outcomes not only of hospital care, but of the entire care chain (so also physiotherapists, occupational therapists, dieticians, etc.). In this way, healthcare providers can learn from each other's outcomes, and the incentive to provide more and more care shifts to an incentive to provide better and better care.

Inzicht in uitgevraagde variabelen voor kwaliteitsmetingen en handvatten voor verbetering.

KMPG Plexus Management summary June 2016

Since 1 January 2015, municipalities have been responsible for care and support close to home in their own neighbourhoods. Many municipalities deploy social neighbourhood teams to organise appropriate care and social support. In these neighbourhood teams, social workers with different professional backgrounds work together and call on the help of volunteers and informal carers. This new way of caring together in the neighbourhood raises a number of ethical issues that deserve attention, concludes the Centre for Ethics and Health (CEG). These are examined and described in this report.

Download the full report.

Specialist mental health care anno 2016

As things stand, most patients receive an amount of care in line with guideline recommendations. On an annual basis, the average number of treatment minutes now fluctuates between eleven hundred minutes (generalised anxiety disorder) and nineteen hundred minutes (schizophrenia). At the same time, there is a thirteen per cent group of patients within the specialist mental health services who are in treatment for long periods, with more than three thousand treatment minutes per year), and achieve relatively little health gain.

Clinicians themselves are positive about effective care, but also mention a number of barriers: treatments 'without health gains' may well be effective in preventing health loss or worrying side effects. The guidelines give little guidance on how to conclude a treatment. Also, it is often unclear whether a treatment is (permanently) effective and, in the short term, ending treatment requires more administrative effort than continuing treatment. In this situation, both practitioner and patient are not always reassured that a patient can return to the same practitioner if necessary.

Solutions for effective scaling-down in specialist mental health care
Treatment time can be used more efficiently by using new, more effective forms and methods of treatment, such as group therapies and blended therapy (combination of individual therapy, e-health and self-management).
2.Forty per cent of spending in specialist mental health care goes to the thirteen per cent group of patients who are treated the longest. The question is whether all these patients are best placed in specialist mental health care.
3.Current guidelines pay little attention to effective treatment, periodic evaluation and scaling down/ending treatment. Attention to this in the guidelines and training will give practitioners better tools to steer targeted and appropriate care.
Ideally, the reimbursement model should support the substantive direction and appropriate use of care. This is currently insufficiently the case. Further research is desirable into how the reimbursement model can better reflect the desired situation, with the removal of undesirable incentives to continue treatment and obstacles to effective 'scaling down' of care.

Finally, we recommend testing new policies in pilot projects. The various parties, professionals, care providers, referrers, health insurers, municipalities, etc. are still in the process of finding their role in the way things have been working for a few years now. They are better able in living labs to find the cooperation needed to achieve described goals.

Read the full report here.

For a ministerial conference on antimicrobial resistance (AMR), researchers from the Celsus academy published a report describing five inspiring good practices of AMR prevention in the Netherlands (in three hospitals, a nursing home and an organisation of general practitioners). Each of these 'good practices' has been developed into a business case in this report, and in each business case, the antimicrobial policy pursued was found to be cost-effective. Both in adequate use of antimicrobials and improved compliance with infection control measures.

Antimicrobial resistance (AMR) is one of the biggest threats to public health and affordability of care. Usually harmless conditions can become life-threatening due to resistant bacteria, and an additional problem is that there are virtually no new antimicrobial agents in development. Measures are needed that prevent AMR or significantly reduce its likelihood.

Each of the measures described in this report has investment costs, but whether these are low or high, a positive 'return on investment' and a short payback period are always possible for the Dutch situation (examples are: reduced use of contained antimicrobials, shorter admission time or less required care staff).

However, the most important gain is that patient health and safety were significantly improved (this through fewer antimicrobial prescriptions, fewer infections and/or less frequent resistance development).

AMR is a global problem, but a direct translation to European policy cannot be made on the basis of this report. The cost-effectiveness of each measure may be different in a different EU healthcare system. This report is meant to inspire optimal AMR prevention.

Read the full report and the paper released for this conference.

An international comparison of cost control instruments

The other countries in this comparison are Belgium, Germany, Sweden and the United States. In addition to similar levels of wealth, these countries, like England, represent a broad spectrum of systems and consider healthcare to be among the core functions of the state.

Conditional admission

All these countries use forms of conditional admission, a recent and important development. This tool prevents provision from being widely offered while its effectiveness is uncertain, and at the same time encourages future research and innovations. Application of this tool is currently concentrated on medicines in particular, but undoubtedly deserves wider application.

Supply management

Each of the countries studied applies some form of supply control. However, there are major differences between countries in the degree of central and decentralised control and the scope of the facilities for which this is deployed. Moreover, the responsibilities for regulation and financing do not always lie with one party.

4 case studies

Finally, using four case studies - the DaVinci robot, transplant medicine, paediatric oncology and rare diseases - we looked more specifically at instruments that countries deploy when introducing these new expensive care facilities. These four cases show many similarities in terms of regulation: it is 'minimal' in recent robotic surgery, quite intensive in transplant medicine, stimulating rather than controlling in rare diseases, and in paediatric oncology, given the large number of facilities, self-regulation seems to be the norm.

Read the full report Cost containment of expensive healthcare facilities here.

The influence of fiscal institutions on health care policy in the United States and the Netherlands.

Wat domineert het zorgbeleid: begrotingsregels of de politieke arena?

"Laat zien wat je waard bent!"Embedding basic set of quality indicators Physiotherapy in (cardio)thoracic and abdominal surgery into the Plan-Do-Check-Act quality cycle.
Through Measurement to Improvement

The Emergency Care Knowledge Network (IQ healthcare department, Radboudumc) has released its 2015 annual report. The report provides information on the team's research, publications and educational activities.

Extra attention has been given to the NHG Framework Training "GP and Emergency Care", the national survey on X-ray diagnostics at the GP outpatient clinic and the development of the questionnaire on patient experiences in primary care.

Do you have any questions or research ideas? Please email paul.giesen@radboudumc.nl or marleen.smits@radboudumc.nl.
You can download a PDF of the annual report here.

In 2013, the Ministry of Health, Welfare and Sport set up the Wastage Reporting Point, where citizens can report the wastage they observe in healthcare. However, because this is anecdotal information, it is not yet possible to say anything about the extent and distribution of waste in Dutch healthcare on the basis of these reports. The Celsus academy was therefore commissioned by the Long-term Care Directorate of the Ministry of Health, Welfare and Sport to map what is known in the scientific literature about waste in long-term care.

We explored the literature for the five themes that deal with current wastage. These are: 1) reduce inappropriate care; 2) improve the primary process; 3) reduce food disposal; 4) reduce administrative burden and overhead; and 5) reduce fraud.... It appears that little scientific research has been done on waste within long-term care. The most evidence is on food waste, a topic on which several initiatives are ongoing.

We also explored regional variation in long-term care use with and without stay. Practice variation can be an indication of over- or under-use. The exploratory analyses in this report are not sufficiently robust to draw a far-reaching conclusion. Nevertheless, there are indications of waste within Dutch long-term care, given the variation in use of care with and without a stay between regions.

Read the report for more information!

Evaluatie van adviestrajecten bij problematisch ziekteverzuim.

"Laat zien wat je waard bent!"Embedding basic set of quality indicators Physiotherapy in (cardio)thoracic and abdominal surgery into the Plan-Do-Check-Act quality cycle.
Through Measurement to Improvement

The Emergency Care Knowledge Network (IQ healthcare department, Radboudumc) has released its 2014 annual report.

In 2014, the knowledge network researchers published 11 scientific articles and 15 reports. The titles of these can be found in the annual report.
Extra attention was given to the development of the national triage core set, the arrival of the framework training programme 'GP and Emergency Care' and the promotion of Wendy Thijssen (SEH doctor).

The annual report also includes a wish list for future research based on research, bottlenecks and wishes from "the field".

Do you have any questions or research ideas? Please email paul.giesen@radboudumc.nl or marleen.smits@radboudumc.nl.
You can download a PDF of the annual report here.

International Health Policy Survey 2014. M.J. Faber, T. van Loenen, G.P. Westert

Veiligheidsbeleid in de langdurige zorg. De rol van bestuurders bij patiëntveiligheid
Drs. Loes von Dusseldorp, Dr. Lisette Schoonhoven, Dr. Hub Hamers
Nijmegen

Wassen zonder water - Kosten effectiviteit van een zich snel verspreidende verpleeghuisinterventie voor zorgafhankelijke patiënten. Algemene samenvatting. Dr. Betsie van Gaal, Drs. W. Geense, Dr. L. Schoonhoven, Prof. dr. Theo van Achterberg

An exploratory international comparison

Omvang en financiering van het basispakket; Een verkennende internationale vergelijking.

Evaluatie Pilot Visitatiemodule
Drs. Juliette Cruijsberg, Dr. Jozé Braspenning

Masterplan voor het Nederlands expertisecentrum Prader-Willi syndroom. M.Harmsen, M. Ouwens

Monitoring vaccinatiegraad Nationaal Programma Grieppreventie 2012 B. Jansen, M. Tacken, J. Mulder, J. Korevaar, A. Schlief, W. Tiersma, J. Braspenning

Monitoring vaccinatiegraad Nationaal Programma Grieppreventie 2012. B. Jansen, M. Tacken, J. Mulder, J. Korevaar, A. Schlief, W. Tiersma, J. Braspenning

Research report on the use of Nurse Specialists at the Eindhoven Emergency Department.

Read the full report

Een pas op de plaats Implementation of lifestyle interventions in patient care

Drs. Irene van de Glind, Dr. Maud Heinen, Prof. dr. Theo van Achterberg

Implementatie van leefstijlinterventies in de patiëntenzorg

Nijmegen, mei 2013

drs. Irene van de Glind

dr. Maud Heinen

prof.dr. Theo van Achterberg

Onnodige zorg in de Nederlandse gezondheidszorg, gezien vanuit het perspectief van de huisarts.

Deelonderzoek 1. Ervaren kwaliteit triage MKA in Nederland. Keizer E, Peters Y, Smits M, Gijsen R, Kommer GJ, Huibers L, Giesen P. Nijmegen, IQ healthcare/RIVM, 2013

Deelonderzoek 2: inventarisatie triage ambulancezorg in Westerse landen: Literatuurstudie en Enquête. Keizer E, Huibers L, Gijsen R, Peters Y, Smits M, Kommer GJ, Giesen P. Nijmegen, IQ healthcare/RIVM, 2013

De HARING-tools. Dertien instrumenten voor ondersteuning bij het opstellen, herzien, implementeren en evalueren van richtlijnen. M. Hilbink, M. Ouwens, T. Kool

Towards outcome financing in Dutch healthcare; current and future possibilities

No cure, no pay? Onderweg naar uitkomstbekostiging  in de Nederlandse zorg; huidige en toekomstige mogelijkheden.

Universal challenge: sustainable long-term care.

Voorstudie Functioneel Ontwerp landelijk register professionele standaarden en meetinstrumenten.

International Health Policy Survey 2012. Commonwealth Fund. Onderzoek onder huisartsen in 11 landen. Dr. MJ Faber,T van Loenen, MSc, Prof. dr. GP Westert.

De toetsing van toetsingsinstrumenten. Evaluatie van toetsingsinstrumenten van patiëntenorganisaties vanuit diverse perspectieven. Drs. S. Winters, Drs. J. Wammes , Dr. M.Ouwens, Dr. M. Faber.

De relatie tussen volume en kwaliteit van zorg. Tijd voor een brede benadering. Teun Zuiderent-Jerak. Tijn Kool, Jany Rademakers

Monitoring vaccinatiegraad. Nationaal Programma Grieppreventie 2011. B. Jansen, M. Tacken, J. Mulder, S. Visscher, A. Schlief, W. Tiersma, J. Braspenning

Keuzehulp. ziekenhuiszorgIndicatorclustering en reductie. Dr. M. Faber, Drs. Linda de Gouw, Dr. Mirjam Harmsen

Kiezen borstkankerpatiënten voor kwaliteit? Borstkankerpatiënten over vergelijkende kwaliteitsinformatie borstkankerzorg.
Dr. Maaike Dautzenberg. Drs. Jan-Willem Weenink, Dr. Marjan Faber, Dr. Mariëlle Ouwens

Kwaliteitsindicatoren. Eerstelijns Fysiotherapie (Kwaliefy). Uitvraag en gebruik 2011. S. van Dulmen, H. Calsbeek, J. Cruijsberg, J. Koetsenruijter, J. Braspenning

Attitudes en zorg van huisartsen ten aanzien van patiënten met overmatig alcoholgebruik. Drs. M. Keurhorst, Drs. G, van de Ven, Drs. E, Keizer, Dr. M, Laurant

Vroegsignalering en korte interventies: een vragenlijststudie onder medisch specialisten, verpleegkundigen en afdelingshoofden. Drs. M. Keurhorst, Drs. E. Keizer, Drs. J. Cruijsberg, Dr. M. Laurant

De wijkverpleegkundige van de toekomst .Myrna Keurhorst, MSc,Sanne Kusters, MSc, Dr. Miranda Laurant

Ondersteuning van huisartsen en ziekenhuizen bij vroegsignalering en kortdurende interventies door de verslavingszorg- en GGZ-instellingen. Drs. M. Keurhorst, Drs. E. Keizer, Drs. J. Cruijsberg, Dr. M. Laurant