Biomedical subjects

N S Klazinga

Publications and source records attributed to N S Klazinga.

At least 19 recordsLinked to original sources

PubMed2006

The effect of national guidelines on the implementation of outpatient preoperative evaluation clinics in Dutch hospitals.

BACKGROUND AND OBJECTIVES: Preoperative evaluation performed by anaesthesiologists primarily aims to estimate the risk of perioperative complications and to create opportunities to optimize the patients' condition before surgery. In this study an inventory was made of the current practice of preoperative evaluation in Dutch hospitals. It was estimated how many hospitals had implemented an outpatient preoperative evaluation clinic in 2004. Subsequently, current practice was compared with the results of a previous inventory (2000). It was also evaluated to what extent the guidelines of the Dutch Health Council and the Netherlands Society of Anaesthesiology were followed. METHODS: The study consisted of two phases. First, a literature research was performed and pilot interviews were constructed. The interviews were conducted face-to-face with anaesthesiologists in a sample of Dutch hospitals. Based on the results, written questionnaires were constructed. In the second phase these questionnaires were sent to all general and academic hospitals in the Netherlands. RESULTS: In 2004, 74% of the hospitals had an outpatient preoperative evaluation clinic, compared with 50% in 2000. The percentage of hospitals with an outpatient preoperative evaluation clinic available for all elective patients increased from 20% to 52%. CONCLUSIONS: The Dutch guidelines on preoperative evaluation seem to have influenced current practice. An increase in the number of outpatient preoperative evaluation clinics was seen after the guidelines were published. The implementation of an outpatient preoperative clinic seems to warrant that anaesthesiologists are carrying out the activities prescribed by the guidelines. Most hospitals without a clinic aim to implement one in the future.

Anesthesia Department, Hospital↗

PubMed2006

Local health systems in 21st century: who cares?-An exploratory study on health system governance in Amsterdam.

BACKGROUND: There is a growing awareness that there should be a public health perspective to health system governance. Its intrinsic population health orientation provides the ultimate ground for determining the health needs and governing collaborative care arrangements within which these needs can be met. Notwithstanding differences across countries, population health concerns are not central to European health reforms. Governments currently withdraw leaving governance roles to care providers and/or financiers. Thereby, incentives that trigger the uptake of a public health perspective are often ignored. METHODS: In this study we addressed this issue in the city of Amsterdam. Using a qualitative study design, we explored whether there is a public health perspective to the governance practices of the municipality and the major sickness fund in Amsterdam. And if so, what the scope of this perspective is. And if not, why not. RESULTS: Findings indicate that the municipality has a public health perspective to local health system governance, but its scope is limited. The municipality facilitates rather than governs health care provision in Amsterdam. Furthermore, the sickness fund runs major financial risks when adapting a public health perspective. It covers an insured population that partly overlaps the Amsterdam population. Returns on investments in population health are therefore uncertain, as competitors would also profit from the sickness fund's investments. CONCLUSION: The local health system in Amsterdam is not consistently aligned to the health needs of the Amsterdam population. The Amsterdam case is not unique and general consequences for local health system governance are discussed.

Cities↗

PubMed2006

[Historical health posters as expressions of public health dilemmas].

Historical health posters as expressions of public health dilemmas. The University of Amsterdam's historical collection of health and safety posters (1914-1960) from various countries deals primarily with workplace safety, infectious diseases and the early detection of cancer. Distinct underlying socio-medical dilemmas emerge in four areas: the industrial-political issues behind promoting responsible behaviour in the workplace; class issues in public tuberculosis education; public morality in anti-venereal propaganda, and dealing with fear and hope in the management of cancer. The main goal of the historical posters was to establish a general awareness of both health and individual responsibility. Yet this collection illustrates how socio-medical, political and cultural contextual factors strongly influenced the message and style of the posters.

Advertising↗

PubMed2006

Evidence-based re-engineering: re-engineering the evidence--a systematic review of the literature on business process redesign (BPR) in hospital care.

PURPOSE: Business process redesign (BPR) is used to implement organizational transformations towards more customer-focused and cost-effective care. Ideally, these innovations should be carefully described and evaluated so that "best practices" can be re-applied. To investigate this, available evidence was collected on patient care redesign projects. DESIGN/METHODOLOGY/APPROACH: The Ebsco Business Source Premier, Embase and Medline databases were searched. Studies on innovations related to re-engineering patient care that used before-after design as minimum prerequisites were selected. General characteristics, logistic parameters and other outcome measures to determine the objectives and results and interventions used were looked at. FINDINGS: A total of 86 studies that conformed to the criteria were found: a minority mentioned measurable parameters in their objectives. In the majority of studies, multiple interventions were combined within single studies, making it impossible to compare the effects of individual interventions. Only three randomized controlled trials were found. Furthermore, inconsistencies were noted between the study objectives and the reported results. Many more issues were reported in the results than were mentioned in the study aims. It would appear that publications were hard to find owing to a lack of specific MeSH headings. Nearly 7,500 abstracts were scanned and from these it was concluded that clear and univocal research methods, terms and reporting guidelines are advisable and must be developed in order to learn and benefit from BPR innovations in health care organizations. ORIGINALITY/VALUE: This appears to be the first time available evidence about redesign projects in hospitals has been systematically collected and assessed.

Evidence-Based Medicine↗

PubMed2005

[Dutch medical specialists as authors of scientific publications in English on clinical drug research (1997/'03)].

OBJECTIVE: To determine the number and type of medical specialists in Dutch hospitals that were authors of scientific papers published in English in the field of clinical drug research in the period 1997/'03. DESIGN: Descriptive. METHOD: PubMed was searched for articles on clinical drug research published in February 1997-January 2003. (Co)authors were included if they were registered in the Geneeskundig Adresboek 2002-2003 (Medical Address Book 2002-2003) as a medical specialist working in a hospital. Hospitals were categorized as academic, non-academic teaching, general or non-affiliated. Journals were categorized by the type of published research: fundamental or biomedical, disease-specific, or specialty-specific. RESULTS: A total of 1776 articles in 426 journals were retrieved with at least 1 medical specialist listed as a (co)author. 1728 medical specialists were identified as authors, which represents 11% of the 16.065 registered medical specialists in The Netherlands. Most authors were involved in the nonsurgical specialties, primarily internist subspecialties, followed by paediatrics, cardiology, and neurology. The authors were employed in nearly all Dutch hospitals. The 1728 specialists had a total of 4952 authorships; 57% of the authors and 70% of the authorships came from academic hospitals. The average impact factor, the number of articles and the number ofauthorships were greatest in the disease-specific journal category. In the period 1997/'03 the number of authorships from non-academic teaching hospitals and general hospitals decreased, while the number of authorships from academic hospitals increased, particularly with regard to the number of co-authorships.

Humans↗

PubMed2005

Implementing global knowledge in local practice: a WHO lung health initiative in Nepal.

Clinical practice guidelines are used widely to improve the quality of primary health care in different health systems, including those of low-income countries. Often developed at international level and adapted to national contexts to increase the feasibility of effective uptake, guideline initiatives aim to transfer global scientific knowledge into local practice. The WHO's Practical Approach to Lung Health (PAL) is an example of such an initiative and is currently being developed to improve the quality of care for youths and adults with respiratory diseases. We assessed ex-ante the feasibility of successful implementation of PAL in a pilot programme in rural Nepal, studying three components: the quality of the innovation (i.e. the guidelines), the effectiveness of the implementation strategy (i.e. training) and the receptiveness of the social system of health staff at all levels (i.e. social and organizational characteristics). We assessed the guideline innovation with the AGREE instrument for guidelines, the intended implementation strategy by critical comparison with literature on effective strategies, and the social system with both a stakeholder analysis and a descriptive analysis of the health care system at district level. This ex-ante assessment of an adaptive local implementation of international WHO guidelines showed that in July 2002 the 'implementability' of the package was challenged on the three components studied. To increase the chances of successful implementation, the national guideline development process should be improved and the implementation strategy needs to be upgraded. In order to successfully transfer global knowledge into local practice, we need to develop additional multifactorial sustained interventions that tackle other culture-specific and health system-specific barriers as well. The primary health workers are key informants for these barriers.

Community Health Services↗

PubMed2004

[Prevention demands a more ambitious approach. Response to the cabinet policy document 'Live healthier for longer 2004-2007; also a matter of healthy behavior'].

In the cabinet policy document 'Live healthily for longer 2004-2007; also a matter of healthy behaviour' the Dutch Secretary of State for Health, Welfare and Sport assumes that many health problems are linked to behaviours such as smoking and lack of physical activity. He places the prime responsibility for that with the citizens and also with local councils, trade and industry, care providers and schools. However conscious behavioural choices by individual citizens form only a small part of the cause-effect chain that leads to ill health. It is incorrect to ascribe the differences in unhealthy behaviour to freely made behavioural choices. Moreover it begs the question as to whether the proposed measures will be effective. Over and above all this, the finances that are available to strengthen preventative measures are completely inadequate. The central government should be encouraging the health care sector to devise a more central position for prevention and ensuring that effective opportunities for prevention are used as much as possible. After all, it is expected of the central government that it will look after the collective interests and protect and promote the health of the population. The necessary improvements can only be achieved through a much more ambitious approach than that presented by the cabinet.

Exercise↗

PubMed2004

An implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis of the knee and hip.

Implementation studies are recommended to assess the feasibility and effectiveness in real-life of programmes which have been tested in randomized controlled trials (RCTs). We report on an implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis (OA) of the knee or hip. Three types of primary health-care providers (n = 18) delivered the OA Knee programme (n = 20) and the OA Hip programme (n = 20), supported by programme manuals and implementation guidelines, in four regions. The outcome measures were pain and mobility. The Knee programme had OA knowledge and self-efficacy as additional outcome measures. Differences in outcome measures and background variables of participants were assessed between the RCTs and the implementation study. Positive effects (P < 0.05) were found for OA knowledge, pain and self-efficacy in the Knee programme (n = 157), and for pain in the Hip programme (n = 132). No effect was found for mobility. Effect sizes of the RCTs and the present study were comparable. Background variables did not explain the variance in the outcome measures. The outcomes of the previous RCTs and the implementation study were comparable, and indicated the ecological validity of the two programmes. The implications for nationwide dissemination and implementation in The Netherlands are discussed.

Aged↗

PubMed2004

Developing a national performance indicator framework for the Dutch health system.

OBJECTIVE: To report on the first phase of the development of a national performance indicator framework for the Dutch health system. METHODS: In January 2002, we initiated an informed interactive process with the intended users-policymakers at the Ministry of Health, Welfare and Sport-and academics to develop both the conceptual framework and its content. Decisions were based on consensus after discussing strategic goals of the health system, information needs of policy makers at the Ministry of Health, Welfare and Sport, and studying existing theory and international experiences with national performance indicator frameworks. We identified objectives and criteria for a framework at the national level, constructed a conceptual model, and selected indicator areas. RESULTS: As a starting point we chose a balanced scorecard reflecting four perspectives towards health system management information at the national level. These perspectives are consumer orientation, finances, delivery of high quality care, and the ability to learn and grow. We then linked the Lalonde model for population health to a balanced scorecard model. The constructed model makes the relationship between population health and health system management apparent, and facilitates the presentation of performance information from various perspectives. The model reflects the strategic goals of the Dutch health system, i.e. contributing to the production of health by providing necessary health care of good quality that is accessible for all Dutch citizens while simultaneously informing policy makers about the performance of the entire health system in all sectors (care, cure, prevention, and social services). The selected indicator areas for health system management information (20 in total) reflect the policy and management functions of the government and the defined public goals of the health system. The model was formally adopted by the Ministry of Health, Welfare and Sport in February 2003, and since then individual indicator areas have been operationalized by 30 representatives of various departments at the Ministry with continuous external research support. CONCLUSION: The merit of linking the balanced scorecard inspired model to public health data is that it facilitates the visualization of the contribution of the health system to the improvement of population health. The method of an intensive interactive indicator development process between policy makers and researchers has so far proven successful.

Delivery of Health Care↗

PubMed2004

How safe is the safety paradigm?

This paper reviews safety initiatives in the health systems of the UK, Canada, Australia, and the US. Initiatives to tackle safety shortcomings involve public-private collaborations. Patient safety agencies (to institute learning, action and safety culture), adverse event reporting and, to a lesser extent, safety related performance indicators are currently used to design safer health systems. Their benefits are mixed, but there is little debate as to their possible side effects. Foreseeable adverse effects of multiple safety organisations stem from them being too many, too vague, too narrowly focused, threatened by the medical practice environment, and too optimistic. Safety related performance indicators are most developed in the US but suffer from inadequacies of administrative data, underreporting, variable indicator definitions, "extended" use, and low sensitivity of the diagnosis coding system, and arguable preventability of the prescribed conditions. A critical appraisal of the implications of these deficiencies is important to assure the safety of current health system safety initiatives and to establish evidence based safety. It is necessary to embed health system safety (as well as patient safety) in the societal culture, structures, and policies which promote effective, user centred, high performance care while allowing for healthy innovation.

Australia↗

PubMed2003

[Cardiovascular risk factors for Surinamese in the Netherlands: a literature review].

OBJECTIVE: To obtain an overview of the prevalence of cardiovascular risk factors in Surinamese (Hindustani and Creoles) individuals in the Netherlands and the implications of this for secondary prevention. DESIGN: Literature study. METHOD: A Medline literature search was carried out for the period 1985-2001 with the keywords 'cardiovascular risk factor' or 'cardiovascular risk factors', and 'Surinamese'. In addition to this, so-called grey literature was searched and the reference lists of articles found were also checked. A total of 7 studies were selected. RESULTS: Smoking is less frequent among Surinamese individuals in the Netherlands compared to the indigenous population, especially in women. The prevalence of both hypertension and diabetes is higher among the Surinamese. Data on dyslipidaemia are almost absent; it is only known that hypercholesterolaemia is less prevalent among the Surinamese. Ethnicity is not included in the risk cards used in the secondary treatment of cardiovascular diseases. CONCLUSION: The lack of research with respect to the cardiovascular risk profile of Surinamese (Hindustani and Creoles) in the Netherlands indicates an unfavourable profile compared to the indigenous Dutch population. This difference justifies further research into the differentiation of prevention and treatment according to ethnic origin.

Adolescent↗

PubMed2003

Supporting Dutch medical specialists with the implementation of visitatie recommendations: a descriptive evaluation of a 2-year project.

OBJECTIVE: To improve the quality of patient care by supporting the implementation of practice-specific visitatie (external peer review) recommendations. DESIGN: A descriptive evaluation of an intervention strategy (Quality Consultation). Data collection through participatory observation, telephone interviews, and a postal survey. SETTING: Twenty-five specialist group practices (67 specialists) from the specialty societies of surgeons, paediatricians, and gynaecologists, supported in their implementation efforts by two experienced management consultants. INTERVENTION: Approximately 20 h of management consultancy. The Quality Consultation took a site-specific multifaceted implementation approach; its tool kit consisted of various management and quality improvement support methods. MAIN MEASURES: Choice of recommendations supported; type of interventions offered; degree of implementation; appreciation of implementation results and process; and impact of management consultants as assessed by participants. RESULTS: The level of participation was high and evaluation of the consultants and the impact of their support positive. Most implementation projects were related to strategic issues or the functioning of the specialist group. Every specialist group was offered multiple interventions, both participatory and non-participatory. The degree of implementation was rated 4.0 on a 5-point scale; the scores for the implementation result and process were 6.6 on a 10-point scale. CONCLUSIONS: Visitatie seems to inherently enforce the development of management of medical specialist care. This might also be true for other external peer review models. The development of effective specialist groups deserves high priority in order to implement visitatie recommendations successfully. Management consultants can be instrumental in this process.

Clinical Medicine↗

PubMed2003

Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement.

ISSUES: Countries and international organizations have recently renewed their interest in how health systems perform. This has led to the development of performance indicators for monitoring, assessing, and managing health systems to achieve effectiveness, equity, efficiency, and quality. Although the indicators populate conceptual frameworks, it is often not very clear just what the underlying concepts might be or how effectiveness is conceptualized and measured. Furthermore, there is a gap in the knowledge of how the resultant performance data are used to stimulate improvement and to ensure health care quality. ADDRESSING THE ISSUES: This paper therefore explores, individually, the conceptual bases, effectiveness and its indicators, as well as the quality improvement dynamics of the performance frameworks of the UK, Canada, Australia, US, World Health Organization, and Organisation for Economic Co-operation and Development. RESULTS: We see that they all conceive health and health system performance in one or more supportive frameworks, but differ in concepts and operations. Effectiveness often implies, nationally, the achievement of high quality outcomes of care, or internationally, the efficient achievement of system objectives, or both. Its indicators are therefore mainly outcome and, less so, process measures. The frameworks are linked to a combination of tools and initiatives to stimulate and manage performance and quality improvement. CONCLUSIONS: These dynamics may ensure the proper environment for these conceptual frameworks where, alongside objectives such as equity and efficiency, effectiveness (therefore, quality) becomes the core of health systems performance.

Australia↗

PubMed2002

Urgency coding as a dynamic tool in management of waiting lists for psychogeriatric nursing home care in The Netherlands.

Criteria are used to prioritise patients on waiting lists for health care services. This is also true for waiting lists for admission to psychogeriatric nursing homes. A patient's position on these latter waiting lists is determined by (changes in) urgency and waiting time. The present article focuses on the process and outcome of an urgency coding system in a fair selection of patients. It discusses the use of urgency codes in the daily practice of waiting list management and the related waiting times. Patients and their informal caregivers were followed from entry on the waiting list to admission to a nursing home. Caregivers were interviewed during the waiting period and after their relative's admission to a nursing home, and the formal urgency codes on the waiting list were monitored. Seventy-eight of the initial 93 patients were admitted to a nursing home. High urgency codes were commonly assigned and the waiting times were shorter for patients with higher urgency codes. Negative consequences of an urgency coding system, e.g. patients with less urgency not being admitted at all and patients not being admitted to the nursing home of their choice, could not be demonstrated. Patients without higher urgency codes were admitted after a mean waiting time of 28 weeks. It may be questioned whether this long waiting time is problematic, because satisfaction of the caregivers with regard to waiting times was not influenced by the actual waiting times. An urgency coding system enables health care professionals to react to changes in the situation of both patients and caregivers by adjusting urgency codes to influence the length of time until nursing home admission.

Aged↗

PubMed2002

Cost-effectiveness of a family and DNA based screening programme on familial hypercholesterolaemia in The Netherlands.

AIMS: To estimate the cost-effectiveness of the current screening programme on Familial Hypercholesterolaemia (FH) in relatives of diagnosed FH-patients in The Netherlands. METHODS AND RESULTS: Data from 2229 screened FH-relatives, including age, sex, risk factor status and screening outcome, were combined with the Framingham risk function and national disease-specific cost data to arrive at a model-based comparison of survival and costs, with and without the screening programme. Cost-effectiveness ratios were computed for various treatment strategies, with no screening as reference. Costs per life year gained varied between 25.5- and 32-thousand Euros, depending upon the precise treatment strategy after a positive screen. The costs for screening (tracing the FH-positive individuals) were much lower than the follow-up costs (treatment), of which 80% were costs for statins. Consequently, the costs per life year gained of alternative screening programmes are about the same. CONCLUSION: The cost-effectiveness ratio of FH screening is within the range requiring explicit political consideration in The Netherlands. As the costs of statin treatment are the single most important determinant of costs, policy decisions reduce to decisions on the acceptability of statin treatment for this risk group. Pending major changes in statin price, clear guidelines should be developed on how screen positive individuals should be treated, since not all of them have an elevated cholesterol level.

Adolescent↗

PubMed2002

Community-based integrated care: myth or must?

ISSUE: In spite of the many efforts that have been made to rationalize and improve the functioning and the quality of health care delivery in industrialized countries, too limited a degree of success has been achieved so far. This paper argues that this limited success originates from a lack of coherence among the various strategies and instruments developed to rationalize and improve the delivery of health care. ADDRESSING THE ISSUE: This fact can be shown by reducing the complexity of today's health care into three levels of decision making: the primary process of patient care, the organizational context, and the financing and policy context of health care systems. Distinct rationales exist on each of these three levels of decision making as actors have their own perspectives, cultures, disciplines, and traditions concerning the delivery of health care. These differences can often result in ambiguity of goals, conflicting interests between decision makers, bureaucracy, poor information transfer, and limited use of the available scientific knowledge on all three levels. In such a context, rationalization and quality-improvement efforts are frustrated and will have limited effectiveness. Therefore, the various rationalization strategies and instruments on all three levels of decision making should be embedded in our health care systems in a synergistic way. DEMONSTRATING THE PROPOSED SOLUTION: Community-based integrated care is a promising approach to addressing this issue successfully. How this concept might function as a unifying concept for quality improvement will be illustrated by relevant developments in the Academic Medical Center, University of Amsterdam in The Netherlands.

Community Health Services↗

PubMed2001

A policy analysis of the introduction and dissemination of external peer review (visitatie) as a means of professional self-regulation amongst medical specialists in The Netherlands in the period 1985-2000.

By examining the introduction and dissemination of external peer review through site-visits (visitatie) amongst Dutch medical specialists, this paper sets out to deepen our insight into the dynamics of professional self-regulation and health care policy making. We explore how visitatie has been used in the political process between medical specialists and the state, serving as a strategy in protecting the autonomy of physicians. In the late eighties and early nineties, factors both internal as well as external to the medical profession all together determined the start and spread of visitatie. The conflict between state and doctors over the specialists' income, the introduction of the market oriented policies, new visions on quality assurance, the debate on the future of medical specialistic care and a new legal framework on quality assurance, challenged the medical community to find ways to reconfirm the public's trust in the self-regulating mechanism of the profession. One answer is found in carrying out 300-400 visitaties annually. During the past years, many stakeholders have perceived visitatie as a credible instrument in assuring quality patient care. The dynamics of professionalization and measurable impact of visitatie will determine whether or not it is here to stay.

Health Services Research↗

PubMed2001

Medical audit: threat or opportunity for the medical profession. A comparative study of medical audit among medical specialists in general hospitals in The Netherlands and England, 1970-1999.

Medical audit has been introduced among hospital specialists in both the Netherlands and England. In the Netherlands following some local experiments, medical audit was promoted nationally as early as 1976 by the medical profession itself and became a mandatory activity under the Hospital Licensing Act of 1984. In England it was the government who promoted medical audit as a compulsory activity for medical specialists, in particular since 1989. In this article the development and introduction of medical audit in the two health care systems is described and its impact on the clinical autonomy of medical specialists gauged. It is concluded that in both countries external pressures seem to have been crucial in the 'compulsory' introduction of medical audit. Although there are differences in the organisation and culture of the medical profession in the two countries, in both countries medical audit turned out to be an instrument 'controlled' by the profession itself. The question whether medical audit is instrumental in preserving clinical autonomy has also been addressed. Our conclusion is that in its present form medical audit in the two countries has not been a threat to the clinical autonomy of the medical profession. At the same time it is clear that the study of one quality instrument is insufficient to draw conclusions about the development of clinical autonomy, let alone autonomy in general. Moreover, it remains to be seen how medical audit can survive alongside quality improvement mechanisms such as accreditation, certification, performance indicators and formal quality systems (ISO, EFQM) where hospital management executes more control. The history of medical audit in the Netherlands and England over the past 30 years does illustrate, however, the capability of the profession to maintain autonomy through re-negotiated mechanisms for self-control.

England↗