eHealth is most effective when integrated into conventional health care in a “hybrid” health care model. In order to achieve high-quality hybrid health care, eHealth must benefit patients and must... Show moreeHealth is most effective when integrated into conventional health care in a “hybrid” health care model. In order to achieve high-quality hybrid health care, eHealth must benefit patients and must be effectively integrated and organized within regular health care. This thesis describes the evaluation of eHealth from both a patient perspective and an organizational perspective. Chapters 2 and 3 present patients’ views of an online patient portal. Chapters 4 and 5 describe the factors that affect the organization of high-quality hybrid health care and use these as inputs to develop a tailored quality management model and accompanying self-assessment questionnaire: the Hybrid Health Care Quality Assessment (HHQA) (Chapter 5). Health care organizations can use the model and questionnaire to gain insight into ways of improving the quality of their hybrid care. Show less
Noorduyn, J.C.A.; Graaf, V.A. van de; Willigenburg, N.W.; Scholten-Peeters, G.G.M.; Mol, B.W.; Heymans, M.W.; ... ; ESCAPE Res Grp 2022
Purpose Marker-by-treatment analyses are promising new methods in internal medicine, but have not yet been implemented in orthopaedics. With this analysis, specific cut-off points may be obtained,... Show morePurpose Marker-by-treatment analyses are promising new methods in internal medicine, but have not yet been implemented in orthopaedics. With this analysis, specific cut-off points may be obtained, that can potentially identify whether meniscal surgery or physical therapy is the superior intervention for an individual patient. This study aimed to introduce a novel approach in orthopaedic research to identify relevant treatment selection markers that affect treatment outcome following meniscal surgery or physical therapy in patients with degenerative meniscal tears. Methods Data were analysed from the ESCAPE trial, which assessed the treatment of patients over 45 years old with a degenerative meniscal tear. The treatment outcome of interest was a clinically relevant improvement on the International Knee Documentation Committee Subjective Knee Form at 3, 12, and 24 months follow-up. Logistic regression models were developed to predict the outcome using baseline characteristics (markers), the treatment (meniscal surgery or physical therapy), and a marker-by-treatment interaction term. Interactions with p < 0.10 were considered as potential treatment selection markers and used these to develop predictiveness curves which provide thresholds to identify marker-based differences in clinical outcomes between the two treatments. Results Potential treatment selection markers included general physical health, pain during activities, knee function, BMI, and age. While some marker-based thresholds could be identified at 3, 12, and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times. Conclusion This novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. However, this study may serve as an exemplar for other orthopaedic trials to investigate the heterogeneity in treatment effect. It will help clinicians to quantify the additional benefit of one treatment over another at an individual level, based on the patient's baseline characteristics. Show less
This study reports the findings of a 2.5 year intervention project to reduce psychosocial risks and increase employee well-being in 15 emergency departments in the Netherlands. The project uses the... Show moreThis study reports the findings of a 2.5 year intervention project to reduce psychosocial risks and increase employee well-being in 15 emergency departments in the Netherlands. The project uses the psychosocial risk management approach “PRIMA” which includes cycles of risk assessment, designing and implementing changes, evaluating changes and adapting the approach if necessary. In addition, principles of participative action research were used to empower the departments in designing and implementing their own actions during the project. Next to determining overall effects, the study aims to assess potential moderators including the level of intervening (organization-directed or multilevel), process variables (the number and fit of actions to risk factors, communication and employee participation) and partaking in a Psychosocial Safety Climate intervention offered during the second half of the project. The results of linear mixed-model analyses showed that all job factors improved with the exception of autonomy, which did increase halfway the project but not when considering the entire timeframe. In addition, work engagement decreased and symptoms of burnout remained stable. Emergency departments that implemented more fitting actions, communicated better and involved their employees more in the process, had more favorable changes in job factors and more stable well-being. More activity (based on the number of actions implemented) and a multilevel approach regarding stress management did not lead to greater improvements. The Psychosocial Safety Climate intervention was effective in improving Psychosocial Safety Climate, but a longer follow-up period seems required to evaluate its effect on job factors and well-being. Overall, the project resulted in positive changes in most job factors, and its findings emphasize the importance of process variables in stress management interventions. Longer follow-up and higher quality multilevel interventions (including professional support for employees with stress-related complaints) seem essential to also improve well-being. Show less
It is well documented that both ethnic/cultural differences as well as language differences complicate a satisfying and effective doctor-patient relationship. Although these differences are... Show moreIt is well documented that both ethnic/cultural differences as well as language differences complicate a satisfying and effective doctor-patient relationship. Although these differences are also present during communication between Deaf patients and their hearing physicians, the volume and quality of research on healthcare facilities for deaf and hard of hearing (DHH) people has not kept up with research on hearing people. This thesis studied the barriers experienced by this patient group, their nature and impact, and possible (cost-effective) solutions to tackle these barriers. The theoretical background, development and use of a guideline to translate and validate standardized questionnaires into sign language is described. The barriers in providing healthcare for severely DHH patients can be classed as follows: 1) communication barriers, 2) barriers due to limited health knowledge and 3) barriers due to deaf cultural features. The results of these studies indicate that DHH people in the Netherlands experience a significantly lower physical, and often also psychological quality of life compared to the rest of the population. Several countries provide specialized facilities to improve healthcare access for this patient group. Though most of these services are likely to be cost-effective, no scientific data are available to support this assumption. Show less
Quality and safety improvement is a relatively novel discipline in healthcare practice and research that solidified in the early 21st century. Since then, various systems have been installed to... Show moreQuality and safety improvement is a relatively novel discipline in healthcare practice and research that solidified in the early 21st century. Since then, various systems have been installed to collect information on various types of adverse outcomes, such as adverse events, incidents and patient complaints. Data from these systems can be used to evaluate care delivered to individual cases as well as to study aggregated data for patterns, trends and other insights. More research is warranted to assess whether these systems actually meet the objective of continuous, systemwide learning and improvement. It was expected that existing practices could benefit from individual optimization as well as better integration, because most of this intelligence is currently stored and used in isolation. The research in this PhD thesis focused on how we can learn most effectively from various types of adverse outcomes in healthcare, in order to continuously improve the care delivered to patients. Specific research questions included how we can learn from: i) case discussions at morbidity and mortality conferences ; ii) integrating available information sources (e.g., incidents, patient experiences); iii) the context of everyday practice that produces both adverse and desired outcomes. Show less
The idea of citizens and public professionals collaborating to provide public services has widely spread in several countries around the globe. Co-production is often presented as the go-to... Show moreThe idea of citizens and public professionals collaborating to provide public services has widely spread in several countries around the globe. Co-production is often presented as the go-to solution for challenges like a legitimacy crisis of both the government and the market, and financial concerns. Yet, co-production also brings new challenges for the citizens, public professionals and public organizations involved. Why do citizens sometimes become disappointed with coproduction? Why do professionals at times feel constrained when interacting with citizens? Although co-production literature is booming, these issues still remain unsolved. This dissertation contributes to our understanding of why individual citizens and public professionals engage in co-production, and what the role of mutual perceptions of this engagement is. The study is innovative in both its approach (focusing on the individuals involved instead of on the collaborative networks, processes, and organizations) and the research methods applied (proposing a mixed method research design in a research field dominated by single case studies and qualitative research methods). The book presents a variety of studies to empirically unravel citizens’ and professionals’ engagement in the co-production of public services. The cases include client councils in healthcare organizations, neighborhood watch schemes, and representative advisory councils at primary schools. Show less
The role of individual characteristics in incidences of elder abuse has long been highest on research and policy agendas. Now, it is timely to discuss factors that go beyond victim and perpetrator.... Show moreThe role of individual characteristics in incidences of elder abuse has long been highest on research and policy agendas. Now, it is timely to discuss factors that go beyond victim and perpetrator. Environmental factors also play an important role in elder abuse. In this paper, we address the framing of elder abuse as a social and health problem. Attention is paid to the factors that influence societal context and the Healthcare system, its organization, structure, and principles Show less
