BackgroundAlthough local initiatives commonly express a wish to improve population health and wellbeing using a population health management (PHM) approach, implementation is challenging and... Show moreBackgroundAlthough local initiatives commonly express a wish to improve population health and wellbeing using a population health management (PHM) approach, implementation is challenging and existing tools have either a narrow focus or lack transparency. This has created demand for practice-oriented guidance concerning the introduction and requirements of PHM.MethodsExisting knowledge from scientific literature was combined with expert opinion obtained using an adjusted RAND UCLA appropriateness method, which consisted of six Dutch panels in three Delphi rounds, followed by two rounds of validation by an international panel.ResultsThe Dutch panels identified 36 items relevant to PHM, in addition to the 97 items across six elements of PHM derived from scientific literature. Of these 133 items, 101 were considered important and 32 ambiguous. The international panel awarded similar scores for 128 of 133 items, with only 5 items remaining unvalidated. Combining literature and expert opinion gave extra weight and validity to the items.DiscussionIn developing a maturity index to help assess the use and progress of PHM in health regions, input from experts counterbalanced a previous skewedness of item distribution across the PHM elements and the Rainbow Model of Integrated Care (RMIC). Participant expertise also improved our understanding of successful PHM implementation, as well as how the six PHM elements are best constituted in a first iteration of a maturity index. Limitations included the number of participants in some panels and ambiguity of language. Further development should focus on item clarity, adoption in practice and item interconnectedness.ConclusionBy employing scientific literature enriched with expert opinion, this study provides new insight for both science and practice concerning the composition of PHM elements that influence PHM implementation. This will help guide practices in their quest to implement PHM. Show less
Risk stratification, the systematic assessment of patients’ profiles in order to assign individual risk scores, can be used to provide personalized and population care according to that risk. In... Show moreRisk stratification, the systematic assessment of patients’ profiles in order to assign individual risk scores, can be used to provide personalized and population care according to that risk. In different countries, risk stratification is used to identify the right subpopulations for specific care interventions and lower expensive care utilization such as emergency care and hospitalization. In the Netherlands, risk stratification is not yet notably used in primary care. Despite the great possibilities due to the widespread catchment area of primary care in the Netherlands and the gatekeepers function of general practitioners, systematic risk stratification approaches in Dutch primary care are minimal. The aim of this dissertation was therefor to identify and asses a suitable risk stratification tool to be used in Dutch primary care. The main question was answered by describing a study assessing the model performance of US-based hospitalization and high costs models applied in the Dutch primary care setting. Both models showed good performance regarding discrimination and calibration properties. In addition, the models were adjusted to best fit the Dutch primary care situation. Coefficients of the underlying predictors of the models were adjusted, improving the good model performances for both the hospitalization and the high costs model. Show less
In the Netherlands acute care organisations are overstretched and overcrowded. The acute care networks involve different organisations, including Emergency Departments (EDs), General Practice... Show moreIn the Netherlands acute care organisations are overstretched and overcrowded. The acute care networks involve different organisations, including Emergency Departments (EDs), General Practice Cooperatives (GPCs), ambulance services, acute mental health services, and home care and nursing home organisations. Crowding gives rise to major problems in healthcare and is caused by a combination of factors. As the general population continues to age, so too does the burden on the shrinking working force. Another factor is the suboptimal use of acute care, as a relatively high proportion of acute care use goes to patients presenting problems that are considered to have low urgency. Furthermore, the large number of acute care organisations involved increases the fragmentation caused by healthcare providers working independently and with too little communication, which stands in the way of effective cooperation. Due to the large number of organisations involved, there are multiple entrance and exit routes for patients in acute care organisations. Effective communication and coordination between all stakeholders at different levels of an organizational structure is crucial to providing high quality acute care.The main objective of this thesis is to find clues how and where acute care in the Netherlands can be improved at all integration levels. Insight into the various mechanisms should enable us to maintain accessibility of acute care for all citizens in the future. Show less
