Kwaliteitsindicatoren: hoe cliënten er wijzer van kunnen worden. Een reactie.

In bovenstaand commentaar “Indicatoren voor kwaliteit van zorg. Wie worden er wijzer van, de patiënten of de managers?” wordt als casus het Europese PROGRESS-project “Quality management by result-oriented indicators” ingebracht. 1 Vilans, landelijk kenniscentrum voor langdurende zorg, heeft namens Nederland aan dit project deelgenomen. De auteurs van het commentaar plaatsen op een aantal punten kanttekeningen bij het project. Op uitnodiging van de redactie geven wij hier graag een reactie op

Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: A systematic review

Background The aim of this study was to describe barriers and facilitators for shared decision making (SDM) as experienced by older patients with multiple chronic conditions (MCCs), informal caregivers and health professionals. Methods A structured literature search was conducted with 5 databases. Two reviewers independently assessed studies for eligibility and performed a quality assessment. The results from the included studies were summarized using a predefined taxonomy. Results Our search yielded 3838 articles. Twenty-eight studies, listing 149 perceived barriers and 67 perceived facilitators for SDM, were included. Due to poor health and cognitive and/or physical impairments, older patients with MCCs participate less in SDM. Poor interpersonal skills of health professionals are perceived as hampering SDM, as do organizational barriers, such as pressure for time and high turnover of patients. However, among older patients with MCCs, SDM could be facilitated when patients share information about personal values, priorities and preferences, as well as information about quality of life and functional status. Informal caregivers may facilitate SDM by assisting patients with decision support, although informal caregivers can also complicate the SDM process, for example, when they have different views on treatment or the patient’s capability to be involved. Coordination of care when multiple health professionals are involved is perceived as important. Conclusions Although poor health is perceived as a barrier to participate in SDM, the personal experience of living with MCCs is considered valuable input in SDM. An explicit invitation to participate in SDM is important to older adults. Health professionals need a supporting organizational context and good communication skills to devise an individualized approach for patient care

Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs

Background. Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested. Aims and objectives. The purpose of this paper is to examine the inter-rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs.Design. Survey was among pressure ulcer experts.Methods. Fifty-six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter-rater reliability was calculated.Results. The multirater-Kappa for the entire group of experts was 0.80 (P < 0.001).Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers).Conclusions. The inter-rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear.Relevance to clinical practice. The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer Classification software package has been developed to facilitate learning

Shifting from “What is the matter?” to “What matters to you?”: Shared decision making for older adults with multiple chronic conditions and their informal caregivers

Shared decision making (SDM) contributes to personalized decisions that fit patients’ preferences when choosing treatment for a condition. However, older adults often experience multiple chronic conditions (MCCs). Therefore, the implementation of SDM requires special characteristics. The aim of this thesis was to describe the development and evaluation of an intervention to improve SDM in older adults with MCC. Following the Medical Research Council framework for developing complex interventions, the SDMMCC intervention was developed step-wise. First, a literature review on barriers and facilitators for SDM and empirical research about older adults’ views and preferences on important health topics were conducted. Secondly, we developed the measuring instrument Observer OPTIONMCC for SDM with older adults with MCCs. Subsequently, in a co-creation process with end-users, we developed a training for geriatricians and a preparatory tool for older adults with MCCs and informal caregivers. After assessing feasibility, the intervention was implemented and evaluated in a pragmatic trial (N=216) in geriatric outpatient clinics of two Dutch hospitals. Finally, we studied the influence of personal characteristics of older adults, such as health literacy, anxiety and education in participation and outcomes of SDM. The SDMMCC intervention resulted in improvement in the discussion of a number of essential SDM topics, while other topics declined. The process evaluation showed clear indicators for how the intervention could be further improved to also result in effects on the reported outcomes of patients and caregivers. Tailoring SDM communication to health literacy levels is important for high-quality SDM communication and thus for better outcomes

Voorkom een tweede val in het ziekenhuis!

Geen samenvatting beschikbaa

Familiebegeleiding bij ontslagvoorbereiding

Geen samenvatting beschikbaa

Aandacht voor de mantelzorger in de ontslagprocedure

Geen samenvatting beschikbaa