Towards coordination and tailoring of hospital care for patients with multimorbidity

Patients with multimorbidity (two or more chronic conditions) often receive fragmented hospital care, organized around separate medical specialties and focused on single diseases. Without coordination and tailoring of care, fragmented hospital care can lead to adverse outcomes. In this thesis, Verhoeff explored which strategies can contribute to improved coordination and tailoring of hospital care when multiple medical specialties are involved, in order to ensure good quality and experience of hospital care for patients with multimorbidity. First, Verhoeff explored the current Dutch hospital care for multimorbidity. These studies showed that maintaining an overview can be complex and that care professionals experience barriers for tailoring and coordinating care. Next, she developed and tried out an intervention for hospital care coordination. She learned that it is important to show the results of coordination and tailoring, and that patient selection should be refined. Her other studies illustrated how hospitals could use their own electronic health record (EHR) data to find patients who benefit most from coordination and tailoring of care.A shared vision and efforts throughout the entire healthcare system are necessary to improve coordination and tailoring of hospital care. Verhoeff recommends introducing a multimorbidity care perspective in hospitals, and organization and innovation of collaboration between care professionals in case of multimorbidity. It is important to acknowledge that coordination and tailoring of care are extra tasks that need prioritization, organization, and financing. In the future, hospitals offer tailored and coordinated hospital care for patients with multimorbidity, that benefits both patients and healthcare professionals

Coordinating and tailoring hospital care for patients with multimorbidity:who will take the lead?

OBJECTIVE: To gain insight in medical specialists' and nurse practitioners' opinions on multimorbidity and coordination and tailoring of hospital care.DESIGN: Exploratory mixed-method design.METHOD: From August 2018 until January 2019, 35 Dutch medical associations were asked to forward a digital survey with open- and close-ended questions to their members. We used qualitative and quantitative methods to analyze the data. The main themes were identified with inductive, thematic analysis.RESULTS: There were 554 respondents from 22 associations, 43% of the medical specialist respondents were internist (n=221). The qualitative analysis of the answers regarding what is required in hospital care for patients with multimorbidity resulted in eight themes at the patient's, professional's and hospital organization's level. To the open question about who should take the lead, respondents most often answered the geriatrician or internist, followed by the general practitioner, 'the care professional who is treating the main problem', a nurse practitioner/physician assistant and the 'attending physician of the primary team'. All geriatricians and almost all internists felt they possessed the competencies to take the lead in hospital care for patients with multimorbidity.CONCLUSION: Medical specialists' and nurse practitioners' diverse ideas about who should take the lead in hospital care for patients with multimorbidity were a noteworthy finding. It is important to start local conversations about how to divide roles and responsibilities regarding the coordination and tailoring of hospital care for patients with multimorbidity.</p

How “elderly-proof” are the current medical specialist guidelines in the Netherlands?

De prevalentie van multimorbiditeit stijgt met de leeftijd: ruim 70% van de 75-plussers heeft drie of meer chronische aandoeningen, veelal gecombineerd met kwetsbaarheid. In de huidige medische praktijk vormt evidence-based medicine met evidence-based richtlijnen de basis voor de behandeling. Het doel van deze studie is nagaan hoe toepasbaar de huidige medisch specialistische richtlijnen in de praktijk zijn bij de heterogene groep ouderen. Alle richtlijnen uit de Nederlandse Richtlijnendatabase werden onderzocht. De twaalf ouderen-specifieke richtlijnen werden vergeleken met de aanbevelingen uit de ‘methodiek’. In 117 richtlijnen (54%) werden algemene termen, zoals “oudere(n)” gevonden. Een leeftijdsgrens werd vermeld in 26 richtlijnen (12%). De term “kwetsbaarheid” werd genoemd in 38 richtlijnen (18%), de term “comorbiditeit” in 107 (50%) en “cognitieve problemen” in acht (4%). Vijf ouderen-specifieke richtlijnen maakten een onderscheid tussen wel en niet kwetsbare ouderen. Drie richtlijnen bespraken relevante uitkomstmaten voor ouderen. De resultaten laten zien dat de huidige richtlijnen in de praktijk niet optimaal toepasbaar zijn bij de diverse groepen ouderen. Ons inziens is aanpassing van de richtlijnen bij voorkeur door middel van implementatie van de ontwikkelde richtlijnmethodiek een noodzakelijke eerste stap in het bruikbaar maken van de huidige evidence-based richtlijnen uit de tweede lijn in Nederland voor de groeiende groep kwetsbare en multimorbide ouderen

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Executieve functies : het geheim om tot leerprestaties te komen

Voor u ligt het onderzoek ‘Executieve functies: het geheim om tot leerprestaties te komen’, een onderzoek naar de executieve functies van de leerlingen van de E. du Marchie van Voorthuysenschool. Deze scriptie is geschreven als afstudeeropdracht om de opleiding Pedagogiek aan Windesheim te kunnen voltooien. Uiteindelijk is dit onderzoek aan de opdrachtgever en opleiding gepresenteerd en heeft dit onderzoek de scriptieprijs ‘Windesheims Beste’ gekregen van hogeschool Windesheim. Het onderzoek is door de jury geprezen om de maatschappelijke relevantie en innovatie. Een onderdeel van de toekenning van ‘Windesheims Beste’ was het publiceren van dit onderzoek. Deze publicatie is bedoeld voor belangstellenden voor dit onderwerp. Daarbij spreek ik de hoop uit dat mensen in het onderwijs deze publicatie gaan lezen en zich bewust worden van het belang van dit onderwerp. Ik hoop dat er professionals zijn die dit onderwerp, passend bij de eigen schoolomgeving, gaan toepassen. Uit verschillende onderzoeken is gebleken dat leerproblemen bij leerlingen verminderd kunnen worden wanneer de executieve functies gestimuleerd worden; de leerprestaties van leerlingen worden dan vergroot. Leerlingen doen hierdoor meer succeservaringen op, wat niet alleen op cognitief vlak effect heeft, maar zeker ook op sociaal-emotioneel gebied. Vanuit dit onderzoek zijn er verschillende aanbevelingen geformuleerd. Er is getracht deze zó te formuleren, dat ze gemakkelijk in de praktijk kunnen worden toegepast in verschillende onderwijssituaties. Daarbij is het wel belangrijk te vermelden dat iedere onderwijssituatie anders is, waarbij sprake is van andere soorten leerlingen en onderwijsvormen. De gestelde aanbevelingen kunnen dan ook als inspiratiebron gebruikt worden, waarbij mensen uit het onderwijs uitgedaagd worden de aanbevelingen aan te passen aan de eigen onderwijssituatie

Guidelines for customised integrated care in multimorbidity

In patients with multimorbidity, healthcare providers follow various disease-specific guidelines. Besides the fact that simultaneous treatment of several chronic diseases can be intensive for the patient, there is also the risk of contradictory advice or interactions when all recommendations are applied simultaneously. There are a number of developments to make guidelines more applicable to the growing target group of multimorbid patients. The 'Methodology for senior-proof guidelines' describes how to pay attention to patients with multimorbidity in all phases of guideline development. In addition, integrated guideline use for multimorbidity is being developed through a new modular structure with the use of interconnections. The future doctor will have to acquire knowledge and skills in translating treatment goals of patients with multimorbidity into an integral and coordinated tailor-made plan in cooperation with other professionals. A guideline for the treatment of multimorbidity can provide support in working across domains without directly applicable evidence.</p

Richtlijnen voor passende zorg bij multimorbiditeit

In patients with multimorbidity, healthcare providers follow various disease-specific guidelines. Besides the fact that simultaneous treatment of several chronic diseases can be intensive for the patient, there is also the risk of contradictory advice or interactions when all recommendations are applied simultaneously. There are a number of developments to make guidelines more applicable to the growing target group of multimorbid patients. The 'Methodology for senior-proof guidelines' describes how to pay attention to patients with multimorbidity in all phases of guideline development. In addition, integrated guideline use for multimorbidity is being developed through a new modular structure with the use of interconnections. The future doctor will have to acquire knowledge and skills in translating treatment goals of patients with multimorbidity into an integral and coordinated tailor-made plan in cooperation with other professionals. A guideline for the treatment of multimorbidity can provide support in working across domains without directly applicable evidence