Trends in kwaliteitsmanagement in de gezondheidszorg: breder, van intern naar extern en op weg naar houdbaarheid...

In de jaren tachtig van de vorige eeuw ontstond expliciet belangstelling voor de kwaliteit van de gezondheidszorg in het licht van een enorme en tot dan toe verwelkomde kostenexplosie in de gezondheidszorg. Vanwege de grote kostenstijging ten opzichte van het bruto nationaal product werden toenemend vragen gesteld bij de toegevoegde waarde voor de maatschappij. Tevens bleek uit met name het werk van Wennberg en anderen, dat er grote verschillen in medische consumptie tussen regio’s en landen bestonden, zonder dat dit een relatie had met gemeten behandelresultaat of gemiddelde levensduur. In een aantal stappen – soms worden die ook als generaties aangeduid – is vervolgens de weg van kwaliteitsmanagement ingeslagen

Close cooperation with Health Technology Assessment expertise is crucial for implementation and ultimately reimbursement of innovations in oncology

The Organisation of European Cancer Institutes OECI working group on Health Economics and Cost Benefit in Oncology suggests four actions that are needed to improve alignment and integration between clinicians, researchers, and Health Technology Assessment (HTA) experts and agencies: 1) HTA expertise is necessary close to or within the comprehensive cancer centres (CCC); 2) HTA expertise should be physically present throughout the translational research process; 3) Appropriate knowledge is necessary within the research staff; 4) Close cooperation between translational researchers, clinicians, and health economists guarantees clinical ownership. Fulfilling these conditions may help the translational research field in oncology to interact with agencies and efficiently move innovative technologies through the translational research stages into that of implementation and diffusion. This brings innovative treatments faster to the patient with a greater chance of reimbursement

Establishing cost-effectiveness of genetic targeting of cancer therapies

The clinical benefit of a new genomic instrument, the 70-gene signature for breast cancer patients, is being evaluated in a randomised clinical trial. The early, controlled implementation process is supported by a Constructive Technology Assessment to help decision-making in an uncertain time of development

Effective cooperation influencing performance: a study in Dutch hospitals

Objective: This study focuses on cooperation between physicians and managers and aspects of that cooperation that can provide leads for interventions aimed at enhancing hospital performance. - \ud Design: We performed a qualitative study on cooperation between physicians and managers and the influence of that cooperation on hospital performance, and structured the resulting data according to the conditions of Allport's theory on intergroup conflicts. - \ud Setting: General hospitals in the Netherlands. - \ud Participants: Thirty physicians (surgical and internal) and managers (strategic, tactic and operational) working in five different hospitals. - \ud Interventions: In-depth interviews exploring the influence of cooperation between physicians and managers on hospital performance. - \ud Main Outcome Measures: Respondents confirmed the complexity of the relationship between physicians and managers and the link between their cooperation and hospital performance. Mentioned aspects such as power and status differences, clarity in decision-making and personal click, are important in determining the effectiveness of the cooperation between physicians and managers. - \ud Results: Our study suggests that the effectiveness of cooperation between physicians and managers is related to the uptake of quality initiatives and hospital performance. - \ud Conclusions: The complex relationship between physicians and managers can be referred to as an intergroup conflict situation. We combined Allport's Contact theory conditions with aspects found in our study leading to the following facilitating conditions: address common goals; create interdependent tasks; arrange the support of authorities and respect the medical domain. They will enhance intra-hospital cooperation and therewith hospital performance

Establishing cost-effectiveness of genetic targeting of cancer therapies\ud

The clinical benefit of a new genomic instrument, the 70-gene signature\ud for breast cancer patients, is being evaluated in a randomised clinical\ud trial. The early, controlled implementation process is supported by a\ud Constructive Technology Assessment to help decision-making in an\ud uncertain time of developmen

Bouwen aan een kwaliteitssysteem in de revalidatiezorg: Een poging tot constructive technology assessment van een kwaliteitssysteem in een gezondheidszorginstelling

In dit proefschrift staat de vraag naar de meerwaarde van (investeringen in) een kwaliteitssysteem in een revalidatiecentrum centraal. In de gezondheidszorg wordt vanaf het midden van de jaren tachtig toenemend gesproken over kwaliteit. De aandacht hiervoor groeide toen geleidelijk aan bleek dat de ontwikkeling van de zorgvraag en (met name de financiering van) het aanbod steeds minder op elkaar aansloten. Onder andere een toenemend beroep op zorgvoorzieningen door de verouderende en steeds meer eisende bevolking, én het door de overheid, met het oog op de collectieve lasten, noodzakelijk geachte kosten-beheersingsbeleid, zijn hiervoor belangrijke redenen. Binnen de sector groeit de bezorgdheid over de kwaliteit van de zorgverlening; de vanzelfsprekendheid waarmee men er vanuit ging dat een goed eindproduct geleverd zou worden, verdwijnt. In navolging van industrie en commerciële dienstverlening wordt het begrip kwaliteitszorg geïntroduceerd. In 1989 en 1990 werden - toen nog in verband met de door de commissie Dekker voorgestelde marktwerking en deregulering - door de KNMG (Koninklijke Nederlandse Maatschappij ter bevordering van de Geneeskunstl twee conferenties over een "landelijk kwaliteitsbeleid" georganiseerd; door de betrokken partijen in de gezondheidszorg werd toen, voor een periode van vijf jaar, een aantal afspraken gemaakt over uitgangspunten en gewenste ontwikkelingen. Onder andere werd vastgelegd dat de aanbieders van zorg het initiatief zouden nemen om "binnen een half jaar te komen tot het maken van afspraken over de ontwikkeling van kwaliteitssystemen" (zie bijlage 1). Op verzoek van de deelnemers is er door de Nationale Raad voor de Volksgezondheid een commissie Voortgang Ontwikkeling Kwaliteitsbeleid ingesteld, die de ontwikkelingen op dit terrein ging bewaken. In 1995 heeft, aangestuurd door die commissie, een evaluatie plaatsgevonden van de wijze waarop aan de eerder gemaakte afspraken vorm is gegeven en is er opnieuw een landelijke kwaliteitsconferentie geweest. Hier zijn afspraken voor de periode 1995-2000 vastgelegd over begripsverheldering, externe beoordeling, ontwikkeling van kwaliteitssystemen, informatie over de kwaliteit van zorg- en verzekeringsaanbod en prikkels en voorwaarden voor kwaliteitsbeleid. Bijvoorbeeld werd (opnieuw) afgesproken dat expliciet aandacht besteed zal gaan worden aan de organisatiebrede opbouw van kwaliteitssystemen

Functional status and prosthesis use in amputees, measured with the Prosthetic Profile of the Amputee (PPA) and the short version of the Sickness Impact Profile (SIP68)

Amputation of (a part of) the lower extremity will cause loss or disturbance of locomotion. With prosthetic devices and rehabilitation many amputees are able to restore their locomotive function as well as their social function. Maintenance or restoration of function after discharge is even more important. In rehabilitating amputees, prosthetic devices can improve mobility. Little is known about whether these devices will still be used at home after discharge and if the improvement in functioning is stable. To verify whether the treatment strategy of amputees is sufficient or needs to be modified, it is important to check if the goals of rehabilitation are achieved. Outcome in amputees used to be related to mortality and cure, especially mobility, for example, by the Amputee Activity Score, a measure for activity, not related to age, sex or handicap (Day, 1981). Recently, ‘quality of life’ and ‘reintegration in normal life’ have been emphasized in measuring outcomes of rehabilitation programmes. Research on 42 amputees (Nissen and Newman, 1992) indicated that more attention should be paid to community, mobility, recreation and additional illnesses after amputation to improve reintegration to normal living. The purpose of this study is to evaluate (1) the status at discharge and (2) the maintenance of physical functioning (including mobility) and psycho-social functioning after a follow-up period of 2 months after discharge from a rehabilitation setting. Since mobility is related to prosthesis use, prosthesis use is also evaluated

A Systematic Review of Web-Based Interventions for Patient Empowerment and Physical Activity in Chronic Diseases: Relevance for Cancer Survivors

Background: Patient empowerment reflects the ability of patients to positively influence their health and health behavior such as physical activity. While interactive Web-based interventions are increasingly used in various chronic disease settings to enhance empowerment and physical activity, such interventions are still uncommon for cancer survivors. Objective: The objective of this study was to systematically review the literature regarding interactive Web-based interventions. We focused on interventions aimed at increasing patient empowerment and physical activity for various chronic conditions, and explored their possible relevance for cancer survivors. Methods: Searches were performed in PubMed, Embase, and Scopus to identify peer-reviewed papers reporting on randomized controlled trials that studied the effects of Web-based interventions. These interventions were developed for adults with diabetes, cardiovascular disease, chronic obstructive pulmonary disease, heart failure, or cancer. Intervention characteristics, effects on patient empowerment and physical activity, information on barriers to and facilitators of intervention use, users’ experiences, and methodological quality were assessed. Results were summarized in a qualitative way. We used the recommendations of the Institute of Medicine (IOM) regarding cancer survivorship care to explore the relevance of the interventions for cancer survivors. Results: We included 19 papers reporting on trials with 18 unique studies. Significant, positive effects on patient empowerment were reported by 4 studies and 2 studies reported positive effects on physical activity. The remaining studies yielded mixed results or no significant group differences in these outcomes (ie, no change or improvement for all groups). Although the content, duration, and frequency of interventions varied considerably across studies, commonly used elements included education, self-monitoring, feedback/tailored information, self-management training, personal exercise program, and communication (eg, chat, email) with either health care providers or patients. Limited information was found on barriers, facilitators, and users’ experiences. Methodological quality varied, with 13 studies being of moderate quality. The reported Web-based intervention elements appeared to be highly relevant to address the specific needs of cancer survivors as indicated by the IOM. Conclusions: We identified 7 common elements of interactive, Web-based interventions in chronic disease settings that could possibly be translated into eHealth recommendations for cancer survivors. While further work is needed to determine optimal intervention characteristics, the work performed in other chronic disease settings provides a basis for the design of an interactive eHealth approach to improve patient empowerment and physical activity in cancer survivors. This may subsequently improve their health status and quality of life and reduce their need for supportive car