Launching the Delta Alliance: Content report phase 3

Delta Alliance is an international knowledge-driven network organisation. Its mission is to improve the resilience of deltas through more integrated and effective efforts, building on scientific research and knowledge exchange. It aims at disclosure of knowledge for application by a wide audience of end-users from the knowledge institutions, public partners and private sector, as well as to identification of upcoming research agenda

De HSMR beproefd: Aard en invloed van meetfouten bij het bepalen van het gestandaardiseerde ziekenhuissterftecijfer

Wagner, C. [Promotor

Predicting hospital mortality among frequently readmitted patients: HSMR biased by readmission.

BACKGROUND: Casemix adjusted in-hospital mortality is one of the measures used to improve quality of care. The adjustment currently used does not take into account the effects of readmission, because reliable data on readmission is not readily available through routinely collected databases. We have studied the impact of readmissions by linking admissions of the same patient, and as a result were able to compare hospital mortality among frequently, as opposed to, non-frequently readmitted patients. We also formulated a method to adjust for readmission for the calculation of hospital standardised mortality ratios (HSMRs). METHODS: We conducted a longitudinal retrospective analysis of routinely collected hospital data of six large non-university teaching hospitals in the Netherlands with casemix adjusted standardised mortality ratios ranging from 65 to 114 and a combined value of 93 over a five-year period. Participants concerned 240662 patients admitted 418566 times in total during the years 2003 - 2007. Predicted deaths by the HSMR model 2008 over a five-year period were compared with observed deaths. RESULTS: Numbers of readmissions per patient differ substantially between the six hospitals, up to a factor of 2. A large interaction was found between numbers of admissions per patient and HSMR-predicted risks. Observed deaths for frequently admitted patients were significantly lower than HSMR-predicted deaths, which could be explained by uncorrected factors surrounding readmissions. CONCLUSIONS: Patients admitted more frequently show lower risks of dying on average per admission. This decline in risk is only partly detected by the current HSMR. Comparing frequently admitted patients to non-frequently admitted patients commits the constant risk fallacy and potentially lowers HSMRs of hospitals treating many frequently admitted patients and increases HSMRs of hospitals treating many non-frequently admitted patients. This misleading effect can only be demonstrated by an analysis over a prolonged period, but occurs, in effect, every day of the year. This finding is relevant for all countries where hospitals use HSMR for monitoring and improving hospital performance. The use of 'admission frequency' as additional adjustment variable may provide a more accurate HSMR. (aut. ref.

The role of inflammation in mesenchymal stromal cell therapy in osteoarthritis, perspectives for post-traumatic osteoarthritis: a review

Item does not contain fulltextOA is a complex and highly prevalent degenerative disease affecting the whole joint, in which factors like genetic predisposition, gender, age, obesity and traumas contribute to joint destruction. ∼50-80% of OA patients develop synovitis. OA-associated risk factors contribute to joint instability and the release of cartilage matrix fragments, activating the synovium to release pro-inflammatory factors and catabolic enzymes in turn damaging the cartilage and creating a vicious circle. Currently, no cure is available for OA. Mesenchymal stromal cells (MSCs) have been tested in OA for their chondrogenic and anti-inflammatory properties. Interestingly, MSCs are most effective when administered during synovitis. This review focusses on the interplay between joint inflammation and the immunomodulation by MSCs in OA. We discuss the potential of MSCs to break the vicious circle of inflammation and describe current perspectives and challenges for clinical application of MSCs in treatment and prevention of OA, focussing on preventing post-traumatic OA

Launching the Delta Alliance: Content report phase 3

Delta Alliance is an international knowledge-driven network organisation. Its mission is to improve the resilience of deltas through more integrated and effective efforts, building on scientific research and knowledge exchange. It aims at disclosure of knowledge for application by a wide audience of end-users from the knowledge institutions, public partners and private sector, as well as to identification of upcoming research agenda