Overbruggen:Rede bij het vertrek als hoogleraar Revalidatie en Handicap door Prof. dr. W.J.A. van den Heuvel

Afscheidscollege van Prof. dr. W.J.A. van den Heuvel, Hoogleraar Revalidatie en Handicap in de Faculteiten der Geneeskunde en Gezondheidswetenschappe

Indicatoren voor kwaliteit van zorg. Wie worden er wijzer van, de patiënten of de managers?

Onder de titel ‘Kwaliteit heeft prioriteit’ organiseerde de Orde van Medisch Specialisten onlangs zijn eerste nationale congres. Misschien wat aan de late kant, maar het belang is er niet minder om. Nationaal en internationaal wordt beleid gevoerd om de kwaliteit van zorg te stimuleren. Voorwaarden voor de bevordering van kwaliteit van zorg zijn dat duidelijk is wat kwaliteit van zorg is en dat die kwaliteit transparant is. Meten van die kwaliteit is dan noodzakelijk gevolgd door maatregelen (richtlijnen) om de kwaliteit te verbeteren. Het RIVM concludeert echter, dat het begrip kwaliteit van zorg niet eenduidig is. Kwaliteitsindicatoren dragen dan niet vanzelfsprekend bij aan inzicht in betere kwaliteit, zoals onderzoek aantoont. Indicatoren voor kwaliteit van zorg missen de essentie van de zorg

Explaining quality of life with crisis theory

Based on the premises of crisis theory. we expected cancer patients in-crisis to report a poorer quality of life (QL) and cancer patients post-crisis to report a similar level of overall QL in comparison to healthy individuals. To explain these hypothesized findings, we expected the coping resources and strategies of patients in-crisis to be equally effective and those of patients post-crisis to be more effective as compared to those of healthy individuals. The sample consisted of: (a) 217 consecutive cancer patients in the acute phases of their illness (patients in-crisis) (b) 192 disease-free cancer patients (patients post-crisis): and (c) 201 randomly selected healthy individuals. Established measures of QL, self-esteem and neuroticism (coping resources) and coping behavior (coping strategies) were mailed. As expected. patients in-crisis reported a poorer QL (p <0.001) and patients post-crisis a similar overall QL as compared to healthy individuals. There were no significant or systematic differences between the mean levels of coping resources and strategies between the respective groups, Two-way analysis of variance indicated a group X coping resource interaction effect on overall QL for self-esteem (p <0.01). As expected, the amount of variance of overall QL explained by self-esteem was largest for patients post-crisis (27%) and comparable for patients in-crisis and healthy individuals (10 and 11%). Patients in-crisis were not able to make their coping resources and strategies more effective, whereas patients post-crisis seemed to have enhanced the effectiveness of self-esteem in restoring their QL as compared to healthy persons. Copyright (C) 2002 John Wiley Sons, Ltd

Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury

PURPOSES: The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI) and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. METHODS: The transmural care model was developed in cooperation with the Dutch Association of Spinal Cord Injured Patients, community nurses, general practitioners, rehabilitation nurses, rehabilitation managers, physiatrists and researchers. The core component of the care model consists of a transmural nurse, who ‘liaises’ between people with SCI living in the community, professional primary care professionals and the rehabilitation centre. The transmural care model provides a job description containing activities to support people with SCI and their family/partners and activities to promote continuity of care. The transmural care model was implemented in two Dutch rehabilitation centres. The following three aspects, as experienced by the transmural nurses, were evaluated: the extent to which the care model was implemented; enabling factors and barriers for implementation; strength and weakness of the care model. RESULTS: The transmural care model was not implemented in all its details, with a clear difference between the two rehabilitation centres. Enabling factors and barriers for implementation were found at three levels: 1. the level of the individual professional (e.g. competencies, attitude and motivation), 2. the organisational and financing level (e.g. availability of facilities and finances), and 3. the social context (the opinion of colleagues, managers and other professionals involved with the care). The most important weakness experienced was that there was not enough time to put all the activities into practice. The strength of the care model lies in the combination of support of patients after discharge, support of and cooperation with primary care professionals, and feedback of experiences to the clinical rehabilitation teams. CONCLUSION: We recommend further improving and implementing the care model and encourage other care professionals and researchers to share their implementation experiences of follow-up care innovations for people with SCI

Psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q)

Objective: To evaluate the psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q) in patients with atrial fibrillation. Design: A prospective study of the patients who underwent DC electrical cardioversion. Setting: Clinics of cardiology and thoracic surgery of the University Hospital in Groningen, the Netherlands. Main outcome measures: The disease-specific MLHF-Q and generic measures of quality of life were administered. The sensitivity to change over time was tested with effect sizes (ES). Internal consistency of MLHF-Q scales was estimated with Cronbach's alpha. To evaluate the construct validity multitrait-multimethod analysis was applied. The 'known group validity' was evaluated by the comparison of mean scores and effect sizes between two groups of the New York Heart Association (NYHA) classification (NYHA I versus II-III). Stability of MLHF-Q scales was estimated in a subgroup of patients who remained stable. Perfect congruence analysis and factor analysis were applied to confirm the a priori determined structure. Results: Cronbach's alpha was :0.80 of the MLHF-Q scales. Perfect congruence analysis (PCA) showed that the results resemble quite well the a priori assumed factor structure. Multitrait-multi method analysis showed convergent validity coefficients ranging from 0.59 to 0.73 (physical impairment dimension) and 0.39 to 0.69 (emotional dimension). The magnitude of change can be interpreted as medium (ES = 0.50). The results of a 'test-retest' analysis in a stable group can be valued as satisfactory for the MLHF-Q scales (Pearson's r > 0.60). The physical dimension and the overall score of the MLHF-Q discriminated significantly between the NYHA I and II-III groups (p <0.001) with large effect sizes (ES > 1.0). Conclusions: The MLHF-Q has solid psychometric properties and the outcome of the current study indicates that the MLHF-Q is an effective and efficient instrument