Evolution in the orbital structure of quiescent galaxies from MAGPI, LEGA-C, and SAMI surveys: direct evidence for merger-driven growth over the last 7 Gyr

We present the first study of spatially integrated higher-order stellar kinematics over cosmic time. We use deep rest-frame optical spectroscopy of quiescent galaxies at redshifts z = 0.05, 0.3, and 0.8 from the SAMI, MAGPI, and LEGA-C surveys to measure the excess kurtosis h4 of the stellar velocity distribution, the latter parametrized as a Gauss-Hermite series. Conservatively using a redshift-independent cut in stellar mass (⁠⁠) and matching the stellar-mass distributions of our samples, we find 7σ evidence of h4 increasing with cosmic time, from a median value of 0.019 ± 0.002 at z = 0.8 to 0.059 ± 0.004 at z = 0.06. Alternatively, we use a physically motivated sample selection based on the mass distribution of the progenitors of local quiescent galaxies as inferred from numerical simulations; in this case, we find 10σ evidence. This evolution suggests that, over the last 7 Gyr, there has been a gradual decrease in the rotation-to-dispersion ratio and an increase in the radial anisotropy of the stellar velocity distribution, qualitatively consistent with accretion of gas-poor satellites. These findings demonstrate that massive galaxies continue to accrete mass and increase their dispersion support after becoming quiescent

Different higher order kinematics between star-forming and quiescent galaxies based on the SAMI, MAGPI, and LEGA-C surveys

We present the first statistical study of spatially integrated non-Gaussian stellar kinematics spanning 7 Gyr in cosmic time. We use deep, rest-frame optical spectroscopy of massive galaxies (stellar mass ⁠) at redshifts z = 0.05, 0.3, and 0.8 from the SAMI, MAGPI, and LEGA-C surveys, to measure the excess kurtosis h4 of the stellar velocity distribution, the latter parametrized as a Gauss–Hermite series. We find that at all redshifts where we have large enough samples, h4 anticorrelates with the ratio between rotation and dispersion, highlighting the physical connection between these two kinematic observables. In addition, and independently from the anticorrelation with rotation-to-dispersion ratio, we also find a correlation between h4 and M⋆, potentially connected to the assembly history of galaxies. In contrast, after controlling for mass, we find no evidence of independent correlation between h4 and aperture velocity dispersion or galaxy size. These results hold for both star-forming and quiescent galaxies. For quiescent galaxies, h4 also correlates with projected shape, even after controlling for the rotation-to-dispersion ratio. At any given redshift, star-forming galaxies have lower h4 compared to quiescent galaxies, highlighting the link between kinematic structure and star-forming activity

Zorgcoördinatie over grenzen heen: Een exploratie van zorgcoördinatie en zorgpaden over grenzen heen in de eerstelijn en als link tussen eerstelijn en het ziekenhuis

Background: Patients with complex chronic conditions often require care coordination to ensure a good quality of care. Strategies to improve care coordination do not always have the desired results. This ispartly due to incomplete understanding of the key concepts of care coordination. The lack of clarity is a result of multiple existing definitions and theoretical frameworks for the study of care coordination, each with a different emphasis. In 2007, the Agency for Healthcare Research and Quality defined care coordination as "the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling ofpersonnel and other resources needed to carry out all required patient care activities, and is often managed by the exchange of information among participants responsible for different aspects of care ." A uniform, comprehensive theoretical framework for the study of care coordination is needed to provide us more insight in the key concepts and the links between these key concepts. This insight is important when developing, implementing and evaluating strategies to improve care coordination. Aim: This dissertation aims to gainmore insight in care coordination by exploring key concepts of care coordination and the links between these key concepts. The secondary aimis to inquire care pathways as a possible strategy to improve care coordination in primary care and to bridge primary and hospital care. These objectives are translated into the following research questions: 1. What key concepts of care coordination and links between thesekey concepts can be identified in international literature and in dailyexperiences of patients and healthcare professionals? 2. To which extent can care pathways support or create elements necessary to improve care coordination across boundaries of primary and hospital care and in primary care leading to more quality of care? Methods: First, existing theoretical frameworks for the study ofcare coordination were identified through a literature review. An in-depth analysis of these theoretical frameworks was performed to identify key concepts of care coordination and links between these key concepts. Second, key concepts of care coordination and links between these key concepts were further explored in patients and primary healthcare professionals experiences of care coordination. A qualitative research design was used. Twenty-two patients who had breast cancer surgery were selectedin three hospitals in Flanders (Belgium) and interviewed. Primary healthcare professionals involved in the care of these patients were invited to participate in a focus group. Six focus groups were organized. Data were analyzed using constant comparative analysis. An adaptive theory approach was used, which combines both inductive and deductive procedures, meaning data were analyzed to confirm, refute and explore the previous identified theoretical concepts and links, but also to explore new theoretical concepts and links between these concepts. Third, an in-depth analysis of multiple cases developing a new or evaluating an already existing care pathway was performed to assess to which extent key concepts of care coordination are supported or created by care pathways. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results. Finally, an exploratory trial was performed to explore whether revising an existing care pathway would improve quality of care enhancing patient outcomes. A pre-post intervention postal survey was used. Quality of care was translated into process and outcome indicators. These indicators were measured in two groups receiving a postal questionnaire: onegroup before (pre-intervention) and another group after implementation of a revised care pathway (post-intervention). Results: The in-depth analysis identified 14 key concepts of care coordination and links between these key concepts. Nine of the fourteen keyconcepts were further explored in patients experiences of care coordination. Roles and quality of relationship were identified as core keyconcepts. Quality of relationship was extended to quality of relationship with the patient. Patient characteristics was newly identified. These 15 key concepts of care coordination were found and further explored in healthcare professionals experiences. Links between these 15 concepts were identified, including 9 newly identified links. The development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, enhanced existing and newly constructed structures, knowledge and information technology, administrative operational processes, defining and knowing each other s roles, building qualitative relationships, exchanging information and formulating and sharing goals. Observed improvement in process and outcome indicators after implementing a revised care pathway were not statistically significant after correcting for multiple testing. Conclusions: A comprehensive theoretical framework emerges bringing all results together. The developed theoretical framework emphasizes the importance of relational coordination when developing effective coordination strategies. Relational coordination refers to clearly defined roles, knowing and respecting each other s roles, collaboration, the bond with and trust of the patient, communication and shared goals. External factors and (inter)organizational mechanisms should enhance these aspectsof relational coordination. The developed theoretical framework also emphasizes that patients influence care coordination affecting quality outcomes. Care pathways across the primary-hospital care continuum enhance components of care coordination.status: publishe

Zorgpaden als methodiek voor transmurale zorgcoördinatie

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RAI-project: Bevordering van de communicatie tussen zorgverleners betrokken bij de zorg voor oudere afhankelijke personen

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The search for a feasible instrument to measure the care needs of the elderly

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Hoe transmurale zorgpaden opbouwen?

Dit draaiboek is een hulpmiddel voor organisaties die in hun lokale regio een transmuraal zorgpad willen ontwikkelen. De aanleiding daartoe kan velerlei zijn. Misschien omdat nieuwe problemen in de zorgverlening zich stellen, waarbij, zoals steeds meer frequent gebeurt, meerdere disciplines zowel uit de eerstelijn als uit het ziekenhuis, revalidatiecentrum of woon- en zorgcentrum betrokken dienen te worden om samen een optimale kwaliteit van zorg te kunnen leveren. Of misschien omdat een reeds lang bestaand probleem maar niet opgelost geraakt, en sommigen zich afvragen of er meer gecoördineerde zorgopzet nodig is met duidelijke taakomschrijving, spelregels en afspraken tussen meerdere disciplines. Dit draaiboek start vanuit de algemene methodiek van zorgpaden en inventariseert een brede veldervaring uit vijf innovatieve projecten die de laatste jaren zijn opgezet rond oncologische transmurale zorgverbetering in drie Vlaamse regio’s. Leerervaringen uit deze veldprojecten werden in dit draaiboek verwerkt. Dank zij een projectsubsidiering vanuit de Koning Boudewijn Stichting via het Johnson & Johnson Fonds voor gezondheidsprojecten kon een onderzoeksteam van de K.U.Leuven deze projecten opvolgen. De specifieke opdracht bestond hieruit te leren en veralgemeenbare boodschappen te formuleren. Op basis van zowel theoretische kennis als praktische ervaring en reflectie uit de veldprojecten kwam het voorliggend draaiboek tot stand. Beschouw dit draaiboek als een soort overzicht van opties, boodschappen, reflecties, waarschuwingen en aanbevelingen die op basis van reflectie uit concrete veldervaringen is naar voren gekomen. Dit draaiboek is geen blauwdruk, geen vast scenario hoe van nu af aan transmurale projecten zullen moeten verlopen om tot resultaten te leiden. Het is eerder een hulpmiddel voor de praktijk en zal waar nodig of gewenst aangepast moeten worden aan de specifieke wensen of eisen van de gebruikers. Dit soort implementatieprocessen kan immers niet zomaar worden opgelegd, doorlopen, en op een vastgestelde termijn operationeel gaan draaien. Dit draaiboek bestaat uit vier delen. Een eerste deel bevat een definiëring en situering van (transmurale) zorgpaden en aanverwante concepten. In het tweede deel wordt de methodiek van zorgpaden kort theoretisch toegelicht. We vertrekken daarbij vanuit het 7-fasen model met telkens praktische tips, aandachtspunten, uitdagingen en illustraties aan de hand van voorbeelden uit de opgevolgde projecten. Ten derde worden enkele belangrijke algemene aspecten bij transmurale zorgpaden beschreven. In de huidige context van de gezondheidszorg zijn immers de nodige randvoorwaarden absoluut nog niet aanwezig om massaal op de hier voorgestelde wijze te gaan werken. Er zal nog een hele tijd moeten gewerkt worden met “early innovators”, die enthousiast binnen het bestaande kader dingen willen vernieuwen, en zo stilaan zullen kunnen bouwen aan de ondersteunings- en financieringskaders die nodig zullen zijn om in de toekomst meer en meer blijvend met kwaliteitsverbetering via transmurale zorgpaden te kunnen werken. Tot slot werden in het kader van dit project ook een aantal vernieuwende instrumenten ontwikkeld en uitgetest.status: publishe

Focus groups to explore healthcare professionals' experiences of care coordination: towards a theoretical framework for the study of care coordination

Abstract Background Strategies to improve care coordination between primary and hospital care do not always have the desired results. This is partly due to incomplete understanding of the key concepts of care coordination. An in-depth analysis of existing theoretical frameworks for the study of care coordination identified 14 interrelated key concepts. In another study, these 14 key concepts were further explored in patients? experiences. Additionally, ?patient characteristics? was identified as a new key concept in patients? experiences and the previously identified key concept ?quality of relationship? between healthcare professionals was extended to ?quality of relationship? with the patient. Together, these 15 interrelated key concepts resulted in a new theoretical framework. The present study aimed at improving our understanding of the 15 previously identified key concepts and to explore potentially previous unidentified key concepts and the links between these by exploring how healthcare professionals experience care coordination. Methods A qualitative design was used. Six focus groups were conducted including primary healthcare professionals involved in the care of patients who had breast cancer surgery at three hospitals in Belgium. Data were analyzed using constant comparative analysis. Results All 15 previously identified key concepts of care coordination were further explored in healthcare professionals? experiences. Links between these 15 concepts were identified, including 9 newly identified links. The concept ?external factors? was linked with all 6 concepts relating to (inter)organizational mechanisms; ?task characteristics?, ?structure?, ?knowledge and information technology?, ?administrative operational processes?, ?cultural factors? and ?need for coordination?. Five of these concepts related to 3 concepts of relational coordination; ?roles?, ?quality of relationship? and ?exchange of information?. The concept of ?task characteristics? was only linked with ?roles? and ?exchange of information?. The concept ?patient characteristics? related with the concepts ?need for coordination? and ?patient outcome?. Outcome was influenced by ?roles?, ?quality of relationship? and ?exchange of information?. Conclusions External factors and the (inter)organizational mechanism should enhance ?roles? and ?quality of relationship? between healthcare professionals and with the patient as well as ?exchange of information?, and setting and sharing of common ?goals? to improve care coordination and quality of care.status: publishe

MDS/RAI als voorbereiding op een multidisciplinair team: een verkennende studie

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