Differences in quality of care as perceived by persons with intellectual disabilities and their relatives.

Background: Health care organizations involve their clients in policymaking to deliver lient-orientated care and to improve the quality of care. However, in the care delivered to persons with intellectual disabilities, because of problems with communication skills, proxies are often used to gain information about the perceived quality of care. Research on the similarity between self-report and proxies, reveals contra dictionary evidence. The aim of this study is to explore differences between the views of persons with intellectual disabilities and their relatives about the quality of care. Methods: Using a combination of qualitative and quantitative methods a new instrument for measuring quality of care from the perspective of persons with intellectual disabilities’ relatives was developed. Persons with intellectual disabilities were involved from the beginning. Subsequently, this instrument was sent to 5400 clients’ relatives of a large Dutch care provider (response-rate: 58.4%). A total of 87 persons with mild intellectual disabilities were interviewed using an adapted version of the instrument. The design of the study allowed comparison on 26 quality aspects. Differences between the two groups were explored using Chi-square statistics (P < 0.05). Results: In general, persons with intellectual disabilities are more critical about the quality of care compared to their relatives, in areas that relate to ‘the support in the housing situation’ and ‘the care plan’. Significant differences were found in seven aspects: (i) care givers treat the patient seriously and respectful (ii) care givers make a good estimation of the client’s need for support (iii) care givers provide leisure activities (iv) caregivers pay attention to the clients’ sexuality (v) care givers take action if the client is not satisfied with his daily activities (vi) the client has a care plan (vii) agreements in the care plan are well explained to the client. Conclusions: According to this study, the persons with intellectual disability experience the quality of care differently than their relatives. This pleads for caution in the interpretation of the perceived care by relatives as a good reflection of persons with intellectual disabilities’ view. Triangulation in evaluating quality of care is suggested. (aut.ref.

Are patients' preferences regarding the place of treatment heard and addressed at the point of referral: an exploratory study based on observations of GP-patient consultations

Contains fulltext : 125245.pdf (publisher's version ) (Open Access)BACKGROUND: Today, in several north-western European countries, patients are encouraged to choose, actively, a healthcare provider. However, patients often visit the provider that is recommended by their general practitioner (GP). The introduction of patient choice requires GPs to support patients to be involved, actively, in the choice of a healthcare provider. We aim to investigate whether policy on patient choice is reflected in practice, i.e. what the role of the patient is in their choices of healthcare providers at the point of referral and to what extent GPs' and patients' healthcare paths influence the role that patients play in the referral decision. METHODS: In 2007-2008, we videotaped Dutch GP-patient consultations. For this study, we selected, at random, 72 videotaped consultations between 72 patients and 39 GPs in which the patient was referred to a healthcare provider. These were analysed using an observation protocol developed by the researchers. RESULTS: The majority of the patients had little or no input into the choice of a healthcare provider at the point of referral by their GP. Their GPs did not support them in actively choosing a provider and the patients often agreed with the provider that the GP proposed. Patients who were referred for diagnostic purposes seem to have had even less input into their choice of a provider than patients who were referred for treatment. CONCLUSIONS: We found that the GP chooses a healthcare provider on behalf of the patient in most consultations, even though policy on patient choice expects from patients that they choose, actively, a provider. On the one hand, this could indicate that the policy needs adjustments. On the other hand, adjustments may be needed to practice. For instance, GPs could help patients to make an active choice of provider. However, certain patients prefer to let their GP decide as their agent. Even then, GPs need to know patients' preferences, because in a principal-agent relationship, it is necessary that the agent is fully informed about the principal's preferences

Performance indicators used to assess the quality of primary dental care.

An appropriate quality of medical care including dental care should be an objective of every government that aims to improve the oral health of its population. OBJECTIVES: To determine performance indicators that could be used to assess the quality of primary dental care at different levels of a health care system, the sources for data collection and finally, the dimensions of quality measured by these indicators. METHOD: An explorative study of the international literature was conducted using medical databases, journals and books, and official websites of organisations and associations. RESULTS: This resulted in a set of 57 indicators, which were classified into the following dimensions for each intended user group: For patients: health outcomes and subjective indicators; for professionals: their performance and the rates of success, failure and complications; for health care system managers and policymakers: their resources, finances and health care utilisation. CONCLUSION: A set of 57 performance indicators were identified to assess the quality of primary dental care at the levels of patients, professionals and the health care system. These indicators could be used by managers and decision-makers at any level of the health care system according to the characteristics of the services. (aut. ref.

Consensus lage rugklachten: bekendheid, acceptatie en gebruik in de

Middels een enquête onder alle leden van de NOV werd nagegaan n welke mat

Quality of health care according to people with Down syndrome, their parents and support staff-A qualitative exploration

Contains fulltext : 229778.pdf (Publisher’s version ) (Open Access)BACKGROUND: People with Down syndrome (PDS) have complex healthcare needs. Little is known about the quality of health care for PDS, let alone how it is appraised by PDS and their caregivers. This study explores the perspectives of PDS, their parents and support staff regarding quality in health care for PDS. METHOD: The present authors conducted semi-structured interviews with 18 PDS and 15 parents, and focus groups with 35 support staff members (of PDS residing in assisted living facilities) in the Netherlands. RESULTS: According to the participants, healthcare quality entails well-coordinated health care aligned with other support and care systems, a person-centred and holistic approach, including respect, trust and provider-patient communication adapted to the abilities of PDS. CONCLUSIONS: Our findings may be used to improve health care for PDS, and provide insight into how health care could match the specific needs of PDS

Differences between family practices in the associations of patient characteristics with health care experiences

When comparing health care providers, patient experience data are usually adjusted for case-mix associations to ensure fair comparisons. Previous studies in the United States showed that case-mix associations sometimes vary across health care providers. Such variation could indicate differential provider behavior for patient subgroups, in which case current adjustment techniques might be inappropriate. To see whether this variation is also apparent in a health care system different from the U.S. system, the authors analyzed Dutch patients' experiences with family practice care. Using multilevel random slope models, the associations between age, general health status, mental health status, education, sex, and ethnicity on one hand and reported experiences on the other hand were assessed across family practices. The authors found only five significant variances between case-mix coefficients, all for outcomes related to health care professionals' conduct. These findings correspond to previous U.S. findings, suggesting that the case-mix variations reported here and previously constitute a rather robust phenomenon. (aut. ref.

De CQ-index Reumatische Aandoeningen: hanteerbaar en geschikt voor visitatie?

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Why U.S. health care expenditure and ranking on health care indicators are so different from Canada’s

Health care expenditure, United States, Canada, I10, I12,