Perspectives of older patients on the preventability of their unplanned emergency department return visit within 30 days in the Netherlands: a multicentre mixed methods study.

Objective: Older adults are prone to unplanned emergency department (ED) return visits (URVs). Knowledge about patient perspectives on the preventability and reasons for these URVs is limited and lacks a representable ED study population. This study aims to determine the proportion of URVs and to explore the preventability and underlying causes as perceived by a wide range of older adults and their caregivers.

Stakeholders' perspectives on capturing societal cost savings from a quality improvement initiative: A qualitative study.

Background: Besides improving the quality of care, quality improvement initiatives often also intend to produce cost savings. An example is prehabilitation, which can reduce complication rates and the length of stay in the hospital. However, the process from utilization reductions to actual societal cost savings remains uncertain in practice.

Understanding regional variation in euthanasia using geomedical frameworks: a critical ethical reflection.

Considerable geographical variation in the uptake of euthanasia has been reported: some municipalities in the Netherlands have a 25 times higher euthanasia rate than other municipalities. Current 'geomedical' frameworks for interpreting practice variation in health care utilization seem inadequately tailored to understand regional variation in morally controversial procedures such as euthanasia. The aim of this conceptual article is threefold: i) to add relevant medical ethical principles to current frameworks; ii) to provide a four-step ethical-geomedical model for the interpretation of geographical differences in the utilization of health care in general and for ethically controversial treatments in specific; iii) to gain better understanding of the existing geographical variation in the incidence of euthanasia by using this framework in our analysis.

Patient, caregiver and professional views on preventable emergency admissions of older patients, a multi-method study in three Dutch hospitals.

Background: Older adults are too often hospitalized from the emergency department (ED) without needing hospital care. Knowledge about rates and causes of these preventable emergency admissions (PEAs) is limited. This study aimed to assess the proportion of PEAs, the level of agreement on perceived preventability between physicians and patients, and to explore their underlying causes as perceived by patients, their relatives, and the admitting physician.

Low-value chronic prescription of acid reducing medication among Dutch general practitioners: impact of a patient education intervention.

Background: Dyspepsia is a commonly encountered clinical condition in Dutch general practice, which is often treated through the prescription of acid-reducing medication (ARM). However, recent studies indicate that the majority of chronic ARM users lack an indication for their use and that their long-term use is associated with adverse outcomes. We developed a patient-focussed educational intervention aiming to reduce low-value (chronic) use of ARM.

Design of a Multiple-Behavior Change Intervention for Supporting Self-management in Patients With Chronic Heart Failure: An Intervention Mapping Approach.

Background: Nonadherence to medication and low physical activity contribute to morbidity, mortality, and decreased quality of life among patients with chronic heart failure (CHF). Effective interventions that can be delivered during routine clinical care are lacking.

Objective: We aimed to adapt the feasible and cost-effective Adherence Improving self-Management Strategy (AIMS) for patients with human immunodeficiency virus (HIV) to CHF treatment.

The association of the STarT Back Screening Tool and type of leg pain with low back pain disability trajectories: a prospective cohort study.

Background: Multiple factors influence the recovery process of low back pain (LBP). The identification and increased knowledge of prognostic factors might contribute to a better understanding of the course of LBP. The purpose of this study is to investigate the association of the STarT Back Screening Tool (SBST) risk score and the type of leg pain (non-radiating LBP, referred non-radicular, and radicular radiating leg pain) with the disability trajectory (at baseline, the slope, and recovery at one year) in adults with low back pain.

Trends in low-value GP care during the COVID-19 pandemic: a retrospective cohort study.

Background: Several studies showed that during the pandemic patients have refrained from visiting their general practitioner (GP). This resulted in medical care being delayed, postponed or completely forgone. The provision of low-value care, i.

Non-indicated vitamin B- and D-testing among Dutch hospital clinicians: a cross-sectional analysis in data registries.

Objectives: To assess the extent of non-indicated vitamin B- and D-testing among Dutch clinicians and its variation among hospitals.

Design: Cross-sectional study using registration data from 2015 to 2019.

Participants: Patients aged between 18 and 70 years who received a vitamin B- or D-test.

Characteristics Associated With Telemonitoring Use Among Patients With Chronic Heart Failure: Retrospective Cohort Study.

Background: Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown to what degree telemonitoring has been adopted by hospitals and if the use of telemonitoring is associated with certain patient characteristics.

Sustainable adoption of noninvasive telemonitoring for chronic heart failure: A qualitative study in the Netherlands.

Objective: Noninvasive telemonitoring aims to improve healthcare for patients with chronic heart failure (HF) by reducing hospitalizations and improving patient experiences. Yet, sustainable adoption seems to be limited. Therefore, the goal of our study is to gain insight in the processes that support sustainable adoption of telemonitoring for patients with HF.

Low-value wound care: Are nurses and physicians choosing wisely? A mixed methods study.

Background: Choosing Wisely is an international movement that stimulates conversations about unnecessary care. The campaign created five recommendations including a statement that less wound care is sometimes better.

Aims: The study aims to evaluate nurses' and physicians' adherence to the Choosing Wisely recommendations for acute wound care in the Netherlands and the barriers and facilitators to improve this.

[Trends in number of vitamin B12- and D-determinations in the Netherlands].

Objective: To gain insight into the volume of vitamin B12- and D-determinations over time.

Design: A retrospective cohort study.

Method: Using declaration data of around 3.

Effect of ED-based transitional care interventions by healthcare professionals providing transitional care in the emergency department on clinical, process and service use outcomes: a systematic review.

Objective: Suboptimal transitional care (ie, needs assessment and coordination of follow-up care) in the emergency department (ED) is an important cause of ED revisits and hospital admissions and may potentially harm patients, especially frail older adults. We aimed to systematically review the effect of ED-based interventions by health professionals who are dedicated to providing transitional care to older adults.

Design: Systematic review.

Use of regional transmural agreements to support the right care in the right place for patients with chronic heart failure-a qualitative study.

Background: Chronic heart failure (CHF) poses a major challenge for healthcare systems. As these patients' needs vary over time in intensity and complexity, the coordination of care between primary and secondary care is critical for them to receive the right care in the right place. To support the continuum of care needed, Dutch regional transmural agreements (RTAs) between healthcare providers have been developed.

Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study.

Objective: We aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework.

Design And Methods: This study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determinants of the scaling of healthcare innovations and interventions.

Cascade of decisions meet personal preferences in sciatica treatment decisions.

Study Design: An in-depth interview study including patients, general practitioners, neurologists and neurosurgeons.

Objective: To gain insight in decision-making in sciatica care, by identifying patients' and physicians' preferences for treatment options, and the differences between and within both groups.

Summary Of Background Data: Sciatica is a self-limiting condition, which can be treated both conservatively and surgically.

[From compliance with volume standards to learning from healthcare outcomes].

The authors provide an update of an article about volume standards that was published in this journal in 2013. A systematic literature review uncovered trends in volume-outcomes research (2014-2021): studies focused on outcomes after concentration of care in the Netherlands, attempted to define volume thresholds and assessed whether experience in a specific operation can influence outcomes in similar procedures. Available research still does not shed much light on the mechanisms underlying the volume-outcome relationship.

[Plans of the Rutte IV administration: more control by the government, less personnel, lower budget].

The Rutte IV administration can and will spend much less on healthcare than its predecessor. A difficult task. Providing less low-value care, that is healthcare with no or little benefit for the patient given the alternatives, by physicians is one way to improve quality and reduce costs.

Low-value pharmaceutical care among Dutch GPs: a retrospective cohort study.

Background: Low-value pharmaceutical care exists in general practice. However, the extent among Dutch GPs remains unknown.

Aim: To assess the prevalence of low-value pharmaceutical care among Dutch GPs.

Advance care planning in primary care: a retrospective medical record study among patients with different illness trajectories.

Background: Advance Care Planning (ACP) enables physicians to align healthcare with patients' wishes, reduces burdensome life-prolonging medical interventions, and potentially improves the quality of life of patients in the last phase of life. However, little objective information is available about the extent to which structured ACP conversations are held in general practice. Our aim was to examine the documentation of ACP for patients with cancer, organ failure and multimorbidity in medical records (as a proxy for ACP application) in Dutch general practice.

Increased adherence to perioperative safety guidelines associated with improved patient safety outcomes: a stepped-wedge, cluster-randomised multicentre trial.

Background: National Dutch guidelines have been introduced to improve suboptimal perioperative care. A multifaceted implementation programme (IMPlementatie Richtlijnen Operatieve VEiligheid [IMPROVE]) has been developed to support hospitals in applying these guidelines. This study evaluated the effectiveness of IMPROVE on guideline adherence and the association between guideline adherence and patient safety.

Hospitals Bending the Cost Curve With Increased Quality: A Scoping Review Into Integrated Hospital Strategies.

Background: A lack of knowledge exists on real world hospital strategies that seek to improve quality, while reducing or containing costs. The aim of this study is to identify hospitals that have implemented such strategies and determine factors influencing the implementation.

Methods: We searched PubMed, EMBASE, Web of Science, Cochrane Library and EconLit for case studies on hospital-wide strategies aiming to increase quality and reduce costs.