Uniform Registration Agreements on Cholesteatoma Care: A Nationwide Consensus Procedure.

Background: To coordinate and align the content for registration of cholesteatoma care.

Methods: Systematic Delphi consensus procedure, consisting three rounds: two written sessions followed by a face-to-face meeting. Before this procedure, input on important patient outcomes was obtained.

Medication management strategy for older people with polypharmacy in general practice: a qualitative study on prescribing behaviour in primary care.

Background: For older patients with polypharmacy, medication management is a process of careful deliberation that needs periodic adjustment based on treatment effects and changing conditions. Because of the heterogeneity of the patient group, and limited applicability of current guidelines, it is difficult for GPs to build up a routine.

Aim: To gain insight into GPs' medication management strategies for patients with polypharmacy, and to explore the GPs' perspectives and needs on decision-making support to facilitate this medication management.

Inter-practice variation in polypharmacy prevalence amongst older patients in primary care.

Purpose: Complex medication management in older people with multiple chronic conditions can introduce practice variation in polypharmacy prevalence. This study aimed to determine the inter-practice variation in polypharmacy prevalence and examine how this variation was influenced by patient and practice characteristics.

Methods: This cohort study included 45,731 patients aged 55 years and older with at least one prescribed medication from 126 general practices that participated in NIVEL Primary Care Database in the Netherlands.

Case-mix adjustment for diabetes indicators: a systematic review.

Objectives: Case-mix adjustment is generally considered indispensable for fair comparison of healthcare performance. Inaccurate results are also unfair to patients as they are ineffective for improving quality. However, little is known about what factors should be adjusted for.

Quality of chronic kidney disease management in primary care: a retrospective study.

Background: Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality.

Aim: To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies.

Design And Setting: Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults).

Longevity of direct restorations in Dutch dental practices. Descriptive study out of a practice based research network.

Objectives: The aim of this retrospective practice-based study was to investigate the longevity of direct restorations placed by a group of general dental practitioners (GDPs) and to explore the effect of practice/operator, patient, and tooth/restoration related factors on restoration survival.

Methods: Electronic Patient Files of 24 general dental practices were used for collecting the data for this study. From the patient files, longevity of 359,548 composite, amalgam, glass-ionomer and compomer placed in 75,556 patients by 67 GDPs between 1996 and 2011 were analyzed.

Dutch influenza vaccination rate drops for fifth consecutive year.

Aim: To determine the prevalence and trend of the influenza vaccination-rate of the overall target population in the period 2008-2013, with a specific focus on groups at risk such as patients with cardiovascular diseases, lung diseases, diabetes and aged 60 years and older.

Methods: In an observational longitudinal study electronic medical records data from the Dutch representative network of general practices, LINH, were analyzed. For each influenza vaccination season, 2008-2013, the number of vaccinated and unvaccinated patients at risk are compared by chi-square tests (χ(2)) for linear trends, linear-by-linear association.

Multimorbidity patterns in a primary care population aged 55 years and over.

Background: To support the management of multimorbid patients in primary care, evidence is needed on prevalent multimorbidity patterns.

Objective: To identify the common and distinctive multimorbidity patterns.

Methods: Clinical data of 120480 patients (≥55 years) were extracted from 158 general practices in 2002-11.

Patient characteristics associated with measurement of routine diabetes care: an observational study.

Background: Non-modifiable patient characteristics, including age, gender, ethnicity as well as the occurrence of multi-morbidities, are associated with processes and outcomes of diabetes care. Information on these factors can be used in case mix adjustment of performance measures. However, the practical relevance of such adjustment is not clear.

Patients' expectations of variation in quality of care relates to their search for comparative performance information.

Background: Choice of hospital based on comparative performance information (CPI) was introduced for Dutch healthcare consumers at least 5 years ago, but CPI use has not yet become commonplace. Our aim was to assess the role of patients' expectations regarding variation in the quality of hospital care in determining whether they search for CPI.

Methods: A questionnaire (for a cross-sectional survey) was distributed to 475 orthopaedic patients in a consecutive sample, who underwent primary hip or knee replacement in a university, teaching, or community hospital between September 2009 and July 2010.

Effect of accreditation on the quality of chronic disease management: a comparative observational study.

Background: Practice accreditation is widely used to assess and improve quality of healthcare providers. Little is known about its effectiveness, particularly in primary care. In this study we examined the effect of accreditation on quality of care regarding diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD).

Organizational determinants of high-quality routine diabetes care.

Objective: Randomized trials showed that changes in healthcare organization improved diabetes care. This study aimed to identify which organizational determinants were associated with patient outcomes in routine diabetes care.

Design: Observational study, in which multilevel regression analyses were applied to examine the impact of 12 organizational determinants on diabetes care as separate measures and as a composite score.

Comparative performance information plays no role in the referral behaviour of GPs.

Background: Comparative performance information (CPI) about the quality of hospital care is information used to identify high-quality hospitals and providers. As the gatekeeper to secondary care, the general practitioner (GP) can use CPI to reflect on the pros and cons of the available options with the patient and choose a provider best fitted to the patient's needs. We investigated how GPs view their role in using CPI to choose providers and support patients.

Exploring consumer values of comparative performance information for hospital choice.

Background: In many countries, market orientation in healthcare has resulted in the publication of comparative performance information (CPI). Most of the research in this field is oriented towards the content and the presentation format of CPI while little is known about how consumers value CPI and the use of this information.

Aim: The aim of this study was to clarify the perceived value that CPI brings for consumers of healthcare.

Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain.

Background: Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of adherence to the national CPG for low back pain by Dutch physical therapists.

Methods: We systematically developed a program to improve adherence to the Dutch physical therapy guidelines for low back pain.

Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial.

Background: Chronic kidney disease (CKD) is highly prevalent in patients with diabetes or hypertension in primary care. A shared care model could improve quality of care in these patients

Aim: To assess the effect of a shared care model in managing patients with CKD who also have diabetes or hypertension. Design and setting A cluster randomised controlled trial in nine general practices in The Netherlands.

Pandemic influenza A(H1N1)pdm09 improves vaccination routine in subsequent years: a cohort study from 2009 to 2011.

Background: In 2009 the pandemic influenza virus A(H1N1)pdm09 emerged with guidance that people at risk should be vaccinated. It is unclear how this event affected the underlying seasonal vaccination rate in subsequent years.

Purpose: To investigate the association of pandemic influenza A(H1N1)pdm09 and seasonal flu vaccination status in 2009 with vaccination rates in 2010 and 2011.

Precision of individual and composite performance scores: the ideal number of indicators in an indicator set.

Background: In many countries, quality indicators are used to assess the quality of care of family practice. Such assessments need to have an adequate precision, so that the results can be interpreted correctly. However, a small sample size per practitioner can lead to inadequate precision.

[Increased multimorbidity in patients in general practice in the period 2003-2009].

Objective: To determine the prevalence of chronic multimorbidity and its increase in primary care.

Design: Descriptive longitudinal study.

Method: We selected patients suffering from chronic pulmonary disease, chronic cardiovascular disease, or diabetes from a national representative general practice research database (LINH).

Adherence to clinical practice guidelines for low back pain in physical therapy: do patients benefit?

Background: Various guidelines for the management of low back pain have been developed to enhance the effectiveness and efficiency of care. Evidence that guideline-adherent care results in better health outcomes, however, is not conclusive.

Objective: The main objective of this study was to assess whether a higher percentage of adherence to the Dutch physical and manual therapy guidelines for low back pain is related to improved outcomes.

Labour intensity of guidelines may have a greater effect on adherence than GPs' workload.

Background: Physicians' heavy workload is often thought to jeopardise the quality of care and to be a barrier to improving quality. The relationship between these has, however, rarely been investigated. In this study quality of care is defined as care 'in accordance with professional guidelines'.

An overview of patients' preference for, and satisfaction with, care provided by general practitioners and nurse practitioners.

Aim And Objectives: To assess patients' views on the care provided by nurse practitioners compared with that provided by general practitioners and to determine factors influencing these views.

Background: Many countries have sought to shift aspects of primary care provision from doctors to nurses. It is unclear how patients view these skill mix changes.

Management of children's urinary tract infections in Dutch family practice: a cohort study.

Background: Optimal clinical management of childhood urinary tract infections (UTI) potentiates long-term positive health effects. Insight into the quality of care in Dutch family practices for UTIs was limited, particularly regarding observation periods of more than a year. Our aim was to describe the clinical management of young children's UTIs in Dutch primary care and to compare this to the national guideline recommendations.

Logistic support service improves processes and outcomes of diabetes care in general practice.

Background: Guidelines for type 2 diabetes care in general practice are well known and accepted, but the implementation falls short.

Objective: To implement these guidelines by introducing a diabetes support service (DSS) to support the care delivered by the GP.

Methods: A controlled, non-randomised study with delayed intervention in the control group; 78 GPs (n=51 for the intervention and n=21 for the control group) in the south of the Netherlands and 613 of their type 2 diabetic patients participated.