Data to knowledge to improvement: creating the learning health system.

detail key domains, tools, and actions required to enact learning health systems for continuous intelligent improvement in healthcare

Psychosocial care responses to terrorist attacks: a country case study of Norway, France and Belgium.

Background: The international terrorism threat urges societies to invest in the planning and organization of psychosocial care. With the aim to contribute to cross-national learning, this study describes the content, target populations and providers of psychosocial care to civilians after terrorist attacks in Norway, France and Belgium.

Methods: We identified and reviewed pre- and post-attack policy documents, guidelines, reports and other relevant grey literature addressing the psychosocial care response to terrorist attacks in Oslo/Utøya, Norway on 22 July 2011; in Paris, France on 13 November 2015; and in Brussels, Belgium on 22 March 2016.

Conceptualizing Vulnerability for Health Effects of the COVID-19 Pandemic and the Associated Measures in Utrecht and Zeist: A Concept Map.

The COVID-19 pandemic and the associated measures have impacted the health of many. Not all population groups are equally vulnerable to such health effects, possibly increasing health inequalities. We performed a group concept mapping procedure to define a common, context-specific understanding of what makes people vulnerable to health effects of the pandemic and the measures.

Development, Implementation, and Evaluation of an Advance Care Planning Program for Professionals in Palliative Care of People With Intellectual Disability.

In this article we describe how an advance care planning (ACP) program was developed, implemented, and evaluated. Our aim was to improve ACP in palliative care for people with intellectual disability (ID). The program was based on 10 competencies needed for ACP and was developed in a co-design process with people with ID, relatives, and professionals.

Sustainment of Innovations in Palliative Care: A Survey on Lessons Learned From a Nationwide Quality Improvement Program.

Context: Although much is known about factors influencing short-term implementation, little is known about what factors are relevant for the long-term sustainment of innovations. In the Dutch National Quality Improvement Program for Palliative Care, innovations were implemented in 76 implementation projects.

Objectives: To give insight into the sustainment strategies used and factors facilitating and hindering sustainment.

Bending the quality curve.

With this paper, we initiate the Supplement on Deepening our Understanding of Quality in Australia (DUQuA). DUQuA is an at-scale, cross-sectional research programme examining the quality activities in 32 large hospitals across Australia. It is based on, with suitable modifications and extensions, the Deepening our Understanding of Quality improvement in Europe (DUQuE) research programme, also published as a Supplement in this Journal, in 2014.

What is important for advance care planning in the palliative phase of people with intellectual disabilities? A multi-perspective interview study.

Background: Advance care planning (ACP) is the process of discussing and documenting wishes and preferences for future care. Research about ACP for people with intellectual disabilities (ID) is limited. This study describes what is important for ACP in the palliative phase of people with intellectual disabilities.

What proportion of initially prescribed antidepressants is still being prescribed chronically after 5 years in general practice? A longitudinal cohort analysis.

Objectives: Antidepressant prescribing almost doubled in the Netherlands between 1996 and 2012, which could be accounted for by longer continuation after the first prescription. This might be problematic given a growing concern of large-scale antidepressant dependence. We aimed to assess the extent and determinants of chronic antidepressant prescribing among patient aged 18 years and older.

Perspectives of nursing professionals and older adults differ on aspects of care for older people after a nationwide improvement program.

Background: The perspectives of nursing professionals might differ from those of older adults when it comes to care for older people. This cross-sectional study compares the views of older adults with the views of nursing professionals on the quality of care after a nationwide improvement program for care for older people was implemented (2008-2016) in the Netherlands.

Methods: Questionnaire data were used from 385 nursing professionals (response rate 51%) that were part of the Nursing Staff Panel, a nationwide representative group of nursing staff, and working in home care, hospitals or general practices.

Multicentre analysis of current ST-elevation myocardial infarction acute care pathways.

Background: Rapid reperfusion with percutaneous coronary intervention (PCI) is vital for patients with ST segment elevation myocardial infarction (STEMI). However, the guideline-recommended time targets are regularly exceeded. The goal of this study was to gain insight into how Dutch PCI centres try to achieve these time targets by comparing their care processes with one another and with the European guideline-recommended process.

Advance Care Planning in Palliative Care for People With Intellectual Disabilities: A Systematic Review.

Context: Advance care planning (ACP) is defined as a person-centered, ongoing process of communication that facilitates patients' understanding, reflection, and discussion of goals, values, and preferences for future care. There is evidence for the general palliative care population that ACP increases compliance with patients' end-of-life preferences and improves quality of care near the end of life.

Objectives: To gain insight into what is known about the use and effects of ACP in palliative care for people with intellectual disabilities (IDs).

Potential for substitution of mental health care towards family practices: an observational study.

Background: Substitution is the shift of care from specialized health care to less expensive and more accessible primary health care. It seems promising for restraining rising mental health care costs. The goal of this study was to investigate a potential for substitution of patients with psychological or social problems, but without severe psychiatric disorders, from Dutch specialized mental health care to primary care, especially family practices.

Consultations in general practices with and without mental health nurses: an observational study from 2010 to 2014.

Objectives: To investigate care for patients with psychological or social problems provided by mental health nurses (MHNs), and by general practitioners (GPs) with and without MHNs.

Design: An observational study with consultations recorded by GPs and MHNs.

Setting: Data were routinely recorded in 161-338 Dutch general practices between 2010 and 2014.

Current training on the basics of robotic surgery in the Netherlands: Time for a multidisciplinary approach?

Introduction: The following research questions were answered: (1) What are the training pathways followed by the current robot professionals? (2) Are there any differences between the surgical specialties in robot training and robot use? (3) What is their opinion about multidisciplinary basic skills training?

Methods: An online questionnaire was sent to 91 robot professionals in The Netherlands. The questionnaire contained 21 multiple-choice questions focusing on demographics, received robot training, and their opinion on basic skills training in robotic surgery.

Results: The response rate was 62 % (n = 56): 13 general surgeons, 16 gynecologists, and 27 urologists.

Use of general practice services 5 years after an episode of mental illness: case-control study using electronic records.

Background: Depression, anxiety, and emotional distress occur frequently and are usually treated in general practice. Little has been reported about the long-term course of these conditions and the long-term use of medical services.

Aim: To follow up patients with depression, anxiety, and emotional distress in general practice for 5 years and examine the length and number of index episodes, prescribing behaviour, and the use of services in general practice.

Quality of pharmaceutical care at the pharmacy counter: patients' experiences versus video observation.

Introduction: Consumer Quality Index questionnaires are used to assess quality of care from patients' experiences.

Objective: To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations.

Methods: Pharmaceutical encounters in four pharmacies were video-recorded.

Perspectives of people with mild intellectual disabilities on care relationships at the end of life: A group interview study.

Background: Care relationships are crucial in tailoring the end-of-life care of a person with intellectual disabilities (ID) to their needs. Yet, almost all studies on end-of-life care for people with ID have been conducted among caregivers. The views of people with ID about care relationships at the end of life have not been a specific focus of research.

Crew resource management training in the intensive care unit. A multisite controlled before-after study.

Introduction: There is a growing awareness today that adverse events in the intensive care unit (ICU) are more often caused by problems related to non-technical skills than by a lack of technical, or clinical, expertise. Team training, such as crew resource management (CRM), aims to improve these non-technical skills. The present study evaluated the effectiveness of CRM in the ICU.

Exploring the treatment delay in the care of patients with ST-elevation myocardial infarction undergoing acute percutaneous coronary intervention: a cross-sectional study.

Background: A short delay between diagnosis and treatment for patients diagnosed with ST-elevation myocardial infarction (STEMI) is vital to prevent cardiac damage and mortality. The objective of this study was to explore the treatment delay and associated factors in the management of patients diagnosed with STEMI going for percutaneous coronary intervention (PCI).

Methods: In a cross-sectional multicenter study, the treatment delay (time between first electrocardiogram and start of PCI procedure) of STEMI patients in seven PCI centers in the Netherlands was measured.

Data quality issues impede comparability of hospital treatment delay performance indicators.

Aim: To assess the comparability of five performance indicator scores for treatment delay among patients diagnosed with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention in relation to the quality of the underlying data.

Methods: Secondary analyses were performed on data from 1017 patients in seven Dutch hospitals. Data were collected using standardised forms for patients discharged in 2012.

Patient-provider interaction during medication encounters: A study in outpatient pharmacies in the Netherlands.

Objective: To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated.

Methods: Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded.

End-of-life communication: a retrospective survey of representative general practitioner networks in four countries.

Context: Effective communication is central to high-quality end-of-life care.

Objectives: This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics.

Methods: This cross-sectional, retrospective survey was conducted with representative GP networks.

The course of apraxia and ADL functioning in left hemisphere stroke patients treated in rehabilitation centres and nursing homes.

Objective: To study the course of apraxia and daily life functioning (ADL) in left hemisphere stroke patients with apraxia.

Design: Prospective cohort study.

Setting: Rehabilitation centres and nursing homes.