Rosella Hermens

Quality of integrated care for patients with head and neck cancer: Development and measurement of clinical indicators.

To improve the quality of integrated care, we developed indicators for assessing current practice in a large reference center for head and neck oncology.

Quality of integrated care for patients with nonsmall cell lung cancer: variations and determinants of care.

In the current study, the authors focused on determinants influencing the quality of care and variations in the actual quality of integrated care for patients with nonsmall cell lung cancer (NSCLC) to estimate whether there is room for improvement.

Impact of an integrated care program for patients with head and neck cancer on the quality of care

The management of patients with head and neck cancer is complex, and implementation of an integrated care program might improve the quality of care.

Improving patient-centeredness of fertility care using a multifaceted approach: study protocol for a randomized controlled trial.

BackgroundBeside traditional outcomes of safety and (cost-)effectiveness, the Institute of Medicine states patient-centeredness as an independent outcome indicator to evaluate the quality of healthcare. Providing patient-centered care is important because patients want to be heard for their ideas and concerns. Healthcare areas associated with high emotions and intensive treatment periods could especially benefit from patient-centered care. How care can become optimally improved in patient-centeredness is unknown. Therefore, we will conduct a study in the context of Dutch fertility care to determine the effects of a multifaceted approach on patient-centeredness, patients’ quality of life (QoL) and levels of distress. Our aims are to investigate the effectiveness of a multifaceted approach and to identify determinants of a change in the level of patient-centeredness, patients’ QoL and distress levels. This paper presents the study protocol.Methods/DesignIn a cluster-randomized trial in 32 Dutch fertility clinics the effects of a multifaceted approach will be determined on the level of patient-centeredness (Patient-centredness Questionnaire – Infertility), patients’ QoL (FertiQoL) and levels of distress (SCREENIVF). The multifaceted approach includes audit and feedback, educational outreach visits and patient-mediated interventions. Potential determinants of a change in patient-centeredness, patients’ QoL and levels of distress will be collected by an addendum to the patients’ questionnaire and a professionals’ questionnaire. The latter includes the Organizational Culture Assessment Instrument about the clinic’s culture as a possible determinant of an increase in patient-centered care.DiscussionThe study is expected to yield important new evidence about the effects of a multifaceted approach on levels of patient-centeredness, patients’ QoL and distress in fertility care. Furthermore, determinants associated with a change in these outcome measures will be studied. With knowledge of these results, patient-centered care and thus the quality of healthcare can be improved. Moreover, the results of this study could be useful for similar initiatives to improve the quality of care delivery. The results of this project are expected at the end of 2013.Trial registrationClinicialtrials.gov NCT01481064

Oncologic multidisciplinary team meetings: evaluation of quality criteria

RATIONALE, AIMS AND OBJECTIVES To develop a guideline with quality criteria for an optimal structure and functioning of a multidisciplinary team meeting (MTM), and to assess to what extent the Dutch MTMs complied with these criteria. METHOD A literature search and expert opinions were used to develop a guideline for optimal MTMs. In order to assess adherence to the guideline, we conducted interviews with MTM chairs and observed general and tumour-specific MTMs in seven hospitals. RESULTS The new guideline included the following domains: (i) organization of the MTMs; (ii) membership of the MTM and roles and responsibilities of the members; (iii) the meeting itself; and (iv) documentation of meeting-recommendations. We observed good adherence to the quality criteria on the organization of the MTMs. Only the required coordinator/administrative support was often absent, particularly during general MTMs. Regarding membership of MTMs and roles, the recommended average attendance of 100% of the core disciplines was never reached and particularly the role of the chair needs improvement. Regarding the meeting itself, many interruptions took place and relevant information about the diagnoses of the cases was not available in 4-5% of the cases. Concerning the documentation of meeting-recommendations, only in a quarter of the meetings a specific form was used for the documentation. CONCLUSIONS We found a lot of diversity in the organization of MTMs. The variation in compliance with the quality criteria may decrease with better knowledge about the quality criteria around MTMs and by overcoming practical barriers for the effective organization of MTMs.

Improvement of hospital care for patients with non-Hodgkin's lymphoma: protocol for a cluster randomized controlled trial (PEARL study)

BackgroundMalignant lymphomas constitute a diverse group of cancers of lymphocytes. One well-known disease is Hodgkin’s lymphoma; the others are classified as non-Hodgkin’s lymphoma (NHL). NHLs are the most common hematologic neoplasms in adults worldwide, and in 2012 over 170,000 new cases were estimated in the United States and Europe.In previous studies, several practice gaps in hospital care for patients with NHL have been identified. To decrease this variation in care, the present study aims to perform a problem analysis in which barriers to and facilitators for optimal NHL care will be identified and, based on these findings, to develop (tailored) improvement strategies. Subsequently, we will assess the effectiveness, feasibility and costs of the improvement strategies.Methods/designBarriers and facilitators will be explored using the literature, using interviews and questionnaires among physicians involved in NHL care, and patients diagnosed with NHL. The results will be used to develop a tailored improvement strategy. A cluster randomized controlled trial involving 19 Dutch hospitals will be conducted. Hospitals will be randomized to receive either an improvement strategy tailored to the barriers and facilitators found or, a standard strategy of audit and feedback.The effects of both strategies will be evaluated using previously developed quality indicators. Adherence to the indicators will be measured before and after the intervention period based on medical records from newly diagnosed NHL patients. To study the feasibility of both strategies, a process evaluation will be additionally performed. Data about exposure to the different elements of the strategies will be collected using questionnaires. Economic evaluation from a healthcare perspective will compare the two implementation strategies, where the costs of the implementation strategy and changes in healthcare consumption will be assessed.DiscussionThe presence of variation in the use of diagnostic tests, treatment, and follow-up between different physicians in different hospitals in the Netherlands is important for patients. To reduce the existing variation in care, implementation of tailored interventions to improve NHL care is necessary.Trial registrationThis trial is registered at ClinicalTrial.gov as the PEARL study, registration number NCT01562509.

P244 Development Of A Tailor-Made Implementation Strategy To Facilitate Adherence To The Dutch Postpartum Hemorrhage Guideline And Moet-Instructions

Background Despite the introduction of a national guideline and the Managing Obstetric Emergencies and Trauma (MOET) course the incidence of postpartum haemorrhage (PPH) is increasing. We suspected inadequate guideline implementation to be underlying. Objective Our objective was to develop and pilot test a tailor-made implementation strategy for the Dutch PPH guideline and the MOET course to increase guideline adherence. Methods Firstly, we aggregated the results of a current care and diagnostic analysis, which yielded barriers for guideline implementation, together with evidence found in international literature. Main barriers among professionals were lack of a checklist available in the labour ward, inadequate high-risk patient identification and lack of team communication. Patients mentioned insufficient information supply. Secondly, we developed different implementation tools for professionals and patients, based on these results. These tools were evaluated in a pilot testing among both groups. Results The strategy affects the period between the last trimester of the pregnancy till the end of the third stage of delivery. The tools for professionals consisted of a high-risk identification checklist, a care bundle for PPH prevention, and a PPH treatment checklist. As patient empowerment tools a patient passport and an information website were developed. Professionals had no points for improvement concerning the tools. Patients commented on the website, and changes were made accordingly. Discussion We developed a tailor-made strategy for PPH guideline implementation. The next step in the implementation process is to evaluate the feasibility of the strategy, including an effect, process and cost evaluation.