TLEMsafe is a European Project dedicated to generating semi-automated 3-D image-analyzing tools to simulate the musculoskeletal (M-S) system of patients. The patient-specific parameters are fed into models with which the patient specific functional outcome.
By: Radboud, Twente, Lueven, Anybody technology, Warsaw, Brainlab AG, Munich
Outcome measures prostate cancer
We use patient reported outcome measurements to improve quality and transparency of care for Dutch patients with localized prostate cancer. This “care tracking system” consist of a website and iPhone/Android App where patients answer questions about cancer.
By: Maasstad Ziekenhuis
The Dialogue Model
The Dialogue Model is an evidence based method to achieve partnership, joined evaluation and agreement with patients/clients and their relatives. Through dialogue an understandable and manageable narrative is created combining professional reflections and findings with beliefs, views, values and needs of the patient system. A picture is used as a graphic interface to stimulate the two-way flow of information. Informed consent, empowerment and shared decision-making are the key words that characterize the Dialogue Model. It has been designed and studied (RCT) in youth mental health and is nowadays also used in general care. Patients/clients and professionals advocate the Dialogue Model.
By: Orbis medical centre
Outpatient THA program
In the past decades the number of total hip arthroplasties (THA) has increased and with an aging and more demanding population this number is thought to grow even further. Historically the length of stay (LOS) in the Netherlands was approximately two weeks, and in many European countries it still is. A fast track program with emphasis on process optimization and a thorough breakdown of medical tradition was set up to improve on patient satisfaction and recovery. After final improvements, in April 2014 we started an outpatient THA program to enable patients to leave the hospital on the day of surgery.
Quality of care cycle for tonsillectomy in children
In 2004 a study on tonsillectomy in children was published by a Dutch research group. It presented new evidence, that supported a strategy of watchful waiting instead of tonsillectomy in children that suffered from only mild complaints. The Dutch ENT-association started a quality of care cycle by developing a guideline. The guideline suggested further research on adenoidectomy. This research was executed by the same group as mentioned earlier. The guideline was revised. Recently, I did a budget impact analysis on this quality of care cycle. Up till 2013 the cycle resulted in approximately € 6 million in savings. Better patient care for less money!
Cost-effectiveness of food allergy diagnostics
Currently, for diagnosis of food allergy a DBPCP is often essential This test is expensive, uncomfortable for the patient and carries the risk of an anaphylactic shock. Rijnstate Hospital, University Wageningen and the out-patient Allergy Clinic Arnhem showed that for cow’s milk allergy the DBPCP can often be substituted safely for an in vitro Basophil Activation Test(BAT). The BAT is cheap, can be applied to many other food allergens, and only requires a small volume of blood. Rijnstate Hospital (and partners) will establish an allergy diagnostic centre to perform centrally the BATs for the Dutch health care market to achieve further cost reduction and quality improvement.
By: Rijnstate & partners
Interventional pain management of the sacro iliac joint
Minmal invasive procedure, minimal tissue damage, low cost procedure, effective and safe. To achieve an effective blokkade of the S-I joint,it is necessary to block the ramus dorsalis of: the first,second and third sacral nerve and of the fifth lumbar nerve. Sometimes also of the forth lumbar nerve. We use a SMK 10cm. needle with a 10 mm. tip.We bend the last 10 mm about 10 degrees upwards, with the bevel down.Under radiografic guidance the needle must penetrate the skin one cm lateral of the fourth sacral foramen withe the tip upwards.A little more caudal in an obese patient.Connect the needle to the radiofrequency set and start stimulating at 0,4 volt/50 Hz.The needle is advanced cranially,close to the sacral bone and 0,5 to 1,0 cm lateral of the foraminae.This until a stimulation reaction is given by the patient.Lesion is made after injecting some local anesthesia.Correction in all directions is possible by rotating the needle.After the first lesion the needle is moved upwards until the next stimulation reactioon of the patient.It is possible to achieve three sacral bloks and the L5 ramus dorsalis with this procedure.Sometimes it is necessary to make a new start at level S2 to block the S1 and L5 ramus dorsalis.
By: Admiraal de Ruyter Ziekenhuis
Redesign of care for older patients with hip fracture
We have redesigned our care for older patients with hip fractures by reconnecting the full range of involved healthcare workers with the outcome from the individual patient’ perspective. Leading specialist is the doctor of geriatric medicine instead of the surgeon. We defined the best possible outcome as a full rehabilitation to the functional and cognitive status prior to the fracture. Furthermore we emphasized on in-hospital empowerment of the informal caregivers like family. In our project, the whole of provided care is greater than the sum of the parts. Reconnection to the final outcome was the driving force.
Achmea Program quality of care
The Achmea program Quality of Care is the largest private initiative in the Netherlands to achieve continuous quality improvement. We aim to realize transparency on health outcome measures and nationwide implementation for 40% of healthcare (starting point in 2011: +8%). The program covers 22 conditions ranging from lower back pain to dementia. Following the implementation and learning cycles, the business case now shows potential savings of >75.000 QoLs and EUR 325 million, without exhausting our investment funds (EUR 30 million). Quality and cost go along: the best providers (top quartile in outcomes distribution) proved to be the cheapest.
Personalised treatment of morbid obesity
Obesity is an increasing global health problem with 10% of the population being obese. Although considered to be generated by environmental factors, not everyone sharing the same ‘obesogenic environment’ is obese. Twin studies provide strong evidence that body weight regulation is highly heritable (up to 85%). However, mutations in obesity genes can only be identified in 10% of the morbid obese cases. I aim to investigate morbid obese cases by using next generation sequencing techniques to identify new obesity genes and assess the implications of highly-penetrant forms of morbid obesity for response to treatment.
By UMC Utrecht
Continuous monitoring patients’ vital signs at the surgical ward using wearable’s
Interval measurements of vital signs in surgical patients at the ward is performed to diagnose abnormal postoperative course. The measurements are time-consuming and disturb patient’s rest. Due to interval measurements subclinical deterioration can be missed. New technology such as Visimobile and HealthPatch allows for remote continuous monitoring of vital signs using wearable devices transmitting relevant data to nurses and clinicians. We designed a comparative study in surgical patients, assessing efficacy and ease of use of wearable devices. We expect reduced workload of medical personnel, reduced patient’s distress, and early recognition of (sub)clinical deterioration allowing for appropriate intervention and more intensive support.
By Radboud UMC
Hysterosalpingo-Foam Sonography (HyFoSy) a new technique of visualizing tubal patency
Several test are available to demonstrate tubal patency in case of female subfertility, including hysterosalpingography and laparoscopy with blue dye test.
We have introduced a Gel as a contrastmedium for intra-uterine ultrasound. When this gel is diluted and mixed a foam is created, sufficient fluid to pass patent tubes with microbubbles to show echogeniety during ultrasonographic examination.
We found a clean safe, non-toxic and cheap alternative for visualizing tubal patency. This investigation can be performed with standard transvaginal ultrasonography equipment without the use of X-ray (hysterosalpingography) or general anaesthesia (laparoscopy with contrast dye) and has minimal inconveniences for the patient.
By Spaarne Ziekenhuis
Value Based HIV care
In het OLVG zijn als eerste ter wereld negen HIV zorg uitkomstindicatoren vastgesteld: 1) Mortaliteit binnen een jaar, 2) en 3) Gezondheidstoestand (fysiek en emotioneel) na 1 en 5 jaar (mbv vragenlijst RAND 36), 4) Optreden van depressie (mbv HADS score) 5) en 6) HIV onderdrukking binnen 6 maanden na – en gedurende 5 jaar na start therapie, 7) Medicatie switch vanwege bijwerkingen, 8) Optreden van hartvaatziekten, 9) Patienten lost to follow up. Over indicator 4-9 zijn 15 jaar retrospectieve data, sinds augustus 2014 worden alle indicatoren propsectief gemonitord, over indicator 4-9 zijn 15 jaar retrospectieve data.
Cost effective quality of care gain by reduction of surgery of patients with oesophageal cancer
In about thirty percent of cases pathologists cannot detect any tumour cells in surgically removed oesophageal material following a chemo-radio therapy treatment. This observation implies that not operating becomes an option in those cases where the tumour responded very well. This project uses cutting edge molecular technologies to test, before the therapy is started, which patients should consider not to undergo the operation. The test will support the patient-physician’s shared decision making process in avoiding this radical operation with its profound negative implications for the patient’s quality of life. The effect on quality of life and cost of care are measured in this implementation study.
By: MC leeuwarden, Zorgbelang Fryslan, IMTA, vitromics
MC leeuwarden, Zorgbelang Fryslan, IMTA, vitromics
CZ wil de beste zorg voor haar verzekerden: zorg die de meeste waarde oplevert voor de patiënt. Er is sprake van waarde als de patiënt door zorgverlening de doelen bereikt die hij met die zorg nastreeft. Dit bij een zo hoog mogelijke kwaliteit tegen zo laag mogelijke kosten. CZ wil door middel van zorginkoop prikkels uitdelen om de kans op doelrealisatie door de patiënt groter te maken. Hiervoor is een model ontwikkeld waardoor de zorginkopers geholpen worden te sturen op dié elementen die de doelrealisatie in de weg staan of juist versterken: de “waardebeïnvloedende elementen’. Volledige toepassing van het model leidt tot waardegedreven zorginkoop. Binnen de farmacie hebben we dit voor de inkoop 2015 reeds weten te realiseren.
Early group education of CKD patients
Early group-education of CKD patients; the impact on pre-emptive kidney transplantation. Patients experience difficulties talking with relatives/friends about their health situation. Living Kidney Donation is frequently overlooked. Hospital social-workers offer patient education of family and friends in their home situation. The gathering involves a discussion about current and future health status and treatment modalities. Data of survival on dialysis, after LKD and deceased donor transplantation are given. Risks and benefits of LKD for recipient and donor are presented. Participants welcomed the family counseling . Until august 2014 education was given to 60 families. Potential donors showed up in 52 cases.
By: Maasstad Ziekenhuis
well-being instrument for kidney patients
It’s hard for patients to put into words how they feel and experience the different stages of disease. Measuring-instrument (NCCN2003/IKA 2006) adapted for kidney patients, conducted by a hospital socialworker during home-visit. Annualy repetition and when situation changes, multidisciplinary insightful. In 2013 at 118 patients decreased the well-being metres, 62 men/56 women. 80% is seriously tired, 50% experience less daily functioning, 40% experience sadness/grief and 27% give their wellbeing inadequate. Patients get more control on their medical situation and well-being. It provides information to the patient and to practitioners about the condition. Possible startingpoint for treatmentplan.
By: Maasstad Ziekenhuis
The Dutch ParkinsonNet is a nationwide professional network, with 2,700 specifically trained healthcare professionals from 12 disciplines working within 68 regional networks. Core elements include disease-specific professional training, multidisciplinary collaboration, and patient-centeredness (emphasis on self-management in the home situation). ParkinsonNet improves quality of care (better guideline adherence), reduces disease complications (e.g. >50% reduction in hip fractures) and lowers the costs (savings up to €20 million Euros annually). The British Medical Journal labelled ParkinsonNet a revolution in chronic disease management. Together with Dutch insurers, we have taken concrete steps to now finance this integral network for good outcomes per invested Euro.
By Radboud UMC, VGZ en CZ
Dutch Living Donor Kidney Exchange Program
Kidney transplantation is the best solution for patients with renal failure. One out of six kidney patients is incompatible with his/her living donor (blood group or positive cross match). The Dutch Living Donor Kidney Exchange Program has become an efficient solution for these couples. An important factor for the success of our program is the unique collaboration between all eight kidney transplantation centers in the Netherlands, the National Reference Laboratory for Histocompatibility, and the Dutch Transplant Foundation. The algorithm of our innovative matching program ensures that the maximum number of patients will be helped and that this is done fairly.
By: Erasmus MC
Care for Outcome
Care for Outcome is a project of Santeon, an umbrella organization of six top clinical hospitals in the Netherlands. Care for Outcome started in 2012, defining a compact set of outcome indicators for prostate cancer and lung cancer, using a development process based on principles of value based health care. In February 2014 we presented the indicator sets and the first results of the outcomes of three Santeon hospitals. We use these outcomes to compare and learn between the six hospitals in creating an improvement cycle in our care, with remarkable results. In April 2015 we will present the outcomes of all six Santeon hospitals for four medical conditions in oncology.