Janneke Schilp - Academia.edu (original) (raw)
Papers by Janneke Schilp
BMC health services research, Mar 20, 2018
Background: Quality systems are believed to be positively related to quality and safety in health... more Background: Quality systems are believed to be positively related to quality and safety in healthcare. However, there is no convincing evidence for this relationship in the literature. This study aims to examine the association between the development stage of hospital quality systems and the implementation of patient safety themes at the process level. Methods: This study combines data from a national survey on the development stage of quality systems in Dutch hospitals with results from an evaluation study of the Dutch Hospital Patient Safety Program. Data on the development stage of quality systems were collected in Dutch hospitals in 2011. A total of 73 quality coordinators completed a questionnaire (response rate 77%) covering five quality system domains: policy and strategy, human resource management, patient involvement, practice guidelines, and systematic quality improvement. Data were included on the implementation of five patient safety themes from the Dutch Hospital Safety Program. Process indicators for each theme were measured every four to six weeks, resulting in ten measurements in each hospital. Data were analyzed using multilevel analysis. Results: The mean score for hospital quality system development was 2.30 (range 1 to 3). The mean scores for the various quality system domains ranged from 1.56 (Patient Involvement) to 2.66 (Human Resources Management). The mean percentages for the implementation of the patient safety themes ranged from 12% for the 'Pain' process indicator to 73% for execution of the 'Time-Out Procedure'. The intraclass correlation coefficients of the interceptonly model ranged between 11.6 and 51.6, which indicates large differences between hospitals in the implementation of the patient safety themes. Positive associations between quality system development stage and implementation of patient safety themes were found for four of the five patient safety themes, although they were not statistically significant. Conclusions: This study found no association between the development stage of a hospital quality system and the implementation of patient level safety themes at the process level. This rejects the hypothesis that quality improvement is caused by a positive relationship between structure (the quality system) and processes (the safety program implementation), which in their turn mold the quality of care at the patient level.
BMC Health Services Research, 2016
Background: By assessing patient safety culture, healthcare providers can identify areas for impr... more Background: By assessing patient safety culture, healthcare providers can identify areas for improvement in patient safety culture. To achieve this, these assessment outcomes have to be relevant and presented clearly. The aim of our study was to explore healthcare professionals' views on the feedback of a patient safety culture assessment. Methods: Twenty four hospitals participated in a patient safety culture assessment in 2012. Hospital departments received feedback in a report and on a website. In a survey, we evaluated healthcare professionals' views on this feedback and the effect of additional information about patient safety culture improvement strategies on the appraisal of the feedback. 20 hospitals participated in part I (evaluation of the report), 13 hospitals participated in part II (evaluation of the website). Results: Healthcare professionals (e.g. members of staff and department heads/managers) rated the feedback in the report and on the website positively (average mean on different aspects = 7.2 on a scale from 1 to 10). Interpreting results was sometimes difficult, and information was sometimes lacking, like specific recommendations and improvement strategies. The provision of additional general information on patient safety culture improvement strategies resulted only in a higher appraisal of the attractiveness (lay-out) of the report and the understandability of the feedback report. The majority (84 %) of the healthcare professionals agreed or partly agreed that the feedback on patient safety culture stimulated actions to improve patient safety culture. However, a quarter also stated that although the feedback report provided insight into the patient safety culture, they did not know how to improve patient safety culture in their hospital. Conclusions: Healthcare professionals seem to be positive about the feedback on patient safety culture and its effect on stimulating patient safety culture improvement. To optimally tune feedback on patient safety culture towards healthcare professionals, the following might help: 1) pay attention to the understandability of outcomes for its intended users; and 2) create feedback that is tailored towards specific hospital departments.
BMC Health Services Research, 2015
Background: To investigate the average and extrapolated excess length of stay and direct costs of... more Background: To investigate the average and extrapolated excess length of stay and direct costs of adverse events (AEs) and preventable AEs in Dutch hospitals, and to evaluate patient characteristics associated with excess length of stay and costs. Methods: Data of a large retrospective patient record review study on AEs was used. A stratified sample of 20 Dutch hospitals was included. Excess length of stay and costs attributable to AEs and preventable AEs were calculated and extrapolated to a national estimate. The association between patient characteristics and excess length of stay (and costs thereof) attributable to AEs and preventable AEs was investigated through multilevel linear regression analyses. Results: A total of 2975 patient records were included in the analysis, of which 325 experienced one or more AEs. Hospital patients experiencing an AE stayed 5.11 (95 % CI 3.91-6.30) more days in hospital and cost €2600 (95 % CI €1968-€3232) more compared to those without an AE. There was no significant difference in days and costs between preventable and non-preventable AEs. Extrapolated to a national level, AEs cost more than €300 million, which was 1.3 % of the national hospital care budget. Patients with hospital-acquired infections had a statistically significant longer length of stay compared to the reference group (patients with AEs on the cardiovascular system). Conclusions: This study showed that AEs lead to substantial excess length of stay and increased costs. Special attention should be paid to patients with AEs due to an hospital-acquired infection.
Bestuurders van zorginstellingen zijn verantwoordelijk voor de kwaliteit en veiligheid van de zor... more Bestuurders van zorginstellingen zijn verantwoordelijk voor de kwaliteit en veiligheid van de zorg in hun instelling. Het is voor bestuurders belangrijk om inzicht te krijgen in de kwaliteit van zorgprocessen en cliëntgerelateerde uitkomsten. In dit artikel wordt een nieuwe methode toegelicht die hierbij kan ondersteunen, de SAVE-methodiek. De SAVE-methodiek heeft als doel om sturingsinformatie te creëren uit de systematische analyse van cliëntendossiers. Verpleegkundigen en artsen dragen in de methodiek bij aan het in kaart brengen van knelpunten en het opstellen van verbeteracties.
British Journal of Nutrition, 2011
Undernutrition may be an important modifiable risk factor for poor clinical outcomes in older ind... more Undernutrition may be an important modifiable risk factor for poor clinical outcomes in older individuals. To achieve earlier detection or prevention of undernutrition, more information is needed about risk factors for the development of undernutrition in community-dwelling older individuals. The objective was to identify early determinants of incident undernutrition in a prospective population-based study. Baseline data (1992–3) on socio-economic, psychological, medical, functional, lifestyle and social factors of 1120 participants aged 65–85 years of the Longitudinal Aging Study Amsterdam were used. Undernutrition, defined as a BMI < 20 kg/m2 or self-reported involuntary weight loss ≥ 5 % in the last 6 months, was assessed every 3 years during a 9-year follow-up period. Cox proportional-hazards regression analysis was used to investigate the association between early determinants at baseline and incident undernutrition. In 9 years, 156 participants (13·9 %) developed undernutr...
Journal of the American Medical Directors Association, 2014
Objectives: Undernutrition in older age is associated with adverse clinical outcomes and high hea... more Objectives: Undernutrition in older age is associated with adverse clinical outcomes and high health care costs. This study aimed to evaluate the cost-effectiveness of a dietetic treatment in primary care compared with usual care in older, undernourished, community-dwelling individuals. Design: A parallel randomized controlled trial. Setting: Primary care. Participants: A total of 146 undernourished, independently living older (!65 years) individuals. Intervention: Dietetic treatment. Measurements: Main outcomes were change in kilogram body weight compared with baseline and quality-adjusted life years (QALYs) after 6 months. Costs were measured from a societal perspective. The main analysis was performed according to the intention-to-treat principle. Multiple imputation was used to impute missing data and bootstrapping was used to estimate uncertainty surrounding cost differences and incremental cost-effectiveness ratios. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated. Results: The participants were randomized to receive either dietetic treatment (n ¼ 72) or usual care (n ¼ 74). After 6 months, no statistically significant differences were found between the dietetic treatment and usual care group in body weight change (mean difference 0.78 kg, 95% CI À0.26e1.82), QALYs (mean difference 0.001, 95% CI À0.04e0.04) and total costs (mean difference V1645, 95% CI À525e3547). The incremental cost-utility ratio (ICUR) for QALYs was not interpretable. The incremental cost-effectiveness ratio (ICER) for body weight gain was 2111. The probability that dietetic treatment is cost-effective compared with usual care was 0.78 for a ceiling ratio of V5000 for body weight and 0.06 for a ceiling ratio of V20.000 for QALY. Conclusion: In this study, dietetic treatment in older, undernourished, community-dwelling individuals was not cost-effective compared with usual care.
Clinical Nutrition Supplements, 2011
Rationale: Studies concerning the prevalence of undernutrition in the community are scarce. Aim o... more Rationale: Studies concerning the prevalence of undernutrition in the community are scarce. Aim of this study was to identify the prevalence rates of undernutrition in community-dwelling older individuals (65 y) using data from various settings in primary care and home care. Methods: Prevalence rates of undernutrition were calculated in three samples: (1) 1289 community-dwelling individuals participating in a large prospective populationbased study, the Longitudinal Aging Study Amsterdam (LASA), in 1998/99; (2) 814 patients of a home care organization in 2009/10; and (3) 1878 patients from general practices during the annual influenza vaccination in 2009/10. Nutritional status was assessed with the Short Nutritional Assessment Questionnaire 65+ (SNAQ 65+). Results: Mean age was 81.6 y (sd 7.4) in the home care sample, 77.3 (sd 6.7) in the LASA sample and 75.3 (sd 6.5) in the general practice sample. The prevalence of undernutrition was highest in the home care sample (35%), followed by the general practice (12%) and LASA (11%) samples. Prevalence of undernutrition increased significantly with increasing age in the general practice and LASA samples. Gender differences were observed in the general practice and home care samples. Conclusion: The prevalence of undernutrition in community-dwelling older persons is relatively high, especially in home care patients. Assessment of undernutrition in primary care and home care can be an important step in the early treatment of undernutrition.
Clinical Nutrition Supplements, 2011
Clinical Nutrition Supplements, 2011
Rationale: Studies concerning the prevalence of undernutrition in the community are scarce. Aim o... more Rationale: Studies concerning the prevalence of undernutrition in the community are scarce. Aim of this study was to identify the prevalence rates of undernutrition in community-dwelling older individuals (65 y) using data from various settings in primary care and home care. Methods: Prevalence rates of undernutrition were calculated in three samples: (1) 1289 community-dwelling individuals participating in a large prospective populationbased study, the Longitudinal Aging Study Amsterdam (LASA), in 1998/99; (2) 814 patients of a home care organization in 2009/10; and (3) 1878 patients from general practices during the annual influenza vaccination in 2009/10. Nutritional status was assessed with the Short Nutritional Assessment Questionnaire 65+ (SNAQ 65+). Results: Mean age was 81.6 y (sd 7.4) in the home care sample, 77.3 (sd 6.7) in the LASA sample and 75.3 (sd 6.5) in the general practice sample. The prevalence of undernutrition was highest in the home care sample (35%), followed by the general practice (12%) and LASA (11%) samples. Prevalence of undernutrition increased significantly with increasing age in the general practice and LASA samples. Gender differences were observed in the general practice and home care samples. Conclusion: The prevalence of undernutrition in community-dwelling older persons is relatively high, especially in home care patients. Assessment of undernutrition in primary care and home care can be an important step in the early treatment of undernutrition.
![Research paper thumbnail of [Pain registration: for the benefit of the inspectorate or the patient?]](https://attachments.academia-assets.com/39817212/thumbnails/1.jpg)
](Nederlands tijdschrift voor geneeskunde, 2014
Increasing attention is currently being directed to the measurement and treatment of pain. A rece... more Increasing attention is currently being directed to the measurement and treatment of pain. A recent study concluded that the implementation of a patient safety programme was successful because 99% of the hospitals indicated that they measure postoperative pain. However, another recent study, evaluating this safety programme, concluded that hospitals could improve the implementation of pain measurements, as only 56% of the postoperative patients were subject to standardized pain measurements during the first 3 days following surgery. The reason for this notable difference may be the tendency to implement pain registration mainly for external justification purposes. The attitude towards pain needs to change; too often it is still considered as an uninteresting side effect of treatment. Insight in the internal utility and effects of pain registration might help to further improve the quality of postoperative pain management. Acute Pain Service teams should have a facilitating role.
BMC Nephrology
Contrast-induced nephropathy (CIN) is a common cause of acute renal failure in hospital patients.... more Contrast-induced nephropathy (CIN) is a common cause of acute renal failure in hospital patients. To prevent CIN, identification and hydration of high-risk patients is important. Prevention of CIN by hydration of high-risk patients was one of the themes to be implemented in the Dutch Hospital Patient Safety Program. This study investigates to what extent high-risk patients are identified and hydrated before contrast administration. Hospital-related and admission-related factors associated with the hydration of high-risk patients are identified. The adherence to the guideline concerning identification and hydration of high-risk patients for CIN was evaluated retrospectively in 4297 patient records between November 2011 and December 2012. A multilevel logistic regression analysis was used to investigate the association between hospital-related and patient-related factors and hydration. The mean percentage patients with a known estimated Glomerular Filtration Rate before contrast admin...
BMJ Open
Preventable adverse drug events (ADEs) are closely related to administration processes of parente... more Preventable adverse drug events (ADEs) are closely related to administration processes of parenteral medication. The Dutch Patient Safety Program provided a protocol for administering parenteral medication to reduce the amount of ADEs. The execution of the protocol was evaluated and a cost estimation was performed to provide insight in the associated costs of protocol compliance. A longitudinal evaluation study was performed in secondary care. A total of 2154 observations of the administration process of parenteral medication were carried out within 10 measurements in 19 hospitals between November 2011 and December 2012. The total time needed for the process was measured in a sample of five hospitals. Multilevel linear and logistic regression analyses were used to analyse the trend over time of the implementation and to assess the association between hospital and administration characteristics, and compliance of the protocol. A cost estimation provided insight into the costs of perf...
A lot of patients experience pain after surgery. Assessing pain with standardized measurement ins... more A lot of patients experience pain after surgery. Assessing pain with standardized measurement instruments can provide insight in the prevalence of pain. The authors evaluated the implementation of the interventions of the Dutch National Patient Safety Program concerning the theme ‘Early recognition and treatment of Pain’. The number of pain measurements and magnitude of registered pain scores were determined for 4673 postoperative patient records. On average 56% of the patients on the nursing department surgery received three standardized pain measurements on each three days after surgery. Almost half of the patients received three standardized pain measurements on the 1st day after surgery. This percentage decreased to 29% on the 3rd postoperative day. More than half of the patients experienced moderate pain in the first three days after surgery and 9% experienced severe pain. Most of the patients received pain management, but no identifiable interventions were taken for, on averag...
BMJ open, 2014
Preventable adverse drug events (ADEs) are closely related to administration processes of parente... more Preventable adverse drug events (ADEs) are closely related to administration processes of parenteral medication. The Dutch Patient Safety Program provided a protocol for administering parenteral medication to reduce the amount of ADEs. The execution of the protocol was evaluated and a cost estimation was performed to provide insight in the associated costs of protocol compliance. A longitudinal evaluation study was performed in secondary care. A total of 2154 observations of the administration process of parenteral medication were carried out within 10 measurements in 19 hospitals between November 2011 and December 2012. The total time needed for the process was measured in a sample of five hospitals. Multilevel linear and logistic regression analyses were used to analyse the trend over time of the implementation and to assess the association between hospital and administration characteristics, and compliance of the protocol. A cost estimation provided insight into the costs of perf...
Nederlands Tijdschrift voor Evidence Based Practice, 2011
BMC health services research, Mar 20, 2018
Background: Quality systems are believed to be positively related to quality and safety in health... more Background: Quality systems are believed to be positively related to quality and safety in healthcare. However, there is no convincing evidence for this relationship in the literature. This study aims to examine the association between the development stage of hospital quality systems and the implementation of patient safety themes at the process level. Methods: This study combines data from a national survey on the development stage of quality systems in Dutch hospitals with results from an evaluation study of the Dutch Hospital Patient Safety Program. Data on the development stage of quality systems were collected in Dutch hospitals in 2011. A total of 73 quality coordinators completed a questionnaire (response rate 77%) covering five quality system domains: policy and strategy, human resource management, patient involvement, practice guidelines, and systematic quality improvement. Data were included on the implementation of five patient safety themes from the Dutch Hospital Safety Program. Process indicators for each theme were measured every four to six weeks, resulting in ten measurements in each hospital. Data were analyzed using multilevel analysis. Results: The mean score for hospital quality system development was 2.30 (range 1 to 3). The mean scores for the various quality system domains ranged from 1.56 (Patient Involvement) to 2.66 (Human Resources Management). The mean percentages for the implementation of the patient safety themes ranged from 12% for the 'Pain' process indicator to 73% for execution of the 'Time-Out Procedure'. The intraclass correlation coefficients of the interceptonly model ranged between 11.6 and 51.6, which indicates large differences between hospitals in the implementation of the patient safety themes. Positive associations between quality system development stage and implementation of patient safety themes were found for four of the five patient safety themes, although they were not statistically significant. Conclusions: This study found no association between the development stage of a hospital quality system and the implementation of patient level safety themes at the process level. This rejects the hypothesis that quality improvement is caused by a positive relationship between structure (the quality system) and processes (the safety program implementation), which in their turn mold the quality of care at the patient level.
BMC Health Services Research, 2016
Background: By assessing patient safety culture, healthcare providers can identify areas for impr... more Background: By assessing patient safety culture, healthcare providers can identify areas for improvement in patient safety culture. To achieve this, these assessment outcomes have to be relevant and presented clearly. The aim of our study was to explore healthcare professionals' views on the feedback of a patient safety culture assessment. Methods: Twenty four hospitals participated in a patient safety culture assessment in 2012. Hospital departments received feedback in a report and on a website. In a survey, we evaluated healthcare professionals' views on this feedback and the effect of additional information about patient safety culture improvement strategies on the appraisal of the feedback. 20 hospitals participated in part I (evaluation of the report), 13 hospitals participated in part II (evaluation of the website). Results: Healthcare professionals (e.g. members of staff and department heads/managers) rated the feedback in the report and on the website positively (average mean on different aspects = 7.2 on a scale from 1 to 10). Interpreting results was sometimes difficult, and information was sometimes lacking, like specific recommendations and improvement strategies. The provision of additional general information on patient safety culture improvement strategies resulted only in a higher appraisal of the attractiveness (lay-out) of the report and the understandability of the feedback report. The majority (84 %) of the healthcare professionals agreed or partly agreed that the feedback on patient safety culture stimulated actions to improve patient safety culture. However, a quarter also stated that although the feedback report provided insight into the patient safety culture, they did not know how to improve patient safety culture in their hospital. Conclusions: Healthcare professionals seem to be positive about the feedback on patient safety culture and its effect on stimulating patient safety culture improvement. To optimally tune feedback on patient safety culture towards healthcare professionals, the following might help: 1) pay attention to the understandability of outcomes for its intended users; and 2) create feedback that is tailored towards specific hospital departments.
BMC Health Services Research, 2015
Background: To investigate the average and extrapolated excess length of stay and direct costs of... more Background: To investigate the average and extrapolated excess length of stay and direct costs of adverse events (AEs) and preventable AEs in Dutch hospitals, and to evaluate patient characteristics associated with excess length of stay and costs. Methods: Data of a large retrospective patient record review study on AEs was used. A stratified sample of 20 Dutch hospitals was included. Excess length of stay and costs attributable to AEs and preventable AEs were calculated and extrapolated to a national estimate. The association between patient characteristics and excess length of stay (and costs thereof) attributable to AEs and preventable AEs was investigated through multilevel linear regression analyses. Results: A total of 2975 patient records were included in the analysis, of which 325 experienced one or more AEs. Hospital patients experiencing an AE stayed 5.11 (95 % CI 3.91-6.30) more days in hospital and cost €2600 (95 % CI €1968-€3232) more compared to those without an AE. There was no significant difference in days and costs between preventable and non-preventable AEs. Extrapolated to a national level, AEs cost more than €300 million, which was 1.3 % of the national hospital care budget. Patients with hospital-acquired infections had a statistically significant longer length of stay compared to the reference group (patients with AEs on the cardiovascular system). Conclusions: This study showed that AEs lead to substantial excess length of stay and increased costs. Special attention should be paid to patients with AEs due to an hospital-acquired infection.
Bestuurders van zorginstellingen zijn verantwoordelijk voor de kwaliteit en veiligheid van de zor... more Bestuurders van zorginstellingen zijn verantwoordelijk voor de kwaliteit en veiligheid van de zorg in hun instelling. Het is voor bestuurders belangrijk om inzicht te krijgen in de kwaliteit van zorgprocessen en cliëntgerelateerde uitkomsten. In dit artikel wordt een nieuwe methode toegelicht die hierbij kan ondersteunen, de SAVE-methodiek. De SAVE-methodiek heeft als doel om sturingsinformatie te creëren uit de systematische analyse van cliëntendossiers. Verpleegkundigen en artsen dragen in de methodiek bij aan het in kaart brengen van knelpunten en het opstellen van verbeteracties.
British Journal of Nutrition, 2011
Undernutrition may be an important modifiable risk factor for poor clinical outcomes in older ind... more Undernutrition may be an important modifiable risk factor for poor clinical outcomes in older individuals. To achieve earlier detection or prevention of undernutrition, more information is needed about risk factors for the development of undernutrition in community-dwelling older individuals. The objective was to identify early determinants of incident undernutrition in a prospective population-based study. Baseline data (1992–3) on socio-economic, psychological, medical, functional, lifestyle and social factors of 1120 participants aged 65–85 years of the Longitudinal Aging Study Amsterdam were used. Undernutrition, defined as a BMI < 20 kg/m2 or self-reported involuntary weight loss ≥ 5 % in the last 6 months, was assessed every 3 years during a 9-year follow-up period. Cox proportional-hazards regression analysis was used to investigate the association between early determinants at baseline and incident undernutrition. In 9 years, 156 participants (13·9 %) developed undernutr...
Journal of the American Medical Directors Association, 2014
Objectives: Undernutrition in older age is associated with adverse clinical outcomes and high hea... more Objectives: Undernutrition in older age is associated with adverse clinical outcomes and high health care costs. This study aimed to evaluate the cost-effectiveness of a dietetic treatment in primary care compared with usual care in older, undernourished, community-dwelling individuals. Design: A parallel randomized controlled trial. Setting: Primary care. Participants: A total of 146 undernourished, independently living older (!65 years) individuals. Intervention: Dietetic treatment. Measurements: Main outcomes were change in kilogram body weight compared with baseline and quality-adjusted life years (QALYs) after 6 months. Costs were measured from a societal perspective. The main analysis was performed according to the intention-to-treat principle. Multiple imputation was used to impute missing data and bootstrapping was used to estimate uncertainty surrounding cost differences and incremental cost-effectiveness ratios. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated. Results: The participants were randomized to receive either dietetic treatment (n ¼ 72) or usual care (n ¼ 74). After 6 months, no statistically significant differences were found between the dietetic treatment and usual care group in body weight change (mean difference 0.78 kg, 95% CI À0.26e1.82), QALYs (mean difference 0.001, 95% CI À0.04e0.04) and total costs (mean difference V1645, 95% CI À525e3547). The incremental cost-utility ratio (ICUR) for QALYs was not interpretable. The incremental cost-effectiveness ratio (ICER) for body weight gain was 2111. The probability that dietetic treatment is cost-effective compared with usual care was 0.78 for a ceiling ratio of V5000 for body weight and 0.06 for a ceiling ratio of V20.000 for QALY. Conclusion: In this study, dietetic treatment in older, undernourished, community-dwelling individuals was not cost-effective compared with usual care.
Clinical Nutrition Supplements, 2011
Rationale: Studies concerning the prevalence of undernutrition in the community are scarce. Aim o... more Rationale: Studies concerning the prevalence of undernutrition in the community are scarce. Aim of this study was to identify the prevalence rates of undernutrition in community-dwelling older individuals (65 y) using data from various settings in primary care and home care. Methods: Prevalence rates of undernutrition were calculated in three samples: (1) 1289 community-dwelling individuals participating in a large prospective populationbased study, the Longitudinal Aging Study Amsterdam (LASA), in 1998/99; (2) 814 patients of a home care organization in 2009/10; and (3) 1878 patients from general practices during the annual influenza vaccination in 2009/10. Nutritional status was assessed with the Short Nutritional Assessment Questionnaire 65+ (SNAQ 65+). Results: Mean age was 81.6 y (sd 7.4) in the home care sample, 77.3 (sd 6.7) in the LASA sample and 75.3 (sd 6.5) in the general practice sample. The prevalence of undernutrition was highest in the home care sample (35%), followed by the general practice (12%) and LASA (11%) samples. Prevalence of undernutrition increased significantly with increasing age in the general practice and LASA samples. Gender differences were observed in the general practice and home care samples. Conclusion: The prevalence of undernutrition in community-dwelling older persons is relatively high, especially in home care patients. Assessment of undernutrition in primary care and home care can be an important step in the early treatment of undernutrition.
Clinical Nutrition Supplements, 2011
Clinical Nutrition Supplements, 2011
Rationale: Studies concerning the prevalence of undernutrition in the community are scarce. Aim o... more Rationale: Studies concerning the prevalence of undernutrition in the community are scarce. Aim of this study was to identify the prevalence rates of undernutrition in community-dwelling older individuals (65 y) using data from various settings in primary care and home care. Methods: Prevalence rates of undernutrition were calculated in three samples: (1) 1289 community-dwelling individuals participating in a large prospective populationbased study, the Longitudinal Aging Study Amsterdam (LASA), in 1998/99; (2) 814 patients of a home care organization in 2009/10; and (3) 1878 patients from general practices during the annual influenza vaccination in 2009/10. Nutritional status was assessed with the Short Nutritional Assessment Questionnaire 65+ (SNAQ 65+). Results: Mean age was 81.6 y (sd 7.4) in the home care sample, 77.3 (sd 6.7) in the LASA sample and 75.3 (sd 6.5) in the general practice sample. The prevalence of undernutrition was highest in the home care sample (35%), followed by the general practice (12%) and LASA (11%) samples. Prevalence of undernutrition increased significantly with increasing age in the general practice and LASA samples. Gender differences were observed in the general practice and home care samples. Conclusion: The prevalence of undernutrition in community-dwelling older persons is relatively high, especially in home care patients. Assessment of undernutrition in primary care and home care can be an important step in the early treatment of undernutrition.
Nederlands tijdschrift voor geneeskunde, 2014
Increasing attention is currently being directed to the measurement and treatment of pain. A rece... more Increasing attention is currently being directed to the measurement and treatment of pain. A recent study concluded that the implementation of a patient safety programme was successful because 99% of the hospitals indicated that they measure postoperative pain. However, another recent study, evaluating this safety programme, concluded that hospitals could improve the implementation of pain measurements, as only 56% of the postoperative patients were subject to standardized pain measurements during the first 3 days following surgery. The reason for this notable difference may be the tendency to implement pain registration mainly for external justification purposes. The attitude towards pain needs to change; too often it is still considered as an uninteresting side effect of treatment. Insight in the internal utility and effects of pain registration might help to further improve the quality of postoperative pain management. Acute Pain Service teams should have a facilitating role.
BMC Nephrology
Contrast-induced nephropathy (CIN) is a common cause of acute renal failure in hospital patients.... more Contrast-induced nephropathy (CIN) is a common cause of acute renal failure in hospital patients. To prevent CIN, identification and hydration of high-risk patients is important. Prevention of CIN by hydration of high-risk patients was one of the themes to be implemented in the Dutch Hospital Patient Safety Program. This study investigates to what extent high-risk patients are identified and hydrated before contrast administration. Hospital-related and admission-related factors associated with the hydration of high-risk patients are identified. The adherence to the guideline concerning identification and hydration of high-risk patients for CIN was evaluated retrospectively in 4297 patient records between November 2011 and December 2012. A multilevel logistic regression analysis was used to investigate the association between hospital-related and patient-related factors and hydration. The mean percentage patients with a known estimated Glomerular Filtration Rate before contrast admin...
BMJ Open
Preventable adverse drug events (ADEs) are closely related to administration processes of parente... more Preventable adverse drug events (ADEs) are closely related to administration processes of parenteral medication. The Dutch Patient Safety Program provided a protocol for administering parenteral medication to reduce the amount of ADEs. The execution of the protocol was evaluated and a cost estimation was performed to provide insight in the associated costs of protocol compliance. A longitudinal evaluation study was performed in secondary care. A total of 2154 observations of the administration process of parenteral medication were carried out within 10 measurements in 19 hospitals between November 2011 and December 2012. The total time needed for the process was measured in a sample of five hospitals. Multilevel linear and logistic regression analyses were used to analyse the trend over time of the implementation and to assess the association between hospital and administration characteristics, and compliance of the protocol. A cost estimation provided insight into the costs of perf...
A lot of patients experience pain after surgery. Assessing pain with standardized measurement ins... more A lot of patients experience pain after surgery. Assessing pain with standardized measurement instruments can provide insight in the prevalence of pain. The authors evaluated the implementation of the interventions of the Dutch National Patient Safety Program concerning the theme ‘Early recognition and treatment of Pain’. The number of pain measurements and magnitude of registered pain scores were determined for 4673 postoperative patient records. On average 56% of the patients on the nursing department surgery received three standardized pain measurements on each three days after surgery. Almost half of the patients received three standardized pain measurements on the 1st day after surgery. This percentage decreased to 29% on the 3rd postoperative day. More than half of the patients experienced moderate pain in the first three days after surgery and 9% experienced severe pain. Most of the patients received pain management, but no identifiable interventions were taken for, on averag...
BMJ open, 2014
Preventable adverse drug events (ADEs) are closely related to administration processes of parente... more Preventable adverse drug events (ADEs) are closely related to administration processes of parenteral medication. The Dutch Patient Safety Program provided a protocol for administering parenteral medication to reduce the amount of ADEs. The execution of the protocol was evaluated and a cost estimation was performed to provide insight in the associated costs of protocol compliance. A longitudinal evaluation study was performed in secondary care. A total of 2154 observations of the administration process of parenteral medication were carried out within 10 measurements in 19 hospitals between November 2011 and December 2012. The total time needed for the process was measured in a sample of five hospitals. Multilevel linear and logistic regression analyses were used to analyse the trend over time of the implementation and to assess the association between hospital and administration characteristics, and compliance of the protocol. A cost estimation provided insight into the costs of perf...
Nederlands Tijdschrift voor Evidence Based Practice, 2011