Leti Van Bodegom-vos - Academia.edu (original) (raw)

Papers by Leti Van Bodegom-vos

Implementation Science, 2013

Background: The Dutch multidisciplinary sciatica guideline recommends that the team of profession... more Background: The Dutch multidisciplinary sciatica guideline recommends that the team of professionals involved in sciatica care and the patient together decide on surgical or prolonged conservative treatment (shared decision making [SDM]). Despite this recommendation, SDM is not yet integrated in sciatica care. Existing literature concerning barriers and facilitators to SDM implementation mainly focuses on one discipline only, whereas multidisciplinary care may involve other barriers and facilitators, or make these more complex for both professionals and patients. Therefore, this qualitative study aims to identify barriers and facilitators perceived by patients and professionals for SDM implementation in multidisciplinary sciatica care.

Quality in primary care

To improve the feasibility of shifting medical specialist to general practitioner (GP) services i... more To improve the feasibility of shifting medical specialist to general practitioner (GP) services in patient-centred health care systems, it is important to know how this substitution is valued by patients. However, insight into patients' preferences is lacking. This study aims to fill this gap by assessing whether patients' preferences for substitution are related to the type of medical intervention. Questionnaires were sent to 1000 members of the Dutch Insurants Panel (potential patients). Panel members were asked about their preferences for and use of medical specialist and GP services regarding 11 medical interventions. Six hundred and ninety-four members (69%) responded. We used multilevel multinomial regression to analyse the data. Preferences were significantly related to medical intervention type. GP services were preferred for follow-up treatments (e.g. removing stitches) and non-complex invasive treatments (e.g. removal of lumps), and medical specialist services were...

Annals of the Rheumatic Diseases

ABSTRACT Disclosure of Interest None Declared

The Journal of bone and joint surgery. American volume, Jan 17, 2015

Cell salvage is used to reduce allogeneic red blood-cell (RBC) transfusions in total hip arthropl... more Cell salvage is used to reduce allogeneic red blood-cell (RBC) transfusions in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We performed a meta-analysis to assess the effectiveness of cell salvage to reduce transfusions in THA and TKA separately, and to examine whether recent trials change the conclusions from previous meta-analyses. We searched MEDLINE through January 2013 for randomized clinical trials evaluating the effects of cell salvage in THA and TKA. Trial results were extracted using standardized forms and pooled using a random-effects model. Methodological quality of the trials was evaluated using the Cochrane Collaboration's tool for risk-of-bias assessment. Forty-three trials (5631 patients) were included. Overall, cell salvage reduced the exposure to allogeneic RBC transfusion in THA (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.51 to 0.85) and TKA (RR, 0.51; 95% CI, 0.39 to 0.68). However, trials published in 2010 to 2012, with a lower ...

Annals of the Rheumatic Diseases

Quality in primary care, 2013

To improve the feasibility of shifting medical specialist to general practitioner (GP) services i... more To improve the feasibility of shifting medical specialist to general practitioner (GP) services in patient-centred health care systems, it is important to know how this substitution is valued by patients. However, insight into patients' preferences is lacking. This study aims to fill this gap by assessing whether patients' preferences for substitution are related to the type of medical intervention. Questionnaires were sent to 1000 members of the Dutch Insurants Panel (potential patients). Panel members were asked about their preferences for and use of medical specialist and GP services regarding 11 medical interventions. Six hundred and ninety-four members (69%) responded. We used multilevel multinomial regression to analyse the data. Preferences were significantly related to medical intervention type. GP services were preferred for follow-up treatments (e.g. removing stitches) and non-complex invasive treatments (e.g. removal of lumps), and medical specialist services were...

Annals of the Rheumatic Diseases, 2012

ABSTRACT Background Literature (1) and daily practice indicate a need for interactive forms of ed... more ABSTRACT Background Literature (1) and daily practice indicate a need for interactive forms of education to enhance guideline usage, but the evidence on their effectiveness is lacking. Objectives The aim of this study was to investigate the effectiveness of an interactive workshop as part of the implementation of the Dutch physical therapy (PT) guideline for hip and knee osteoarthritis (HKOA). Methods In 5 regions in the Netherlands, all PTs who were a member of the Royal Dutch Society of Physical Therapy were randomly assigned to an interactive workshop (IW) or a control group (C). IW comprised presentations of the content of the guideline and 3 clinical cases with the cooperation of 3 patient partners and 3 expert PTs per region, executed according to the method of clinical reasoning and lasted 3 hours. C was a waiting list group who received IW after 4 months. Assessments were done before the educational course, immediately afterwards and three months thereafter. Assessments consisted of the Quality Indicators for Physical therapy in Hip and Knee Osteoarthritis (QIP-HKOA) questionnaire, containing 18 questions on the usage of the guideline (total score range 0-72), a 19-items knowledge questionnaire (total score range 0-76) and a questionnaire concerning barriers in using the guideline (total score range 0-80). In addition, sociodemographic characteristics of the participants were recorded. Statistical analysis included comparisons of total mean scores between the IW and C across 3 time points by using Linear Mixed Models. Results In total 3778 PTs were invited, of whom 275 (7.3%) were willing to take part in the study. They were randomly assigned to IW (n=141) or C (n=134). There were no sociodemografic differences at baseline between IW and C. The statistic analyses showed a significant difference between groups in favour of IW concerning all 3 outcome measures (see Table 1). Conclusions An interactive educational course with the support of patients and following a process of clinical reasoning was found to be an effective strategy to improve adherence with recommendations in the Dutch physical therapy guideline for HKOA. Also knowledge about the guideline improved and less barriers to use the guideline were experienced in daily clinical practice after 3 months. Funding This project was funded by the Royal Dutch Society of Physical Therapy and the Dutch Arthritis Association. Disclosure of Interest None Declared

PLoS ONE, 2014

Introduction: Due to the increasing specialization of medical professionals, patients are treated... more Introduction: Due to the increasing specialization of medical professionals, patients are treated by multiple disciplines. To ensure that delivered care is patient-centered, it is crucial that professionals and the patient together decide on treatment (shared decision making (SDM)). However, it is not known how SDM should be integrated in multidisciplinary practice. This study determines the most important factors for SDM implementation in sciatica care, as it is known that a prior inventory of factors is crucial to develop a successful implementation strategy.

Transfusion, 2014

BACKGROUND: Despite evidence that the bloodsaving measures (BSMs) erythropoietin (EPO) and intra-... more BACKGROUND: Despite evidence that the bloodsaving measures (BSMs) erythropoietin (EPO) and intra-and postoperative blood salvage are not (cost-)effective in primary elective total hip and knee arthroplasties, they are used frequently in Dutch hospitals. This study aims to assess the impact of barriers associated with the intention of physicians to stop BSMs. STUDY DESIGN AND METHODS: A survey among 400 orthopedic surgeons and 400 anesthesiologists within the Netherlands was performed. Multivariate logistic regression was used to identify barriers associated with intention to stop BSMs. RESULTS: A total of 153 (40%) orthopedic surgeons and 100 (27%) anesthesiologists responded. Of all responders 67% used EPO, perioperative blood salvage, or a combination. After reading the evidence on non-cost-effective BSMs, 50% of respondents intended to stop EPO and 53% to stop perioperative blood salvage. In general, barriers perceived most frequently were lack of attention for blood management (90% of respondents), department priority to prevent transfusions (88%), and patient characteristics such as comorbidity (81%). Barriers significantly associated with intention to stop EPO were lack of interest to save money and the impact of other involved parties. Barriers significantly associated with intention to stop perioperative blood salvage were concerns about patient safety, lack of alternatives, losing experience with the technique, and lack of interest to save money. CONCLUSION: Physicians experience barriers to stop using BSMs, related to their own technical skills, patient safety, current blood management policy, and lack of interest to save money. These barriers should be targeted in strategies to make BSM use cost-effective. ABBREVIATIONS: BSM(s) = blood-saving measure(s); TDF = theoretical domains interview framework; THA = total hip arthroplasty; TKA = total knee arthroplasty.

Rheumatology, 2013

To compare the effectiveness of two educational courses aiming to improve adherence to recommenda... more To compare the effectiveness of two educational courses aiming to improve adherence to recommendations in a Dutch physiotherapy practice guideline for hip and knee OA. Physiotherapists (PTs) from three regions in The Netherlands were invited to participate in a study comparing an interactive workshop (IW) with conventional education (CE). Participants were randomly assigned to one of the two courses. Satisfaction with the course (scale 0-10), knowledge (score range 0-76) and guideline adherence (score range 0-72) were measured at baseline, immediately after the educational course and 3 months after that. Data were analysed using a linear mixed model. In total, 203 (10%) PTs participated in the IW (n = 108) and the CE (n = 95). There were no differences between groups at baseline. Satisfaction was significantly higher in the IW than in the CE group [mean scores (S.D.) 7.5 (1.1) and 6.7 (1.6), respectively (P < 0.001)]. A significantly greater improvement in adherence was seen over time in the IW group compared with the CE group (F = 3.763, P = 0.024), whereas the difference in improvement of knowledge was not significant (F = 1.283, P = 0.278). An IW led to greater satisfaction and was more effective in improving adherence to recommendations in a PT guideline on hip and knee OA than CE, whereas the increase in knowledge did not differ significantly.

Implementation Science, 2014

Implementation Science, 2014

Background: National and international evidence-based guidelines for hip and knee osteoarthritis ... more Background: National and international evidence-based guidelines for hip and knee osteoarthritis recommend to start with (a combination of) conservative treatments, followed by surgical intervention if a patient does not respond sufficiently to conservative treatment options. Despite these recommendations, there are strong indications that conservative treatments are not optimally used in orthopedic practice. Our study aims to quantify the use of conservative treatments in Dutch orthopedic practice and to explore the barriers and facilitators for the use of conservative treatments that should be taken into account in a strategy to improve the embedding of conservative treatments in hip and knee osteoarthritis in orthopedic practice. Methods: This study consists of three phases. First, current use of conservative treatments in patients with hip and knee osteoarthritis will be explored using an internet-based survey among at least 100 patients to identify the underused conservative treatments. Second, barriers and facilitators for the use of conservative treatments in orthopedic practice will be identified using semi-structured interviews among 10 orthopedic surgeons and 5 patients. The interviews will be followed by an internet-based survey among approximately 450 orthopedic surgeons and at least 100 patients in which the identified barriers and facilitators will be ranked by importance. Finally, an implementation strategy will be developed based on the results of the previous phases using intervention mapping.

Implementation Science, 2012

Background: Sciatica is a common condition worldwide that is characterized by radiating leg pain ... more Background: Sciatica is a common condition worldwide that is characterized by radiating leg pain and regularly caused by a herniated disc with nerve root compression. Sciatica patients with persisting leg pain after six to eight weeks were found to have similar clinical outcomes and associated costs after prolonged conservative treatment or surgery at one year follow-up. Guidelines recommend that the team of professionals involved in sciatica care and patients jointly decide about treatment options, so-called interprofessional shared decision making (SDM). However, there are strong indications that SDM for sciatica patients is not integrated in daily practice. We designed a study aiming to explore the barriers and facilitators associated with the everyday embedding of SDM for sciatica patients. All related relevant professionals and patients are involved to develop a tailored strategy to implement SDM for sciatica patients. Methods: The study consists of two phases: identification of barriers and facilitators and development of an implementation strategy. First, barriers and facilitators are explored using semi-structured interviews among eight professionals of each (para)medical discipline involved in sciatica care (general practitioners, physical therapists, neurologists, neurosurgeons, and orthopedic surgeons). In addition, three focus groups will be conducted among patients. Second, the identified barriers and facilitators will be ranked using a questionnaire among a representative Dutch sample of 200 GPs, 200 physical therapists, 200 neurologists, all 124 neurosurgeons, 200 orthopedic surgeons, and 100 patients. A tailored team-based implementation strategy will be developed based on the results of the first phase using the principles of intervention mapping and an expert panel. Discussion: Little is known about effective strategies to increase the uptake of SDM. Most implementation strategies only target a single discipline, whereas multiple disciplines are involved in SDM among sciatica patients. The results of this study can be used as an example for implementing SDM in other patient groups receiving multidisciplinary complex care (e.g., elderly) and can be generalized to other countries with similar context, thereby contributing to a worldwide increase of SDM in preference sensitive choices.

Implementation Science, 2012

Background: Total hip and knee arthroplasties are two of the most commonly performed procedures i... more Background: Total hip and knee arthroplasties are two of the most commonly performed procedures in orthopedic surgery. Different blood-saving measures (BSMs) are used to reduce the often-needed allogenic blood transfusions in these procedures. A recent large randomized controlled trial showed it is not cost effective to use the BSMs of erythropoietin and perioperative autologous blood salvage in elective primary hip and knee arthroplasties. Despite dissemination of these study results, medical professionals keep using these BSMs. To actually change practice, an implementation strategy is needed that is based on a good understanding of target groups and settings and the psychological constructs that predict behavior of medical professionals. However, detailed insight into these issuses is lacking. Therefore, this study aims to explore which groups of professionals should be targeted at which settings, as well as relevant barriers and facilitators that should be taken into acount in the strategy to implement evidence-based, cost-effective blood transfusion management and to de-implement BSMs. Methods: The study consists of three phases. First, a questionnaire survey among all Dutch orthopedic hospital departments and independent treatment centers (n = 99) will be conducted to analyze current blood management practice. Second, semistructured interviews will be held among 10 orthopedic surgeons and 10 anesthesiologists to identify barriers and facilitators that are relevant for the uptake of cost-effective blood transfusion management. Interview questions will be based on the Theoretical Domains Interview framework. The interviews will be followed by a questionnaire survey among 800 medical professionals in orthopedics and anesthesiology (400 professionals per discipline) in which the identified barriers and facilitators will be ranked by frequency and importance. Finally, an implementation strategy will be developed based on the results from the previous phases, using principles of intervention mapping and an expert panel. Discussion: The developed strategy for cost-effective blood transfusion management by de-implementing BSMs is likely to reduce costs for elective hip and knee arthroplasties. In addition, this study will lead to generalized knowledge regarding relevant factors for the de-implementation of non-cost-effective interventions and insight in the differences between implementation and de-implementation strategies.

Implementation Science, 2011

Background: Many hospitals have taken actions to make care delivery for specific patient groups m... more Background: Many hospitals have taken actions to make care delivery for specific patient groups more processoriented, but struggle with the question how to deal with process orientation at hospital level. The aim of this study is to report and discuss the experiences of hospitals with implementing process-oriented organisation designs in order to derive lessons for future transitions and research.

Implementation Science, 2011

Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a... more Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of qualitymanagement systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. Methods: The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. Results: MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. Conclusions: It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.

Implementation Science, 2013

Background: The Dutch multidisciplinary sciatica guideline recommends that the team of profession... more Background: The Dutch multidisciplinary sciatica guideline recommends that the team of professionals involved in sciatica care and the patient together decide on surgical or prolonged conservative treatment (shared decision making [SDM]). Despite this recommendation, SDM is not yet integrated in sciatica care. Existing literature concerning barriers and facilitators to SDM implementation mainly focuses on one discipline only, whereas multidisciplinary care may involve other barriers and facilitators, or make these more complex for both professionals and patients. Therefore, this qualitative study aims to identify barriers and facilitators perceived by patients and professionals for SDM implementation in multidisciplinary sciatica care.

Disability and Rehabilitation, 2014

Purpose: To determine the effectiveness of an interactive educational intervention on a physiothe... more Purpose: To determine the effectiveness of an interactive educational intervention on a physiotherapy guideline for hip and knee osteoarthritis. Method: Physiotherapists were randomly allocated to a 3-h interactive educational course with the collaboration of three patient partners or no intervention. Assessments comprised questionnaires on adherence (score range 0-24), knowledge (score range 0-76), and barriers to use the guideline (score range 0-80). Assessments were conducted 1 week before the interactive course (T0) immediately after (T1), and 3 months thereafter (T2). Change scores were compared between the groups by means of Mann-Whitney U tests and linear mixed models. Results: 284 of 4328 eligible PTs (7%) were included. The intervention (n ¼ 133) was significantly more effective than no intervention (n ¼ 151) concerning self-reported adherence and knowledge with mean differences in change scores (95% CI) at T1 and T2 being 1.4 (0.7-2.0) and 0.9 (0.2-1.7) for adherence and 6.8 (4.5-9.1) and 3.9 (1.7-6.2) for knowledge, (all p values50.005). In both groups the barrier score increased at T1 and decreased at T2, with a significantly larger increase at T1 and decrease at T2 in the intervention group (mean differences 3.1 (1.8-4.4) and 3.3 (0.5-6.1), respectively. Conclusions: A short interactive educational course with patient participation on a PT guideline on hip and knee osteoarthritis showed a small to moderate positive effect on self-reported guideline adherence and knowledge, whereas for perceived barriers an advantage was only seen on the longer term.

BMC Musculoskeletal Disorders, 2013

Background: Blood loss in hip and knee arthroplasties may necessitate allogeneic blood transfusio... more Background: Blood loss in hip and knee arthroplasties may necessitate allogeneic blood transfusions. Different blood-saving measures (BSMs) were introduced to reduce these transfusions. Purpose of the present study was to assess the frequency of BSM use, stratified by type and hospital setting of orthopaedic departments in the Netherlands.

Implementation Science, 2013

Background: The Dutch multidisciplinary sciatica guideline recommends that the team of profession... more Background: The Dutch multidisciplinary sciatica guideline recommends that the team of professionals involved in sciatica care and the patient together decide on surgical or prolonged conservative treatment (shared decision making [SDM]). Despite this recommendation, SDM is not yet integrated in sciatica care. Existing literature concerning barriers and facilitators to SDM implementation mainly focuses on one discipline only, whereas multidisciplinary care may involve other barriers and facilitators, or make these more complex for both professionals and patients. Therefore, this qualitative study aims to identify barriers and facilitators perceived by patients and professionals for SDM implementation in multidisciplinary sciatica care.

Quality in primary care

To improve the feasibility of shifting medical specialist to general practitioner (GP) services i... more To improve the feasibility of shifting medical specialist to general practitioner (GP) services in patient-centred health care systems, it is important to know how this substitution is valued by patients. However, insight into patients' preferences is lacking. This study aims to fill this gap by assessing whether patients' preferences for substitution are related to the type of medical intervention. Questionnaires were sent to 1000 members of the Dutch Insurants Panel (potential patients). Panel members were asked about their preferences for and use of medical specialist and GP services regarding 11 medical interventions. Six hundred and ninety-four members (69%) responded. We used multilevel multinomial regression to analyse the data. Preferences were significantly related to medical intervention type. GP services were preferred for follow-up treatments (e.g. removing stitches) and non-complex invasive treatments (e.g. removal of lumps), and medical specialist services were...

Annals of the Rheumatic Diseases

ABSTRACT Disclosure of Interest None Declared

The Journal of bone and joint surgery. American volume, Jan 17, 2015

Cell salvage is used to reduce allogeneic red blood-cell (RBC) transfusions in total hip arthropl... more Cell salvage is used to reduce allogeneic red blood-cell (RBC) transfusions in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We performed a meta-analysis to assess the effectiveness of cell salvage to reduce transfusions in THA and TKA separately, and to examine whether recent trials change the conclusions from previous meta-analyses. We searched MEDLINE through January 2013 for randomized clinical trials evaluating the effects of cell salvage in THA and TKA. Trial results were extracted using standardized forms and pooled using a random-effects model. Methodological quality of the trials was evaluated using the Cochrane Collaboration's tool for risk-of-bias assessment. Forty-three trials (5631 patients) were included. Overall, cell salvage reduced the exposure to allogeneic RBC transfusion in THA (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.51 to 0.85) and TKA (RR, 0.51; 95% CI, 0.39 to 0.68). However, trials published in 2010 to 2012, with a lower ...

Annals of the Rheumatic Diseases

Quality in primary care, 2013

To improve the feasibility of shifting medical specialist to general practitioner (GP) services i... more To improve the feasibility of shifting medical specialist to general practitioner (GP) services in patient-centred health care systems, it is important to know how this substitution is valued by patients. However, insight into patients' preferences is lacking. This study aims to fill this gap by assessing whether patients' preferences for substitution are related to the type of medical intervention. Questionnaires were sent to 1000 members of the Dutch Insurants Panel (potential patients). Panel members were asked about their preferences for and use of medical specialist and GP services regarding 11 medical interventions. Six hundred and ninety-four members (69%) responded. We used multilevel multinomial regression to analyse the data. Preferences were significantly related to medical intervention type. GP services were preferred for follow-up treatments (e.g. removing stitches) and non-complex invasive treatments (e.g. removal of lumps), and medical specialist services were...

Annals of the Rheumatic Diseases, 2012

ABSTRACT Background Literature (1) and daily practice indicate a need for interactive forms of ed... more ABSTRACT Background Literature (1) and daily practice indicate a need for interactive forms of education to enhance guideline usage, but the evidence on their effectiveness is lacking. Objectives The aim of this study was to investigate the effectiveness of an interactive workshop as part of the implementation of the Dutch physical therapy (PT) guideline for hip and knee osteoarthritis (HKOA). Methods In 5 regions in the Netherlands, all PTs who were a member of the Royal Dutch Society of Physical Therapy were randomly assigned to an interactive workshop (IW) or a control group (C). IW comprised presentations of the content of the guideline and 3 clinical cases with the cooperation of 3 patient partners and 3 expert PTs per region, executed according to the method of clinical reasoning and lasted 3 hours. C was a waiting list group who received IW after 4 months. Assessments were done before the educational course, immediately afterwards and three months thereafter. Assessments consisted of the Quality Indicators for Physical therapy in Hip and Knee Osteoarthritis (QIP-HKOA) questionnaire, containing 18 questions on the usage of the guideline (total score range 0-72), a 19-items knowledge questionnaire (total score range 0-76) and a questionnaire concerning barriers in using the guideline (total score range 0-80). In addition, sociodemographic characteristics of the participants were recorded. Statistical analysis included comparisons of total mean scores between the IW and C across 3 time points by using Linear Mixed Models. Results In total 3778 PTs were invited, of whom 275 (7.3%) were willing to take part in the study. They were randomly assigned to IW (n=141) or C (n=134). There were no sociodemografic differences at baseline between IW and C. The statistic analyses showed a significant difference between groups in favour of IW concerning all 3 outcome measures (see Table 1). Conclusions An interactive educational course with the support of patients and following a process of clinical reasoning was found to be an effective strategy to improve adherence with recommendations in the Dutch physical therapy guideline for HKOA. Also knowledge about the guideline improved and less barriers to use the guideline were experienced in daily clinical practice after 3 months. Funding This project was funded by the Royal Dutch Society of Physical Therapy and the Dutch Arthritis Association. Disclosure of Interest None Declared

PLoS ONE, 2014

Introduction: Due to the increasing specialization of medical professionals, patients are treated... more Introduction: Due to the increasing specialization of medical professionals, patients are treated by multiple disciplines. To ensure that delivered care is patient-centered, it is crucial that professionals and the patient together decide on treatment (shared decision making (SDM)). However, it is not known how SDM should be integrated in multidisciplinary practice. This study determines the most important factors for SDM implementation in sciatica care, as it is known that a prior inventory of factors is crucial to develop a successful implementation strategy.

Transfusion, 2014

BACKGROUND: Despite evidence that the bloodsaving measures (BSMs) erythropoietin (EPO) and intra-... more BACKGROUND: Despite evidence that the bloodsaving measures (BSMs) erythropoietin (EPO) and intra-and postoperative blood salvage are not (cost-)effective in primary elective total hip and knee arthroplasties, they are used frequently in Dutch hospitals. This study aims to assess the impact of barriers associated with the intention of physicians to stop BSMs. STUDY DESIGN AND METHODS: A survey among 400 orthopedic surgeons and 400 anesthesiologists within the Netherlands was performed. Multivariate logistic regression was used to identify barriers associated with intention to stop BSMs. RESULTS: A total of 153 (40%) orthopedic surgeons and 100 (27%) anesthesiologists responded. Of all responders 67% used EPO, perioperative blood salvage, or a combination. After reading the evidence on non-cost-effective BSMs, 50% of respondents intended to stop EPO and 53% to stop perioperative blood salvage. In general, barriers perceived most frequently were lack of attention for blood management (90% of respondents), department priority to prevent transfusions (88%), and patient characteristics such as comorbidity (81%). Barriers significantly associated with intention to stop EPO were lack of interest to save money and the impact of other involved parties. Barriers significantly associated with intention to stop perioperative blood salvage were concerns about patient safety, lack of alternatives, losing experience with the technique, and lack of interest to save money. CONCLUSION: Physicians experience barriers to stop using BSMs, related to their own technical skills, patient safety, current blood management policy, and lack of interest to save money. These barriers should be targeted in strategies to make BSM use cost-effective. ABBREVIATIONS: BSM(s) = blood-saving measure(s); TDF = theoretical domains interview framework; THA = total hip arthroplasty; TKA = total knee arthroplasty.

Rheumatology, 2013

To compare the effectiveness of two educational courses aiming to improve adherence to recommenda... more To compare the effectiveness of two educational courses aiming to improve adherence to recommendations in a Dutch physiotherapy practice guideline for hip and knee OA. Physiotherapists (PTs) from three regions in The Netherlands were invited to participate in a study comparing an interactive workshop (IW) with conventional education (CE). Participants were randomly assigned to one of the two courses. Satisfaction with the course (scale 0-10), knowledge (score range 0-76) and guideline adherence (score range 0-72) were measured at baseline, immediately after the educational course and 3 months after that. Data were analysed using a linear mixed model. In total, 203 (10%) PTs participated in the IW (n = 108) and the CE (n = 95). There were no differences between groups at baseline. Satisfaction was significantly higher in the IW than in the CE group [mean scores (S.D.) 7.5 (1.1) and 6.7 (1.6), respectively (P < 0.001)]. A significantly greater improvement in adherence was seen over time in the IW group compared with the CE group (F = 3.763, P = 0.024), whereas the difference in improvement of knowledge was not significant (F = 1.283, P = 0.278). An IW led to greater satisfaction and was more effective in improving adherence to recommendations in a PT guideline on hip and knee OA than CE, whereas the increase in knowledge did not differ significantly.

Implementation Science, 2014

Implementation Science, 2014

Background: National and international evidence-based guidelines for hip and knee osteoarthritis ... more Background: National and international evidence-based guidelines for hip and knee osteoarthritis recommend to start with (a combination of) conservative treatments, followed by surgical intervention if a patient does not respond sufficiently to conservative treatment options. Despite these recommendations, there are strong indications that conservative treatments are not optimally used in orthopedic practice. Our study aims to quantify the use of conservative treatments in Dutch orthopedic practice and to explore the barriers and facilitators for the use of conservative treatments that should be taken into account in a strategy to improve the embedding of conservative treatments in hip and knee osteoarthritis in orthopedic practice. Methods: This study consists of three phases. First, current use of conservative treatments in patients with hip and knee osteoarthritis will be explored using an internet-based survey among at least 100 patients to identify the underused conservative treatments. Second, barriers and facilitators for the use of conservative treatments in orthopedic practice will be identified using semi-structured interviews among 10 orthopedic surgeons and 5 patients. The interviews will be followed by an internet-based survey among approximately 450 orthopedic surgeons and at least 100 patients in which the identified barriers and facilitators will be ranked by importance. Finally, an implementation strategy will be developed based on the results of the previous phases using intervention mapping.

Implementation Science, 2012

Background: Sciatica is a common condition worldwide that is characterized by radiating leg pain ... more Background: Sciatica is a common condition worldwide that is characterized by radiating leg pain and regularly caused by a herniated disc with nerve root compression. Sciatica patients with persisting leg pain after six to eight weeks were found to have similar clinical outcomes and associated costs after prolonged conservative treatment or surgery at one year follow-up. Guidelines recommend that the team of professionals involved in sciatica care and patients jointly decide about treatment options, so-called interprofessional shared decision making (SDM). However, there are strong indications that SDM for sciatica patients is not integrated in daily practice. We designed a study aiming to explore the barriers and facilitators associated with the everyday embedding of SDM for sciatica patients. All related relevant professionals and patients are involved to develop a tailored strategy to implement SDM for sciatica patients. Methods: The study consists of two phases: identification of barriers and facilitators and development of an implementation strategy. First, barriers and facilitators are explored using semi-structured interviews among eight professionals of each (para)medical discipline involved in sciatica care (general practitioners, physical therapists, neurologists, neurosurgeons, and orthopedic surgeons). In addition, three focus groups will be conducted among patients. Second, the identified barriers and facilitators will be ranked using a questionnaire among a representative Dutch sample of 200 GPs, 200 physical therapists, 200 neurologists, all 124 neurosurgeons, 200 orthopedic surgeons, and 100 patients. A tailored team-based implementation strategy will be developed based on the results of the first phase using the principles of intervention mapping and an expert panel. Discussion: Little is known about effective strategies to increase the uptake of SDM. Most implementation strategies only target a single discipline, whereas multiple disciplines are involved in SDM among sciatica patients. The results of this study can be used as an example for implementing SDM in other patient groups receiving multidisciplinary complex care (e.g., elderly) and can be generalized to other countries with similar context, thereby contributing to a worldwide increase of SDM in preference sensitive choices.

Implementation Science, 2012

Background: Total hip and knee arthroplasties are two of the most commonly performed procedures i... more Background: Total hip and knee arthroplasties are two of the most commonly performed procedures in orthopedic surgery. Different blood-saving measures (BSMs) are used to reduce the often-needed allogenic blood transfusions in these procedures. A recent large randomized controlled trial showed it is not cost effective to use the BSMs of erythropoietin and perioperative autologous blood salvage in elective primary hip and knee arthroplasties. Despite dissemination of these study results, medical professionals keep using these BSMs. To actually change practice, an implementation strategy is needed that is based on a good understanding of target groups and settings and the psychological constructs that predict behavior of medical professionals. However, detailed insight into these issuses is lacking. Therefore, this study aims to explore which groups of professionals should be targeted at which settings, as well as relevant barriers and facilitators that should be taken into acount in the strategy to implement evidence-based, cost-effective blood transfusion management and to de-implement BSMs. Methods: The study consists of three phases. First, a questionnaire survey among all Dutch orthopedic hospital departments and independent treatment centers (n = 99) will be conducted to analyze current blood management practice. Second, semistructured interviews will be held among 10 orthopedic surgeons and 10 anesthesiologists to identify barriers and facilitators that are relevant for the uptake of cost-effective blood transfusion management. Interview questions will be based on the Theoretical Domains Interview framework. The interviews will be followed by a questionnaire survey among 800 medical professionals in orthopedics and anesthesiology (400 professionals per discipline) in which the identified barriers and facilitators will be ranked by frequency and importance. Finally, an implementation strategy will be developed based on the results from the previous phases, using principles of intervention mapping and an expert panel. Discussion: The developed strategy for cost-effective blood transfusion management by de-implementing BSMs is likely to reduce costs for elective hip and knee arthroplasties. In addition, this study will lead to generalized knowledge regarding relevant factors for the de-implementation of non-cost-effective interventions and insight in the differences between implementation and de-implementation strategies.

Implementation Science, 2011

Background: Many hospitals have taken actions to make care delivery for specific patient groups m... more Background: Many hospitals have taken actions to make care delivery for specific patient groups more processoriented, but struggle with the question how to deal with process orientation at hospital level. The aim of this study is to report and discuss the experiences of hospitals with implementing process-oriented organisation designs in order to derive lessons for future transitions and research.

Implementation Science, 2011

Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a... more Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of qualitymanagement systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. Methods: The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. Results: MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. Conclusions: It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.

Implementation Science, 2013

Background: The Dutch multidisciplinary sciatica guideline recommends that the team of profession... more Background: The Dutch multidisciplinary sciatica guideline recommends that the team of professionals involved in sciatica care and the patient together decide on surgical or prolonged conservative treatment (shared decision making [SDM]). Despite this recommendation, SDM is not yet integrated in sciatica care. Existing literature concerning barriers and facilitators to SDM implementation mainly focuses on one discipline only, whereas multidisciplinary care may involve other barriers and facilitators, or make these more complex for both professionals and patients. Therefore, this qualitative study aims to identify barriers and facilitators perceived by patients and professionals for SDM implementation in multidisciplinary sciatica care.

Disability and Rehabilitation, 2014

Purpose: To determine the effectiveness of an interactive educational intervention on a physiothe... more Purpose: To determine the effectiveness of an interactive educational intervention on a physiotherapy guideline for hip and knee osteoarthritis. Method: Physiotherapists were randomly allocated to a 3-h interactive educational course with the collaboration of three patient partners or no intervention. Assessments comprised questionnaires on adherence (score range 0-24), knowledge (score range 0-76), and barriers to use the guideline (score range 0-80). Assessments were conducted 1 week before the interactive course (T0) immediately after (T1), and 3 months thereafter (T2). Change scores were compared between the groups by means of Mann-Whitney U tests and linear mixed models. Results: 284 of 4328 eligible PTs (7%) were included. The intervention (n ¼ 133) was significantly more effective than no intervention (n ¼ 151) concerning self-reported adherence and knowledge with mean differences in change scores (95% CI) at T1 and T2 being 1.4 (0.7-2.0) and 0.9 (0.2-1.7) for adherence and 6.8 (4.5-9.1) and 3.9 (1.7-6.2) for knowledge, (all p values50.005). In both groups the barrier score increased at T1 and decreased at T2, with a significantly larger increase at T1 and decrease at T2 in the intervention group (mean differences 3.1 (1.8-4.4) and 3.3 (0.5-6.1), respectively. Conclusions: A short interactive educational course with patient participation on a PT guideline on hip and knee osteoarthritis showed a small to moderate positive effect on self-reported guideline adherence and knowledge, whereas for perceived barriers an advantage was only seen on the longer term.

BMC Musculoskeletal Disorders, 2013

Background: Blood loss in hip and knee arthroplasties may necessitate allogeneic blood transfusio... more Background: Blood loss in hip and knee arthroplasties may necessitate allogeneic blood transfusions. Different blood-saving measures (BSMs) were introduced to reduce these transfusions. Purpose of the present study was to assess the frequency of BSM use, stratified by type and hospital setting of orthopaedic departments in the Netherlands.