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  1. Article ; Online: Is the QCI framework suited for monitoring outcomes and costs in a teaching hospital using value-based healthcare principles? A retrospective cohort study.

    van Veghel, Willem / van Dijk, Suzanne C / Klem, Taco Mal / Weel, Angelique E / Bügel, Jean-Bart / Birnie, Erwin

    BMJ open

    2024  Volume 14, Issue 5, Page(s) e080257

    Abstract: Objectives: The objective is to develop a pragmatic framework, based on value-based healthcare principles, to monitor health outcomes per unit costs on an institutional level. Subsequently, we investigated the association between health outcomes and ... ...

    Abstract Objectives: The objective is to develop a pragmatic framework, based on value-based healthcare principles, to monitor health outcomes per unit costs on an institutional level. Subsequently, we investigated the association between health outcomes and healthcare utilisation costs.
    Design: This is a retrospective cohort study.
    Setting: A teaching hospital in Rotterdam, The Netherlands.
    Participants: The study was performed in two use cases. The bariatric population contained 856 patients of which 639 were diagnosed with morbid obesity body mass index (BMI) <45 and 217 were diagnosed with morbid obesity BMI ≥45. The breast cancer population contained 663 patients of which 455 received a lumpectomy and 208 a mastectomy.
    Primary and secondary outcome measures: The quality cost indicator (QCI) was the primary measures and was defined asQCI = (resulting outcome * 100)/average total costs (per thousand Euros)where average total costs entail all healthcare utilisation costs with regard to the treatment of the primary diagnosis and follow-up care. Resulting outcome is the number of patients achieving textbook outcome (passing all health outcome indicators) divided by the total number of patients included in the care path.
    Results: The breast cancer and bariatric population had the highest resulting outcome values in 2020 Q4, 0.93 and 0.73, respectively. The average total costs of the bariatric population remained stable (avg, €8833.55, min €8494.32, max €9164.26). The breast cancer population showed higher variance in costs (avg, €12 735.31 min €12 188.83, max €13 695.58). QCI values of both populations showed similar variance (0.3 and 0.8). Failing health outcome indicators was significantly related to higher hospital-based costs of care in both populations (p <0.01).
    Conclusions: The QCI framework is effective for monitoring changes in average total costs and relevant health outcomes on an institutional level. Health outcomes are associated with hospital-based costs of care.
    MeSH term(s) Humans ; Retrospective Studies ; Hospitals, Teaching/economics ; Female ; Netherlands ; Breast Neoplasms/economics ; Breast Neoplasms/therapy ; Middle Aged ; Obesity, Morbid/economics ; Obesity, Morbid/surgery ; Health Care Costs/statistics & numerical data ; Aged ; Adult ; Male ; Mastectomy/economics ; Quality Indicators, Health Care ; Outcome Assessment, Health Care ; Value-Based Health Care
    Language English
    Publishing date 2024-05-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2023-080257
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  2. Article ; Online: Managing costs and access to healthcare in the Netherlands: impact on primary care.

    van Weel, Chris / Knottnerus, J André / van Schayck, Onno C P

    BMJ (Clinical research ed.)

    2020  Volume 369, Page(s) m1181

    MeSH term(s) Delivery of Health Care ; Health Care Costs ; Health Services Accessibility ; Humans ; Netherlands ; Primary Health Care
    Language English
    Publishing date 2020-04-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.m1181
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  3. Article ; Online: Touching Wood with NAPCRGs 50th anniversary.

    van Weel, Chris

    Family practice

    2022  Volume 39, Issue 5, Page(s) 978–979

    MeSH term(s) Anniversaries and Special Events ; History, 20th Century ; Humans
    Language English
    Publishing date 2022-04-16
    Publishing country England
    Document type Historical Article ; Journal Article
    ZDB-ID 605939-9
    ISSN 1460-2229 ; 0263-2136
    ISSN (online) 1460-2229
    ISSN 0263-2136
    DOI 10.1093/fampra/cmac031
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  4. Article ; Online: Students' experiences with a longitudinal skills training program on breaking bad news: A follow-up study.

    Brouwers, M H / Bor, H / Laan, R / van Weel, C / van Weel-Baumgarten, E

    Patient education and counseling

    2018  Volume 101, Issue 9, Page(s) 1639–1644

    Abstract: Objective: Breaking bad news (BBN) should be trained, preferably early and following a helical model with multiple sessions over time, including feedback on performance. It's unclear how medical students evaluate such an approach.: Methods: We ... ...

    Abstract Objective: Breaking bad news (BBN) should be trained, preferably early and following a helical model with multiple sessions over time, including feedback on performance. It's unclear how medical students evaluate such an approach.
    Methods: We gathered student opinions regarding a helical BBN training programme, the feedback and emotional support they received, and the applicability of the skills training immediately after BBN skills training (Q1) and after finishing their clinical clerkships (Q2).
    Results: Students find a helical curriculum useful, but this declines on follow-up. At Q2 students report less satisfaction with the amount of feedback and emotional support they received and report that the skills training was less applicable in clinical practice compared to what they reported at Q1.
    Conclusion: A helical BBN training programme with early exposure seems to lead to a shift from students being unconsciously incompetent to consciously incompetent. Students would have appreciated more emotional support and feedback.
    Practice implications: We recommend more feedback and emotional support after BBN during clerkships. The gap between classroom and practice can be diminished by emphasizing real life role play and clinical role models should demonstrate continuity and agreement between the skills that are taught and those that are used in clinical practice.
    MeSH term(s) Clinical Clerkship ; Communication ; Curriculum ; Education, Medical, Undergraduate ; Emotions ; Empathy ; Female ; Humans ; Male ; Students, Medical/psychology ; Truth Disclosure
    Language English
    Publishing date 2018-05-07
    Publishing country Ireland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605590-4
    ISSN 1873-5134 ; 0738-3991
    ISSN (online) 1873-5134
    ISSN 0738-3991
    DOI 10.1016/j.pec.2018.05.008
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  5. Article ; Online: Improving the Reporting of Primary Care Research: Consensus Reporting Items for Studies in Primary Care-the CRISP Statement.

    Phillips, William R / Sturgiss, Elizabeth / Glasziou, Paul / Olde Hartman, Tim C / Orkin, Aaron M / Prathivadi, Pallavi / Reeve, Joanne / Russell, Grant M / van Weel, Chris

    Annals of family medicine

    2023  Volume 21, Issue 6, Page(s) 549–555

    Abstract: Primary care (PC) is a unique clinical specialty and research discipline with its own perspectives and methods. Research in this field uses varied research methods and study designs to investigate myriad topics. The diversity of PC presents challenges ... ...

    Abstract Primary care (PC) is a unique clinical specialty and research discipline with its own perspectives and methods. Research in this field uses varied research methods and study designs to investigate myriad topics. The diversity of PC presents challenges for reporting, and despite the proliferation of reporting guidelines, none focuses specifically on the needs of PC. The Consensus Reporting Items for Studies in Primary Care (CRISP) Checklist guides reporting of PC research to include the information needed by the diverse PC community, including practitioners, patients, and communities. CRISP complements current guidelines to enhance the reporting, dissemination, and application of PC research findings and results. Prior CRISP studies documented opportunities to improve research reporting in this field. Our surveys of the international, interdisciplinary, and interprofessional PC community identified essential items to include in PC research reports. A 2-round Delphi study identified a consensus list of items considered necessary. The CRISP Checklist contains 24 items that describe the research team, patients, study participants, health conditions, clinical encounters, care teams, interventions, study measures, settings of care, and implementation of findings/results in PC. Not every item applies to every study design or topic. The CRISP guidelines inform the design and reporting of (1) studies done by PC researchers, (2) studies done by other investigators in PC populations and settings, and (3) studies intended for application in PC practice. Improved reporting of the context of the clinical services and the process of research is critical to interpreting study findings/results and applying them to diverse populations and varied settings in PC.
    MeSH term(s) Humans ; Consensus ; Research Design ; Checklist ; Research Report ; Primary Health Care
    Language English
    Publishing date 2023-11-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2171425-3
    ISSN 1544-1717 ; 1544-1709
    ISSN (online) 1544-1717
    ISSN 1544-1709
    DOI 10.1370/afm.3029
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  6. Article ; Online: Assessment of medical students' integrated clinical communication skills: development of a tailor-made assessment tool.

    Brouwers, M / Custers, J / Bazelmans, E / van Weel, C / Laan, R / van Weel-Baumgarten, E

    BMC medical education

    2019  Volume 19, Issue 1, Page(s) 118

    Abstract: Background: Since patient-centered communication is directly connected to clinical performance, it should be integrated with medical knowledge and clinical skills. Therefore, clinical communication skills should be trained and assessed as an integral ... ...

    Abstract Background: Since patient-centered communication is directly connected to clinical performance, it should be integrated with medical knowledge and clinical skills. Therefore, clinical communication skills should be trained and assessed as an integral part of the student's clinical performance. We were unable to identify a tool, which helps when assessing patient-centered communication skills as an integrated component of medical history taking ('the integrated medical interview'). Therefore, we decided to design a new tailor-made assessment tool, the BOCC (BeOordeling Communicatie en Consultvoering (Dutch), Assessment of Communication and Consultation (English) to help raters assess students' integrated clinical communication skills with the emphasis on patient-centred communication combined with the correct medical content. This is a first initiative to develop such a tool, and this paper describes the first steps in this process.
    Methods: We investigated the tool in a group of third-year medical students (n = 672) interviewing simulated patients. Internal structure and internal consistency were assessed. Regression analysis was conducted to investigate the relationship between scores on the instrument and general grading. Applicability to another context was tested in a group of fourth-year medical students (n = 374).
    Results: PCA showed five components (Communication skills, Problem clarification, Specific History, Problem influence and Integration Skills) with various Cronbach's alpha scores. The component Problem Clarification made the strongest unique contribution to the grade prediction. Applicability was good when investigated in another context.
    Conclusions: The BOCC is designed to help raters assess students' integrated communication skills. It was assessed on internal structure and internal consistency. This tool is the first step in the assessment of the integrated medical interview and a basis for further investigation to reform it into a true measurement instrument on clinical communication skills.
    MeSH term(s) Clinical Competence/standards ; Curriculum ; Education, Medical, Undergraduate/standards ; Educational Measurement/methods ; Health Knowledge, Attitudes, Practice ; Humans ; Medical History Taking ; Models, Educational ; Physician-Patient Relations ; Quality Assurance, Health Care ; Referral and Consultation/standards ; Students, Medical
    Language English
    Publishing date 2019-04-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 2044473-4
    ISSN 1472-6920 ; 1472-6920
    ISSN (online) 1472-6920
    ISSN 1472-6920
    DOI 10.1186/s12909-019-1557-3
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  7. Article ; Online: Ebb and flood nutrient delivery system for sustainable automated crop production

    Giacomelli, G.A. / van Weel, P.A. / Blok, C.

    Acta Horticulturae

    2020  Volume 1296

    Abstract: For more than 40 years ebb and flood irrigation and nutrient delivery systems have been nurturing crops within greenhouse controlled environments. Bedding plants, potted plants, cut flowers and even tomatoes have been produced. An overview and critical ... ...

    Abstract For more than 40 years ebb and flood irrigation and nutrient delivery systems have been nurturing crops within greenhouse controlled environments. Bedding plants, potted plants, cut flowers and even tomatoes have been produced. An overview and critical discussion of the delivery of water, dissolved oxygen and plant nutrients to the root zone of the crop using the ebb and flood principles is discussed in this article. Ebb and flood systems have functioned within automated crop production systems from table transport devices to concrete floor heating systems. The benefits were the easily manageable means to uniformly provide water, dissolved oxygen and plant nutrients to the root zone of the crop, without requiring a fixed plumbing connection, either for inflow during flood or for drainage at ebb. The results were effective transport of water, nutrients and oxygen from the bottom of the root zone upwards, and with saturation of the bottom of the root zone, allowing minimal flushing of nutrients and other dissolved substances from the root zone. All unused irrigation water was collected and returned to storage for future use, creating a recirculating hydroponic system which conserved water and nutrients and directly benefited the environment by eliminating discharge. Fundamental design criteria and operation management practices; integration with concrete floor heating system; and, examples of successful applications are discussed, as are limitations and future applications.
    Keywords Controlled environment ; Crop production ; Greenhouse ; Grow room ; Growing media ; Hydroponics ; Plant factory ; Soilless cultivation ; Substrate
    Subject code 571
    Language English
    Publishing country nl
    Document type Article ; Online
    ISSN 0567-7572
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Omniflow II biosynthetic grafts versus expanded polytetrafluoroethylene grafts for infrainguinal bypass surgery. A single-center retrospective analysis.

    van de Laar, Bart Ct / van Heusden, Hugo C / Pasker-de Jong, Pieternel Cm / van Weel, Vincent

    Vascular

    2021  Volume 30, Issue 4, Page(s) 749–758

    Abstract: Introduction: The aim of this study is to evaluate the outcome of Omniflow II biosynthetic vascular grafts as compared to synthetic expanded polytetrafluoroethylene (ePTFE) grafts in infrainguinal bypass surgery.: Methods: A single-center, ... ...

    Abstract Introduction: The aim of this study is to evaluate the outcome of Omniflow II biosynthetic vascular grafts as compared to synthetic expanded polytetrafluoroethylene (ePTFE) grafts in infrainguinal bypass surgery.
    Methods: A single-center, retrospective, observational study was performed reviewing patients with critical limb ischemia who underwent infrainguinal bypass surgery between 2014 and 2018. Patients characteristics, graft characteristics, and treatment outcomes were collected. Patency rates were compared using Kaplan-Meier estimates.
    Results: Sixty bypasses were performed in 57 patients. For above-knee surgery, six were Omniflow and 13 were synthetic. For below-knee surgery, 19 were Omniflow and 22 were synthetic. Patient characteristics between groups were similar. However, American Society of Anesthesiologists (ASA) classification scores were higher in the Omniflow group as compared to ePTFE (88% was ASA 3 or higher versus 60%;
    Conclusion: Omniflow bypasses were more commonly implanted in patients with higher limb infection rate as confirmed with a higher adapted WIfI score. A trend toward a higher infection rate of Omniflow grafts was observed but not statistically significant. Graft infection rates were relatively low and treatable with antibiotics. No significant difference in graft performance was observed. The choice between the two studied grafts remains based on surgeon's preference.
    MeSH term(s) Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/adverse effects ; Graft Occlusion, Vascular/diagnostic imaging ; Graft Occlusion, Vascular/etiology ; Graft Occlusion, Vascular/surgery ; Humans ; Ischemia/diagnostic imaging ; Ischemia/surgery ; Polytetrafluoroethylene ; Popliteal Artery ; Retrospective Studies ; Treatment Outcome ; Vascular Patency
    Chemical Substances Polytetrafluoroethylene (9002-84-0)
    Language English
    Publishing date 2021-07-01
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 2137151-9
    ISSN 1708-539X ; 1708-5381
    ISSN (online) 1708-539X
    ISSN 1708-5381
    DOI 10.1177/17085381211029815
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  9. Article: Experiences of Clinical Clerkship Students With Mindfulness-Based Stress Reduction: A Qualitative Study on Long-Term Effects.

    van Dijk, Inge / van Beek, Maria H C T / Arts-de Jong, Marieke / Lucassen, Peter L B J / van Weel, Chris / Speckens, Anne E M

    Frontiers in psychology

    2022  Volume 13, Page(s) 785090

    Abstract: Purpose: To explore the mindfulness practice, its long-term effects, facilitators and barriers, in clinical clerkship students 2 years after participation in an 8-week mindfulness-based stress reduction (MBSR) training.: Method: A qualitative study ... ...

    Abstract Purpose: To explore the mindfulness practice, its long-term effects, facilitators and barriers, in clinical clerkship students 2 years after participation in an 8-week mindfulness-based stress reduction (MBSR) training.
    Method: A qualitative study was performed by semi-structured in-depth interviews with 16 clinical clerkship students selected by purposive sampling. Students had participated in a MBSR training 2 years before and were asked about their current mindfulness practice, and the long-term effects of the MBSR training. Thematic analysis was conducted using the constant comparison method. Data saturation was reached after 16 interviews.
    Results: Most interviewees were still engaged in regular, predominantly informal, mindfulness practice, although some discontinued mindfulness practice and reported an "
    Conclusion: Two years after participation in a MBSR training, many interviewees were still engaged in (mostly informal) mindfulness practice contributing to both personal and professional changes. In light of the high clerkship demands, MBSR training could be a valuable addition to medical curricula, supporting medical students in developing necessary competencies to become well-balanced professionals.
    Language English
    Publishing date 2022-03-31
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2563826-9
    ISSN 1664-1078
    ISSN 1664-1078
    DOI 10.3389/fpsyg.2022.785090
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  10. Article ; Online: Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial).

    d'Ailly, P N / Deugd, C / Schep, N W L / Kuijper, T M / Kok, M R / Willemze, A / Coert, J H / de Jong, P H P / Lam-Tse, W K / van der Helm-van Mil, A H M / Tchetverikov, I / Weel-Koenders, A E A M / Bisoendial, R J

    Trials

    2023  Volume 24, Issue 1, Page(s) 229

    Abstract: Background: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care ... ...

    Abstract Background: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up.
    Methods: This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0-100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, based on healthcare costs (iMCQ questionnaire) and productivity loss (iPCQ questionnaire). Follow-up will be scheduled at 3, 6 and 12 months. Patient burden is minimized by combining study visits with regular follow-ups.
    Discussion: Persistent wrist arthritis continues to be a problem for patients with rheumatic joint disease leading to disability. This is the first randomized controlled trial to evaluate the effect, safety and feasibility of arthroscopic synovectomy of the wrist in these patients compared to IACSI.
    Trial registration: Dutch trial registry (CCMO), NL74744.100.20. Registered on 30 November 2020.
    Clinicaltrials: gov NCT04755127. Registered after the start of inclusion on 15 February 2021.
    MeSH term(s) Humans ; Wrist ; Synovectomy/adverse effects ; Prospective Studies ; Quality of Life ; Arthritis, Psoriatic/diagnosis ; Arthritis, Psoriatic/drug therapy ; Arthritis, Psoriatic/surgery ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/drug therapy ; Arthritis, Rheumatoid/complications ; Synovitis/drug therapy ; Antirheumatic Agents/adverse effects ; Injections, Intra-Articular/adverse effects ; Pain/drug therapy ; Treatment Outcome ; Arthroscopy/adverse effects ; Randomized Controlled Trials as Topic
    Chemical Substances Antirheumatic Agents
    Language English
    Publishing date 2023-03-25
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1745-6215
    ISSN (online) 1745-6215
    ISSN 1468-6694 ; 1745-6215
    DOI 10.1186/s13063-023-07129-y
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