Combined multidisciplinary in/outpatient rehabilitation delays definite nursing home admission in advanced Parkinson’s disease patients

Steendam-Oldekamp, Elien; Weerkamp, Nico J.; Vonk, Judith M.; Bloem, Bastiaan R.; Laar, Teus van

doi:10.3389/fneur.2023.1128891

Cited by 7 publications

(1 citation statement)

References 52 publications

(55 reference statements)

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“…We are aware of changing healthcare strategies and innovations in both the innovation and control region, with possible "contamination" due to our pragmatic real world evaluation. For example, in other areas of the Netherlands, a different innovative healthcare model has been introduced which focuses on intensive inpatient rehabilitation of patients who are on the brink of permanent nursing home admission (11). Therefore, we will repeat the main analysis on the population health dimension, in which we will exclude people receiving other complex healthcare interventions that we are aware of in the Netherlands as a sensitivity check.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson’s disease in a dynamic environment

Maas,

van den Bergh,

van den Berg

et al. 2024

Preprint

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BackgroundAn innovative, integrative care model for people with Parkinson (PRIME Parkinson) has gradually been implemented in a selected region of the Netherlands since 2021. A prospective evaluation of this model (PRIME-NL study) was initiated in parallel, spanning the year prior to implementation (baseline) and the implementation period. Following publication of the original study protocol, the COVID-19 crisis delayed implementation of the full PRIME Parkinson care model by two years and hampered the recruitment of study participants.ObjectiveTo describe which methodological adjustments were made to the study protocol because of these developments.MethodsWe compare various outcomes between a region where PRIME Parkinson care was implemented (innovation region) versus the rest of the Netherlands (usual care region). We use healthcare claims data of virtually all people with Parkinson in the Netherlands and annual questionnaires in a representative subsample of 984 people with Parkinson, 566 caregivers and 192 healthcare professionals. Four major methodological adjustments had to be made since publication of the original protocol. First, we extended the evaluation period by two years. Second, we incorporated annual process measures of the stage of implementation of the new care model. Third, we introduced a real-time iterative feedback loop of interim results to relevant stakeholders. Fourth, we updated the statistical analysis plan.DiscussionThis manuscript provides transparency in how the design and analyses of the evaluation study had to be adapted to control for external influences in a dynamic environment, including eruption of the COVID-19 crisis. Our solutions could serve as a template for evaluating other complex healthcare interventions in a dynamic environment.

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Section: Sensitivity Analysesmentioning

confidence: 99%

The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson’s disease in a dynamic environment

Maas,

van den Bergh,

van den Berg

et al. 2024

Preprint

Self Cite

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Multidisciplinary care in Parkinson’s disease

Weise,

Claus,

Dresel

et al. 2024

J Neural Transm

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Parkinson’s Disease (PD) is a multifaceted and progressive disorder characterized by a diverse range of motor and non-motor symptoms. The complexity of PD necessitates a multidisciplinary approach to manage both motor symptoms, such as bradykinesia, gait disturbances and falls, and non-motor symptoms, including cognitive dysfunction, sleep disturbances, and mood disorders, which significantly affect patients’ quality of life. Pharmacotherapy, particularly dopaminergic replacement therapy, has advanced to alleviate many symptoms. However, these medications can also induce side effects or aggravate symptoms like hallucinations or orthostatic dysfunction, highlighting the need for comprehensive patient management. The optimal care for PD patients involves a team of specialists, including neurologists, physical and occupational therapists, speech-language pathologists, psychologists, and other medical professionals, to address the complex and individualized needs of each patient. Here, we illustrate the necessity of such a multidisciplinary approach in four illustrative PD cases with different disease stages and motor and non-motor complications. The patients were treated in different treatment settings (specialized outpatient clinic, day clinic, inpatient care including neurorehabilitation). The biggest challenge lies in organizing and implementing such comprehensive care effectively across different clinical settings.

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The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson’s disease in a dynamic environment

Maas,

van den Bergh,

van den Berg

et al. 2024

BMC Neurol

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Background An innovative, integrative care model for people with Parkinson (PRIME Parkinson) has gradually been implemented in a selected region of the Netherlands since 2021. A prospective evaluation of this model (PRIME-NL study) was initiated in parallel, spanning the year prior to implementation (baseline) and the implementation period. Following publication of the original study protocol, the COVID-19 crisis delayed implementation of the full PRIME Parkinson care model by two years and hampered the recruitment of study participants. Objective To describe which methodological adjustments were made to the study protocol because of these developments. Methods We compare various outcomes between a region where PRIME Parkinson care was implemented (innovation region) versus the rest of the Netherlands (usual care region). We use healthcare claims data of virtually all people with Parkinson in the Netherlands and annual questionnaires in a representative subsample of 984 people with Parkinson, 566 caregivers and 192 healthcare professionals. Four major methodological adjustments had to be made since publication of the original protocol. First, we extended the evaluation period by two years. Second, we incorporated annual process measures of the stage of implementation of the new care model. Third, we introduced a real-time iterative feedback loop of interim results to relevant stakeholders. Fourth, we updated the statistical analysis plan. Discussion This manuscript provides transparency in how the design and analyses of the evaluation study had to be adapted to control for external influences in a dynamic environment, including eruption of the COVID-19 crisis. Our solutions could serve as a template for evaluating other complex healthcare interventions in a dynamic environment.

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Combined multidisciplinary in/outpatient rehabilitation delays definite nursing home admission in advanced Parkinson’s disease patients

Cited by 7 publications

References 52 publications

The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson’s disease in a dynamic environment

The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson’s disease in a dynamic environment

Multidisciplinary care in Parkinson’s disease

The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson’s disease in a dynamic environment

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