Evaluatie van het onderdeel medisch handelen van de accreditering

Doorn, A. L. van; Kirschner, K.; Burgers, Jako; Braspenning, Jozé; Grol, Richard; Bouma, Margriet

doi:10.1007/s12445-010-0061-0

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…Practices which perform the procedure as planned are all accredited, so accreditation does not imply that a certain minimum score on performance indicators has been obtained. In the practice accreditation program validated instruments are used: VIP [18] , clinical indicators [19] and Europep [18] – [20] . Practices could claim an allowance for the costs of the accreditation program from health insurance companies.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of Improvement Plans in Primary Care Practice Accreditation: A Clustered Randomized Trial

et al. 2014

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BackgroundAccreditation of healthcare organizations is a widely used method to assess and improve quality of healthcare. Our aim was to determine the effectiveness of improvement plans in practice accreditation of primary care practices, focusing on cardiovascular risk management (CVRM).MethodA two-arm cluster randomized controlled trial with a block design was conducted with measurements at baseline and follow-up. Primary care practices allocated to the intervention group (n = 22) were instructed to focus improvement plans during the intervention period on CVRM, while practices in the control group (n = 23) could focus on any domain except on CVRM and diabetes mellitus. Primary outcomes were systolic blood pressure <140 mmHg, LDL cholesterol <2.5 mmol/l and prescription of antiplatelet drugs. Secondary outcomes were 17 indicators of CVRM and physician's perceived goal attainment for the chosen improvement project.ResultsNo effect was found on the primary outcomes. Blood pressure targets were reached in 39.8% of patients in the intervention and 38.7% of patients in the control group; cholesterol target levels were reached in 44.5% and 49.0% respectively; antiplatelet drugs were prescribed in 82.7% in both groups. Six secondary outcomes improved: smoking status, exercise control, diet control, registration of alcohol intake, measurement of waist circumference, and fasting glucose. Participants' perceived goal attainment was high in both arms: mean scores of 7.9 and 8.2 on the 10-point scale.ConclusionsThe focus of improvement plans on CVRM in the practice accreditation program led to some improvements of CVRM, but not on the primary outcomes.ClinicalTrials.gov NCT00791362

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Section: Methodsmentioning

confidence: 99%

Effectiveness of Improvement Plans in Primary Care Practice Accreditation: A Clustered Randomized Trial

et al. 2014

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“…The performance indicators covered three domains, clinical care, practice management and patient experience, and were derived from the Dutch National Accreditation Program for general practices [ 18 ]. The target users were asked whether these three domains, the subjects and the indicators were appropriate for the P4P program.…”

Section: Methodsmentioning

confidence: 99%

Design choices made by target users for a pay-for-performance program in primary care: an action research approach

et al. 2012

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Background International interest in pay-for-performance (P4P) initiatives to improve quality of health care is growing. Current programs vary in the methods of performance measurement, appraisal and reimbursement. One may assume that involvement of health care professionals in the goal setting and methods of quality measurement and subsequent payment schemes may enhance their commitment to and motivation for P4P programs and therefore the impact of these programs. We developed a P4P program in which the target users were involved in decisions about the P4P methods. Methods For the development of the P4P program a framework was used which distinguished three main components: performance measurement, appraisal and reimbursement. Based on this framework design choices were discussed in two panels of target users using an adapted Delphi procedure. The target users were 65 general practices and two health insurance companies in the South of the Netherlands. Results Performance measurement was linked to the Dutch accreditation program based on three domains (clinical care, practice management and patient experience). The general practice was chosen as unit of assessment. Relative standards were set at the 25 th percentile of group performance. The incentive for clinical care was set twice as high as the one for practice management and patient experience. Quality scores were to be calculated separately for all three domains, and for both the quality level and the improvement of performance. The incentive for quality level was set thrice as high as the one for the improvement of performance. For reimbursement, quality scores were divided into seven levels. A practice with a quality score in the lowest group was not supposed to receive a bonus. The additional payment grew proportionally for each extra group. The bonus aimed at was on average 5% to 10% of the practice income. Conclusions Designing a P4P program for primary care with involvement of the target users gave us an insight into their motives, which can help others who need to discuss similar programs. The resulting program is in line with target users' views and assessments of relevance and applicability. This may enhance their commitment to the program as was indicated by the growing number of voluntary participants after a successfully performed field test during the procedure. The elements of our framework can be very helpful for others who are developing or evaluating a P4P program.

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“…Previous research shows that the precision of a QI score depends on the number of patients included (numerator). 28 Therefore, only QIs with a numerator of >400 patients were included for calculating a precise indicator score with a confidence limit of ±5 percentage points.…”

Section: Sample Sizementioning

confidence: 99%

Variation in Integrated Head and Neck Cancer Care: Impact of Patient and Hospital Characteristics

Overveld¹,

Takes²,

Braspenning³

et al. 2018

J Natl Compr Canc Netw

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Background: Monitoring and effectively improving oncologic integrated care requires dashboard information based on quality registrations. The dashboard includes evidence-based quality indicators (QIs) that measure quality of care. This study aimed to assess the quality of current integrated head and neck cancer care with QIs, the variation between Dutch hospitals, and the influence of patient and hospital characteristics. Methods: Previously, 39 QIs were developed with input from medical specialists, allied health professionals, and patients' perspectives. QI scores were calculated with data from 1,667 curatively treated patients in 8 hospitals. QIs with a sample size of >400 patients were included to calculate reliable QI scores. We used multilevel analysis to explain the variation. Results: Current care varied from 29% for the QI about a case manager being present to discuss the treatment plan to 100% for the QI about the availability of a treatment plan. Variation between hospitals was small for the QI about patients discussed in multidisciplinary team meetings (adherence: 95%, range 88%-98%), but large for the QI about malnutrition screening (adherence: 50%, range 2%-100%). Higher QI scores were associated with lower performance status, advanced tumor stage, and tumor in the oral cavity or oropharynx at the patient level, and with more curatively treated patients (volume) at hospital level. Conclusions: Although the quality registration was only recently launched, it already visualizes hospital variation in current care. Four determinants were found to be influential: tumor stage, performance status, tumor site, and volume. More data are needed to assure stable results for use in quality improvement.

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Evaluatie van het onderdeel medisch handelen van de accreditering

Cited by 8 publications

References 6 publications

Effectiveness of Improvement Plans in Primary Care Practice Accreditation: A Clustered Randomized Trial

Effectiveness of Improvement Plans in Primary Care Practice Accreditation: A Clustered Randomized Trial

Design choices made by target users for a pay-for-performance program in primary care: an action research approach

Variation in Integrated Head and Neck Cancer Care: Impact of Patient and Hospital Characteristics

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