Dutch Health Care Inspectorate

Many patients with COPD use inhaled corticosteroids (ICS) without proper indication. We developed a multifaceted tailor-made de-implementation strategy—including a toolbox, communication plan, and training—to reduce inappropriate ICS use in general practice. We evaluated its effectiveness (i.e. decline in percentage of patients with COPD that use ICS) and other outcomes during a 15-month study in Drenthe, the Netherlands. Less patients (−4.7%,95%CI: 2.6–6.7%) used ICS at the end of follow-up and the percentage of ICS-users declined by 8.2% (95%CI: 2.9–13.4%) across the 14 practices that fully participated in the project. ICS user percentages declined significantly moreover time in the fully participation group than in the control group (beta-regression, β = −0.041,SE = 0.011, p < 0.01). While these findings are promising, further research is needed to assess additional penetration and sustainability of the strategy in the region and to explore the applicability of comparable regional ICS de-implementation plans.

Population reference data based on self-reported EQ-5D constitute a valuable resource in a broad range of settings. Within the UK, EQ-5D has been included in national population surveys for over 30 years, notably as part of the Health Survey for England, however, the extent to which such data varies over time remains largely unknown. Between 1996 and 2014, the Health Survey for England included the original 3-level version of EQ-5D (EQ-5D-3L) and provides data from more than 100,000 respondents; these data form the basis of the present study. Age-stratified rates of reporting any problem in EQ-5D dimensions were computed for men and women; these were standardised using 1996 as the index year. Logit regression was used to examine the influence of year respondent socio-demographic characteristics, and current health status on rates of reporting any problems in EQ-5D-3L. The data of self-rated health status recorded on a 0-100 scale (EQ VAS) was also analyzed. More than 30% report a problem with Pain/Discomfort with around 20% reporting a problem with Anxiety/Depression, Mobility having a similar problem rate, about 18%. Some 5% of respondents report a problem with Self Care. After an initial fall from 1996, self-reported health remains relatively stable across 10 years, however between 2008 and 2012 rates of reporting any problem increased, particularly in the Anxiety/Depression dimension and amongst older women. Logit regression analysis demonstrates that most of the covariates had statistically significant coefficients, such as age, gender, education, economic activity, income, and long-standing illness/condition. The study demonstrates the stability of EQ-5D responses over time in HSE data from 1996 to 2014. However, there is evidence of periodic deterioration in health status notably in the years immediately after 2007. Further investigation of this effect could have implications for the interpretation and use of population data based on EQ-5D. The study demonstrates the importance in national surveys of the general population of regular collection of health status data using a standardised measure of health-related quality of life.

In the Netherlands, since 1996, there is a national cervical cancer (CC) screening programme in place for women aged 30-60 years. The participation of Turkish- and Moroccan-Dutch women is very low. To facilitate their informed decision-making, we developed a culturally sensitive educational video, and evaluated it through a questionnaire study. Since we used multiple strategies for the recruitment of respondents, we aimed (1) to explore which sampling strategy resulted in which type of respondents, (2) to investigate which sampling strategy and individual characteristics were associated with successful recruitment of other respondents, and (3) to examine similarity between those recruited via respondent-driven sampling (RDS). Six sampling strategies were used and compared to explore their recruitment success: (1) RDS (i.e. peer-to-peer recruitment), (2) public and private women's Facebook groups, (3) Instagram, (4) researchers' network, (5) offline organizations (e.g., community centres and mosques), and (6) other channels (e.g. flyers, infographics, and information meetings). To do this, χ2 tests, a multivariate logistic regression, and intra class correlations (ICCs) were performed. Overall, 782 Moroccan- and 696 Turkish-Dutch respondents were included in the analysis. Almost 40% filled out the questionnaire via RDS. RDS yields more often older, lower educated, and first-generation immigrant women than average. Respondents recruited via RDS have more often low CC screening knowledge and make more often uninformed CC screening decisions than average. Social media channels, however, yielded more younger, highly educated, and second-generation immigrant women than average. Sociodemographic characteristics and attitudes towards CC screening varied more strongly within than between network trees. The probability that paired respondents within a network tree had similar characteristics varied strongly depending on the characteristic. By using RDS and asking respondents to recruit peers, the more hard-to-reach individuals (i.e. older, lower educated, and first-generation immigrants) were reached. By using social media channels, younger, highly educated, and second-generation individuals can be recruited. RDS yielded more often women with low CC screening knowledge and women making uninformed CC screening decisions. To reach the individuals in need of tailored information or an intervention conform their needs, we recommend to use RDS as an intervention delivery strategy. Following RDS, we involved Moroccan- and Turkish-Dutch women in recruiting other Moroccan- and Turkish-Dutch women. Through this recruitment, women were able to fill out our questionnaire, and watch our culturally sensitive educational video to improve their informed decision-making in regard to the CC screening programme.

"INTELLECTUAL LIGHTENING": A tribute to John Harris through a collection of memories, imaginary books, fictional reviews, and an interview. John Harris' impressive and diverse academic career is illustrated and remembered by his colleagues who each contribute with a special memory, story or fake book review, in order to thank John and to cherish the memories. A good philosopher, a kind person, a teacher, different aspects of his work are discussed.

Studying malpractice claims is important to improve quality of health care and patient safety and to educate the individual healthcare providers. The objective of this study was to describe characteristics of neurosurgical claims in the Netherlands. A nationwide retrospective observational study of neurosurgery-related claims closed by Centramed and MediRisk, 2 major insurance companies in the Netherlands, was performed. Relevant data, including type of neurosurgical pathology, theme and category of the claim, type and severity of injury, outcome, and financial burden, were extracted from anonymized claim files. The estimated annual risk was used to determine the risk for claims by adjusting for the number of annually practicing neurosurgeons in the Netherlands. A total of 388 claims against neurosurgeons were closed between 2007 and 2021. Liability was denied in a slight majority of claims (n = 230; 59%). The total burden during this period was €6 165 000 (amount paid out to patients: €5 497 000). The estimated annual risk per Dutch neurosurgeon for a claim was 15.5%, meaning 1 claim per 6.5 years. The case-level analysis of 238 available anonymized claims revealed that most claims were related to spinal pathology (81.5%), followed by cranial pathology (10.9%) and peripheral nerve (7.6%). The motivations for filing claims were mostly related to alleged surgical (56.3%) or diagnostic errors (22.3%). Most of these claims were denied (151/238; 63.4%), and fewer were settled (42/238; 17.6%), sustained (31/238; 13.0%), or closed without final decision (14/238; 5.9%). Neurosurgery-related malpractice claims primarily involved spinal pathology and were mostly related to alleged treatment errors. Most claims did not result in compensation because there seemed to be no liability or culpable injury. However, the annual risk for a claim for Dutch neurosurgeons is considerable.

In a previous rapid realist review (RRR) of international literature insight was provided into how, why, and under what circumstances person-centred care (PCC) in primary care works (or not) among others for people with low health literacy skills and for people with a diverse ethnic and socioeconomic background, by establishing a middle-range programme theory (PT), which describes the relationship between context items, mechanisms, and outcomes. Since the application of PCC in primary care in the Dutch setting is expected to differ from other countries, the objective of this study is to validate the items (face validity) resulting from the RRR for the Dutch setting by assessing consensus on the relevance of items. Four focus group discussions with patient representatives and patients with limited health literacy skills (n = 14), and primary care professionals (n = 11) were held partly combined with a Delphi-study. Items were added to refine the middle-range PT for the Dutch primary care setting. These items indicated that in order to optimally align care to the patient tailored supporting material that is developed together with the target group is important, next to providing tailored communication. Healthcare providers (HCPs) and patients need to have a shared vision and set up goals and action plans together. HCPs should stimulate patient’s self-efficacy, need to be aware of the patient’s (social) circumstances and work in a culturally sensitive way. Better integration between information and communications technology systems, flexible payment models, and patients access to documents, and recorded consultations should be in place. This may result in better alignment of care to the needs of patients, improved accessibility to care, improved patient’s self-efficacy, and improved health-related quality of life. On the long-term higher cost-effectiveness and a higher quality of healthcare can be realised. In conclusion, this study shows that for PCC to be effective in Dutch primary care, the PT based on international literature was refined by leaving out items and adding new items for which insufficient or sufficient consensus, respectively, was found.

The prevention of safety incidents (SI) in health and social care settings is an ongoing undertaking. Limited research has been conducted on SIs outside of acute care. Internationally residential care facilities (RCFs) are typically regulated to promote quality and safeguarding. A part of this regulation is the statutory responsibility of RCFs to notify the regulator about SIs. Notifications include details surrounding SIs and are used to inform the regulatory monitoring approach. The recent development of the Database of Statutory Notifications from Social Care in Ireland facilitates in-depth analysis of notifications which can be used to inform the management of SIs and thus, improve quality and safety. The aim of this study was to analyse narratives provided in statutory notifications for older persons and people with disability, in order to identify current management of SIs, system vulnerabilities and reporting practices. A Qualitative Descriptive approach was taken. A random sample of notifications received in 2018 was drawn and stratified by service-type and notification-type. Data extraction was conducted against priori agreed target areas of management, system vulnerabilities and reporting practices. Inductive thematic analysis was used identifying two parent themes: 'chronology' and 'regulatory input'. 'Chronology' subthemes included 'pre-event', 'immediate response' and 'continued response'. Measures that are resident focused and follow policies and protocols in RCFs to prevent or mitigate the seriousness of SIs were evident in the immediate response and continued response. The actions taken in the immediate and continued response in turn became part of the pre-event of future SIs. Under 'regulatory input' subthemes included 'inaccurate reporting', 'lines of inquiry', 'requests for further information', 'identification of repetitive patterns' and 'satisfactory conclusion'. In conclusion, RCFs manage SIs with short and longer term actions focused on resident wellbeing. These actions in turn become part of the pre-event of future SIs. Regulatory input highlighted regulatory burden.

ObjectivesA just culture is considered a promising way to improve patient safety and working conditions in the healthcare sector, and as such is also of relevance to healthcare regulators who are tasked with monitoring and overseeing quality and safety of care. The objective of the current study is to explore the experiences in healthcare organisations regarding the role of the healthcare inspectorate in enabling a just culture.DesignQualitative study using interviews and focus groups that were transcribed verbatim, and observations of which written reports were made. Transcripts and observation reports were thematically analysed.SettingThree mental healthcare providers, two hospitals and the healthcare inspectorate in the Netherlands.ParticipantsWe conducted 61 interviews and 7 focus groups with healthcare professionals, managers and other staff in healthcare organisations and with inspectors. Additionally, 27 observations were conducted in healthcare organisations.ResultsWe identified three themes in our data. First, professionals and managers in healthcare organisations perceive the inspectorate as a potential catalyst for learning processes, for example, as an instigator of investigating incidents thoroughly, yet also as a potential barrier as its presence and procedures limit how open employees feel they can be. Second, a just culture is considered relational and layered, meaning that relationships between different layers within or outside the organisation might hinder or promote a just culture. Finally, for inspectors to enable a just culture requires finding a balance between allowing organisations the time to take responsibility for quality and safety issues, and timely regulatory intervention when healthcare providers are unwilling or unable to act.ConclusionsIf regulators intend to enable the development of a just culture within healthcare organisations, they must adopt regulatory procedures that support reflection and learning within the organisations they regulate and consider mutual trust as a vital regulatory tool.

Numerous studies have modified the Trauma Injury and Severity Score (TRISS) to improve its predictive accuracy for specific trauma populations. The aim of this study was to develop and validate a simple and practical prediction model that accurately predicts mortality for all acute trauma admissions. This retrospective study used Dutch National Trauma Registry data recorded between 2015 and 2018. New models were developed based on nonlinear transformations of TRISS variables (age, systolic blood pressure (SBP), Glasgow Coma Score (GCS) and Injury Severity Score (ISS)), the New Injury Severity Score (NISS), the sex-age interaction, the best motor response (BMR) and the American Society of Anesthesiologists (ASA) physical status classification. The models were validated in 2018 data and for specific patient subgroups. The models' performance was assessed based on discrimination (areas under the curve (AUCs)) and by calibration plots. Multiple imputation was applied to account for missing values. The mortality rates in the development and validation datasets were 2.3% (5709/245363) and 2.5% (1959/77343), respectively. A model with sex, ASA class, and nonlinear transformations of age, SBP, the ISS and the BMR showed significantly better discrimination than the TRISS (AUC 0.915 vs. 0.861). This model was well calibrated and demonstrated good discrimination in different subsets of patients, including isolated hip fractures patients (AUC: 0.796), elderly (AUC: 0.835), less severely injured (ISS16) (AUC: 878), severely injured (ISS ≥ 16) (AUC: 0.889), traumatic brain injury (AUC: 0.910). Moreover, discrimination for patients admitted to the intensive care (AUC: s0.846), and for both non-major and major trauma center patients was excellent, with AUCs of 0.940 and 0.895, respectively. This study presents a simple and practical mortality prediction model that performed well for important subgroups of patients as well as for the heterogeneous population of all acute trauma admissions in the Netherlands. Because this model includes widely available predictors, it can also be used for international evaluations of trauma care within institutions and trauma systems.