Dutch Healthcare Authority

To explain how government policies affected decision-making on Nurse Practitioner and Physician Assistant employment and training within Dutch healthcare organisations, and how organisational and sectoral circumstances were influential. An online, cross-sectional survey study. A literature- and interview-based program theory was tested using surveys. Respondents from hospital care, (nursing) home care, primary care, and intellectual disability services were recruited using convenience sampling. Data analysis used descriptive statistics and inferential tests. Open-ended responses were analysed using thematic synthesis techniques. Survey results were clustered to assess verification, falsification, or refinement of program theory elements. A total of 568 experts in hiring and training healthcare professionals participated. Respondents indicated that most government policies promoted employment and training. Organisational and sectoral circumstances caused significant variations in Nurse Practitioner and Physician Assistant deployment across healthcare sectors, shaping how decision-makers interpreted and acted on government policies. Specific circumstances within primary care hampered deployment. Government policies stimulated training and employment by: (1) removing practice restrictions (scope of practice expansion, legal acknowledgment), (2) facilitating cost-effective training and deployment (training grants, billing options), (3) providing sectoral knowledge on deployment, training, and healthcare outcomes (funding research and a sectoral knowledge center), and (4) establishing sectoral agreements (on apprenticeships). Organisational and sectoral circumstances significantly influenced outcomes. Key circumstances included flanking policies, stakeholder support, labor market capacity, healthcare demand, organisational resources and aims, and type of decision-makers (medical doctor or manager/director). Familiarity with the professions stimulated deployment. The refined and verified program theory supports designing effective skill-mix policies and facilitating Nurse Practitioner and Physician Assistant employment and training. Tailoring skill-mix policies can optimise outcomes. This offers opportunities for governments, healthcare funders, organisations, and professionals to contribute to healthcare quality, cost efficiency, and patient satisfaction. Healthcare professionals were part of the study population.

BackgroundDespite an ageing population that has higher care demands, home visits by GPs have been declining.AimTo analyse the number of GP home visits from 2017–2023 in The Netherlands, and to investigate whether this trend differed according to age, sex, multimorbidity, and neighbourhood deprivation. In addition, to discover the most common reasons for home visits between 2017 and 2023.Design & settingAn observational study that used data derived from Nivel Primary Care Database (Nivel-PCD), which contained routinely recorded data from approximately 500 Dutch GP practices.MethodThe number of home visits was calculated by age, sex, multimorbidity, and neighbourhood deprivation. Visual inspection was used to investigate the relation between the trend in number of home visits and age, sex, multimorbidity, and neighbourhood deprivation of patients.ResultsA large decrease in the overall number of home visits was observed between 2017 and 2023 (-32%). The largest decrease was between 2019 and 2020 (-15%), but the downward trend continued in 2021 through 2023 (-5% per year). The most profound decline between 2023 and 2017 was found in the number of short home visits (-52%). The number of home visits for intensive GP care increased by 12% between 2017 and 2023.ConclusionWe report a continuing decline in the number of home visits by GPs, comparing 2023 with 2017. Home visits for intensive GP care, often for patients at the end of life, increased since 2017. GPs may be forced to make choices owing to the increasing workload.

PurposeDigital self-management interventions can aid cancer survivors with psychosocial, emotional, physical, and lifestyle support needs, but usage is relatively low due to a lack of awareness and reimbursement. Additionally, there are concerns about e-health exacerbating existing health disparities. To enhance the uptake of digital self-management interventions, the OncoAppstore was launched—a landing page on a well-known Dutch platform that offers cancer survivors credits to purchase these interventions. It is unknown to what extent the nature of the OncoAppstore will influence uptake and appeal to a diverse group of cancer survivors. The current study therefore aimed to explore sociodemographic, clinical, income, and healthcare usage factors associated with its early uptake among survivors.MethodsOncoAppstore usage data were combined with nationwide registry data from Statistics Netherlands, the Netherlands Cancer Registry, and Dutch Hospital Data. Data were analysed descriptively, and differences between OncoAppstore users and non-users were statistically tested using chi-square tests, Fisher’s exact tests, and Mann–Whitney U tests.ResultsOncoAppstore users tended to have higher educational levels and incomes and were more likely to be female, younger on average, and more often of Dutch origin compared to non-users. Users had higher primary and specialist mental healthcare expenditures and lower expenditures on total healthcare, general practitioner, hospital, and pharmaceutical care.ConclusionThe early users of the OncoAppstore appear to be a selective group of cancer survivors as they are primarily individuals with high socioeconomic status. Thus, consistent with other e-health research, the same user patterns are observed. Future research should investigate whether this trend persists after a longer period and what is needed to better reach underrepresented groups.

Abstract Nurses play a pivotal role in the care of older people with malnutrition or who are at risk. However, research shows that they lack the motivation to give adequate nutritional care. To change this motivation, an educational intervention targeted at nurses would be desirable. To optimize learning efficacy, we developed a microlearning intervention and conducted a first evaluation. The aim of this study was to evaluate the microlearning intervention on reaction, learning and behavioral change among nurses. The evaluation was assessed with focus groups, a questionnaire, participant observations and patient records. The data was both qualitatively and quantitatively analyzed. Two focus groups were held with a total of seven nurses. They mostly mentioned positive experiences, stated that their knowledge about nutritional care increased and that their behavior in daily practice changed. Of the 306 participants, who received the intervention, 94 filled in the questionnaire of which 66% was satisfied with the microlearning intervention and over 69% agreed that they learned something new. Five nurses were observed while giving care to a total of twelve older care recipients. No clearly detectable changes in behavior during care moments or in reporting in patient records were observed. Nurses had a mainly positive experience with the microlearning intervention. They confirmed learning and changing behavior in daily practice. However, from observations this behavioral change was not visible. The intervention may be potentially useful in education for (future) nursing professionals. With the microlearning intervention, nurses may be better equipped to provide nutritional care to older people.

Introduction The care for many patients with diabetes mellitus type 2 in the Netherlands, is contracted by a local care group. The healthcare providers, who collectively shape a care group, provide protocolled diabetes care. Differences exist between care groups in terms of their organizational and financial arrangements. These differences may result in variation in outcomes. The aim of this study is to assess whether variation in healthcare costs, diabetes complications and related hospital admissions on the level of care groups exist. Methods A quantitative cohort study was conducted. Patients who used diabetes medication (more than 180 days of defined daily doses per year) for the first time between the years 2014 and 2019 were included. Data were extracted from health insurance claims between 2014 and 2019. Generalized linear mixed models were used to analyse patient variation in healthcare costs (two and six years follow-up), diabetes-related complications and hospital admission days. Intraclass correlation coefficients were calculated to estimate the amount of variation that was attributable to the care groups. Results A large variation in outcome variables was observed between patients and a small variation between care groups. The intraclass correlation coefficient for long-term costs was 0.4%; for short-term costs between 0.1% and 0.3%; for complications 1% and for hospital days 4%. Discussion A large variation between patients with diabetes mellitus type 2 exists in terms of their healthcare costs and complications. In our study, care groups accounted minimally for this variation. A generalized linear mixed model in combination with year cohorts is a tool to study variations in the long-term outcomes of integrated care initiatives.

In healthcare systems with a purchaser–provider split, contracts are an important tool to define the conditions for the provision of healthcare services. Financial risk allocation can be used in contracts as a mechanism to influence provider behavior and stimulate providers to provide efficient and high-quality care. In this paper, we provide new insights into financial risk allocation between insurers and hospitals in a changing contracting environment. We used unique nationwide data from 901 hospital–insurer contracts in The Netherlands over the years 2013, 2016, and 2018. Based on descriptive and regression analyses, we find that hospitals were exposed to more financial risk over time, although this increase was somewhat counteracted by an increasing use of risk-mitigating measures between 2016 and 2018. It is likely that this trend was heavily influenced by national cost control agreements. In addition, alternative payment models to incentivize value-based health care were rarely used and thus seemingly of lower priority, despite national policies being explicitly directed at this goal. Finally, our analysis shows that hospital and insurer market power were both negatively associated with financial risk for hospitals. This effect becomes stronger if both hospital and insurer have strong market power, which in this case may indicate a greater need to reduce (financial) uncertainties and to create more cooperative relationships.

The COVID-19 pandemic has severely affected healthcare delivery across the world. However, little is known about COVID-19’s impact on home healthcare (HHC) services. Our study aimed to: (1) describe the changes in volume and intensity of HHC services and the crisis management policies implemented; (2) understand the responses and the experiences of HHC staff and clients. We conducted an explanatory sequential mixed methods study. First, retrospective client data (N = 43,495) from four Dutch HHC organizations was analyzed. Second, four focus group interviews were conducted for the strategic, tactical, operational, and client levels of the four HHC organizations. Our results showed that both the supply of and demand for Dutch HHC decreased considerably, especially during the first wave (March–June 2020). This was due to factors such as fear of infection, anticipation of a high demand for COVID-19-related care from the hospital sector, and lack of personal protective equipment. The top-down management style initially applied made way for a more bottom-up approach in the second wave (July 2020–January 2021). Experiences vary between levels and waves. HHC organizations need more responsive protocols to prevent such radical scaling-back of HHC in future crises, and interventions to help HHC professionals cope with crisis situations.

Measuring nursing interventions and nurse-sensitive outcomes in a standardized manner is essential because it provides insight into the quality of delivered care. However, there is currently no systematic overview of the interventions conducted by district nurses, the evidence for the effects of these interventions, or what nurse-sensitive outcomes should be measured. 1) To provide an overview of interventions for community-living older people evaluated in district nursing care and evidence for the effects of these interventions and 2) to identify the nurse-sensitive outcomes that are used to evaluate these district nursing care interventions, how these outcomes are measured, and in which patient groups they are applied. A systematic review of the literature. District nursing care. MEDLINE, CINAHL, PsycInfo, and EMBASE. Only experimental studies evaluating district nursing care interventions for communkity-living older people were included. A data extraction form was developed to extract the study characteristics and evaluate interventions and nurse-sensitive outcomes. The methodological quality of the included studies was reviewed using the 13-item critical appraisal tool for randomized controlled trials by the Joanna Briggs Institute. A total of 22 studies were included. The methodological quality of the studies varied, with scores ranging from 6 to 11 on a scale of 0-13. The 22 interventions identified were heterogeneous with respect to intervention components, intervention delivery, and target population. The 44 outcomes identified were grouped into categories following the Nursing Outcome Classification and were measured in various ways and at various times. This is the first systematic review summarizing the evidence for the effectiveness of nurse-led interventions conducted by district nurses on community-living older people. It is unclear what interventions are effective and what outcomes should be used to substantiate district nursing care effectiveness. Because only studies with experimental designs were included, this analysis may provide an incomplete assessment of the effectiveness of interventions in district nursing care. Therefore, it is highly necessary to produce methodologically strong evidence through research programs focusing on district nursing care.

In most studies on hospital merger effects, the unit of observation is the merged hospital, whereas the observed price is the weighted average across hospital products and across payers. However, little is known about whether price effects vary between hospital locations, products, and payers. We expand existing bargaining models to allow for heterogeneous price effects and use a difference‐in‐differences model in which price changes at the merging hospitals are compared with price changes at comparison hospitals. We find evidence of heterogeneous price effects across health insurers, hospital products and hospital locations. These findings have implications for ex ante merger scrutiny.