Netherlands Institute for Health Services Research

Timely discharge of patients who are clinically ready to be discharged from hospitals to the next point of care is a common health system challenge. Ensuring safe and effective discharge holds new urgency, given the backlogs and increased waiting times for inpatient services in many countries after the COVID-19 pandemic. The study aimed to identify policy options for addressing delayed discharges in six European countries (Denmark, France, Germany, the Netherlands, Norway, and Sweden), and to summarise available evidence on their effectiveness. Experts from the Health Systems and Policy Monitor (HSPM) network of the European Observatory on Health Systems and Policies and additional country experts identified relevant policies and initiatives up to November 2023. When evaluations were available, the experts also provided information on their findings. The data collection was followed by a qualitative, cross-country comparative analysis. A total of 17 policies or initiatives were identified in the study countries. Hospital-based initiatives included discharge planning and transitional care. Community and home care initiatives included municipal emergency beds, intensive home rehabilitation, and assisted discharge. Cross-sectoral initiatives ranged from coordination efforts at the regional and municipal levels to decision support systems and financial incentives. Several common factors or principles underpin many of the identified policies and initiatives. These include clarity of responsibility, effective planning and communication, resourcing of community-based capacity, possible unintended consequences of financial penalties, and the need to adopt a systemic approach.

Palliative care enhances the quality of life of patients and their relatives facing a life-threatening illness or vulnerability. Initially, curative and life-prolonging treatments may be given alongside palliative care, but as the end of life approaches, palliative care becomes more prominent. Illness trajectories vary, and a distinction is made between the illness trajectories of cancer, organ failure and dementia or old age. This study compares end-of-life care for patients who died from cancer, organ failure and dementia or old age in the Netherlands, based on general practitioners’ reports. This retrospective cross-sectional study used questionnaires completed by general practitioners within The Dutch Sentinel General Practice Network, a network designed and managed to be representative for the Dutch population (for age, sex and population density). Patients whose death was non-sudden between 1 January 2017 and 31 December 2019 were included. Outcomes include the importance of (curative, life-prolonging and palliative) treatment aims, palliative care provision, end-of-life discussions, and advance care planning. Differences in care between illness trajectory groups (patients with cancer, organ failure and dementia/old age) were analyzed using logistic regression analyses. In the given period, general practitioners registered a total of 1364 deaths. Of these, 686 patients were included. These patients were under care of a general practitioner most of their last year of life and died non-suddenly from cancer (n = 435), organ failure (n = 128) or dementia/old-age (n = 123). As death approached, the importance of curative and life-prolonging treatment aims decreased, while importance of palliation increased, especially for patients with cancer. General practitioners provided palliative care more frequently to patients with cancer (89%) compared to those with organ failure (70%, OR 0.33) or dementia/old-age (79%, OR 0.26). End-of-life discussions were more common with patients with cancer, while one-third of patients with dementia/old age had no end-of-life discussions at all. General practitioners were more aware of the preferred place of death and end-of-life preferences of patients with cancer (92% and 76%), compared to patients with organ failure (81%, OR 0.38 and 56% OR 0.42) and dementia/old-age (87%, OR 0.38 and 50%, OR 0.25). This study indicates that for patients with cancer, treatment is more often aimed at palliation, general practitioners more frequently provide palliative care, and end-of-life topics and advance care planning are discussed more often, compared to patients with organ failure or dementia/old-age. However, patients may have palliative care needs regardless of their illness or life expectancy. Therefore, it is important that palliative care is initiated early in the illness trajectory.

Estimating COVID-19 vaccine effectiveness (VE) by time since vaccination (TSV) is essential for understanding how protection may change over time and enables meaningful comparisons across studies. This is important for accurate comparisons of VE against different SARS-CoV-2 variants/sublineages, across age groups, during different periods post vaccination campaign, or by vaccine type/brand. We provide recommendations for case-control VE studies on estimating and reporting VE analyses by TSV, with the aim of improving quality of these estimates. Our recommendations cover study design and pre-analysis considerations, descriptive analyses, choice of categories of TSV, categorical and continuous modeling approaches, and best practices for reporting VE by TSV. Using a real-life case-control study, we apply these recommendations and include accompanying statistical scripts in R and Stata. These recommendations will serve as a practical resource for researchers conducting VE analyses by TSV. We encourage ongoing refinement of them through input from other study groups.

Introduction: The Symptoms and Perceptions (SaP) questionnaire is a tool developed to assess the occurrence, duration, and severity of physical and psychological symptoms in epidemiological research. The questionnaire covers up to thirty symptoms across multiple organ systems, alongside perceptions and causal beliefs. This study assesses the reliability and validity of the SaP using data from five independent population studies, representing different sample groups, exposure contexts, and timeframes. The main objective is to better understand the potential for standardized symptom assessment in disaster and environmental health studies. Methods: Data from five epidemiological studies in the Netherlands were combined and analyzed. Each health study employed the SaP questionnaire with minor variations in item structure and content (28 to 30 symptom items): Study 1. Electromagnetic fields (N = 5,933; 2011); Study 2. Pesticides (N = 3,756; 2017); Study 3. Industrial area with multiple incidents (N = 2,394; 2020); Study 4. COVID-19 pandemic in a large province (N = 45,903; 2020); Study 5. National health monitor (N = 315,586; 2022). Various indicators of consistency and validity were assessed. Confirmatory factor analysis was performed to evaluate construct validity and dimensionality. In the analyses, a broad range of additional variables was included, such as psychological measures, health data registered in primary care, and proxies of actual and perceived exposure. Results: Analyses showed good internal consistency (Cronbach’s alpha > 0.80 across studies) and convergent and divergent validity, based on associations between symptom scores and data from diverse constructs. Higher levels of perceived exposure were typically accompanied by higher levels of symptom report. The factorial structure of the symptom assessment was confirmed, yielding consistent clusters of symptoms across datasets, in line with primary care classifications. Conclusion: While existing literature predominantly focuses on psychological problems or disorders, a comprehensive and standardized symptom assessment approach is of importance, regardless of the nature and timeframe of an exposure case.

While needs assessment is the starting point of good quality care, there is anecdotal evidence of patients receiving different care in similar circumstances. This study aims to investigate whether practice variation exists in needs assessments conducted by home care nurses and to identify the factors influencing these assessments. A cross-sectional, quantitative retrospective study. Primary care; home care nursing in the Netherlands in 2023. Sampling was based on criterion sampling. Home care organisations were approached based on the following inclusion criteria: organisations providing home care nursing in the Netherlands, organisations from various regions of the country and organisations offering different types of home care nursing (eg, paediatric or palliative care), funded under the Dutch Health Insurance Act (Zvw). Organisations were excluded if they provided home care nursing funded by sources other than the Dutch Health Insurance Act. Home care nurses were recruited from participating organisations, each of whom had recently assessed the care needs of at least five patients. In total, 28 organisations and 258 home care nurses participated in this study, thereby yielding data from 1615 patients. Assessed and delivered minutes of home care per patient per week. Variation was primarily associated with patient-related factors. After accounting for these factors, 83% (assessed minutes) and 88% (delivered minutes) of the total variation was attributed to the patient level, 8% (assessed minutes) and 10% (delivered minutes) to the home care nurses' level and 9% (assessed minutes) and 2% (delivered minutes) to the organisational level. Due to inadequate documentation in electronic health records, many missing values were identified. The lack of nursing documentation suggests that missing factors may have contributed to variations in needs assessments. Thus, further research should comprehensively explore the patient-related factors currently absent from nursing documentation.

BackgroundWith rising cancer survival rates and an increasing number of cancer survivors, the sustainability of secondary care follow-up care is under pressure. Transferring certain follow-up tasks to primary care is suggested as a potential solution, but there is no consensus on the optimal strategy for this.PurposeTo identify preferences of primary and secondary healthcare providers regarding the transfer of follow-up care for breast, colorectal, and prostate cancer, using a discrete choice experiment (DCE).MethodA DCE was conducted among 153 primary and secondary healthcare professionals in the Netherlands. Attributes related to patient and follow-up characteristics included: type of cancer, age, time post-treatment, any protocolled care for comorbidities, recurrence risk, and types of check-up protocols. A conditional logit model and latent class analysis were used to assess preferences and identify subgroups.ResultsHealthcare providers favored the transfer of follow-up care to primary care for prostate cancer patients. Across all cancer types, preferences for substitution were greater in patients aged above 75 years, longer post-treatment, a low recurrence risk, and who were already enrolled in protocolized chronic care. Transfer of basic check-up care was preferred, while extensive check-up was negatively valued, especially by GPs.ConclusionFuture follow-up should focus on patient groups and tasks for which consensus exists that primary care involvement is feasible and appropriate, forming the basis for sustainable, collaborative, and patient-centered models of care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-026-10538-9.

People living in rural Australia experience poorer health outcomes and have reduced access to health services compared with people living in metropolitan areas. Despite guidelines supporting consumer involvement in research, there is low involvement of rural people in health and medical research. Australia’s first Rural Health Consumer Panel (RHCP), established in 2022, assists researchers in gaining a deeper understanding of rural and regional Australians’ perspectives on health and healthcare. Data are collected from panel members via annual online healthcare surveys and community‐based research. This paper presents preliminary findings from two cross‐sectional online health surveys (Registration Survey and Health Survey #1) including demographic characteristics and current health status of panel members, interactions with healthcare professionals in the past 12 months and consumers’ experience of accessing healthcare. Currently, the RHCP has over 190 members. Panel members are aged between 18 and 84 years and reside in a rural location across Australia. Findings reveal that 90% of panel members reported having a past or current health condition, with 77% of panel members reported having two or more health conditions. Panel members consulted a range of health providers in the past 12 months but often encountered barriers in accessing health services. For those who experienced barriers in accessing a health provider, cost, wait times and distance were most frequently reported. The results of the first two RHCP health surveys have highlighted important issues in rural healthcare, allowing us to identify research priorities and direction for further development of the panel. Findings will be used in collaboration with rural health consumers, rural health services, academic institutions and industry partners to drive improvements in healthcare policy and delivery.

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.