Zorginstituut Nederland

Als de bakens zo sterk verschuiven, is het lastig te bepalen wat belangrijk is, waar we ons voor moeten inzetten. Waarmee krijgt het leven, ook het geloofsleven, samenhang en betekenis? Een belangrijk aspect van leiderschap ligt daarmee in het narratieve. Welke betekenis heeft ons geestelijk leven in onze tijd? Welke betekenis hebben we nog als kerk? Annemiek de Jonge laat zien hoe de dimensie van betekenisgeving – ze gebruikt het Engelse “sensemaking” – onze manier van leiderschap diepgaand beïnvloedt. Leiders zijn dan niet zozeer strategische visionairs (vanuit een “causation-frame”) maar interpreterende gidsen (vanuit een “effectuation-frame”).

Childhood trauma has been associated with accelerated biological aging, such as early pubertal development and cellular aging. Less is known about the impact of childhood trauma on brain aging, particularly across mental disorders. This cross-sectional study tested the hypothesis that childhood trauma severity is linked to accelerated brain aging using a large discovery MRI dataset. Another independent dataset was included to replicate findings. The discovery dataset included 495 participants (248 bipolar-I, 126 schizophrenia-spectrum, 121 controls). To replicate findings, we used an independent dataset (n = 163; 80 schizophrenia-spectrum, 83 healthy individuals). Brain age gap estimate (BrainAGE; predicted brain age minus chronological age) was evaluated from T1-weighted MRI scans using pre-trained machine learning models to quantify brain aging, reflecting the difference between brain-predicted and actual age. Linear regressions were performed to assess the relationships between childhood trauma and BrainAGE across samples. In the discovery dataset, higher childhood trauma severity was associated with increased BrainAGE (β = 0.09, P= .048), independent of diagnosis A categorical approach to trauma confirmed a dose-response pattern, with increased BrainAGE in individuals reporting multiple trauma types and across quartiles of cumulative trauma scores. The replication dataset showed similar results. The dimension of deprivation, but not threat, was associated with increased BrainAGE, in both datasets. Educational attainment moderated the effect of deprivation on BrainAGE in the discovery dataset only. This large transdiagnostic study suggests that individuals exposed to childhood trauma, especially deprivation, may undergo a process of accelerated brain aging, independent of psychiatric diagnosis.

BackgroundPolicymakers have embraced substitution of hospital care to more affordable primary care as a means to contain rising healthcare costs and provide care closer to home. Health insurers play an important role in the extent to which substitution of care takes place. This study explores the perspective of Dutch health insurers on barriers and facilitators to facilitate a shift from hospitals to general practice in the current healthcare system.MethodsSemi-structured group interviews were conducted with healthcare purchasers from various health insurers, involving fifteen participants from seven insurers representing 76.5% of the market. Thematic analysis was used to identify perceived facilitators and barriers for effective substitution of care.ResultsLong-term contracts that enable strategic planning and collaboration between general practices and hospitals, as well as strong organizational structures in general practice and long waiting times in hospitals are reported to facilitate substitution. Uncertainties around collaboration under the Competition Act, inadequate compensation through the risk equalization model, complex billing codes for innovative initiatives, a rigid national budgetary framework and strong bargaining power of hospitals as opposed to insurers and general practices are stated to hinder the shift towards general practice.ConclusionsKey areas for improvement to facilitate substitution, as reported by healthcare purchasers, include clear guidelines on insurer collaboration, adjustments to the risk equalization model, strengthening the bargaining power of general practices, and promoting long-term contracts. This study provides insights into the perceived barriers and facilitators for care substitution from the payer’s perspective. Addressing these barriers is essential for facilitating the shift from hospital to general practice care. Also, potential discrepancies between perceptions and current regulations highlight areas where enhanced dialogue and collaboration between policy makers and health insurers could improve mutual understanding and regulatory compliance.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13650-4.

BackgroundThe number of people with multimorbidity is rising, often requiring care from multiple healthcare providers. Although an interdisciplinary care approach is recommended, unclear coordination responsibility contributes to fragmented care. This fragmentation can worsen patient outcomes, such as inappropriate medication use and increased hospital admissions, leading to high healthcare costs and thereby harming the sustainability of the healthcare system. Better insight into the care trajectories of individuals with multimorbidity is needed to inform integrated care recommendations and inform healthcare providers’ roles.MethodsThis retrospective observational study (2013-2022) used Dutch hospital claims data (Vektis) linked with electronic health record data from general practices (Nivel-PCD) for ∼180,000 individuals. Multimorbidity was defined as ≥ 2 chronic diseases. Prevalence proportions were calculated. Healthcare utilization patterns were analyzed over two years following the onset of multimorbidity. A fractional response regression examined the impact of age, sex, number of comorbidities, and death during follow-up on care fragmentation, measured by the Continuity of Care Index (COCI).ResultsPreliminary results show that the prevalence of multimorbidity increased from 15.2% to 29.5% (2013-2022). Within two years of multimorbidity onset, lower continuity of care (COCI) was observed among patients with a higher number of chronic conditions, older age, male sex, and those who died during follow-up, all statistically significant (p < 0.05).ConclusionsThis study highlights various patient characteristics associated with fragmented care, such as older age and a higher number of chronic conditions. These insights are important for improving integrated care for individuals with multimorbidity, especially in light of the growing prevalence of multimorbidity shown in this study and the need to ensure the sustainability of the healthcare system.Key messages• These findings can offer guidance in structuring the integrated care approach, including identifying which patient groups to target and which healthcare providers should be involved.• The findings of this study may also be useful for other countries to enhance care for individuals with multimorbidity and promote sustainable healthcare systems.

ABSTRACT Introduction The global healthcare sector significantly contributes to climate change and other environmental impacts. Despite this, environmental sustainability considerations are often missing from evidence‐based clinical guidelines. To address this gap, we developed a methodological guidance report focused on integrating environmental sustainability into clinical guidelines. Methods An interdisciplinary expert panel systematically developed this methodological guidance report. Data collection involved expert panel meetings and consultations with stakeholders, based on the development of a sustainability guideline focused on reducing the environmental impact of the operating room (OR). The process included an initial inventory and prioritisation phase, guideline development following the GRADE approach, and finalisation and publication. Results The generated insights offer a standardised and readily applicable guidance report for integrating environmental sustainability into clinical guidelines across medical disciplines. This allows guideline developers to implement sustainability considerations in clinical guidelines. Environmental sustainability should be addressed at the start of guideline development, involving interdisciplinary experts. Approaches include integrating environmental outcomes into the PICO framework or adding a search question focused on the environmental impact of interventions. Furthermore, environmental sustainability should be integrated in the Evidence‐to‐Decision framework. If LCAs are included, both the critical appraisal for study quality of LCAs and the GRADE approach for quality of the evidence are recommended. Interpretation This methodological guidance report facilitates a stepwise approach of integrating environmental sustainability into clinical practice through evidence‐based guideline development. While further evaluation and implementation in clinical practice is needed, the framework supports more sustainable clinical decision‐making and contributes to promoting planetary health.

The European Health Technology Assessment (HTA) regulation (HTAR) came into effect in January 2025 and impacts the HTA process in all European Member States. Member States must give due consideration to the joint clinical assessment (JCA) report. This may require adaptations at the national level. This paper describes the anticipated changes to the Dutch national HTA process and how the Dutch National Health Care Institute (Zorginstituut Nederland, ZIN) prepared for this, because sharing experience between Member States can be of general interest for future expansion of the EU HTAR. ZIN’s implementation activities were facilitated by a project-governance structure and by a continuous gap analysis of the current national assessment and appraisal process of medicinal products, resulting in a concrete action plan. The implementation of the HTAR has two major implications for ZIN’s HTA process, namely that the scoping phase starts much earlier and that the JCA report is the starting point for the national assessment. Gaps, challenges and issues were identified in the categories: information and knowledge, IT and template, communication and stakeholder engagement, capacity and resources, and financial aspects. Based on a thorough and well-defined implementation plan, ZIN is ready to implement the HTAR in national HTA processes and to take on (co-)assessor roles for JCA of medicinal products in 2025.

ObjectivesThis study explored the knowledge and awareness of Dutch patients, healthcare professionals (HCPs) and healthcare insurers on the climate impact of inhalers as well as (factors influencing) their attitude towards climate-friendly inhaler prescription.Design/settingWe recruited participants for this qualitative study with purposive sampling. We conducted four online focus groups with patients, six with HCPs and two interviews with healthcare insurer representatives. Determinants were analysed with the Framework Approach.Participants21 patients, 27 HCPs and two healthcare insurer representatives.ResultsKnowledge and awareness on the climate impact of inhalers varied and was generally lower among patients and healthcare insurers than among HCPs. The attitude towards climate-friendly inhaler prescription was variable among patients and mainly positive among HCPs. Both patients and HCPs assigned a greater role to HCPs than to patients in considering climate impact and agreed that patients’ interest must remain paramount. Factors influencing implementation were mainly related to outcome expectancies, such as expected effect on freedom of choice, expected response of patients and expected effect on patients’ health. The latter is partly influenced by beliefs about different types of inhalers. HCPs expressed a need for information and training on the topic and for collaboration with other stakeholders in the field of pulmonary care. Healthcare insurers assign themselves a role in a more climate-friendly healthcare but are reluctant to direct the preference policy on climate impact.ConclusionsBoth patients and HCPs feel climate-friendly inhaler prescription is important. Implementation can be promoted by enhancing awareness and providing HCPs with information on inhaler climate impact, how to safely practice climate-friendly prescription and how to inform patients about its benefits. Both patients and HCPs emphasise the significance of preserving freedom of choice in prescription and highlight the need for a consensus approach on climate-friendly prescribing endorsed by all pulmonary care stakeholders.