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Development of a Person-Centred Integrated Care Approach for Chronic Disease Management in Dutch Primary Care: A Mixed-Method Study
Raaijmakers, L.H.A. ; Schermer, T.R.J. ; Wijnen, M.A.M. ; Bommel, H.E. van ; Michielsen, L. ; Boone, F. ; Vercoulen, J.H. ; Bischoff, E.W.M.A.
2023, Article / Letter to editor (International Journal of Environmental Research and Public Health, iss. 20, (2023), pp. 1-27)
Characterization of Social Risk Factors Among Newborns Seen at an Urban Pediatric Primary Care Predictive of Appointment Nonattendance During the First 6 Months of Life.
Lefchak, B. ; Cushwa, A. ; Kersten, H. ; Courts, K. ; McPeak, K.
2022, Article / Letter to editor (Health Equity, vol. 6, iss. 1, (2022), pp. 40-48)Purpose: Appointment attendance is critical in monitoring health and well-being of children. Low income Medicaid-insured families with newborns often experience social risks that may affect attendance. This project sought to characterize social risk factors present at first newborn visits predictive of future appointment nonattendance. Methods: Retrospective cohort study of minority and Medicaid-insured population at St. Christopher's Hospital for Children using a standardized social risk screener administered at first newborn visits as part of routine clinical care. In total, 720 survey responses between December 2016 and June 2017 were correlated with electronic health record-derived sociodemographic and appointment attendance data in the first 6 months of life. Nonattendance included missed and canceled appointments. Caregiver-reported social risk factors were included as covariates in linear regressions predicting proportion nonattendance outcomes. Results: Newborn caregivers identified many social risk factors including mental health diagnoses (14%), lack of child care support (45%), and food insecurity (9%). Approximately 74% had nonattendance with 41% missing or canceling a quarter or more appointments. Number of siblings (p<0.01) and maternal age (p<0.01) were most predictive for nonattendance, respectively. Other social risks were not significant except for maternal mental health (p=0.01) among those identifying number of risk factors above cohort average (16%). Conclusion: Screening of newborns at first medical visits can be used to characterize social risks. Most social risk factors at first visits were not strongly predictive of nonattendance, although our results suggested associations between non-attendance and maternal demographics, mental health and household makeup.
Comparison of the prevalence of 21 GLIM phenotypic and etiologic criteria combinations and association with 30-day outcomes in people with cancer: A retrospective observational study.
Kiss, N ; Steer, B. ; Schueren, M. de van der ; Loeliger, J ; Alizadehsani, R. ; Edbrooke, L. ; Deftereos, I ; Laing, E. ; Khosravi, A.
2022, Article / Letter to editor (Clinical Nutrition, vol. 41, iss. 5, (2022), pp. 1102-1111)BACKGROUND & AIMS: The Global Leadership Initiative on Malnutrition (GLIM) criteria require validation in various clinical populations. This study determined the prevalence of malnutrition in people with cancer using all possible diagnostic combinations of GLIM etiologic and phenotypic criteria and determined the combinations that best predicted mortality and unplanned hospital admission within 30 days. METHODS: The GLIM criteria were applied, in a cohort of participants from two cancer malnutrition point prevalence studies (N = 2801), using 21 combinations of the phenotypic (≥5% unintentional weight loss, body mass index [BMI], subjective assessment of muscle stores [from PG-SGA]) and etiologic (reduced food intake, inflammation [using metastatic disease as a proxy]) criteria. Machine learning approaches were applied to predict 30-day mortality and unplanned admission. RESULTS: We analysed 2492 participants after excluding those with missing data. Overall, 19% (n = 485) of participants were malnourished. The most common GLIM combinations were weight loss and reduced food intake (15%, n = 376), and low muscle mass and reduced food intake (12%, n = 298). Machine learning models demonstrated malnutrition diagnosis by weight loss and reduced muscle mass plus either reduced food intake or inflammation were the most important combinations to predict mortality at 30-days (accuracy 88%). Malnutrition diagnosis by weight loss or reduced muscle mass plus reduced food intake was most important for predicting unplanned admission within 30-days (accuracy 77%). CONCLUSIONS: Machine learning demonstrated that the phenotypic criteria of weight loss and reduced muscle mass combined with either etiologic criteria were important for predicting mortality. In contrast, the etiologic criteria of reduced food intake in combination with weight loss or reduced muscle mass was important for predicting unplanned admission. Understanding the phenotypic and etiologic criteria contributing to the GLIM diagnosis is important in clinical practice to identify people with cancer at higher risk of adverse outcomes.
A nurse-initiated pain protocol in the ED improves pain treatment in patients with acute musculoskeletal pain
Pierik, JGJ ; Berben, SA ; IJzerman, MJ ; Gaakeer, MI ; van Eenennaam, FL ; van Vugt, AB ; Doggen, CJM
2016, Article / Letter to editor (International Emergency Nursing, vol. 27, (2016), pp. 3-10)While acute musculoskeletal pain is a frequent complaint, its management is often neglected. An implementation of a nurse-initiated pain protocol based on the algorithm of a Dutch pain management guideline in the emergency department might improve this. A pre-post intervention study was performed as part of the prospective PROTACT follow-up study. During the pre-( 15 months, n = 504) and post-period ( 6 months, n = 156) patients' self-reported pain intensity and pain treatment were registered. Analgesic provision in patients with moderate to severe pain ( NRS = 4) improved from 46.8% to 68.0%. Over 10% of the patients refused analgesics, resulting into an actual analgesic administration increase from 36.3% to 46.1%. Median time to analgesic decreased from 10 to 7 min ( P < 0.05), whereas time to opioids decreased from 37 to 15 min ( P < 0.01). Mean pain relief significantly increased to 1.56 NRS-points, in patients who received analgesic treatment even up to 2.02 points. The protocol appeared to lead to an increase in analgesic administration, shorter time to analgesics and a higher clinically relevant pain relief. Despite improvements, suffering moderate to severe pain at ED discharge was still common. Protocol adherence needs to be studied in order to optimize pain management. (C) 2016 Elsevier Ltd. All rights reserved.
Improving the governance of patient safety in emergency care: a systematic review of interventions
Hesselink, G ; Berben, S ; Beune, T ; Schoonhoven, L
2016, Article / Letter to editor (BMJ Open, vol. 6, iss. 1, (2016))Objectives: To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. Design: A systematic review of the literature. Methods: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results: Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions: Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base.

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