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Search Results: 1 - 10 of 8211 matches for " Michel Wensing "
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Organizational interventions to implement improvements in patient care: a structured review of reviews
Michel Wensing, Hub Wollersheim, Richard Grol
Implementation Science , 2006, DOI: 10.1186/1748-5908-1-2
Abstract: To provide an overview of the research evidence on effects of organizational strategies to implement improvements in patient care.Structured review of published reviews of rigorous evaluations.Published reviews of studies on organizational interventions.Searches were conducted in two data-bases (Pubmed, Cochrane Library) and in selected journals. Reviews were included, if these were based on a systematic search, focused on rigorous evaluations of organizational changes, and were published between 1995 and 2003.Two investigators independently extracted information from the reviews regarding their clinical focus, methodological quality and main quantitative findings.A total of 36 reviews were included, but not all were high-quality reviews. The reviews were too heterogeneous for quantitative synthesis. None of the strategies produced consistent effects. Professional performance was generally improved by revision of professional roles and computer systems for knowledge management. Patient outcomes was generally improved by multidisciplinary teams, integrated care services, and computer systems. Cost savings were reported from integrated care services. The benefits of quality management remained uncertain.There is a growing evidence base of rigorous evaluations of organizational strategies, but the evidence underlying some strategies is limited and for no strategy can the effects be predicted with high certainty.Numerous studies have shown that at least 40% of the patients do not receive high-quality medical care [1]. So far, strategies to implement best evidence to improve clinical practice have been mainly targeted at improving the knowledge, attitudes and behaviors of healthcare workers [2]. Examples of these strategies are audit and feedback, reminder systems, educational meetings and educational outreach visits. These strategies appear to achieve a median of 10% absolute change of professional performance and no strategy is uniquely and consistently effective [3].
Improvement of primary care for patients with chronic heart failure: a pilot study
Jan van Lieshout, Michel Wensing, Richard Grol
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-8
Abstract: An observational study was performed in 19 general practices in the south-eastern part of the Netherlands, evaluation involving 15 general practitioners and 77 CHF patients. The programme for improvement comprised educational and organizational components and was delivered by a trained practice visitor to the practices. The evaluation was based on case registration forms completed by health professionals and telephone interviews.Management relating to diet and physical exercise seemed to have improved as eight patients were referred to dieticians and five to physiotherapists. The seasonal influenza vaccination rate increased from 94% to 97% (75/77). No impact on smoking was observed. Pharmaceutical treatment was adjusted according to guideline recommendations in 12% of the patients (9/77); 7 patients started recommended medication and 2 patients received dosage adjustments. General practitioners perceived the programme to be feasible. Clinical task delegation to nurses and assistants increased in some practices, but collaboration with other healthcare providers remained limited.The improvement programme proved to have moderate impact on patient care. Its effectiveness should be tested in a larger rigorous evaluation study using modifications based on the pilot experiences.Heart failure is a chronic disease, which has high prevalence, high burden for patients, high mortality, and high costs of healthcare. The prevalence of chronic heart failure (CHF) in the western world is 1-2% in the general population and 10% or higher in the age group of 85 years and older [1,2]. Hospitalization with CHF as main diagnosis occurred in 2004 in 1.5 per 1.000 men and women, and mortality rates in heart failure patients are - with about 50% in 5 years - markedly higher compared to their age group without heart failure [2,3].International clinical guidelines for the management of CHF provide comparable recommendations on diagnosis, treatment and lifestyle advice [4,5]. The recommended
Patient safety in primary care: a survey of general practitioners in the Netherlands
Sander Gaal, Wim Verstappen, Michel Wensing
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-21
Abstract: A web-based survey of a sample of GPs was undertaken. The items were derived from aspects of patient safety issues identified in a prior interview study. The questionnaire used 10 clinical cases and 15 potential risk factors to explore GPs' views on patient safety.A total of 68 GPs responded (51.5% response rate). None of the clinical cases was uniformly judged as particularly safe or unsafe by the GPs. Cases judged to be unsafe by a majority of the GPs concerned either the maintenance of medical records or prescription and monitoring of medication. Cases which only a few GPs judged as unsafe concerned hygiene, the diagnostic process, prevention and communication. The risk factors most frequently judged to constitute a threat to patient safety were a poor doctor-patient relationship, insufficient continuing education on the part of the GP and a patient age over 75 years. Language barriers and polypharmacy also scored high. Deviation from evidence-based guidelines and patient privacy in the reception/waiting room were not perceived as risk factors by most of the GPs.The views of GPs on safety and risk in primary care did not completely match those presented in published papers and policy documents. The GPs in the present study judged a broader range of factors than in previously published research on patient safety in primary care, including a poor doctor-patient relationship, to pose a potential threat to patient safety. Other risk factors such as infection prevention, deviation from guidelines and incident reporting were judged to be less relevant than by policy makers.Patient safety has received increased attention worldwide [1]. The focus of research is mostly upon hospital care [2], although most patients attain their healthcare in primary care settings, particularly in countries with a strong primary care system [3]. Primary care has been found to be relatively safe although incidents do occur in this setting as well [4]. The occurrence of incidents in primary
What do primary care physicians and researchers consider the most important patient safety improvement strategies?
Sander Gaal, Wim Verstappen, Michel Wensing
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-102
Abstract: A web-based survey was undertaken in an international panel of 58 individuals from eight countries with a strong primary care system. The questionnaire consisted of 38 strategies to improve patient safety. We asked the respondents whether these strategies were currently used in their own country, and whether they felt them to be important.Most of the 38 presented strategies were seen as important by a majority of the participants, but the use of strategies in daily practice varied widely. Strategies that yielded the highest scores (>70%) regarding importance included a good medical record system (82% felt this was very important, while 83% said it was implemented in more than half of the practices), good telephone access (71% importance, 83% implementation), standards for record keeping (75% importance, 62% implementation), learning culture (74% importance, 10% implementation), vocational training on patient safety for GPs (81% importance, 24% implementation) and the presence of a patient safety guideline (81% importance, 15% implementation).An international panel of primary care physicians and researchers felt that many different strategies to improve patient safety were important. Highly important strategies with poor implementation included a culture that is positive for patient safety, education on patient safety for physicians, and the presence of a patient safety guideline.Patient safety is receiving increased attention worldwide [1]. In the last decades, the focus of patient safety research has been mostly focused on hospital care, [2] although in recent years patient safety in primary care has been evolving as well. This is an important development, as most patients attain their health care in primary care settings, particularly in countries with a strong primary care system [3]. Various definitions of patient safety have been published, [4] and probably the shortest description is 'to do no harm to patients'. Primary care has been found to be relatively saf
Family practice nurses supporting self-management in older patients with mild osteoarthritis: a randomized trial
Raymond Wetzels, Chris van Weel, Richard Grol, Michel Wensing
BMC Family Practice , 2008, DOI: 10.1186/1471-2296-9-7
Abstract: Randomized controlled trial of patients (≥ 65 years) with mild hip or knee OA from nine family practices in the Netherlands. Intervention consisted of supporting patients' self-management of OA symptoms using a practice-based nurse. Outcome measures were patients' mobility, using the Timed Up and Go test (TUG), and patient reported functioning, using an arthritis specific scale (Dutch AIMS2 SF).Fifty-one patients were randomized to the intervention group and 53 to the control group. Patient-reported functioning improved on four scales in the intervention group compared to one scale in the control group. However, this result was not significant. Mobility improved in both groups, without a significant difference between the two groups. There were no differences between the groups regarding consultations with family physicians or physiotherapists, or medication use.A nurse-based intervention on older OA patients' self-management did not improve self-reported functioning, mobility or patients' use of health care resources.In our aging population osteoarthritis (OA) is a highly prevalent chronic disease, which has a high impact on burden of disease, quality of life, and use of healthcare. Worldwide estimates are that 10% of men and 18% of women aged 60 years have symptomatic OA [1]. In early stages clinical management of OA is targeted at improving patients' self-management [2-5], losing weight [6], physical exercise [7-11] and adequate use of analgesics. But, medicalization of OA should be avoided. Patients' self-management may improve their life-style and therefore health outcomes, analogue to diabetic patients [12]. Healthcare systems face the challenge to enhance self-management in OA patients on a sufficiently large scale so that all patients are actually reached and helped. Barriers may be that improving patients' life-style often requires substantial investment of both patients' and health professionals' time, as many education programmes require a large number of
Mix of methods is needed to identify adverse events in general practice: A prospective observational study
Raymond Wetzels, René Wolters, Chris van Weel, Michel Wensing
BMC Family Practice , 2008, DOI: 10.1186/1471-2296-9-35
Abstract: In a prospective observational study, with five general practitioners, five methods were applied and compared. The five methods were physician reported adverse events, pharmacist reported adverse events, patients' experiences of adverse events, assessment of a random sample of medical records, and assessment of all deceased patients.A total of 68 events were identified using these methods. The patient survey accounted for the highest number of events and the pharmacist reports for the lowest number. No overlap between the methods was detected. The patient survey accounted for the highest number of events and the pharmacist reports for the lowest number.A mix of methods is needed to identify adverse events in general practice.Patient safety is important in primary care, as most patients and most of their health problems are treated in this setting [1]. Adverse events in primary care occur between five and 80 times per 100 000 consultations [2]. General practitioners (GPs) were positive about reporting adverse events [3], but the validity and usefulness of incident reporting systems remains unclear [[4], page 3]. A range of methods is available for identifying adverse events, such as review of medical records and case reviews of deceased patients [5-7]. The aim of the presented study was to compare five different methods for identifying adverse events in general practice with respect to the number and type of identified events, the patient subgroups affected, and the agreement of events across the methods.A prospective observational study was performed focused on five GPs in two practices in a period of five months (May to October 2006). A total of approximately 8250 patients were registered with the two practices. The ethical committee of the Radboud University Nijmegen Medical Centre approved the study.We defined an adverse event as an unintentional event with actual or potential harm to the patients' health status. This broad definition is consistent with the Inter
Physicians perceived usefulness of high-cost diagnostic imaging studies: results of a referral study in a German medical quality network
Antonius Schneider, Thomas Rosemann, Michel Wensing, Joachim Szecsenyi
BMC Family Practice , 2005, DOI: 10.1186/1471-2296-6-22
Abstract: Thirty-four GPs, one neurologist and one orthopaedic specialist in ambulatory care from a Medical Quality Network documented 234 referrals concerning 97 MRIs, 96 CTs-scan and 41 intracardiac catheters in a three month period. After having received the test results, they indicated if these were useful for diagnosis and treatment of the patient.The physicians' perceived usefulness of tests was lowest in suspected cerebral disease (40% of test results were seen as useful), cervical spine problems (64%) and unexplained abdominal complaints (67%). The perceived usefulness was highest in musculoskeletal symptoms (94%) and second best in cardiological diseases (82%).The perceived usefulness of high-cost diagnostic imaging was lower in unexplained complaints than in specific diseases. Interventions to improve the effectiveness and efficiency of test ordering should focus on clinical decision making in conditions where GPs perceived low usefulness.The continuous medical and technological progress has led to a rising use of high tech diagnostic tests which are often expensive. For that reason many efforts have been undertaken to enhance the effectiveness and efficiency of referrals for diagnostic tests. Studies have pointed out a wide range of reasons for referrals including patients demand for extensive diagnostics. For instance, referral patterns were related to the physicians' attitudes to their role [1] and to the interaction between the physician and patient [2]. Also the social context seems to have a high influence for referral for further diagnostics [3]. Nevertheless, the variation of referral rates remains largely unexplained [4].Concerning expensive diagnostic procedures, Robling et al. found that the referral for diagnosis with MRI had biomedical, personal and contextual reasons [5]. Particularly "vague complaints" were related to a high likelihood for test ordering. A large observational, cross-sectional study revealed the influence of patients' expectations abou
Information exchange networks for chronic illness care in primary care practices: an observational study
Michel Wensing, Jan van Lieshout, Jan Koetsenruiter, David Reeves
Implementation Science , 2010, DOI: 10.1186/1748-5908-5-3
Abstract: The study was linked to a quality improvement project in the Netherlands. All health professionals in the practices were asked to complete a short questionnaire that documented their information exchange relations. Feasibility was determined in terms of response rates and reliability in terms of reciprocity of reports of receiving and providing information. For each practice, a number of network characteristics were derived for each of the chronic conditions.Ten of the 21 practices in the quality improvement project agreed to participate in this network study. The response rates were high in all but one of the participating practices. For the analysis, we used data from 67 health professionals from eight practices. The agreement between receiving and providing information was, on average, 65.6%. The values for density, centralization, hierarchy, and overlap of the information exchange networks showed substantial variation between the practices as well as between the chronic conditions. The most central individual in the information exchange network could be a nurse or a physician.Further research is needed to refine the measure of information networks and to test the impact of network characteristics on the uptake of innovations.Providing healthcare to patients with a chronic illness is an important challenge for health systems, and has major implications for health professionals' tasks, the organization of healthcare delivery, and the societal costs of healthcare [1]. Many patients with chronic illness receive healthcare in primary care settings. Large variations have been reported in the organisation and delivery of chronic illness care in primary care practices [2]. Understanding of the social factors that influence the uptake of clinical or organisational recommendations is, as yet, limited. For example, evidence that perceived team climate and organisational culture are associated with professional performance or health outcomes in primary care is inconsistent
Improvement of primary care for patients with chronic heart failure: A study protocol for a cluster randomised trial comparing two strategies
Jan van Lieshout, Betty Steenkamer, Marjan Knippenberg, Michel Wensing
Implementation Science , 2011, DOI: 10.1186/1748-5908-6-28
Abstract: We describe the study protocol of a cluster randomised controlled trial to examine the effectiveness of tailoring a CHF implementation programme to general practices compared to a standardised way of delivering a programme. The study population will consist of 60 general practitioners (GPs) and the CHF patients they include. GPs are randomised in blocks of four, stratified according to practice size. With a tailored implementation programme GPs prioritise the issues that will form the bases of the support for the practice visits. These may comprise several issues, both educational and organizational.The primary outcome measures are patient's experience of receiving structured primary care for CHF (PACIC, a questionnaire related to the Chronic Care Model), patients' health-related utilities (EQ-5D), and drugs prescriptions using the guideline adherence index. Patients being clustered in practices, multilevel regression analyses will be used to explore the effect of practice size and type of intervention programme. In addition we will examine both changes within groups and differences at follow-up between groups with respect to drug dosages and advice on lifestyle issues. Furthermore, in interviews the feasibility of the programme and goal attainment, organisational changes in CHF care, and formalised cooperation with other disciplines will be assessed.In the tailoring of the programme we will present the GPs a list with barriers; GPs will assess relevance and possibility to solve these barriers. The list is rigorously developed and tested in various projects. The factors for ordering the barriers are related to the innovation, the healthcare professional, the patient, and the context.CHF patients do not form a homogeneous group. Subgroup analyses will be performed based on the distinction between systolic CHF and CHF with preserved left ventricular function (diastolic CHF).ISRCTN: ISRCTN18812755Chronic heart failure (CHF) is a highly prevalent chronic disease with hi
Does the world need a scientific society for research on how to improve healthcare?
Michel Wensing, Jeremy M Grimshaw, Martin P Eccles
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-10
Abstract: In the previous decades, scientific research on "how to improve healthcare" has been increasingly recognized as a legitimate field of research [1,2]. It has evolved under various names, including implementation science, knowledge translation (KT) research, improvement science, evidence-based practice, research utilization, delivery science, and patient safety science [3]. Also across a range of other academic fields, such as clinical epidemiology, medical education, and clinical sciences, researchers have started to pay attention to questions concerning how to improve healthcare. Dedicated scientific journals have emerged, such as Implementation Science, BMJ Quality and Safety, and the International Journal for Quality in Health Care. These developments have occurred across the world, although not at equal speed and shape across countries, facilitated by major health-research funders, such as the Canadian Institutes of Health Research, ZonMW in The Netherlands, the Agency for Healthcare Research and Quality, and (more recently) the National Institutes of Health in the United States [4]. Policy makers at the highest level are calling for more and better research in the area [5-7].From our perspective, as academics engaged with improving healthcare, these developments are very positive. Whilst we continue to have debates on the nomenclature, epistemology, concepts, methods, and ways forward for the field, we share the same ambition. Our core idea is that we need to use a scientific process to understand how knowledge is translated into healthcare practice, management, and policy to achieve the best possible (health) outcomes at the optimum value. This implies that we want to learn about the needs of research users and address those needs. Implementation science has been defined as "the study of the methods and results of the implementation of proven treatments, practices, organizational and management interventions into routine practice" [8]. The variety of other name
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