Publish in OALib Journal

ISSN: 2333-9721

APC: Only $99


Any time

2019 ( 34 )

2018 ( 50 )

2017 ( 71 )

2016 ( 62 )

Custom range...

Search Results: 1 - 10 of 19204 matches for " Richard PTM Grol "
All listed articles are free for downloading (OA Articles)
Page 1 /19204
Display every page Item
Factors influencing success in quality-improvement collaboratives: development and psychometric testing of an instrument
Loes MT Schouten, Richard PTM Grol, Marlies EJL Hulscher
Implementation Science , 2010, DOI: 10.1186/1748-5908-5-84
Abstract: We developed an instrument with content validity based on literature and the opinions of QIC experts. We collected data from 144 healthcare professionals in 44 multidisciplinary improvement teams participating in two QICs and used exploratory factor analysis to assess the construct validity. We used Cronbach's alpha to ascertain the internal consistency.The 50-item instrument we developed reflected expert-opinion-based determinants of success in a QIC. We deleted nine items after item reduction. On the basis of the factor analysis results, one item was dropped, which resulted in a 40-item questionnaire. Exploratory factor analysis showed that a three-factor model provided the best fit. The components were labeled 'sufficient expert team support', 'effective multidisciplinary teamwork', and 'helpful collaborative processes'. Internal consistency reliability was excellent (alphas between .85 and .89).This newly developed instrument seems a promising tool for providing healthcare workers and policy makers with useful information about determinants of success in QICs. The psychometric properties of the instrument are satisfactory and warrant application either as an objective measure or as a checklist.Approaches to collaborative quality improvement currently form one of the most popular methods for organising improvement in hospitals and ambulatory practices. A quality-improvement collaborative (QIC) is an approach emphasising collaborative learning, support, and exchange of insights among different healthcare organisations. It brings together multidisciplinary teams from different organisations and agencies that share a commitment to making small, rapid tests of change that can be expanded to produce breakthrough results in a specific clinical or operational area [1]. Although the underlying basic concept of QIC programmes appears intuitively appropriate, QICs have not been linked to a published evidence base of effectiveness [2]. A recent systematic review of QICs sho
Pretest expectations strongly influence interpretation of abnormal laboratory results and further management
Paul HH Houben, Trudy van der Weijden, Bjorn Winkens, Ron AG Winkens, Richard PTM Grol
BMC Family Practice , 2010, DOI: 10.1186/1471-2296-11-13
Abstract: Prospective study among 87 primary care physicians in the Netherlands who each ordered laboratory tests for 25 patients. They recorded their reasons for ordering the tests (to exclude or confirm disease or to reassure patients) and their pretest disease probability estimates. Upon receiving the results they recorded how they interpreted the tests, their posttest probability estimates and further management. Logistic regression was used to analyse whether the pretest probability and the reasons for ordering tests influenced the interpretation, the posttest probability estimates and the decisions on further management.The physicians ordered tests for diagnostic purposes for 1253 patients; 742 patients had an abnormal result (64%). Physicians' pretest probability estimates and their reasons for ordering diagnostic tests influenced test interpretation, posttest probability estimates and further management. Abnormal results of tests ordered for reasons of reassurance were significantly more likely to be interpreted as normal (65.8%) compared to tests ordered to confirm a diagnosis or exclude a disease (27.7% and 50.9%, respectively). The odds for abnormal results to be interpreted as normal were much lower when the physician estimated a high pretest disease probability, compared to a low pretest probability estimate (OR = 0.18, 95% CI = 0.07-0.52, p < 0.001).Interpretation and management of abnormal test results were strongly influenced by physicians' estimation of pretest disease probability and by the reason for ordering the test. By relating abnormal laboratory results to their pretest expectations, physicians may seek a balance between over- and under-reacting to laboratory test results.Laboratory tests are frequently ordered in routine primary care as part of the diagnostic process, even though the physician's pretest expectation may often be that the probability of disease is low, and they often order tests for other than purely medical reasons, such as patient rea
A cluster randomised controlled trial in primary dental care based intervention to improve professional performance on routine oral examinations and the management of asymptomatic impacted third molars: study protocol
Theodorus G Mettes, Wil JM van der Sanden, Michel Wensing, Richard PTM Grol, Alphons JM Plasschaert
Implementation Science , 2007, DOI: 10.1186/1748-5908-2-12
Abstract: This study is a cluster randomised controlled trial with groups of GDPs as the unit of randomisation. The aim is to determine the effectiveness and efficiency of small group quality improvement on professional decision-making of general dental practitioners (GDPs) in daily practice. Six peer groups ('IQual-groups') shall be randomised either to the intervention arm I or arm II. Groups of GDPs allocated to either of these arms act as each other's control group. An IQual peer group consists of eight to ten GDPs who meet in monthly structured sessions scheduled for discussion on practice-related topics. GDPs in both trial arms receive recently developed evidence-based clinical practice guidelines (CPG) on ROE or MIM. The implementation strategy consists of one interactive IQual group meeting of two to three hours. In addition, both groups of GDPs receive feedback on personal and group characteristics, and are invited to make use of web-based patient risk vignettes for further individual training on risk assessment policy. Reminders (flow charts) will be sent by mail several weeks after the meeting.The main outcome measure for the ROE intervention arm is the use and appropriateness of individualised risk assessment in assigning recall intervals, and for the MIM-intervention group the use and appropriateness of individualised mandibular impacted third molar risk management. Both groups act as each other's control. Pre-intervention data will be collected in study months one through three. Post-intervention data collection will be performed after nine months.Routine oral examination (ROE) refers to periodic monitoring of the general and oral health status of patients. The main purpose of ROEs is to prevent the onset of oral diseases and/or prevent further progression. This allows the introduction of preventive interventions at the appropriate time, and reduces the need for operative interventions. In most developed Western countries, a decreasing prevalence of oral disease
Management of children's urinary tract infections in Dutch family practice: a cohort study
Mirjam Harmsen, Michel Wensing, Jozé CC Braspenning, René J Wolters, Johannes C van der Wouden, Richard PTM Grol
BMC Family Practice , 2007, DOI: 10.1186/1471-2296-8-9
Abstract: In this cohort study, all 0 to 6-year-old children with a diagnosed UTI in 2001 were identified within the Netherlands Information Network of General Practitioners (LINH), which comprises 120 practices. From the Dutch guideline on urinary tract infections, seven indicators were derived, on prescription, follow-up, and referral.Of the 284 children with UTI who could be followed for three years, 183 (64%) were registered to have had one cystitis episode, 52 (18%) had two episodes, and 43 (15%) had three or more episodes. Another six children were registered to have had one or two episodes of acute pyelonephritis. Overall, antibiotics were prescribed for 66% of the children having had ≤ 3 cystitis episodes, two-thirds of whom received the antibiotics of first choice. About 30% of all episodes were followed up in general practice. Thirty-eight children were referred (14%), mostly to a paediatrician (76%). Less than one-third of the children who should have been referred was actually referred.Treatment of childhood UTIs in Dutch family practice should be improved with respect to prescription, follow-up, and referral. Quality improvement should address the low incidence of urinary tract infections in children in family practice.Awareness of the importance of timely diagnosis and treatment of childhood urinary tract infections (UTIs) is growing. Without timely treatment, renal scarring can occur [1], which is likely to affect approximately 5–15% of young children with a UTI [2-5]. Renal scarring is associated with serious health problems in later life, such as hypertension, complications during pregnancy, and renal failure [1]. Optimal clinical management of childhood UTI potentiates long-term positive health effects. Therefore, guidelines across different countries advocate an active approach concerning prescription, follow-up, and referral [6-9].The guideline on UTIs of the Dutch College of General Practitioners (DCGP) states that every childhood UTI should be treated wi
Short- and long-term effects of a quality improvement collaborative on diabetes management
Loes MT Schouten, Marlies EJL Hulscher, Jannes JE van Everdingen, Robbert Huijsman, Louis W Niessen, Richard PTM Grol
Implementation Science , 2010, DOI: 10.1186/1748-5908-5-94
Abstract: Controlled pre- and post-intervention study assessing patient outcomes (hemoglobin A1c, cholesterol, blood pressure, weight, blood lipid levels, and smoking status), professional performance (guideline adherence), and structural aspects of chronic care management from baseline up to 24 months. Analyses were based on 1,861 patients with diabetes in six intervention and nine control regions representing 37 general practices and 13 outpatient clinics.Modest but significant improvement was seen in mean systolic blood pressure (decrease by 4.0 mm Hg versus 1.6 mm Hg) and mean high density lipoprotein levels (increase by 0.12 versus 0.03 points) at two-year follow up. Positive but insignificant differences were found in hemoglobin A1c (0.3%), cholesterol, and blood lipid levels. The intervention group showed significant improvement in the percentage of patients receiving advice and instruction to examine feet, and smaller reductions in the percentage of patients receiving instruction to monitor blood glucose and visiting a dietician annually. Structural aspects of self-management and decision support also improved significantly.At a time of heightened national attention toward diabetes care, our results demonstrate a modest benefit of participation in a multi-institutional quality improvement collaborative focusing on integrated, patient-centered care. The effects persisted for at least 12 months after the intervention was completed.http://clinicaltrials.gov webcite Identifier: NCT 00160017Good clinical care for patients with type 2 diabetes requires increasingly complicated drug regimens, close monitoring, and ongoing self-management support [1,2]. For best results, diabetes care also requires effective bridging of primary and specialist care with providers crossing practice and organizational boundaries [3]. Cooperation between hospitals and general practices that focus on integrated, patient-centered care is vital [4,5].Despite a wealth of evidence and clinical practic
Evaluation of physicians' professional performance: An iterative development and validation study of multisource feedback instruments
Karlijn Overeem, Hub C Wollersheim, Onyebuchi A Arah, Juliette K Cruijsberg, Richard PTM Grol, Kiki MJMH Lombarts
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-80
Abstract: This observational validation study of three instruments underlying multisource feedback (MSF) was set in 26 non-academic hospitals in the Netherlands. In total, 146 hospital-based physicians took part in the study. Each physician's professional performance was assessed by peers (physician colleagues), co-workers (including nurses, secretary assistants and other healthcare professionals) and patients. Physicians also completed a self-evaluation. Ratings of 864 peers, 894 co-workers and 1960 patients on MSF were available. We used principal components analysis and methods of classical test theory to evaluate the factor structure, reliability and validity of instruments. We used Pearson's correlation coefficient and linear mixed models to address other objectives.The peer, co-worker and patient instruments respectively had six factors, three factors and one factor with high internal consistencies (Cronbach's alpha 0.95 - 0.96). It appeared that only 2 percent of variance in the mean ratings could be attributed to biasing factors. Self-ratings were not correlated with peer, co-worker or patient ratings. However, ratings of peers, co-workers and patients were correlated. Five peer evaluations, five co-worker evaluations and 11 patient evaluations are required to achieve reliable results (reliability coefficient ≥ 0.70).The study demonstrated that the three MSF instruments produced reliable and valid data for evaluating physicians' professional performance in the Netherlands. Scores from peers, co-workers and patients were not correlated with self-evaluations. Future research should examine improvement of performance when using MSF.In view of demands for high quality care, many health care systems aim to assess physicians' professional performance. As the ability to self-assess has shown to be limited, there is a need for external assessments [1]. Reliable, valid, feasible and effective measures of performance are vital to support these efforts. Since 1993, multisource f
Factors predicting doctors’ reporting of performance change in response to multisource feedback
Karlijn Overeem, Hub C Wollersheim, Onyebuchi A Arah, Juliette K Cruijsberg, Richard PTM Grol, Kiki MJMH Lombarts
BMC Medical Education , 2012, DOI: 10.1186/1472-6920-12-52
Abstract: This observational study was set in 26 non-academic hospitals in the Netherlands. In total, 458 specialists participated in the MSF program. Besides the collation of questionnaires, the Dutch MSF program is composed of a reflective portfolio and a facilitative interview aimed at increasing the acceptance and use of MSF. All specialists who finished a MSF procedure between May 2008 and September 2010 were invited to complete an evaluation form. The dependent variable was self-reported change. Three categories of independent variables (personal characteristics, experiences with the assessments and mean MSF ratings) were included in the analysis. Multivariate regression analysis techniques were used to identify the relation between the independent variables and specialists’ reported change in actual practice.In total, 238 medical specialists (response rate 52 percent) returned an evaluation form and participated in the study. A small majority (55 percent) of specialists reported to have changed their professional performance in one or more aspects in response to MSF. Regression analyses revealed that two variables had the most effect on reported change. Perceived quality of mentoring positively influenced reported change (regression coefficient beta?=?0.527, p?<?0.05) as did negative scores offered by colleagues. (regression coefficient beta?=??0.157, p?<?0.05). The explained variance of these two variables combined was 34 percent.Perceived quality of mentoring and MSF ratings from colleagues seem to be the main motivators for the self-reported change in response to MSF by specialists. These insights could leverage in increasing the use of MSF for practice change by investing in the quality of mentors.
Blood test ordering for unexplained complaints in general practice: the VAMPIRE randomised clinical trial protocol. [ISRCTN55755886]
Marloes A van Bokhoven, Hèlen Koch, Trudy van der Weijden, Richard PTM Grol, Patrick JE Bindels, Geert-Jan Dinant
BMC Family Practice , 2006, DOI: 10.1186/1471-2296-7-20
Abstract: General practices are randomised over three groups. Group 1 is instructed to order blood tests immediately, group 2 to apply a watchful waiting policy and group 3 also to postpone testing, but supported by our quality improvement strategy. The trial consists of two sub-studies: a diagnostic study at patient level (group 1 versus groups 2 and 3) and a quality improvement study at GP level (group 2 versus group 3). The diagnostic strategy to be used involves of both customary and innovative tests. The quality improvement strategy consists of two small-group meetings and a practice outreach visit. Patient follow-up ends at 12 months after the initial consultation. Primary outcome measures are the accuracy and added value of blood tests for detecting pathology, the effect of a 4-week postponement of test ordering on the blood test characteristics and the quantity of tests ordered. Secondary outcome measures are the course of complaints, quality of life, satisfaction with care, anxiety of patients and practitioners, determinants of physicians' behaviour, health care utilisation and costs.The innovative aspect of this trial is that it combines a clinical-epidemiological study and a quality of care study.'Unexplained complaints' can be defined as: those complaints for which a general practitioner (GP), after clarifying the reason for encounter, taking history and performing physical examination, is unable to establish a diagnosis.[1] This definition reflects a broad continuum of clinical pictures, ranging from complaints of recent onset to more chronic situations in which the physician is convinced that somatic disease is absent. Newly presented unexplained complaints will in most cases be self-limiting, but they can also develop into chronic complaints, or might be the first sign of serious disease.[2] Since GPs are usually the first health care professionals patients present their complaints to, these complaints belong to the particular expertise of GPs, who are used to
Why do patients want to have their blood tested? A qualitative study of patient expectations in general practice
Marloes A van Bokhoven, Marjolein CH Pleunis-van Empel, Hèlen Koch, Richard PTM Grol, Geert-Jan Dinant, Trudy van der Weijden
BMC Family Practice , 2006, DOI: 10.1186/1471-2296-7-75
Abstract: Qualitative study among patients in waiting rooms of general practices. Each patient was presented with a short questionnaire about their preferences in terms of diagnostics. Patients who would like blood tests to be done were interviewed.Fifty-seven (26%) of the 224 respondents wanted blood tests. Twenty-two were interviewed. Patients overestimated the qualities of blood tests. Favourable test results were regarded as proof of good health. Patients regarded blood tests as a useful instrument to screen for serious disorders, and were confirmed in this belief by people in their social environment and by the media. Many patients expected their GP to take an active test ordering approach, though some indicated that they might be convinced if their GP proposed a wait-and-see policy.GPs' perceptions about patient expectations seem justified: patients appear to have high hopes for testing as a diagnostic tool. They expect diagnostic certainty without mistakes and a proof of good health. The question is whether it would be desirable to remove patients' misconceptions, allowing them to participate in policy decisions on the basis of sound information, or whether it would be better to leave the misconceptions uncontested, in order to retain the 'magic' of additional tests and reassure patients. We expect that clarifying the precise nature of patients' expectations by the GP may be helpful in creating a diagnostic strategy that satisfies both patients and GPs. GPs will have to balance the benefits of reassuring their patients by means of blood tests which may be unnecessary against the benefits of avoiding unnecessary tests. Further research is needed into the effects of different types of patient information and the effects of testing on satisfaction and anxiety.Various studies have shown that general practitioners (GPs) regularly order blood tests without good medical arguments [1,2]. Unnecessary supplementary diagnostics have a number of disadvantages. In view of the relat
The effect of watchful waiting compared to immediate test ordering instructions on general practitioners' blood test ordering behaviour for patients with unexplained complaints; a randomized clinical trial (ISRCTN55755886)
Marloes A van Bokhoven, Hèlen Koch, Trudy van der Weijden, Anuska HM Weekers-Muyres, Patrick JE Bindels, Richard PTM Grol, Geert-Jan Dinant
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-29
Abstract: The study is a cluster-randomized clinical trial with three groups, on blood test ordering strategies in patients with unexplained complaints. GPs in group one were instructed to order tests immediately and GPs in group two to apply a watchful waiting approach. GPs in group three received the same instruction as group two, but they were supported by a systematically designed quality improvement strategy. A total of 498 patients with unexplained complaints from 63 practices of Dutch GPs participated. We measured: the percentage of patients for whom tests were ordered and number of tests ordered at the first consultation; performance on the strategy's performance objectives (i.e., ordering fewer tests and specific communication skills); the number of tests ordered after four weeks; and GP and patient characteristics.Immediate test ordering proved feasible in 92% of the patients; watchful waiting in 86% and 84%, respectively, for groups two and three. The two watchful waiting groups did not differ significantly in the achievement of any of the performance objectives. Of the patients who returned after four weeks, none from group one and six from the two watchful waiting groups had tests ordered for them.Watchful waiting is a feasible approach. It does not lead to testing immediately afterwards. Furthermore, watchful waiting was not improved by the quality improvement strategy.Clinical trial registration: ISRCTN55755886'Unexplained complaints in general practice can be defined as those complaints for which a general practitioner (GP), after clarifying the reason for encounter, taking the patient's history and performing physical examination, is unable to establish a diagnosis [1]. On average, 3% to 39% of consultations involve complaints considered unexplained by the GP [2-4]. The diagnostic workup for these patients frequently involves ordering blood tests. In previous research with the same inclusion criteria as used in the study we present here, we found that tests w
Page 1 /19204
Display every page Item

Copyright © 2008-2017 Open Access Library. All rights reserved.