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Bert Vrijhoef

Maastricht University Medical Center, Patient & Care, Faculty Member

National University of Singapore, Saw Swee Hock School of Public Health, Faculty Member

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Bert Vrijhoef (1971) is Principal Research Scientist at Maastricht University Medical Center, CIO of Panaxea B.V. in Amsterdam, and visiting Professor at the Vrije Universiteit Brussels. He is also the Editor-in-Chief of the International Journal of Care Coordination.

Previously, he was Professor in Health Services and Policy Research at the National University of Singapore; Professor in Chronic Care at the Scientific Centre for Care and Welfare, Tilburg University; Scientific Director of the department of Integrated Care at Maastricht UMC; and Director of the Master Health Policy and Innovation Management at Maastricht University. He worked at the MacColl Institute for Healthcare Innovation, as Commonwealth Fund Harkness Fellow.

His work focuses on improving the health of people with chronic diseases by redesigning care; transfer of tasks between healthcare professionals; the cost-effectiveness and implementation of e-Health.  

Examples of ongoing projects he is involved in are: evaluation of NUHS regional health system in Singapore; Project INTEGRATE (EU grant); Scirocco (EU grant); evaluation of expanding independent authority to perform reserved procedures to Physician Assistants, Nurse Practitioners and Technical Physicians (Dutch MoH grants); technology acceptance by elderly (Raak-Pro grant); cost-effectiveness of game in rehabilitation care (CIRAN grant).

Bert has (co)authored 250+ publications (please see his profile at Research Gate) and supervised 150+ students at various universities in the field of health services research at bachelor, master and PhD level. He frequently accepts invitations to present at conferences.

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Papers by Bert Vrijhoef

Zio Integrated Care Network the Netherlands

This case study is part of the Accountable Care in Practice: Global Perspectives series produced ... more This case study is part of the Accountable Care in Practice: Global Perspectives series produced by Duke University's Robert J. Margolis, MD, Center for Health Policy and supported by the Commonwealth Fund. The series explores how organizations across the world have taken steps to improve health outcomes by adopting accountable care policy reforms within diverse organizational and environmental contexts. The aim is to assist US stakeholders to apply the results of these reforms. We consider the critical success factors with each organization's implementation process that could be translated in the US. Additional resources, including an explanation of the accountable care framework, can be found at the Duke-Margolis website.

Economic evaluation of a diabetes disease management programme with a central role for the diabetes nurse specialist

How to write an abstract

Developing care for a changing population: supporting patients with costly, complex needs

Position paper: Organisatie van zorg voor chronische zieken in Belgie

by H. Spitters and Bert Vrijhoef

Towards an international taxonomy of integrated primary care: a Delphi consensus approach

by Inge Boesveld, Dirk Ruwaard, and Bert Vrijhoef

BMC Family Practice, 2015

The impact of redesigning care processes on quality of care: a systematic review

by Arno van Raak, Dirk Ruwaard, and Bert Vrijhoef

BMC Health Services Research, 2015

This literature review evaluates the current state of knowledge about the impact of process redes... more This literature review evaluates the current state of knowledge about the impact of process redesign on the quality of healthcare. Pubmed, CINAHL, Web of Science and Business Premier Source were searched for relevant studies published in the last ten years [2004-2014]. To be included, studies had to be original research, published in English with a before-and-after study design, and be focused on changes in healthcare processes and quality of care. Studies that met the inclusion criteria were independently assessed for excellence in reporting by three reviewers using the SQUIRE checklist. Data was extracted using a framework developed for this review. Reporting adequacy varied across the studies. Process redesign interventions were diverse, and none of the studies described their effects on all dimensions of quality defined by the Institute of Medicine. The results of this systematic literature review suggests that process redesign interventions have positive effects on certain aspects of quality. However, the full impact cannot be determined on the basis of the literature. A wide range of outcome measures were used, and research methods were limited. This review demonstrates the need for further investigation of the impact of redesign interventions on the quality of healthcare.

Assessments Cost-Effectiveness of Telehealth Interventions for Chronic Heart Failure Patients: A Literature Review Care Management Solutions, Philips Research

Objectives: Evidence exists that telehealth interventions (e.g., telemonitoring, telediagnostics,... more Objectives: Evidence exists that telehealth interventions (e.g., telemonitoring, telediagnostics, telephone care) in disease management for chronic heart failure patients can improve medical outcomes, and we aim to give an overview of the cost-effectiveness of these interventions. Methods: Based on the literature search on " heart failure " in combination with " cost " and " telehealth " we selected 301 titles and abstracts. Titles and abstracts were screened for a set of inclusion criteria: telehealth intervention, heart failure as the main disease, economic analysis present and a primary study performed. In the end, thirty-two studies were included for full reading, data extraction, and critical appraisal of the economic evaluation. Results: Most studies did not present a comprehensive economic evaluation, consisting of the comparison of both costs and effects between telehealth intervention and a comparator. Data on telehealth investment costs were lacking in many studies. The few studies that assessed costs and consequences comprehensively showed that telehealth interventions are cost saving with slight improvement in effectiveness, or comparably effective with similar cost to usual care. However, the methodological quality of the studies was in general considered to be low. Conclusions: The cost-effectiveness of telehealth in chronic heart failure is hardly ascertained in peer reviewed literature, the quality of evidence is poor and there was a difficulty in capturing all of the consequences/effects of telehealth intervention. We believe that without full economic analyses the cost-effectiveness of telehealth interventions in chronic heart failure remains unknown.

A Theoretical Lens for Revealing the Complexity of Chronic Care

by Bert Vrijhoef, Jan M De Maeseneer, and Liesbeth Borgermans

Advancing current approaches to disease management evaluation: capitalizing on heterogeneity to understand what works and for whom

Background: Evaluating large-scale disease management interventions implemented in actual health ... more Background: Evaluating large-scale disease management interventions implemented in actual health care settings is a complex undertaking for which universally accepted methods do not exist. Fundamental issues, such as a lack of control patients and limited generalizability, hamper the use of the 'gold-standard' randomized controlled trial, while methodological shortcomings restrict the value of observational designs. Advancing methods for disease management evaluation in practice is pivotal to learn more about the impact of population-wide approaches. Methods must account for the presence of heterogeneity in effects, which necessitates a more granular assessment of outcomes. Methods: This paper introduces multilevel regression methods as valuable techniques to evaluate 'real-world' disease management approaches in a manner that produces meaningful findings for everyday practice. In a worked example, these methods are applied to retrospectively gathered routine health care data covering a cohort of 105,056 diabetes patients who receive disease management for type 2 diabetes mellitus in the Netherlands. Multivariable, multilevel regression models are fitted to identify trends in clinical outcomes and correct for differences in characteristics of patients (age, disease duration, health status, diabetes complications, smoking status) and the intervention (measurement frequency and range, length of follow-up).

Relevance of Hypersexual Disorder to Family Medicine and Primary Care as a Complex Multidimensional Chronic Disease Construct

by Bert Vrijhoef, Jan M De Maeseneer, and Liesbeth Borgermans

Hypersexual disorder (HD) is not defined in a uniform way in the psychiatric literature. In the a... more Hypersexual disorder (HD) is not defined in a uniform way in the psychiatric literature. In the absence of solid evidence on prevalence, causes, empirically validated diagnostic criteria, instruments for diagnosis, consistent guidelines on treatment options, medical and psychosocial consequences, and type of caregivers that need to be involved, HD remains a controversial and relatively poorly understood chronic disease construct. The role of family medicine in the detection, treatment, and followup of HD is not well studied. The purpose of this paper is to describe the complexity of HD as a multidimensional chronic disease construct and its relevance to family medicine and primary care.

Toward Tailored Disease Management for Type 2 Diabetes ARTICLE in AMERICAN JOURNAL OF MANAGED CARE · JANUARY 2012

Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care

Introduction: Primary care has a central role in integrating care within a health system. However... more Introduction: Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care.

Older Adults' Reasons for Using Technology while Aging in Place

Purposive sampling was used to include participants with different health statuses, living arrang... more Purposive sampling was used to include participants with different health statuses, living arrangements, and levels of technology experience. During each home visit: (1) background information on the partici-pants' chronic conditions, major life events, frailty, cognitive functioning, subjective health, ownership and use of technology was gathered, and (2) a semistructured interview was conducted regarding reasons for the level of use of technology. The study was designed to include various types of technology that could support activities of daily living , personal health or safety, mobility, communication, physical activity, personal development, and leisure activities. Thematic analysis was employed to analyze interview transcripts. Results: The level of technology use in the context of aging in place is influenced by six major themes: challenges in the domain of independent living; behavioral options ; personal thoughts on technology use; influence of the social network; influence of organizations, and the role of the physical environment. Conclusion: Older adults' perceptions and use of technology are embedded in their personal , social, and physical context. Awareness of these psychological and contextual factors is needed in order to facilitate aging in place through the use of technology. A conceptual model covering these factors is presented. Abstract Background: Most older adults prefer to age in place, and supporting older adults to remain in their own homes and communities is also favored by policy makers. Technology can play a role in staying independent, active and healthy. However, the use of technology varies considerably among older adults. Previous research indicates that current models of technology acceptance are missing essential predic-tors specific to community-dwelling older adults. Furthermore , in situ research within the specific context of aging in place is scarce, while this type of research is needed to better understand how and why community-dwelling older adults are using technology. Objective: To explore which factors influence the level of use of various types of technology by older adults who are aging in place and to describe these factors in a comprehensive model. Methods: A qualitative explorative field study was set up, involving home visits to 53 community-dwelling older adults, aged 68–95, liv

A conceptual framework for evaluating the conceptualization, implementation and performance of transitional care programmes

by Bert Vrijhoef and Shiou-Liang Wee

Developed health systems want to avoid unnecessary hospital admissions by addressing the needs of... more Developed health systems want to avoid unnecessary hospital admissions by addressing the needs of chronically ill older adults throughout acute episodes of illness. Transitional care (TC) is a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location, of which the main outcome of interest is avoiding hospital readmission. Implementation of TC is complex because it entails different actions to put multiple care components into practice, with various degrees of flexibility of adapting the intervention. Furthermore, the outcome involves behaviour change required by those delivering or receiving the intervention. Although there are examples of promising interventions, the possible variations in conceptualization and implementation present a real challenge for the adaptation of efficacious TC interventions from trial to 'real-world' settings. There is a lack of a theoretical basis or explicit logic model for why adapted interventions should work. This study provides conceptual approaches for the implementation and evaluation of TC programmes. It describes a framework of (1) conceptualization – with respect to the components in an intervention and the population of interest; (2) manner and context of implementation; and (3) evaluation – how these processes of implementation impact health outcomes.

Integrated Chronic Care Management For Patients With Atrial Fibrillation : A Rationale For Redesigning Atrial Fibrillation Care

Atrial Fibrillation (AF) is a highly prevalent heart rhythm disturbance, often associated with un... more Atrial Fibrillation (AF) is a highly prevalent heart rhythm disturbance, often associated with underlying (cardio)vascular disease. Due to this the management of AF is often complex and current practice calls for a more comprehensive, multifactorial and patient-centred approach. Therefore an Integrated Chronic Care approach in AF was developed and implemented in terms of a nurse-led specialized outpatient clinic for patients with AF. A randomised controlled trial comparing the nurse-led approach with usual care demonstrated superiority in terms of cardiovascular hospitalization and death as well as cost-effectiveness in terms of Quality Adjusted Life Years (QALYs) and life years, in favour of the nurse-led approach. Implementing such approach can be difficult since daily practice can be persistent. To highlight the importance of integrated care wherein the nurse fulfils a significant role, and to provide a guide in developing and continuing such approach, this paper presents the theoretical framework of the AF-Clinic based on the principles of the Taxonomy for Integrated Chronic Atrial Fibrillation Management.

Is There a Need for Including Spiritual Care in Interdisciplinary Rehabilitation of Chronic Pain Patients? Investigating an Innovative Strategy

by Bert Vrijhoef, Monique Steegers, Kris Vissers, and Rob Smeets

Objective: Chronic noncancer pain influences patient's quality of life and their ability to cope.... more Objective: Chronic noncancer pain influences patient's quality of life and their ability to cope. Pain relieving medication and other specific treatments commonly integrated in biopsychosocial rehabilitation demonstrate modest benefits in pain relief and improved functioning of individuals. Spiritual care, covering the fourth dimension provides insight, inspires hope and purpose, and is thought to mediate mental and physical health for patients. This study explores the need for its inclusion in interdisciplinary pain rehabilitation and describes the requirements and test environment for evaluation. Methods: Outcomes of spiritual care and interdisciplinary pain rehabilitation in follow-up studies of randomized controlled trials contained in systematic reviews were summarized. Pubmed, Cochrane, and PsycINFO were searched, citation tracking was applied, articles of follow-up studies therein were located. Literature was searched for insights pertaining to requirements for an assessment of including this fourth dimension. Results: No systematic reviews for spiritual care were identified. Five systematic reviews of biopsychosocial rehabilitation containing 14 studies describing long-term outcomes were retrieved. The importance of coping in maintaining long-term outcomes was empirically illustrated. The required test environment is provided by a structured multidimen-sional care pathway separating spirituality from well-being and mental health, with measures of treatment outcome installed enabling a comparison with benchmarks. Conclusions: Active coping seems beneficial for maintaining positive long-term outcomes of interdisciplinary pain rehabilitation Spiritual care may be conducive to active coping. Further research is warranted to explore the additive value of this spiritual care in the context of a multidimensional care pathway. &

Advancing current approaches to disease management evaluation: capitalizing on heterogeneity to understand what works and for whom

Background: Evaluating large-scale disease management interventions implemented in actual health ... more Background: Evaluating large-scale disease management interventions implemented in actual health care settings is a complex undertaking for which universally accepted methods do not exist. Fundamental issues, such as a lack of control patients and limited generalizability, hamper the use of the 'gold-standard' randomized controlled trial, while methodological shortcomings restrict the value of observational designs. Advancing methods for disease management evaluation in practice is pivotal to learn more about the impact of population-wide approaches. Methods must account for the presence of heterogeneity in effects, which necessitates a more granular assessment of outcomes. Methods: This paper introduces multilevel regression methods as valuable techniques to evaluate 'real-world' disease management approaches in a manner that produces meaningful findings for everyday practice. In a worked example, these methods are applied to retrospectively gathered routine health care data covering a cohort of 105,056 diabetes patients who receive disease management for type 2 diabetes mellitus in the Netherlands. Multivariable, multilevel regression models are fitted to identify trends in clinical outcomes and correct for differences in characteristics of patients (age, disease duration, health status, diabetes complications, smoking status) and the intervention (measurement frequency and range, length of follow-up).

Towards an international taxonomy of integrated primary care: a Delphi consensus approach

Collaboration processes and perceived effectiveness of integrated care projects in primary care: a longitudinal mixed-methods study

by Bert Vrijhoef, Dirk Ruwaard, and Antoinette Bont

Background: Collaborative partnerships are considered an essential strategy for integrating local... more Background: Collaborative partnerships are considered an essential strategy for integrating local disjointed health and social services. Currently, little evidence is available on how integrated care arrangements between professionals and organisations are achieved through the evolution of collaboration processes over time. The first aim was to develop a typology of integrated care projects (ICPs) based on the final degree of integration as perceived by multiple stakeholders. The second aim was to study how types of integration differ in changes of collaboration processes over time and final perceived effectiveness.

Zio Integrated Care Network the Netherlands

This case study is part of the Accountable Care in Practice: Global Perspectives series produced ... more This case study is part of the Accountable Care in Practice: Global Perspectives series produced by Duke University's Robert J. Margolis, MD, Center for Health Policy and supported by the Commonwealth Fund. The series explores how organizations across the world have taken steps to improve health outcomes by adopting accountable care policy reforms within diverse organizational and environmental contexts. The aim is to assist US stakeholders to apply the results of these reforms. We consider the critical success factors with each organization's implementation process that could be translated in the US. Additional resources, including an explanation of the accountable care framework, can be found at the Duke-Margolis website.

Economic evaluation of a diabetes disease management programme with a central role for the diabetes nurse specialist

How to write an abstract

Developing care for a changing population: supporting patients with costly, complex needs

Position paper: Organisatie van zorg voor chronische zieken in Belgie

by H. Spitters and Bert Vrijhoef

Towards an international taxonomy of integrated primary care: a Delphi consensus approach

by Inge Boesveld, Dirk Ruwaard, and Bert Vrijhoef

BMC Family Practice, 2015

The impact of redesigning care processes on quality of care: a systematic review

by Arno van Raak, Dirk Ruwaard, and Bert Vrijhoef

BMC Health Services Research, 2015

This literature review evaluates the current state of knowledge about the impact of process redes... more This literature review evaluates the current state of knowledge about the impact of process redesign on the quality of healthcare. Pubmed, CINAHL, Web of Science and Business Premier Source were searched for relevant studies published in the last ten years [2004-2014]. To be included, studies had to be original research, published in English with a before-and-after study design, and be focused on changes in healthcare processes and quality of care. Studies that met the inclusion criteria were independently assessed for excellence in reporting by three reviewers using the SQUIRE checklist. Data was extracted using a framework developed for this review. Reporting adequacy varied across the studies. Process redesign interventions were diverse, and none of the studies described their effects on all dimensions of quality defined by the Institute of Medicine. The results of this systematic literature review suggests that process redesign interventions have positive effects on certain aspects of quality. However, the full impact cannot be determined on the basis of the literature. A wide range of outcome measures were used, and research methods were limited. This review demonstrates the need for further investigation of the impact of redesign interventions on the quality of healthcare.

Assessments Cost-Effectiveness of Telehealth Interventions for Chronic Heart Failure Patients: A Literature Review Care Management Solutions, Philips Research

Objectives: Evidence exists that telehealth interventions (e.g., telemonitoring, telediagnostics,... more Objectives: Evidence exists that telehealth interventions (e.g., telemonitoring, telediagnostics, telephone care) in disease management for chronic heart failure patients can improve medical outcomes, and we aim to give an overview of the cost-effectiveness of these interventions. Methods: Based on the literature search on " heart failure " in combination with " cost " and " telehealth " we selected 301 titles and abstracts. Titles and abstracts were screened for a set of inclusion criteria: telehealth intervention, heart failure as the main disease, economic analysis present and a primary study performed. In the end, thirty-two studies were included for full reading, data extraction, and critical appraisal of the economic evaluation. Results: Most studies did not present a comprehensive economic evaluation, consisting of the comparison of both costs and effects between telehealth intervention and a comparator. Data on telehealth investment costs were lacking in many studies. The few studies that assessed costs and consequences comprehensively showed that telehealth interventions are cost saving with slight improvement in effectiveness, or comparably effective with similar cost to usual care. However, the methodological quality of the studies was in general considered to be low. Conclusions: The cost-effectiveness of telehealth in chronic heart failure is hardly ascertained in peer reviewed literature, the quality of evidence is poor and there was a difficulty in capturing all of the consequences/effects of telehealth intervention. We believe that without full economic analyses the cost-effectiveness of telehealth interventions in chronic heart failure remains unknown.

A Theoretical Lens for Revealing the Complexity of Chronic Care

by Bert Vrijhoef, Jan M De Maeseneer, and Liesbeth Borgermans

Advancing current approaches to disease management evaluation: capitalizing on heterogeneity to understand what works and for whom

Background: Evaluating large-scale disease management interventions implemented in actual health ... more Background: Evaluating large-scale disease management interventions implemented in actual health care settings is a complex undertaking for which universally accepted methods do not exist. Fundamental issues, such as a lack of control patients and limited generalizability, hamper the use of the 'gold-standard' randomized controlled trial, while methodological shortcomings restrict the value of observational designs. Advancing methods for disease management evaluation in practice is pivotal to learn more about the impact of population-wide approaches. Methods must account for the presence of heterogeneity in effects, which necessitates a more granular assessment of outcomes. Methods: This paper introduces multilevel regression methods as valuable techniques to evaluate 'real-world' disease management approaches in a manner that produces meaningful findings for everyday practice. In a worked example, these methods are applied to retrospectively gathered routine health care data covering a cohort of 105,056 diabetes patients who receive disease management for type 2 diabetes mellitus in the Netherlands. Multivariable, multilevel regression models are fitted to identify trends in clinical outcomes and correct for differences in characteristics of patients (age, disease duration, health status, diabetes complications, smoking status) and the intervention (measurement frequency and range, length of follow-up).

Relevance of Hypersexual Disorder to Family Medicine and Primary Care as a Complex Multidimensional Chronic Disease Construct

by Bert Vrijhoef, Jan M De Maeseneer, and Liesbeth Borgermans

Hypersexual disorder (HD) is not defined in a uniform way in the psychiatric literature. In the a... more Hypersexual disorder (HD) is not defined in a uniform way in the psychiatric literature. In the absence of solid evidence on prevalence, causes, empirically validated diagnostic criteria, instruments for diagnosis, consistent guidelines on treatment options, medical and psychosocial consequences, and type of caregivers that need to be involved, HD remains a controversial and relatively poorly understood chronic disease construct. The role of family medicine in the detection, treatment, and followup of HD is not well studied. The purpose of this paper is to describe the complexity of HD as a multidimensional chronic disease construct and its relevance to family medicine and primary care.

Toward Tailored Disease Management for Type 2 Diabetes ARTICLE in AMERICAN JOURNAL OF MANAGED CARE · JANUARY 2012

Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care

Introduction: Primary care has a central role in integrating care within a health system. However... more Introduction: Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care.

Older Adults' Reasons for Using Technology while Aging in Place

Purposive sampling was used to include participants with different health statuses, living arrang... more Purposive sampling was used to include participants with different health statuses, living arrangements, and levels of technology experience. During each home visit: (1) background information on the partici-pants' chronic conditions, major life events, frailty, cognitive functioning, subjective health, ownership and use of technology was gathered, and (2) a semistructured interview was conducted regarding reasons for the level of use of technology. The study was designed to include various types of technology that could support activities of daily living , personal health or safety, mobility, communication, physical activity, personal development, and leisure activities. Thematic analysis was employed to analyze interview transcripts. Results: The level of technology use in the context of aging in place is influenced by six major themes: challenges in the domain of independent living; behavioral options ; personal thoughts on technology use; influence of the social network; influence of organizations, and the role of the physical environment. Conclusion: Older adults' perceptions and use of technology are embedded in their personal , social, and physical context. Awareness of these psychological and contextual factors is needed in order to facilitate aging in place through the use of technology. A conceptual model covering these factors is presented. Abstract Background: Most older adults prefer to age in place, and supporting older adults to remain in their own homes and communities is also favored by policy makers. Technology can play a role in staying independent, active and healthy. However, the use of technology varies considerably among older adults. Previous research indicates that current models of technology acceptance are missing essential predic-tors specific to community-dwelling older adults. Furthermore , in situ research within the specific context of aging in place is scarce, while this type of research is needed to better understand how and why community-dwelling older adults are using technology. Objective: To explore which factors influence the level of use of various types of technology by older adults who are aging in place and to describe these factors in a comprehensive model. Methods: A qualitative explorative field study was set up, involving home visits to 53 community-dwelling older adults, aged 68–95, liv

A conceptual framework for evaluating the conceptualization, implementation and performance of transitional care programmes

by Bert Vrijhoef and Shiou-Liang Wee

Developed health systems want to avoid unnecessary hospital admissions by addressing the needs of... more Developed health systems want to avoid unnecessary hospital admissions by addressing the needs of chronically ill older adults throughout acute episodes of illness. Transitional care (TC) is a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location, of which the main outcome of interest is avoiding hospital readmission. Implementation of TC is complex because it entails different actions to put multiple care components into practice, with various degrees of flexibility of adapting the intervention. Furthermore, the outcome involves behaviour change required by those delivering or receiving the intervention. Although there are examples of promising interventions, the possible variations in conceptualization and implementation present a real challenge for the adaptation of efficacious TC interventions from trial to 'real-world' settings. There is a lack of a theoretical basis or explicit logic model for why adapted interventions should work. This study provides conceptual approaches for the implementation and evaluation of TC programmes. It describes a framework of (1) conceptualization – with respect to the components in an intervention and the population of interest; (2) manner and context of implementation; and (3) evaluation – how these processes of implementation impact health outcomes.

Integrated Chronic Care Management For Patients With Atrial Fibrillation : A Rationale For Redesigning Atrial Fibrillation Care

Atrial Fibrillation (AF) is a highly prevalent heart rhythm disturbance, often associated with un... more Atrial Fibrillation (AF) is a highly prevalent heart rhythm disturbance, often associated with underlying (cardio)vascular disease. Due to this the management of AF is often complex and current practice calls for a more comprehensive, multifactorial and patient-centred approach. Therefore an Integrated Chronic Care approach in AF was developed and implemented in terms of a nurse-led specialized outpatient clinic for patients with AF. A randomised controlled trial comparing the nurse-led approach with usual care demonstrated superiority in terms of cardiovascular hospitalization and death as well as cost-effectiveness in terms of Quality Adjusted Life Years (QALYs) and life years, in favour of the nurse-led approach. Implementing such approach can be difficult since daily practice can be persistent. To highlight the importance of integrated care wherein the nurse fulfils a significant role, and to provide a guide in developing and continuing such approach, this paper presents the theoretical framework of the AF-Clinic based on the principles of the Taxonomy for Integrated Chronic Atrial Fibrillation Management.

Is There a Need for Including Spiritual Care in Interdisciplinary Rehabilitation of Chronic Pain Patients? Investigating an Innovative Strategy

by Bert Vrijhoef, Monique Steegers, Kris Vissers, and Rob Smeets

Objective: Chronic noncancer pain influences patient's quality of life and their ability to cope.... more Objective: Chronic noncancer pain influences patient's quality of life and their ability to cope. Pain relieving medication and other specific treatments commonly integrated in biopsychosocial rehabilitation demonstrate modest benefits in pain relief and improved functioning of individuals. Spiritual care, covering the fourth dimension provides insight, inspires hope and purpose, and is thought to mediate mental and physical health for patients. This study explores the need for its inclusion in interdisciplinary pain rehabilitation and describes the requirements and test environment for evaluation. Methods: Outcomes of spiritual care and interdisciplinary pain rehabilitation in follow-up studies of randomized controlled trials contained in systematic reviews were summarized. Pubmed, Cochrane, and PsycINFO were searched, citation tracking was applied, articles of follow-up studies therein were located. Literature was searched for insights pertaining to requirements for an assessment of including this fourth dimension. Results: No systematic reviews for spiritual care were identified. Five systematic reviews of biopsychosocial rehabilitation containing 14 studies describing long-term outcomes were retrieved. The importance of coping in maintaining long-term outcomes was empirically illustrated. The required test environment is provided by a structured multidimen-sional care pathway separating spirituality from well-being and mental health, with measures of treatment outcome installed enabling a comparison with benchmarks. Conclusions: Active coping seems beneficial for maintaining positive long-term outcomes of interdisciplinary pain rehabilitation Spiritual care may be conducive to active coping. Further research is warranted to explore the additive value of this spiritual care in the context of a multidimensional care pathway. &

Advancing current approaches to disease management evaluation: capitalizing on heterogeneity to understand what works and for whom

Background: Evaluating large-scale disease management interventions implemented in actual health ... more Background: Evaluating large-scale disease management interventions implemented in actual health care settings is a complex undertaking for which universally accepted methods do not exist. Fundamental issues, such as a lack of control patients and limited generalizability, hamper the use of the 'gold-standard' randomized controlled trial, while methodological shortcomings restrict the value of observational designs. Advancing methods for disease management evaluation in practice is pivotal to learn more about the impact of population-wide approaches. Methods must account for the presence of heterogeneity in effects, which necessitates a more granular assessment of outcomes. Methods: This paper introduces multilevel regression methods as valuable techniques to evaluate 'real-world' disease management approaches in a manner that produces meaningful findings for everyday practice. In a worked example, these methods are applied to retrospectively gathered routine health care data covering a cohort of 105,056 diabetes patients who receive disease management for type 2 diabetes mellitus in the Netherlands. Multivariable, multilevel regression models are fitted to identify trends in clinical outcomes and correct for differences in characteristics of patients (age, disease duration, health status, diabetes complications, smoking status) and the intervention (measurement frequency and range, length of follow-up).

Towards an international taxonomy of integrated primary care: a Delphi consensus approach

Collaboration processes and perceived effectiveness of integrated care projects in primary care: a longitudinal mixed-methods study

by Bert Vrijhoef, Dirk Ruwaard, and Antoinette Bont

Background: Collaborative partnerships are considered an essential strategy for integrating local... more Background: Collaborative partnerships are considered an essential strategy for integrating local disjointed health and social services. Currently, little evidence is available on how integrated care arrangements between professionals and organisations are achieved through the evolution of collaboration processes over time. The first aim was to develop a typology of integrated care projects (ICPs) based on the final degree of integration as perceived by multiple stakeholders. The second aim was to study how types of integration differ in changes of collaboration processes over time and final perceived effectiveness.