Background There is significant global policy interest related to enabling a data-driven approach... more Background There is significant global policy interest related to enabling a data-driven approach for evidence-based primary care system development. This paper describes the development and initial testing of a prototype tool (the Problem-Oriented Primary Care System Development Record, or PCSDR) that enables a data-driven and contextualized approach to primary care system development. Methods The PCSDR is an electronic record that enables the systematic input, classification, structuring, storage, processing and analysis of different types of data related to the structure, function and performance of primary care systems over time. Data inputted into the PCSDR was coded using the WHO’s PHC-IMPACT framework and classification system. The PCSDR’s functionalities were tested by using a case study of primary care system development in Tajikistan. Results Tajikistan’s case study demonstrated that the PCSDR is a potentially effective and conceptually-sound tool for the input, classifica...
BackgroundPatient-reported data are widely used for many purposes by different actors within a he... more BackgroundPatient-reported data are widely used for many purposes by different actors within a health system. However, little is known about the use of such data by health insurers. Our study aims to map the evidence on the use of patient-reported data by health insurers; to explore how collected patient-reported data are utilized; and to elucidate the motives of why patient-reported data are collected by health insurers.MethodsThe study design is that of a scoping review. In total, 11 databases were searched on. Relevant grey literature was identified through online searches, reference mining and recommendations from experts. Forty-two documents were included. We synthesized the evidence on the uses of patient-reported data by insurers following a structure-process-outcome approach; we also mapped the use and function of those data by a health insurer.ResultsHealth insurers use patient-reported data for assurance and improvement of quality of care and value-based health care. The p...
BACKGROUND Digital health, which encompasses the use of information and communications technology... more BACKGROUND Digital health, which encompasses the use of information and communications technology in support of health, is a key driving force behind the cultural transformation of medicine towards people-centredness. Thus, eHealth literacy may support better experiences of care supported by innovative digital health solutions. OBJECTIVE To explore the relationship between eHealth literacy and patient-reported experience measures (PREMs) among users of outpatient care in Hungary. METHODS In early 2019, we conducted a cross-sectional survey on a large representative online sample recruited from the Hungarian general population. eHealth literacy was measured with the eHealth Literacy Scale (eHEALS) and PREMs with outpatient care with a set of questions recommended by the Organisation for Economic Co-operation and Development (OECD). Bivariate relationships were explored via polychoric correlation, the Kruskal-Wallis test and chi-square test. To capture non-linear associations, after c...
Most studies showing a volume outcome effect in resection surgery for oesophago-gastric cancer we... more Most studies showing a volume outcome effect in resection surgery for oesophago-gastric cancer were conducted before the centralisation of clinical services. This study evaluated the relation between hospital- and surgeon volume and different risk-adjusted outcomes after oesophago-gastric (OG) cancer surgery in England between 2011 and 2013. In data from the National Oesophago-Gastric Cancer Audit from the UK, multivariable random-effects logistic regression models were used to quantify the effect of surgeon and hospital volume on three outcomes: 30-day and 90-day mortality and anastomotic leakage. The models included patient risk factors to adjust for differences in case-mix among hospitals and surgeons. The between-cluster heterogeneity was estimated with the median odds ratio (MOR). The study included patients treated at 42 hospitals and 329 surgeons. The median (interquartile range) of the annual hospital and surgeon volumes were 110 patients (82 to 137) and 13 patients (8 to 19...
eGEMs (Generating Evidence & Methods to improve patient outcomes), 2016
Introduction: We see increased use of existing observational data in order to achieve fast and tr... more Introduction: We see increased use of existing observational data in order to achieve fast and transparent production of empirical evidence in health care research. Multiple databases are often used to increase power, to assess rare exposures or outcomes, or to study diverse populations. For privacy and sociological reasons, original data on individual subjects can’t be shared, requiring a distributed network approach where data processing is performed prior to data sharing.Case Descriptions and Variation Among Sites: We created a conceptual framework distinguishing three steps in local data processing: (1) data reorganization into a data structure common across the network; (2) derivation of study variables not present in original data; and (3) application of study design to transform longitudinal data into aggregated data sets for statistical analysis. We applied this framework to four case studies to identify similarities and differences in the United States and Europe: Exploring...
This article reviews the work of the Organization for Economic Cooperation and Development (OECD)... more This article reviews the work of the Organization for Economic Cooperation and Development (OECD) Healthcare Quality Indicators Project in the field of patient safety indicators. The article reflects on the logic for international comparison of patient safety indicators in addition to offering an analysis of the state of the national information systems linked to the measurement of patient safety across industrialized countries. To finish, a strategy to improve the compa-rability and availability of data both nationally and internationally is outlined. This strategy has a three-pronged approach: a) introduction of patient safety in the national agenda; b) development and expansion of national information systems and registries to improve both the quality and availability of data and enhance comparability across countries; c) establishment of a clear link between information and action.
An appropriate quality of medical care including dental care should be an objective of every gove... more An appropriate quality of medical care including dental care should be an objective of every government that aims to improve the oral health of its population. To determine performance indicators that could be used to assess the quality of primary dental care at different levels of a health care system, the sources for data collection and finally, the dimensions of quality measured by these indicators. An explorative study of the international literature was conducted using medical databases, journals and books, and official websites of organisations and associations. This resulted in a set of 57 indicators, which were classified into the following dimensions for each intended user group: For patients: health outcomes and subjective indicators; for professionals: their performance and the rates of success, failure and complications; for health care system managers and policymakers: their resources, finances and health care utilisation. A set of 57 performance indicators were identif...
Samenvatting Het past een beetje in de traditie van het public health veld om in de richting van... more Samenvatting Het past een beetje in de traditie van het public health veld om in de richting van politiek en beleid vooral in te gaan op de zaken die worden gemist en als de profeet Jeremia de gevaren voor de volksgezondheid onder de aandacht te brengen. Zo’n bijdrage zou zonder moeite kunnen worden geschreven gezien de hierboven in deze Spectrum geconstateerde ontbrekende consistente visie op volksgezondheid in de verkiezingsprogramma’s en de magere omvang van de onlangs door VWS uitgebrachte preventienota. Toch lijkt dat zowel onterecht als weinig productief. Onterecht, omdat over een heleboel thema’s nu juist wel wordt gerept al is het niet altijd even samenhangend en onderbouwd, en weinig productief omdat een dergelijke houding niet tot politieke actie zal leiden.
Het meten van kwaliteit van zorg is al decennia onderwerp van conceptuele en methodologische besc... more Het meten van kwaliteit van zorg is al decennia onderwerp van conceptuele en methodologische beschouwingen. Geeft het begrip kwaliteit al aanleiding tot verschil in inzicht, ook de diepere betekenis van meten als een gestandaardiseerd sociaal proces van kennisverwerving geeft aanleiding tot zowel naïef optimisme als misplaatst defaitisme. Waren er rond de eeuwwisseling eigenlijk twee soorten doelen die beoogd werden met het meten van kwaliteit, de interne (leren en verbeteren) – en de externe (verantwoording); sinds de stelselwijzigingen in de Nederlandse gezondheidszorg zijn de externe doelen nader gespecificeerd in het genereren van consumenteninformatie om te kiezen, inkoop informatie voor verzekeraars en toezicht informatie voor de diverse toezichthouders in de zorg zoals de IGZ.
Background There is significant global policy interest related to enabling a data-driven approach... more Background There is significant global policy interest related to enabling a data-driven approach for evidence-based primary care system development. This paper describes the development and initial testing of a prototype tool (the Problem-Oriented Primary Care System Development Record, or PCSDR) that enables a data-driven and contextualized approach to primary care system development. Methods The PCSDR is an electronic record that enables the systematic input, classification, structuring, storage, processing and analysis of different types of data related to the structure, function and performance of primary care systems over time. Data inputted into the PCSDR was coded using the WHO’s PHC-IMPACT framework and classification system. The PCSDR’s functionalities were tested by using a case study of primary care system development in Tajikistan. Results Tajikistan’s case study demonstrated that the PCSDR is a potentially effective and conceptually-sound tool for the input, classifica...
BackgroundPatient-reported data are widely used for many purposes by different actors within a he... more BackgroundPatient-reported data are widely used for many purposes by different actors within a health system. However, little is known about the use of such data by health insurers. Our study aims to map the evidence on the use of patient-reported data by health insurers; to explore how collected patient-reported data are utilized; and to elucidate the motives of why patient-reported data are collected by health insurers.MethodsThe study design is that of a scoping review. In total, 11 databases were searched on. Relevant grey literature was identified through online searches, reference mining and recommendations from experts. Forty-two documents were included. We synthesized the evidence on the uses of patient-reported data by insurers following a structure-process-outcome approach; we also mapped the use and function of those data by a health insurer.ResultsHealth insurers use patient-reported data for assurance and improvement of quality of care and value-based health care. The p...
BACKGROUND Digital health, which encompasses the use of information and communications technology... more BACKGROUND Digital health, which encompasses the use of information and communications technology in support of health, is a key driving force behind the cultural transformation of medicine towards people-centredness. Thus, eHealth literacy may support better experiences of care supported by innovative digital health solutions. OBJECTIVE To explore the relationship between eHealth literacy and patient-reported experience measures (PREMs) among users of outpatient care in Hungary. METHODS In early 2019, we conducted a cross-sectional survey on a large representative online sample recruited from the Hungarian general population. eHealth literacy was measured with the eHealth Literacy Scale (eHEALS) and PREMs with outpatient care with a set of questions recommended by the Organisation for Economic Co-operation and Development (OECD). Bivariate relationships were explored via polychoric correlation, the Kruskal-Wallis test and chi-square test. To capture non-linear associations, after c...
Most studies showing a volume outcome effect in resection surgery for oesophago-gastric cancer we... more Most studies showing a volume outcome effect in resection surgery for oesophago-gastric cancer were conducted before the centralisation of clinical services. This study evaluated the relation between hospital- and surgeon volume and different risk-adjusted outcomes after oesophago-gastric (OG) cancer surgery in England between 2011 and 2013. In data from the National Oesophago-Gastric Cancer Audit from the UK, multivariable random-effects logistic regression models were used to quantify the effect of surgeon and hospital volume on three outcomes: 30-day and 90-day mortality and anastomotic leakage. The models included patient risk factors to adjust for differences in case-mix among hospitals and surgeons. The between-cluster heterogeneity was estimated with the median odds ratio (MOR). The study included patients treated at 42 hospitals and 329 surgeons. The median (interquartile range) of the annual hospital and surgeon volumes were 110 patients (82 to 137) and 13 patients (8 to 19...
eGEMs (Generating Evidence & Methods to improve patient outcomes), 2016
Introduction: We see increased use of existing observational data in order to achieve fast and tr... more Introduction: We see increased use of existing observational data in order to achieve fast and transparent production of empirical evidence in health care research. Multiple databases are often used to increase power, to assess rare exposures or outcomes, or to study diverse populations. For privacy and sociological reasons, original data on individual subjects can’t be shared, requiring a distributed network approach where data processing is performed prior to data sharing.Case Descriptions and Variation Among Sites: We created a conceptual framework distinguishing three steps in local data processing: (1) data reorganization into a data structure common across the network; (2) derivation of study variables not present in original data; and (3) application of study design to transform longitudinal data into aggregated data sets for statistical analysis. We applied this framework to four case studies to identify similarities and differences in the United States and Europe: Exploring...
This article reviews the work of the Organization for Economic Cooperation and Development (OECD)... more This article reviews the work of the Organization for Economic Cooperation and Development (OECD) Healthcare Quality Indicators Project in the field of patient safety indicators. The article reflects on the logic for international comparison of patient safety indicators in addition to offering an analysis of the state of the national information systems linked to the measurement of patient safety across industrialized countries. To finish, a strategy to improve the compa-rability and availability of data both nationally and internationally is outlined. This strategy has a three-pronged approach: a) introduction of patient safety in the national agenda; b) development and expansion of national information systems and registries to improve both the quality and availability of data and enhance comparability across countries; c) establishment of a clear link between information and action.
An appropriate quality of medical care including dental care should be an objective of every gove... more An appropriate quality of medical care including dental care should be an objective of every government that aims to improve the oral health of its population. To determine performance indicators that could be used to assess the quality of primary dental care at different levels of a health care system, the sources for data collection and finally, the dimensions of quality measured by these indicators. An explorative study of the international literature was conducted using medical databases, journals and books, and official websites of organisations and associations. This resulted in a set of 57 indicators, which were classified into the following dimensions for each intended user group: For patients: health outcomes and subjective indicators; for professionals: their performance and the rates of success, failure and complications; for health care system managers and policymakers: their resources, finances and health care utilisation. A set of 57 performance indicators were identif...
Samenvatting Het past een beetje in de traditie van het public health veld om in de richting van... more Samenvatting Het past een beetje in de traditie van het public health veld om in de richting van politiek en beleid vooral in te gaan op de zaken die worden gemist en als de profeet Jeremia de gevaren voor de volksgezondheid onder de aandacht te brengen. Zo’n bijdrage zou zonder moeite kunnen worden geschreven gezien de hierboven in deze Spectrum geconstateerde ontbrekende consistente visie op volksgezondheid in de verkiezingsprogramma’s en de magere omvang van de onlangs door VWS uitgebrachte preventienota. Toch lijkt dat zowel onterecht als weinig productief. Onterecht, omdat over een heleboel thema’s nu juist wel wordt gerept al is het niet altijd even samenhangend en onderbouwd, en weinig productief omdat een dergelijke houding niet tot politieke actie zal leiden.
Het meten van kwaliteit van zorg is al decennia onderwerp van conceptuele en methodologische besc... more Het meten van kwaliteit van zorg is al decennia onderwerp van conceptuele en methodologische beschouwingen. Geeft het begrip kwaliteit al aanleiding tot verschil in inzicht, ook de diepere betekenis van meten als een gestandaardiseerd sociaal proces van kennisverwerving geeft aanleiding tot zowel naïef optimisme als misplaatst defaitisme. Waren er rond de eeuwwisseling eigenlijk twee soorten doelen die beoogd werden met het meten van kwaliteit, de interne (leren en verbeteren) – en de externe (verantwoording); sinds de stelselwijzigingen in de Nederlandse gezondheidszorg zijn de externe doelen nader gespecificeerd in het genereren van consumenteninformatie om te kiezen, inkoop informatie voor verzekeraars en toezicht informatie voor de diverse toezichthouders in de zorg zoals de IGZ.
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