Introduction Several studies have indicated that medical referral letters do not convey the neces... more Introduction Several studies have indicated that medical referral letters do not convey the necessary information to ensure sufficient coordination of care. However, there is no definition of the core set of information items that should be communicated in a referral process, and no valid measurements to assess, and thus improve, the quality of such information. The present study aimed to develop and test an instrument to measure the quality of referral information provided by general practitioners to specialised mental health care services for adults.
Objectives: To give an overview on the use and prevalence of clinical pathways. Design: Cross-sec... more Objectives: To give an overview on the use and prevalence of clinical pathways. Design: Cross-sectional descriptive study. Study participants: European Pathway Association (EPA) contact persons in 23 countries. Results: Clinical pathways, also known as critical pathways or ...
European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 2015
Clinical practice variation and the subsequent burden on health care quality has been documented ... more Clinical practice variation and the subsequent burden on health care quality has been documented for patients with ST-elevated myocardial infarction (STEMI). Reduction of clinical practice variation is possible by increasing guideline adherence. Care pathway documents can increase guideline adherence by implementing evidence-based key interventions and quality indicators in daily practice. This study aims to examine guideline adherence of care pathway documents for patients with STEMI. Lay-out, size and timeframe of submitted care pathways documents were analysed. Two independent reviewers used a checklist to systematically assess the guideline adherence of care pathway documents. The checklist comprised a set of key interventions and quality indicators extracted from evidence and international guidelines. The checklist distinguished the evidence level for each item and was validated by expert consensus. Results were verified by inviting participating hospitals to provide feedback. ...
Annali di igiene : medicina preventiva e di comunità
We performed a geographic analysis study on mortality in the town of Vercelli, in order to respon... more We performed a geographic analysis study on mortality in the town of Vercelli, in order to respond to the concerns of the population and some local administrators. Main reason to carry out a detailed and sophisticated study for a city of medium-small size was represented by the presence of various sources of environmental and industrial pressure (i.e. old-generation incinerator for solid urban waste, industrial site for chemicals production, intense agricultural activity of rice production…). The study analyzed census, ISTAT death cards, both from the epidemiological point of view with admirers that SMR standardized spatial analysis using Bayesian models. Overall, both approaches highlighted major risks for the area south of the capital for major cancers such as colorectal and lung and increases worthy of investigation for the young-adult age groups in both genders. And being processed a similar study that considers the incidence oncology. The imminent elaboration of the cartography...
ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acqui... more ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acquired infections and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The ventilator bundle of the Institute of Healthcare Improvement includes five evidence-based guidelines which are proven to be effective in the prevention of VAP. The main purpose of this study is to determine the incidence of VAP at two intensive care units at the Jessa Hospital. In addition, compliance rates with the different elements of the VAP bundle are determined. From 1 January 2011 to 31 March 2011 an explorative study was conducted on a 18-bed surgical intensive care unit (SICU) and a six-bed medical intensive care unit (MICU). VAP was diagnosed using Johanson et al. criteria. Bedside observations and analysis of the electronic patient record were performed in order to determine compliance relative to the VAP bundle. At the SICU 10 VAPs were diagnosed resulting in an incidence of 38.46% and a VAP rate of 22.56. Three VAPs were diagnosed at the MICU. The incidence of VAP at the MICU was 18.75% resulting in a VAP rate of 18.75%. Compliance to all elements of the VAP bundle was observed in 0.52% (SICU) and 19.64% (MICU) of the observations. Compliance at the level of individual elements of the bundle varies between 1.03% and 99.48% (SICU) and 32.14% and 100% (MICU).
... Correspondence: Kris Vanhaecht, Center for Health Services and Nursing Research, Catholic Uni... more ... Correspondence: Kris Vanhaecht, Center for Health Services and Nursing Research, Catholic University Leuven, Kapucijnenvoer 35, 4th Floor, B-3000 Leuven, Belgium (Email:Kris.Vanhaecht{at}med.kuleuven.be). ABSTRACT. ... The left board: Bottlenecks and Question Marks. ...
ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional p... more ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional power concerning pathways, the actual follow-up, challenges in cross-boundary development and the support provided by information and communication technology (ICT). The study design included a qualitative study using semi-structured interviews with 88 care pathway coordinators and members of the executive board in 57 health-care organizations enrolled in the Belgian–Dutch Clinical Pathway Network. The study revealed that the most important objectives for introducing care pathways are more standardization and quality of care. In 76% of the interviewed organizations, pathways are discussed in a committee. There is a lack of continuous follow-up when care pathways are implemented. Pathways can facilitate cross-boundary care, but are a challenge because of the fragmentation within primary care. There is a need for more ICT support for care pathways. In conclusion, the executive board members and pathway coordinators state that clearly formulated objectives, a special steering committee, a clear follow-up to keep pathways alive, cross-boundary collaboration and ICT support are among the main challenges for the management of an organization.
Studies in health technology and informatics, 2004
Clinical pathways are commonly developed for homogenous patient groups. We were wondering if the ... more Clinical pathways are commonly developed for homogenous patient groups. We were wondering if the traditional patient classification systems could be used for classifying clinical pathways. To examine the utility of patient classification systems for clinical pathways, a sample of 13 clinical pathways was analyzed, involving a total of 412 patients. Three classification systems were tested: International Classification of Diseases, Ninth Revision (ICD9-CM), Clinical Coding System (CCS) data and All-Patient Redefined Diagnosis Related Groups (APR-DRG). Categorization with ICD9-CM and CCS shows rather wide variation. However, when restricting for the principal codes, CCS classification shows an almost homogeneous relationship with clinical pathways. APR-DRG's are already corrected for secondary procedures and are difficult to assess. Categorization with the Risk Of Mortality (ROM) is more homogeneous than with the Severity Of Illness (SOI). Patient groups in clinical pathways are r...
The goal of reducing the length of a patient's hospital stay after orthopaedic surgery has re... more The goal of reducing the length of a patient's hospital stay after orthopaedic surgery has recently gained much interest from surgeons and hospital administrators. The influence of hospital stay reduction on qualitative outcome is not always documented. The purpose of this study was to investigate this relationship in more detail. We report our experience with patients undergoing total knee arthroplasty. In 2000, an in-hospital clinical pathway for patients undergoing total knee arthroplasty was instituted at the University Hospitals Pellenberg, Belgium. We evaluated this pathway in 103 patients by using a pre-experimental, interrupted, time-series design. This pathway significantly decreased length of stay by 33% without negatively affecting functional outcomes during hospitalisation. In further research also the long-term effects have to be studied.
Complex chronic conditions often require long-term care from various healthcare professionals. Th... more Complex chronic conditions often require long-term care from various healthcare professionals. Thus, maintaining quality care requires care coordination. Concepts for the study of care coordination require clarification to develop, study and evaluate coordination strategies. In 2007, the Agency for Healthcare Research and Quality defined care coordination and proposed five theoretical frameworks for exploring care coordination. This study aimed to update current theoretical frameworks and clarify key concepts related to care coordination. We performed a literature review to update existing theoretical frameworks. An in-depth analysis of these theoretical frameworks was conducted to formulate key concepts related to care coordination. Our literature review found seven previously unidentified theoretical frameworks for studying care coordination. The in-depth analysis identified fourteen key concepts that the theoretical frameworks addressed. These were 'external factors', ...
... Title: Ontwikkeling en implementatie van een klinisch pad voor chirurgie van intracraniële tu... more ... Title: Ontwikkeling en implementatie van een klinisch pad voor chirurgie van intracraniële tumoren. Authors: Janssen, L × Sermeus, Walter Goffin, Jan Vanhaecht, Kris De Wispelaere, G Judong, M. Issue Date: 2003. Host Document: Ligament vol:2 pages:19-24. ...
Introduction Several studies have indicated that medical referral letters do not convey the neces... more Introduction Several studies have indicated that medical referral letters do not convey the necessary information to ensure sufficient coordination of care. However, there is no definition of the core set of information items that should be communicated in a referral process, and no valid measurements to assess, and thus improve, the quality of such information. The present study aimed to develop and test an instrument to measure the quality of referral information provided by general practitioners to specialised mental health care services for adults.
Objectives: To give an overview on the use and prevalence of clinical pathways. Design: Cross-sec... more Objectives: To give an overview on the use and prevalence of clinical pathways. Design: Cross-sectional descriptive study. Study participants: European Pathway Association (EPA) contact persons in 23 countries. Results: Clinical pathways, also known as critical pathways or ...
European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 2015
Clinical practice variation and the subsequent burden on health care quality has been documented ... more Clinical practice variation and the subsequent burden on health care quality has been documented for patients with ST-elevated myocardial infarction (STEMI). Reduction of clinical practice variation is possible by increasing guideline adherence. Care pathway documents can increase guideline adherence by implementing evidence-based key interventions and quality indicators in daily practice. This study aims to examine guideline adherence of care pathway documents for patients with STEMI. Lay-out, size and timeframe of submitted care pathways documents were analysed. Two independent reviewers used a checklist to systematically assess the guideline adherence of care pathway documents. The checklist comprised a set of key interventions and quality indicators extracted from evidence and international guidelines. The checklist distinguished the evidence level for each item and was validated by expert consensus. Results were verified by inviting participating hospitals to provide feedback. ...
Annali di igiene : medicina preventiva e di comunità
We performed a geographic analysis study on mortality in the town of Vercelli, in order to respon... more We performed a geographic analysis study on mortality in the town of Vercelli, in order to respond to the concerns of the population and some local administrators. Main reason to carry out a detailed and sophisticated study for a city of medium-small size was represented by the presence of various sources of environmental and industrial pressure (i.e. old-generation incinerator for solid urban waste, industrial site for chemicals production, intense agricultural activity of rice production…). The study analyzed census, ISTAT death cards, both from the epidemiological point of view with admirers that SMR standardized spatial analysis using Bayesian models. Overall, both approaches highlighted major risks for the area south of the capital for major cancers such as colorectal and lung and increases worthy of investigation for the young-adult age groups in both genders. And being processed a similar study that considers the incidence oncology. The imminent elaboration of the cartography...
ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acqui... more ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acquired infections and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The ventilator bundle of the Institute of Healthcare Improvement includes five evidence-based guidelines which are proven to be effective in the prevention of VAP. The main purpose of this study is to determine the incidence of VAP at two intensive care units at the Jessa Hospital. In addition, compliance rates with the different elements of the VAP bundle are determined. From 1 January 2011 to 31 March 2011 an explorative study was conducted on a 18-bed surgical intensive care unit (SICU) and a six-bed medical intensive care unit (MICU). VAP was diagnosed using Johanson et al. criteria. Bedside observations and analysis of the electronic patient record were performed in order to determine compliance relative to the VAP bundle. At the SICU 10 VAPs were diagnosed resulting in an incidence of 38.46% and a VAP rate of 22.56. Three VAPs were diagnosed at the MICU. The incidence of VAP at the MICU was 18.75% resulting in a VAP rate of 18.75%. Compliance to all elements of the VAP bundle was observed in 0.52% (SICU) and 19.64% (MICU) of the observations. Compliance at the level of individual elements of the bundle varies between 1.03% and 99.48% (SICU) and 32.14% and 100% (MICU).
... Correspondence: Kris Vanhaecht, Center for Health Services and Nursing Research, Catholic Uni... more ... Correspondence: Kris Vanhaecht, Center for Health Services and Nursing Research, Catholic University Leuven, Kapucijnenvoer 35, 4th Floor, B-3000 Leuven, Belgium (Email:Kris.Vanhaecht{at}med.kuleuven.be). ABSTRACT. ... The left board: Bottlenecks and Question Marks. ...
ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional p... more ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional power concerning pathways, the actual follow-up, challenges in cross-boundary development and the support provided by information and communication technology (ICT). The study design included a qualitative study using semi-structured interviews with 88 care pathway coordinators and members of the executive board in 57 health-care organizations enrolled in the Belgian–Dutch Clinical Pathway Network. The study revealed that the most important objectives for introducing care pathways are more standardization and quality of care. In 76% of the interviewed organizations, pathways are discussed in a committee. There is a lack of continuous follow-up when care pathways are implemented. Pathways can facilitate cross-boundary care, but are a challenge because of the fragmentation within primary care. There is a need for more ICT support for care pathways. In conclusion, the executive board members and pathway coordinators state that clearly formulated objectives, a special steering committee, a clear follow-up to keep pathways alive, cross-boundary collaboration and ICT support are among the main challenges for the management of an organization.
Studies in health technology and informatics, 2004
Clinical pathways are commonly developed for homogenous patient groups. We were wondering if the ... more Clinical pathways are commonly developed for homogenous patient groups. We were wondering if the traditional patient classification systems could be used for classifying clinical pathways. To examine the utility of patient classification systems for clinical pathways, a sample of 13 clinical pathways was analyzed, involving a total of 412 patients. Three classification systems were tested: International Classification of Diseases, Ninth Revision (ICD9-CM), Clinical Coding System (CCS) data and All-Patient Redefined Diagnosis Related Groups (APR-DRG). Categorization with ICD9-CM and CCS shows rather wide variation. However, when restricting for the principal codes, CCS classification shows an almost homogeneous relationship with clinical pathways. APR-DRG's are already corrected for secondary procedures and are difficult to assess. Categorization with the Risk Of Mortality (ROM) is more homogeneous than with the Severity Of Illness (SOI). Patient groups in clinical pathways are r...
The goal of reducing the length of a patient's hospital stay after orthopaedic surgery has re... more The goal of reducing the length of a patient's hospital stay after orthopaedic surgery has recently gained much interest from surgeons and hospital administrators. The influence of hospital stay reduction on qualitative outcome is not always documented. The purpose of this study was to investigate this relationship in more detail. We report our experience with patients undergoing total knee arthroplasty. In 2000, an in-hospital clinical pathway for patients undergoing total knee arthroplasty was instituted at the University Hospitals Pellenberg, Belgium. We evaluated this pathway in 103 patients by using a pre-experimental, interrupted, time-series design. This pathway significantly decreased length of stay by 33% without negatively affecting functional outcomes during hospitalisation. In further research also the long-term effects have to be studied.
Complex chronic conditions often require long-term care from various healthcare professionals. Th... more Complex chronic conditions often require long-term care from various healthcare professionals. Thus, maintaining quality care requires care coordination. Concepts for the study of care coordination require clarification to develop, study and evaluate coordination strategies. In 2007, the Agency for Healthcare Research and Quality defined care coordination and proposed five theoretical frameworks for exploring care coordination. This study aimed to update current theoretical frameworks and clarify key concepts related to care coordination. We performed a literature review to update existing theoretical frameworks. An in-depth analysis of these theoretical frameworks was conducted to formulate key concepts related to care coordination. Our literature review found seven previously unidentified theoretical frameworks for studying care coordination. The in-depth analysis identified fourteen key concepts that the theoretical frameworks addressed. These were 'external factors', ...
... Title: Ontwikkeling en implementatie van een klinisch pad voor chirurgie van intracraniële tu... more ... Title: Ontwikkeling en implementatie van een klinisch pad voor chirurgie van intracraniële tumoren. Authors: Janssen, L × Sermeus, Walter Goffin, Jan Vanhaecht, Kris De Wispelaere, G Judong, M. Issue Date: 2003. Host Document: Ligament vol:2 pages:19-24. ...
Uploads
Papers by Kris Vanhaecht