scholarly journals Regional and hospital variation in commonly performed paediatric otolaryngology procedures in the Netherlands: a population-based study of healthcare utilisation between 2016 and 2019

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046840
Author(s):  
Juliëtte J C M van Munster ◽  
Joost J G Wammes ◽  
Rolf H Bremmer ◽  
Amir H Zamanipoor Najafabadi ◽  
Raphael J Hemler ◽  
...  
Keyword(s):  
The Netherlands ◽  
Healthcare Utilisation ◽  
Care Process ◽  
Resource Utilisation ◽  
Ventilation Tube ◽  
Tube Insertion ◽  
High Quality ◽  
Cross Sectional ◽  
Referral Rates ◽  
Hospital Variation

ObjectiveIn the past few decades, there has been an increase in high-quality studies providing evidence on the effectiveness of commonly performed procedures in paediatric otolaryngology. We believe that now is the time to re-evaluate the care process. We aimed to analyse (1) the regional variation in incidence and referrals of adenoidectomies, tonsillectomies and ventilation tube insertions in children in the Netherlands between 2016 and 2019, (2) whether regional surgical rates, referral rates and in-hospital surgical rates were associated with one another, and (3) the hospital variation in healthcare costs, which indicates the utilisation of resources.DesignRepeated cross-sectional analysis.SettingFour neighbouring Dutch provinces comprising 2.8 million inhabitants and 14 hospitals.ParticipantsChildren aged 0–15 years.Outcome measuresWe analysed variation in regional surgical rates and referral rates per 1000 inhabitants and in-hospital surgical rates per 1000 clinic visitors, adjusted for age and socioeconomic status. Furthermore, the relationships between referral rates, regional surgical rates and in-hospital surgical rates were estimated. Lastly, variation in resource utilisation between hospitals was estimated.ResultsAdenoidectomy rates differed sixfold between regions. Twofold differences were observed for adenotonsillectomy rates, ventilation tube insertion rates and referral rates. Referral rates were negatively associated with in-hospital surgical rates for adenotonsillectomies, but not for adenoidectomies and ventilation tube insertions. In-hospital surgical rates were positively associated with regional rates for adenoidectomies and adenotonsillectomies. Significant variation between hospitals was observed in costs for all resources.ConclusionsWe observed low variation in tonsillectomies and ventilation tube insertion and high variation in adenoidectomies. Indications for a tonsillectomy and ventilation tube insertion are well defined in Dutch guidelines, whereas this is not the case for an adenoidectomy. Lack of agreement on indications can be expected and high-quality effectiveness research is required to improve evidence-based guidelines on this topic.

Construct validity of a simulator for myringotomy with ventilation tube insertion

2009 ◽  
Vol 141 (5) ◽  
pp. 603-608 ◽  
Author(s):  
Peter G. Volsky ◽  
Brian B. Hughley ◽  
Shayn M. Peirce ◽  
Bradley W. Kesser
Keyword(s):  
Construct Validity ◽  
Repeated Measures ◽  
Strongly Correlated ◽  
Ventilation Tube ◽  
Surgical Experience ◽  
Tube Insertion ◽  
Cross Sectional ◽  
Anatomic Model ◽  
Time To Completion

Objectives: To establish construct validity of an anatomic model as a simulator for myringotomy with ventilation tube insertion and to assess its subjective appeal. Study Design: Cross-sectional, repeated-measures comparative evaluation of simulator. Setting: University academic otolaryngology residency program. Subjects and Methods: Using an anatomic model of the human auricle, ear canal, eardrum, and middle ear space, 18 otolaryngologists of various levels of training performed 10 timed procedures: myringotomy with ventilation tube insertion. Errors were recorded, and participants reported the quality of their experience. Results: Both time-to-completion and errors per trial discriminated novices from non-novice participants; novices (02:23, 95% confidence interval [CI], 01:42-03:04) were 3.6 times slower than non-novices (00:39, 95% CI, 00:35-00:43) and 6.5 times more error prone (novices 2.16 errors/trial, 95% CI, 1.68-2.64; non-novices 0.33 errors/trial, 95% CI, 0.21-0.45). Errors were strongly correlated with prior surgical experience. All participants required more time to complete the first trial, and their performance stabilized thereafter. Overall, the simulation was perceived as a valuable experience. Conclusion: Our model is a valid platform for simulating myringotomy with ventilation tube insertion. The model discriminates novices from non-novices, has a learning curve, and is perceived to be a valuable and realistic teaching tool by users.

scholarly journals Specialist palliative care teams and characteristics related to referral rate: a national cross-sectional survey among hospitals in the Netherlands

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
M.S. Boddaert ◽  
A. Stoppelenburg ◽  
J. Hasselaar ◽  
Y.M. van der Linden ◽  
K.C.P. Vissers ◽  
...  
Keyword(s):  
Palliative Care ◽  
The Netherlands ◽  
Referral Rate ◽  
Outpatient Clinics ◽  
Specialist Palliative Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Referral Rates ◽  
Palliative Care Teams ◽  
Education Participation

Abstract Background Specialist palliative care teams (SPCTs) in hospitals improve quality of life and satisfaction with care for patients with advanced disease. However, referrals to SPCTs are often limited. To identify areas for improvement of SPCTs’ service penetration, we explored the characteristics and level of integration of palliative care programmes and SPCTs in Dutch hospitals and we assessed the relation between these characteristics and specialist palliative care referral rates. Methods We performed a secondary analysis of a national cross-sectional survey conducted among hospitals in the Netherlands from March through May 2018. For this survey, a previously developed online questionnaire, containing 6 consensus-based integration indicators, was sent to palliative care programme leaders in all 78 hospitals. For referral rate we calculated the number of annual inpatient referrals to the SPCT as a percentage of the number of total annual hospital admissions. Referral rate was dichotomized into high (≥ third quartile) and low (< third quartile). Characteristics of SPCTs with high and low referral rate were compared using univariate analyses. P-values < 0.05 were considered significant. Results In total, 63 hospitals (81%) participated in the survey, of which 62 had an operational SPCT. The palliative care programmes of these hospitals consisted of inpatient consultation services (94%), interdisciplinary staffing (61%), outpatient clinics (45%), dedicated acute care beds (21%) and community-based palliative care (27%). The median referral rate was 0.56% (IQR 0.23–1.0%), ranging from 0 to 3.7%. Comparing SPCTs with high referral rate (≥1%, n = 17) and low referral rate (< 1%, n = 45) showed significant differences for SPCTs’ years of existence, staffing, their level of education, participation in other departments’ team meetings, provision of education and conducting research. With regard to integration, significant differences were found for the presence of outpatient clinics and timing of referrals. Conclusion In the Netherlands, palliative care programmes and specialist palliative care teams in hospitals vary in their level of integration and development, with more mature teams showing higher referral rates. Appropriate staffing, dedicated outpatient clinics, education and research appear means to improve service penetration and timing of referral for patients with advanced diseases.

scholarly journals Characteristics and healthcare utilisation patterns of high-cost beneficiaries in the Netherlands: a cross-sectional claims database study

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e017775 ◽  
Author(s):  
Joost Johan Godert Wammes ◽  
Marit Tanke ◽  
Wilma Jonkers ◽  
Gert P Westert ◽  
Philip Van der Wees ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
The Netherlands ◽  
Health System ◽  
Diagnosis Related Groups ◽  
Healthcare Utilisation ◽  
The Elderly ◽  
Cross Sectional ◽  
Medical Needs ◽  
Treatment Use

ObjectiveTo determine medical needs, demographic characteristics and healthcare utilisation patterns of the top 1% and top 2%–5% high-cost beneficiaries in the Netherlands.DesignCross-sectional study using 1 year claims data. We broke down high-cost beneficiaries by demographics, the most cost-incurring condition per beneficiary and expensive treatment use.SettingDutch curative health system, a health system with universal coverage.Participants4.5 million beneficiaries of one health insurer.MeasuresAnnual total costs through hospital, intensive care unit use, expensive drugs, other pharmaceuticals, mental care and others; demographics; most cost-incurring and secondary conditions; inpatient stay; number of morbidities; costs per ICD10-chapter (International Statistical Classification of Diseases, 10th revision); and expensive treatment use (including dialysis, transplant surgery, expensive drugs, intensive care unit and diagnosis-related groups >€30 000).ResultsThe top 1% and top 2%–5% beneficiaries accounted for 23% and 26% of total expenditures, respectively. Among top 1% beneficiaries, hospital care represented 76% of spending, of which, respectively, 9.0% and 9.1% were spent on expensive drugs and ICU care. We found that 54% of top 1% beneficiaries were aged 65 years or younger and that average costs sharply decreased with higher age within the top 1% group. Expensive treatments contributed to high costs in one-third of top 1% beneficiaries and in less than 10% of top 2%–5% beneficiaries. The average number of conditions was 5.5 and 4.0 for top 1% and top 2%–5% beneficiaries, respectively. 53% of top 1% beneficiaries were treated for circulatory disorders but for only 22% of top 1% beneficiaries this was their most cost-incurring condition.ConclusionsExpensive treatments, most cost-incurring condition and age proved to be informative variables for studying this heterogeneous population. Expensive treatments play a substantial role in high-costs beneficiaries. Interventions need to be aimed at beneficiaries of all ages; a sole focus on the elderly would leave many high-cost beneficiaries unaddressed. Tailored interventions are needed to meet the needs of high-cost beneficiaries and to avoid waste of scarce resources.

Adenoid mast cells and their role in the pathogenesis of otitis media with effusion

2006 ◽  
Vol 120 (7) ◽  
pp. 556-560 ◽  
Author(s):  
B Abdullah ◽  
S Hassan ◽  
D Sidek ◽  
H Jaafar
Keyword(s):  
Mast Cells ◽  
Light Microscopy ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Computer Software ◽  
Ventilation Tube ◽  
Tube Insertion ◽  
Cross Sectional

Introduction: Otitis media with effusion (OME) is an inflammation of the middle ear in which a collection of liquid is present in the middle-ear space while the tympanic membrane is intact. The association between adenoid inflammation and OME has long been noted but the exact mechanism is still much debated. We studied the role of adenoid mast cells in the causation of OME.Objective: To study the distribution and role of adenoid mast cells in the causation of OMEMethodology: A cross-sectional, prospective study was carried out in the otorhinolaryngologic clinic, department of otorhinolaryngology (ORL), Science University of Malaysia, from June 1999 to September 2001. A total number of 50 cases were studied. Twenty-five of these patients underwent adenoidectomy, while another 25 patients underwent adenoidectomy and myringotomy with ventilation tube insertion. The adenoid specimens from all patients were examined for the number of adenoid mast cells present, using light microscopy and toluidine blue as the staining agent. The results were analysed using SPSS version 10.0 computer software.Result: The population of adenoid mast cells in children with OME was significantly greater than that in children without OME (p = 0.000).Conclusion: The increased number of adenoid mast cells in patients with OME suggests that inflammation may play a role in this condition.

scholarly journals Independent Treatment Centres Are Not a Guarantee for High Quality and Low Healthcare Prices in The Netherlands – A Study of 5 Elective Surgeries

2020 ◽  
Author(s):  
Anouk Dorine Maria Tulp ◽  
Florien Margareth Kruse ◽  
Niek Waltherus Stadhouders ◽  
Patrick P.T. Jeurissen
Keyword(s):  
Quality Of Care ◽  
The Netherlands ◽  
Elective Surgery ◽  
Cruciate Ligament ◽  
Ordinary Least Squares ◽  
Quality Data ◽  
Care Process ◽  
High Quality ◽  
List Prices

Background: Independent treatment centres (ITCs) are a growing phenomenon in many healthcare systems. Focus factory theory predicts that ITCs provide high quality healthcare with low prices, through specialisation, high-volume and routine. This study examines if ITC care outperforms general hospital (GH) care within a regulated competition system in the Netherlands, by focusing on differences in healthcare quality and price. Methods: The cross-sectional study combined publicly available quality data, list prices and insurer contracts for 2017. Clinical outcomes of 5 elective surgeries (total hip and knee replacement, anterior cruciate ligament (ACL), cataract and carpal tunnel surgeries) were compared using zero-or-one inflated beta-regressions, corrected for underlying structural factors (ie, volume of care, process and structure indicators, and chain affiliation). Furthermore, price differences between ITCs and GHs were examined using ordinary least squares regressions. Lastly, we analysed quality of care in relation to the number of insurance contracts of the 4 largest Dutch insurance companies using ordered logistic regressions. Results: Quality differences between ITCs and GHs were found to be inconsistent across procedures. No facility type performed better overall. There were no differences exhibited in the list prices between ITCs and GHs. No consistent relationship was found between the underlying factors and quality or price, in different procedures and time. We found no indication for selective contracting based on quality within the ITC sector. Conclusions: This study found no evidence that ITCs outperform GHs on quality or price. This evidence does not support the focus factory theory. The substantial practice variation in quality of care may justify more evidence-based contracting within the market for elective surgery.

Qualitative anatomical restoration of the contact point of teeth – prevention of localized forms of periodontal diseases

2020 ◽  
Vol 25 (1) ◽  
pp. 10-15
Author(s):  
L. Yu. Orekhova ◽  
O. V. Prokhorova ◽  
V. Yu. Shefov
Keyword(s):  
Comparative Analysis ◽  
Computer Simulations ◽  
Periodontal Diseases ◽  
Contact Point ◽  
Clinical Stage ◽  
High Quality ◽  
Cross Sectional ◽  
Clinical Stages ◽  
Anatomical Restoration ◽  
Approximal Surfaces

Relevance. The restoration of a high-quality anatomical and functional contact point of teeth plays an important role in preventing the development of localized forms of periodontal disease.Purpose. Development of recommendations for qualitative anatomical restoration of the contact point of teeth for the prevention of localized forms of periodontal diseases.Materials and methods. In our study, which consisted of pre-clinical and clinical stages, were analyzed 50 CT scan of the chewing group teeth calculated the ratio of approximal surfaces of molars and premolars to the width of their crowns and computer simulations of the results of restoration of contact point. We also conducted a comparative analysis of wedges of different material with different cross-sectional shapes. At the clinical stage, the restoration of the contact point of teeth in patients according to our recommendations was carried out.Results. On the basis of the data obtained during the study, a formula for calculating the height and size of the restored contact point was compiled. Recommendations for anatomical restoration of the contact point are formulated.Conclusion. The application of the recommendations developed by us allows anatomically qualitatively restore the contact point and prevent the development of localized periodontal diseases.

scholarly journals Complementary Medicine and Self-Care Strategies in Women with (Recurrent) Urinary Tract and Vaginal Infections: A Cross-Sectional Study on Use and Perceived Effectiveness in The Netherlands

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 250
Author(s):  
Louise Witteman ◽  
Herman A. van Wietmarschen ◽  
Esther T. van der Werf
Keyword(s):  
Urinary Tract ◽  
The Netherlands ◽  
Complementary Medicine ◽  
Self Care ◽  
Future Research ◽  
Perceived Effectiveness ◽  
Vaginal Infections ◽  
Cross Sectional ◽  
Treatment Implementation ◽  
Specific Symptoms

Due to the excessive use of antibiotic and antimycotic treatments, the risk of resistant microbes and fungi is rapidly emerging. Previous studies have demonstrated that many women with (recurrent) urinary tract infection (UTI) and/or vaginal infections (VIs) welcome alternative management approaches to reduce the use of antibiotics and antifungals and avoid short- and long-term adverse effects. This study aims to determine which complementary medicine (CM) and self-care strategies are being used by women suffering from (recurrent) UTI and VI in The Netherlands and how they perceive their effectiveness in order to define directions for future research on safety, cost-effectiveness, and implementation of best practices. A cross-sectional online survey was performed among women, ≥18 years old, with a history of UTIs; 162 respondents were included in the data analysis, with most participants aged between 50 and 64 years (36.4%). The women reported having consulted a CM practitioner for UTI-specific symptoms (23.5%) and VI-specific symptoms (13.6%). Consultations of homeopaths, acupuncturists, and herbal physicians are most often reported. Overall, 81.7% of the women suffering from UTI used complementary or self-care strategies besides regular treatment, and 68.7% reported using CM/self-care strategies to treat vaginal symptoms. UTI- related use of cranberries (51.9%), vitamin C (43.8%), and D-mannose (32.7%) were most reported. Perceived effectiveness was mostly reported for homeopathic remedies and D-mannose. The results showed a substantial burden of UTI and VI on daily and sexual activities. Besides the frequency of use, the indication of perceived effectiveness seems to be an important parameter for further and rigorously designed research to encourage nonantibiotic/antifungal treatment implementation into daily clinical practice.

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