Sinds 2014 is Zorginstituut Nederland verantwoordelijk voor de informatievoorziening aan burgers over kwaliteit van zorg. Deze informatie is te vinden op de website kiesBeter.nl. Om keuzeinformatie over de zorg te presenteren heeft het Zorginstituut begin 2014 een nieuw format bedacht. In dit format wordt per aandoening de zorgroute die een patient doorloopt visueel weergegeven. Voor elke fase (diagnose, behandeling, controle/nazorg, etc.) wordt aangegeven welke keuzemomenten er zijn en worden links naar specifieke informatie over zorg, zorgverleners en eventuele verschillende behandelingen gepresenteerd. Het idee van een dergelijke presentatiewijze is nieuw en het is nog niet bekend of mensen de zorgroute begrijpelijk of bruikbaar vinden.
Op basis van literatuur en gesprekken met patientenorganisaties concluderen we dat de
presentatie van een zorgroute patienten mogelijk kan stimuleren om gefundeerde keuzes voor een zorgaanbieder te maken. De website van het Zorginstituut wordt door patientenorganisaties gezien als een goede startplek om deze informatie te presenteren, waarbij patienten vervolgens kunnen worden doorverwezen naar de website/informatie van de patientenorganisaties. Voordat de zorgroute voor meerdere aandoeningen geimplementeerd wordt op kiesBeter.nl, is het belangrijk om het format uit te testen onder een groep patienten en enkele aandachtspunten omtrent de haalbaarheid te onderzoeken. (aut. ref.)
The Care-Related Quality of Life survey for Chronic Heart Failure (CaReQoL CHF) is a newly developed patient-reported outcome measure (PROM) that measures care-related quality of life in patients diagnosed with chronic heart failure. This study describes the psychometric properties of the questionnaire and its relationship with disease severity and global rating of quality of care.Insurance companies selected patients with a recorded diagnosis of chronic heart failure and for whom the hospital submitted a billing statement in the last year. Exploratory factor analysis, Cronbach's alpha and item-rest correlation were used to construct the CaReQoL CHF. Construct validity was assessed by examining the mean values of the CaReQoL CHF scales for the categories of the widely-used New York Heart Association (NYHA) functional classification and by correlating the global rating of quality of care with the CaReQoL CHF scales.One thousand eighteen patients with chronic heart failure filled out the CaReQoL CHF (RR: 35.7%). The CaReQoL CHF consists of 20 items and three scales: social and emotional problems, physical limitations, and being in safe hands. The mean scores of the three scales differed significantly for the NYHA categories, particularly for the social-emotional problems and physical limitation scales. The 'being in safe hands' scale showed a moderate positive correlation with the global rating of quality of care.The CaReQoL CHF is a concise and valid PROM that matches patients' priorities in healthcare. It adds a new element to existing quality of life questionnaires for patients with chronic heart failure, that is 'being in safe hands' scale. This scale is relevant for patients because they experience anxiety and tension about their condition. Future research should determine whether the CaReQoL CHF can help healthcare providers in daily practice to focus treatment on outcomes of care that are relevant to individual patients.
Abstract Background Public reports about health‐care quality have not been effectively used by consumers thus far. A possible explanation is inadequate presentation of the information. Objective To assess which presentation features contribute to consumers’ correct interpretation and effective use of comparative health‐care quality information and to examine the influence of consumer characteristics. Design Fictitious Consumer Quality Index (CQI) data on home care quality were used to construct experimental presentation formats of comparative information. These formats were selected using conjoint analysis methodology. We used multilevel regression analysis to investigate the effects of presenting bar charts and star ratings, ordering of the data, type of stars, number of stars and inclusion of a global rating. Setting and participants Data were collected during 2 weeks of online questioning of 438 members of an online access panel. Results Both presentation features and consumer characteristics (age and education) significantly affected consumers’ responses. Formats using combinations of bar charts and stars, three stars, an alphabetical ordering of providers and no inclusion of a global rating supported consumers. The effects of the presentation features differed across the outcome variables. Conclusions Comparative information on the quality of home care is complex for consumers. Although our findings derive from an experimental situation, they provide several suggestions for optimizing the information on the Internet. More research is needed to further unravel the effects of presentation formats on consumer decision making in health care.
Background
By assessing patient safety culture, healthcare providers can identify areas for improvement in patient safety culture. To achieve this, these assessment outcomes have to be relevant and presented clearly. The aim of our study was to explore healthcare professionals’ views on the feedback of a patient safety culture assessment.
Methods
Twenty four hospitals participated in a patient safety culture assessment in 2012. Hospital departments received feedback in a report and on a website. In a survey, we evaluated healthcare professionals’ views on this feedback and the effect of additional information about patient safety culture improvement strategies on the appraisal of the feedback. 20 hospitals participated in part I (evaluation of the report), 13 hospitals participated in part II (evaluation of the website).
Results
Healthcare professionals (e.g. members of staff and department heads/managers) rated the feedback in the report and on the website positively (average mean on different aspects = 7.2 on a scale from 1 to 10). Interpreting results was sometimes difficult, and information was sometimes lacking, like specific recommendations and improvement strategies. The provision of additional general information on patient safety culture improvement strategies resulted only in a higher appraisal of the attractiveness (lay-out) of the report and the understandability of the feedback report. The majority (84 %) of the healthcare professionals agreed or partly agreed that the feedback on patient safety culture stimulated actions to improve patient safety culture. However, a quarter also stated that although the feedback report provided insight into the patient safety culture, they did not know how to improve patient safety culture in their hospital.
Conclusions
Healthcare professionals seem to be positive about the feedback on patient safety culture and its effect on stimulating patient safety culture improvement. To optimally tune feedback on patient safety culture towards healthcare professionals, the following might help:
1) pay attention to the understandability of outcomes for its intended users; and
2) create feedback that is tailored towards specific hospital departments.
Verzekerden vinden dat de dienstverlening van hun zorgverzekeraars is verbeterd. De verschillen tussen zorgverzekeraars zijn kleiner geworden. Ze zouden zich meer moeten profileren op de inkoop van zorg.
Gemiddeld goed
De kwaliteit van de dienstverlening van zorgverzekeraars is beter geworden, zeggen verzekerden. NIVEL-onderzoeker Jany Rademakers: “Sinds de invoering van het nieuwe zorgstelsel hebben de zorgverzekeraars zich allereerst vooral gericht op de premies. Verzekeraars lijken nu meer aandacht te besteden aan de kwaliteit van de dienstverlening. Rekeningen worden sneller betaald, de telefonische bereikbaarheid en de hulp van de klantenservice zijn beter geworden.”
Sterke punten
Tegelijkertijd verdwijnen door de verbeterde kwaliteit de onderlinge verschillen tussen zorgverzekeraars. Rademakers: “Veel verzekeraars die vorig jaar minder goed scoorden op dienstverlening, hebben hun achterstand inmiddels ingelopen. Dit betekent dat verzekeraars hun sterke punten moeten koesteren en uitbouwen om de concurrentie voor te blijven. De zorginkoop – waar we ook dit jaar nog nauwelijks verschillen zien – is bijvoorbeeld nog relatief onontgonnen terrein. Ze zouden zich daarop kunnen profileren.”
Verbeterpunten
Op een paar punten kan het beter. Voor veel consumenten is nog steeds onduidelijk in welke mate ze moeten bijbetalen voor zorg. Verder blijft de toestemmingsprocedure voor bepaalde zorg lastig en leidt deze bij een aantal patienten tot uitstel. Ook geven verzekerden aan dat het moeilijk is om niet-gecontracteerde zorg te krijgen.
KiesBeter.nl
Het NIVEL (Nederlands instituut voor onderzoek van de gezondheidszorg) verzamelde in samenwerking met het Centrum Klantervaring Zorg voor het derde achtereenvolgende jaar informatie bij verzekerden over de kwaliteit van service van zorgverzekeraars en de geleverde zorg voor de website www.kiesBeter.nl. Deze site van het RIVM helpt consumenten bij het maken van keuzes in de zorg.
CQ-index
Van mei tot september 2007 werden de ervaringen van verzekerden gemeten. Vrijwel alle (32) zorgverzekeraars namen op vrijwillige basis deel aan het onderzoek, 8088 verzekerden vulden een vragenlijst (de CQ-index Zorg en Zorgverzekering) in. Op basis hiervan zijn de algemene prestaties van de zorgverzekeraars vastgesteld en de verschillen in kaart gebracht.
Several western countries have introduced managed competition in their health care system. In the Netherlands, a new health insurance law was introduced in January 2006 making it easier to switch health insurer each year.The objective was to measure people's intention to switch health insurer and actual switching behaviour. We also examined whether some groups were less inclined to switch health insurer and/or had more difficulty to exert their intention to switch.In October 2006, members of three Dutch panels indicated whether they intended to switch health insurer during that year's open enrollment period. In the beginning of 2007, the same people were asked whether they indeed switched health insurer.Only 1% intended to switch health insurer. Women, older people, lower educated people, people who were insured for a longer period and people who reported a bad or moderate health were less inclined to switch health insurer. The amount of switching was higher among individuals who intended to switch (31%) than among individuals who did not know whether they would switch (7%) and individuals with no intention to switch (2%). Among those who intended to switch health insurer, women and people who reported a good health switched health insurer more often. The years of enrollment were also associated with actual switching behaviour.We might have to temper the optimistic expectations on enhanced choice. Future research should determine why people do not switch health insurer when they intend to and which barriers they experience.
