Over the last years, several initiatives on early detection and intervention have been put in place to proactively identify health and social problems in (frail) older people. An overview of the initiatives currently available in the Netherlands is lacking, and it is unknown whether they meet the preferences and needs of older people. Therefore, the objectives of this study were threefold: 1. To identify initiatives on early detection and intervention for older people in the Netherlands and compare their characteristics; 2. To explore the experiences of professionals with these initiatives; and 3. To explore to what extent existing initiatives meet the preferences and needs of older people. We performed a qualitative descriptive study in which we conducted semi-structured interviews with seventeen experts in preventive elderly care and three group interviews with volunteer elderly advisors. Data were analysed using the framework analysis method. We identified eight categories of initiatives based on the setting (e.g. general practitioner practice, hospital, municipality) in which they were offered. Initiatives differed in their aims and target groups. The utilization of peers to identify problems and risks, as was done by some initiatives, was seen as a strength. Difficulties were experienced with identifying the target group that would benefit from proactive delivery of care and support most, and with addressing prevalent issues among older people (e.g. psychosocial issues, self-reliance issues). Although there is a broad array of initiatives available, there is a discrepancy between supply and demand. Current initiatives insufficiently address needs of (frail) older people. More insight is needed in "what should be done by whom, for which target group and at what moment", in order to improve current practice in preventive elderly care.
textabstractDiabetes mellitus comprises a clinically and genetically heterogeneous group of
disorders that have one common feature: abnormally high levels of glucose in
the blood. The most common form is non-insulin dependent diabetes mellitus
(NlDDM); about 80-90% of all diabetic patients has NlDDM. Other forms of diabetes
are insulin-dependent diabetes mellitus (lDDM) and gestational diabetes.
• In 1985, the World Health Organization (WHO) defined new criteria for diabetes
mellitus based upon the oral glucose tolerance test (OGIT). During the
OGIT test the fasting glucose level is measured, followed by the measurement of
the glucose level, 2 hours after an intake of 75 g glucose. Depending on whether
the glucose levels have been measured in the blood, plasma or serum, cut-off
values have been defined. Three diagnoses can be made: normal glUcose
tolerance, impaired glucose tolerance (IGT) or diabetes mellitus.
The OGIT is often used in epidemiological research. However, in clinical
practice, the diagnosis diabetes is usually based on the presence of the classic
symptoms of diabetes (polyuria, hunger, thirst, weight loss, tiredness) combined
with a single abnormal blood glucose level, or on two abnormal levels without
complaints measured on different occasions.
Introduction: Several countries adopted population management (PM) to achieve Berwick’s Triple Aim: simultaneously improving quality of care, improving population’s health, and reducing per capita costs. Also in the Netherlands, the concept of PM is embraced. In 2013, the Dutch Ministry of Health designated nine regional innovation initiatives as ‘pioneer sites’ in a nationwide effort to achieve a better health, improved quality of care and cost control (Triple Aim). The National Institute for Public Health and the Environment (RIVM) has monitored these sites with a particular focus on their design, the Triple Aim, and the experiences of members of the steering groups of the sites. In this presentation the development of the sites during the first 1,5 year are presentedMethods: The following information about the pioneer sites is collected each quarter using interviews, published documents and websites: 1) aims of the PM site; 2) structure (legal entity, involved organizations and their roles, governance); 3) risk stratification and population identification; 4) financing and incentives; 5) included interventions; 6) barriers/facilitators. Next to this, sixty semi-structured interviews were conducted, including all members of the board of the nine pioneer sites. Interviewees’ roles varied, but they were mostly directors/ managers of care groups, hospitals and patient-organizations. The interviews focused on barriers and facilitators in achieving the sites ambitions. Additional elaborated themes were: 1) financial incentives/ contracts, 2) quality of care and 3) transparency of information between involved organizations.In addition data on the Triple Aim have been collected by using national registration data on costs (Vektis) and health (Dutch National health monitor) as well as an additional questionnaire among a randomized selected sample of the populations of the nine sites (in total n=5030) identify the quality of care.Results: Health care providers, insurers and often stakeholders like municipalities and representatives of citizens / patients are working jointly to achieve sustainable care and support. Based on a number of interventions they attempt to lay the foundation for the necessary cooperation, organization and funding of the sites. Pioneer sites are run by stakeholders’ representatives. According to them, first experiences indicate that cooperation has improved. At the same time, the sites are still seeking the best organizational and management structures to work with and exploring new forms of funding such as shared savings. Transparency between stakeholders is still limited. Consequently, pioneer sites could still not yet focus on the true needs of the population, insurers cannot optimally pay for performance and feedbackcycli are lacking or lack behind.Discussion and conclusion: For the pioneer sites to be successful, good cooperation is essential. This requires that organizational interests of all stakeholders are more aligned to the objectives of the pioneer sites. Alternative forms of funding as well as transparency of the quality and costs of care need attention.
Abstract Aims To test a s imulation model, the MICADO model, for estimating the long‐term effects of interventions in people with and without diabetes. Methods The MICADO model includes micro‐ and macrovascular diseases in relation to their risk factors. The strengths of this model are its population scope and the possibility to assess parameter uncertainty using probabilistic sensitivity analyses. Outcomes include incidence and prevalence of complications, quality of life, costs and cost‐effectiveness. We externally validated MICADO 's estimates of micro‐ and macrovascular complications in a Dutch cohort with diabetes ( n = 498 400) by comparing these estimates with national and international empirical data. Results For the annual number of people undergoing amputations, MICADO 's estimate was 592 (95% interquantile range 291–842), which compared well with the registered number of people with diabetes‐related amputations in the Netherlands (728). The incidence of end‐stage renal disease estimated using the MICADO model was 247 people (95% interquartile range 120–363), which was also similar to the registered incidence in the Netherlands (277 people). MICADO performed well in the validation of macrovascular outcomes of population‐based cohorts, while it had more difficulty in reflecting a highly selected trial population. Conclusions Validation by comparison with independent empirical data showed that the MICADO model simulates the natural course of diabetes and its micro‐ and macrovascular complications well. As a population‐based model, MICADO can be applied for projections as well as scenario analyses to evaluate the long‐term (cost‐)effectiveness of population‐level interventions targeting diabetes and its complications in the Netherlands or similar countries.
In the near future, the number of stroke patients and their related healthcare costs are expected to rise. The purpose of this study was to estimate this expected increase in stroke patients in the Netherlands. We sought to determine what the future developments in the number of stroke patients due to demographic changes and trends in the prevalence of smoking and hypertension in terms of the prevalence, incidence, and potential years of life lost might be.A dynamic, multistate life table was used, which combined demographic projections and existing stroke morbidity and mortality data. It projected future changes in the number of stroke patients in several scenarios for the Dutch population for the period 2000 to 2020. The model calculated the annual number of new patients by age and sex by using incidence rates, defined by age, sex, and major risk factors. The change in the annual number of stroke patients is the result of incident cases minus mortality numbers.Demographic changes in the population suggest an increase of 27% in number of stroke patients per 1000 in 2020 compared with 2000. Extrapolating past trends in the prevalence of smoking behavior, hypertension, and stroke incidence resulted in an increase of 4%.The number of stroke patients in the Netherlands will rise continuously until the year 2020. Our study demonstrates that a large part of this increase in the number of patients is an inevitable consequence of the aging of the population.
Introduction: Integrated care for older adults living at home aims to provide holistic, multidisciplinary and person-centered care. One of the services provided in several integrated care programs is the comprehensive geriatric assessment (CGA), conducted to identify older adults’ care needs. There are many different ways to conduct a CGA. However, it is still unclear what distinguishes these CGAs from each other. Also, it is yet unknown to what extent the principles of integrated care (holism, multidisciplinarity and person-centredness) are reflected in CGAs. The objectives of this study were to: 1) compare different CGAs conducted within integrated care programs for older adults living at home, and 2) describe how the principles of integrated care were applied in these CGAs. Methods: A systematic literature search was conducted to identify integrated care programs including a CGA. Data were extracted on main characteristics of identified CGA tools and procedures, and how principles of integrated care were applied in these CGAs. Results: Twenty-six programs were included in this study, of which most were implemented in the Netherlands and the U.S. Twenty different CGA tools and procedures were identified. The majority of CGAs aimed to have a holistic, multidisciplinary and person-centred approach, although the way and extent to which CGAs incorporated these principles differed. Discussion: This systematic review highlights the variability of CGAs used in integrated care for older people living at home. The overview of CGAs may promote further exchange of CGA tools and procedures, and help researchers and professionals to not reinvent the wheel.
coordinate care for older people in home environments and to improve health outcomes while constraining healthcare expenditures.These initiatives take place in a diverse range of settings and contexts.There is still little knowledge of how to successfully implement integrated care and how to transfer successful initiatives to other regions and health systems.Therefore, a cross-European research project, called SUSTAIN, was initiated.Partners from nine EU Member States collaborate to: 1. improve established integrated care initiatives for older people and 2. make improvements applicable and adaptable to other health systems and regions in Europe.In this symposium, we present the SUSTAIN project and findings from the first phase of the project.First, we outline the overall design of the SUSTAIN project.Second, we present the experiences of one of the participating initiatives in the Netherlands with facilitators and barriers regarding the delivery of integrated care, and starting-points for improvement of current practice.Lastly, we will show the results of overarching analyses, which integrate and compare outcomes of evaluations done at the initiatives in all seven countries.After attending this session, participants will be aware of a diverse range of existing integrated care initiatives in Europe and will be able to explain how the SUSTAIN project aims to improve integrated care for older people across Europe.
