Global Aim: To optimize health care quality and to achieve best patient outcomes at the local, regional, national and international level, through excellent research and education. Specific Aims:
- Evaluate treatment effectiveness by exploiting between-hospital variation in comparative effectiveness research (CER)
- Innovate the implementation and evaluation of patient reported outcome and experience measures, using the value based healthcare (VbHC) approach
- Advancing personalized medicine (PM) through research on outcome prediction, patient centered care, shared decision making, and advance care planning
- Develop and evaluate evidence based interventions to improve patient safety (PS) and to prevent health care related infections
Research Activities
This ACE focuses on translational, clinical and epidemiological research. Examples include:
1.CER:
- Plastic and Reconstructive Surgery: Clinically diagnostic and therapeutic studies using extensive data from hand and wrist clinics.
- Rehabilitation, Neurosurgery, Public Health and Neurology: Studies on variations in outcome, process, and structure of care to identify effective interventions and improve quality of care in neurotrauma.
2.VBHC:
- Expert group VBHC: Introduction and use of PROMs
- iBMG: Research on the governance of quality, including the role of external regulators on the implementation and sustainability of quality measures.
- Plastic and Reconstructive Surgery and Breast Cancer Center: Multidisciplinary outcome studies on breast reconstruction; PROMs after breast conserving surgery; shared decision making.
3.PM:
- Palliative and End-of-Life Care: Development of an instrument for decision making in the final stage of life; personalized symptom management in advanced cancer by internet monitoring. Multi-center RCT for advance care planning in oncology patients.
4.PS:
- Infection Prevention: patient safety with continued surveillance, intervention and prevention of highly resistant microorganisms; intervention to combat mechanisms of spreading. Collaborations: ICHOM, Karolinska Hospital; Mayo Clinic; Imperial College London; EONS (European Oncology Nursing Society); OPCARE (international collaboration to optimize care for the dying); IKNL; NFU; AMC; TU Delft; LUMC.
Collaborations
ICHOM, Karolinska Hospital; Mayo Clinic; Imperial College London; EONS (European Oncology Nursing Society); OPCARE (international collaboration to optimize care for the dying); IKNL; NFU; AMC; TU Delft; LUMC.
Contributions
ACE participants provide the course "Physician and Society" (bachelor medicine) and the internship "Population health" (master medicine) for medical students, including education on health care quality. Specific topics are also integrated in disease-oriented courses (e.g. prevention of Health Care Associated Infections in the course "Infection and Immunity).
In 2012 the Dutch review committee of basic medical education recommended curriculum shifts, including more focus on health care quality. A longitudinal track ('leerlijn Samenwerken voor Optimale Zorg en Preventie') is currently being implemented by members of the ACE. Post graduate teaching on health care quality topics is integrated in courses of the Netherlands Institute of Health Sciences (NIHES).
Contributions are made to the NFU master program on Quality and Safety of healthcare, and the master Healthcare Management (iBMG). Besides these efforts education is given to nurses (pre and postgraduate), research fellows, and medical specialists in training, nationally and internationally. Moreover there is strong participation in the Consultation center for Patient related Research (CPO) and proposed ACE Quantitative Methods. Plastic Surgery organizes the minor 'Reconstruction: from Head to Hands'; responsible for 'lijnonderwijs Academische Vorming' of Clinical Technology BSc.
Care Activities
The research in the ACE focusses on 5 disease groups and results of our studies will be directly used to improve patient care. In addition, infection prevention, eHealth and patient safety contribute to improvement of patient care for multiple diseases.
- Neurological Disorders (treatment and rehabilitation) - Stroke - Brain Tumors - Traumatic Brain Injury
- Oncological Disorders - Larynx Carcinoma - Breast Cancer
- Congenital Malformations - Cleft Lip Palate - Hemifacial Microsomia - Congenital Hand Abnormalities
- Acute Care - Pediatric Intensive Care - Pediatric Emergency Care - Adult Intensive Care
- Chronic & Palliative Care: - Pressure ulcers - End of life care All these disease groups are working with care pathways and are multidisciplinary. Groups 1,2,3 and 5 are participating in the Value Based Healthcare (VBHC) program.
Societal Relevance to Research, Education and Patient Care
With our Health Care Quality and comparative effectiveness research we aim to assess the cost-effectiveness of existing treatments and interventions, which has direct implications for the health care and society. Moreover, we develop methods to use quality registries and benchmarks to identify optimal treatment approaches.
Examples include the Net-QuRe and CENTER-TBI projects that will cover both hospital and rehabilitation care for patients with moderate and severe brain injury, with a focus on outcome measures, so that the continuous care chain for TBI is covered. The infrastructure that results from these projects will be used for future studies in- and outside the field of TBI and will allow for (inter)national involvement of acute care hospitals and rehabilitation centers.
Another topic with high societal relevance is infection prevention. Infection prevention in the hospital is a prerequisite for safe patient care. The ministry of health has focused on the resistant microorganisms. Several of our PIs are in (inter)national guideline committees, e.g. on breast reconstruction, palliative and end-of-life care, and national program of prevention HRMO, and VBHC.
Viability of Research, Education and Patient Care
The PIs of our ACE are in different age groups and different phases in their scientific career. In addition, our ACE includes a large number of PhD students, who are supervised by a large set of postdocs and assistant professors. The PIs of the ACE participate in numerous international collaborations and are in the (inter)national top of their research fields.
In terms of publications, 3 of our PIs have over 500 publications in Pubmed, an additional 3 have over 200 publications and an additional 9 have over 100 publications. All more junior researchers are actively involved in international projects and are encouraged to undertake international research visits.
PhD students have the opportunity to present their work on international conferences on a yearly basis. The department of public health was in the front to use a yearly structured talent review as a standard procedure. Talent reviews will also be implemented at the level of the complete ACE.
Key and relevant publications of the last five years
- van de Bovenkamp, H., Stoopendaal, A., & Bal, R. (2016). Living with layers. The governance and regulation of health care quality in an institutionally layered system. Public Policy & Administration.
- de Putter CE, Selles RW, Polinder S, Panneman MJ, Hovius SE, van Beeck EF. Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study. J Bone Joint Surg Am. 2012 May 2;94(9):e561-7.
- De Raaf PJ, de Klerk C, Timman R, Busschbach JJ, Oldenmenger WH, van der Rijt CCD. Systematic monitoring and treatment of physical symptoms to alleviate fatigue in patients with advanced cancer: a randomized controlled trial. J Clin Oncol, 2013; 31: 716-723
- Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC, Boersma E, Helder OK. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. Lancet Infect Dis. 2016 Jun;16(6):724-34.
- Vos EL, Jager A, Verhoef C, Voogd AC, Koppert LB. Overall survival in patients with a re-excision following breast conserving surgery compared to those without in a large population-based cohort. Eur J Cancer. 2015 Feb;51(3):282-91.
- Latour JM, Duivenvoorden HJ, Tibboel D, Hazelzet JA; EMPATHIC Study Group. The shortened EMpowerment of PArents in THe Intensive Care 30 questionnaire adequately measured parent satisfaction in pediatric intensive care units. J Clin Epidemiol. 2013 Sep; 66:1045-50
- Visser IH, Hazelzet JA, Albers MJ, Verlaat CW, Hogenbirk K, van Woensel JB, van Heerde M, van Waardenburg DA, Jansen NJ, Steyerberg EW. Mortality prediction models for pediatric intensive care: comparison of overall and subgroup specific performance. Intensive Care Med. 2013 May;39(5):942-50
- Elbert NJ, Os-Medendorp van H, Renselaar van W, Ekeland AG, Hakkaart-van Roijen L, Raat H, Nijsten TEC, Pasmans SGMA. Effectiveness and cost-effectiveness of eHealth interventions in somatic diseases: a systematic review of systematic reviews and meta-analyses. J Med Internet Res. 2014 Apr 16;16(4):e110
- Berkhemer OA, ….., Lingsma HF, …… Steyerberg EW, ……, van der Lugt A, ….., Dippel DW; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 Jan 1;372(1):11-20
- Rietjens JA, Korfage IJ, ….., Jabbarian LJ…. Polinder S, …., van der Heide A. Advance care planning - a multi-centre cluster randomised clinical trial: the research protocol of the ACTION study. BMC Cancer. 2016 Apr 8;16(1):264
PhD theses of the last five years
- Maasland, L., 2011. Improving Stroke Care, Quality of care and health education in patients with stroke or TIA. D. Dippel, P Koudstaal
- Van Dishoeck, AM., 2015. Indicators for quality of hospital care: beyond the numbers E Steyerberg, J Mackenbach
- Fischer, C., 2015. Quality indicators for hospital care: reliability and validity. E. Steyerberg N Klazinga
- Slaghuis, S., 2016. Riding the waves of quality improvement.R. Bal
- Kan,H., 2015. Straightforward. Innovation and evaluation of Dupuytren’s disease. S Hovius
- Gopie, J., 2013. The psychological impact of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer. Tibben
- Boerboom, W., 2016. Subarachnoid haemorrhage: a study on long-term consequences. GM Ribbers
- Visser, M., 2016. How to cope with Stroke? The effectiveness of Problem solving Therapy GM Ribbers en J van Busschbach
- Witkamp FE., 2014. What happens & what matters: a study on palliative and terminal care in the hospital. A. van der Heide, C.C.D. van der Rijt
- Erasmus, V., 2012. Compliance to hand hygiene guidelines in hospital care; E Steyerberg