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1دورية أكاديمية
المؤلفون: Benahmed, Nadia
المساهمون: Devos, Carl, San Miguel, Lorena, Vinck, Imgard, Vankelst, Liesbeth, Verschueren, Marguerite, Obyn, Caroline, Paulus, Dominique, Christiaens, Wendy
مصطلحات موضوعية: Infant, Newborn, Length of Stay, Maternal Health Services, Postnatal care, Postpartum Period, Pregnancy, R232, statistics and numerical data [Subheading], WQ 500 General works. Postnatal care
جغرافية الموضوع: Study HSR 2013-15
الوقت: 2013-15
الوصف: 32 p. ; ill., ; FORWORD 1 -- ABSTRACT 2 -- SYNTHESE 5 -- 1. INTRODUCTION 7 -- 1.1. POSTNATAL CARE MATTERS FOR MANY 7 -- 1.2. THE TREND TOWARDS SHORTER HOSPITAL STAYS AFTER CHILDBIRTH IN ITS SOCIETAL CONTEXT 7 -- 1.2.1. Shorter length of stay after childbirth 7 -- 1.2.2. The formalisation of support resources during the transition to parenthood 7 -- 1.3. GOAL: CONCEPTUALISATION OF BUILDING BLOCKS FOR INTEGRATED AND SEAMLESS POSTNATAL CARE IN BELGIUM 8 -- 1.4. DEFINITIONS 8 -- 1.4.1. Healthy mothers and term infants 8 -- 1.4.2. Postnatal period 8 -- 1.5. METHODS 8 -- 2. PROBLEMS IN THE ORGANISATION OF POSTNATAL CARE 9 -- 2.1. MACRO LEVEL PROBLEMS 9 -- 2.2. DISPERSED LOCAL INITIATIVES 10 -- 3. BUILDING BLOCKS FOR INTEGRATED AND SEAMLESS POSTNATAL CARE IN BELGIUM 10 -- 3.1. PLAN AND COORDINATE POSTNATAL CARE 12 -- 3.1.1. A multidisciplinary perinatal care network around each mother and newborn 12 -- 3.1.2. Coordinate, register and prepare by means of a shared web-based maternity record 13 -- 3.1.3. Perinatal care coordinators 14 -- 3.1.4. National Perinatal Care Platform 15 -- 3.2. ANTENATAL PREPARATION RESULTING IN AN INDIVIDUAL POSTNATAL CARE PLAN 15 -- 3.3. PROVIDE SEAMLESS POSTNATAL CARE, LESS AT HOSPITAL, MORE AT HOME 16 -- 3.3.1. Shift inpatient to outpatient care after uncomplicated vaginal delivery 16 -- 3.3.2. Discharge: seamless care with a clinical pathway 18 -- 3.3.3. Guarantee follow-up at home during the first week of life 18 -- 3.4. DEVELOP AND IMPLEMENT UNIFORM READMISSION PROCEDURES FOR NEWBORNS AND THEIR MOTHERS 20 -- 3.5. PROCESSES IN SUPPORT OF QUALITY OF POSTNATAL CARE 21 -- 3.5.1. Quality criteria based on clinical guideline for postnatal care 21 -- 3.5.2. Upgrade competences and foresee appropriate training for midwives and physicians 21 -- 3.6. SUPPORT PARENTS IN THEIR (NEW) CARING ROLE 21 -- 3.6.1. Provide maternity home assistance 21 -- 3.6.2. Foster peer support 22 -- 3.7. PAYMENT SYSTEMS TO FACILITATE INTEGRATED AND SEAMLESS POSTNATAL CARE AND IN SUPPORT OF SHORTER HOSPITAL STAYS 23 -- ...
وصف الملف: A4
العلاقة: KCE Reports; Health Services Research (HSR); Vignette : https://kce.docressources.info/thumbnail.php?type=1&id=3460Test; https://kce.docressources.info/index.php?lvl=notice_display&id=3460Test; 3460; urn:ISBN:D/2014/10.273/82
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2دورية أكاديمية
المؤلفون: Benahmed, Nadia
المساهمون: Devos, Carl, San Miguel, Lorena, Vinck, Imgard, Vankelst, Liesbeth, Verschueren, Marguerite, Obyn, Caroline, Paulus, Dominique, Christiaens, Wendy
مصطلحات موضوعية: Infant, Newborn, Length of Stay, Maternal Health Services, Postnatal care, Postpartum Period, Pregnancy, R232, statistics and numerical data [Subheading], WQ 500 General works. Postnatal care
جغرافية الموضوع: Study HSR 2013-15
الوقت: 2013-15
الوصف: 42 p. ; ill., ; 1. COMPETENCES FOR THE ORGANISATION OF MATERNITY HOME CARE ASSISTANCE 2-- 2. LIST OF NOMENCLATURE CODES FOR THE SELECTION OF DELIVERIES IN THE IMA-AIM DATABASE 4-- 3. NUMBER OF DELIVERIES PER YEAR IN BELGIUM (INPATIENT & OUTPATIENT) 5-- 4. NUMBER OF DELIVERIES AND NUMBER OF M BEDS BY HOSPITAL 6-- 5. EXPLANATION NOMENCLATURE CODES FOR MIDWIFE CONSULTATIONS 7-- 6. LENGTH OF STAY BY NUMBER OF DELIVERIES FOR EACH MATERNITY WARD 9-- 7. LENGTH OF STAY PER HOSPITAL IN FUNCTION OF THE DELIVERIES PER BED RATIO FOR 2011. 10-- 8. MEAN LENGTH OF STAY IN FUNCTION OF THE PROPORTION OF CAESAREAN SECTIONS 11-- 9. INFORMED CONSENT FORM FOCUS GROUP INTERVIEWS 12-- 9.1. INFORMATIE VOOR DEELNEMERS 12-- 9.2. TOESTEMMINGSVERKLARING 13-- 10. INTERVIEW GUIDE MATERNITY HOME CARE ASSISTANCE SERVICES 14-- 10.1. INTRODUCTIE 14-- 10.2. VRAGEN 15-- 11. INTERVIEW GUIDE FOR MOTHERS WITH CLASSIC HOSPITAL STAY 16-- 11.1. INTRODUCTIE 16-- 11.2. VRAGEN 17-- 12. INTERVIEW GUIDE FOR MOTHERS WITH A SHORT HOSPITAL STAY 20-- 12.1. INTRODUCTIE 20-- 12.2. VRAGEN 21-- 13. INTERVIEW GUIDE FOR PHYSICIANS AND MIDWIVES 24-- 13.1. INTRODUCTIE 24-- 13.2. VRAGEN 25-- 14. QUOTES FROM FOCUS GROUP INTERVIEWS WITH HEALTH CARE PROFESSIONALS AND MOTHERS 27-- 14.1. QUOTES FROM HEALTH CARE PROFESSIONALS 27
وصف الملف: A4
العلاقة: KCE Reports; Health Services Research (HSR); Vignette : https://kce.docressources.info/thumbnail.php?type=1&id=3461Test; https://kce.docressources.info/index.php?lvl=notice_display&id=3461Test; 3461; urn:ISBN:D/2014/10.273/83
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3دورية أكاديمية
المؤلفون: Benahmed, Nadia
المساهمون: Devos, Carl, San Miguel, Lorena, Vinck, Imgard, Vankelst, Liesbeth, Verschueren, Marguerite, Obyn, Caroline, Paulus, Dominique, Christiaens, Wendy
مصطلحات موضوعية: Infant, Newborn, Length of Stay, Maternal Health Services, Postnatal care, Postpartum Period, Pregnancy, R232, statistics and numerical data [Subheading], WQ 500 General works. Postnatal care
جغرافية الموضوع: Studie HSR 2013-15
الوقت: 2013-15
الوصف: 31 p. ; ill., ; In het budgetvoorstel voor de gezondheidszorg van de regering vindt men een maatregel om het verblijf in de kraamkliniek na de bevalling in te korten. Dit voorstel volgt daarmee een internationale trend, waarbij vrouwen met hun pasgeboren baby steeds vroeger de kraamafdeling verlaten. Volgens het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) is dit in België, waar de duur van de kraamverblijven nog steeds hoger ligt dan in de meeste andere westerse landen, ook mogelijk, maar daarvoor is wel een grondige reorganisatie van de postnatale zorg noodzakelijk. Het KCE stelt een model voor, gebaseerd op de wetenschappelijke literatuur, op voorbeelden uit het buitenland en op het advies van moeders en de betrokken zorgverstrekkers. Het stelt voor om postnatale zorg beter te integreren in de periode die start in de zwangerschap en die doorloopt tot enkele weken na de geboorte. Het dringt ook aan op initiatieven om ouders in hun nieuwe rol te ondersteunen, met daarbij extra aandacht voor kwetsbare gezinnen. ; VOORWOORD 1 -- SAMENVATTING 2 -- ACHTERGROND 2 -- DOEL 2 -- METHODEN 3 -- RESULTATEN 3 -- POSTNATALE ZORG IN BELGIË 3 -- BOUWSTENEN VOOR EEN BETERE POSTNATALE ZORG IN BELGIË 4 -- CONCLUSIE 4 -- SYNTHESE 5 -- INHOUDSTAFEL 5 -- 1. INLEIDING 7 -- 1.1. DE VERBLIJFSDUUR IN DE KRAAMKLINIEK WORDT KORTER 7 -- 1.1.1. Hoeveel geboorten zijn er in België? 7 -- 1.1.2. Definities en methoden 8 -- 2. WELKE ZIJN DE BELANGRIJKSTE PROBLEMEN IN DE ORGANISATIE VAN DE POSTNATALE ZORG IN BELGIË? 9 -- 2.1. OP MACROSCOPISCH NIVEAU 9 -- 2.2. OP LOKAAL NIVEAU 10 -- 3. AANBEVELINGEN VOOR GEÏNTEGREERDE EN CONTINUE POSTNATALE ZORG 11 -- 3.1. PLANNEN EN COÖRDINEREN VAN EEN TOTAALTRAJECT VAN ZWANGERSCHAP TOT POSTPARTUM 13 -- 3.1.1. Een multidisciplinair perinataal netwerk rond elke (toekomstige) moeder en kind 13 -- 3.1.2. Een elektronisch moederschapsdossier 13 -- 3.1.3. Een perinatale zorgcoördinator 15 -- 3.1.4. Een Nationaal Platform voor Perinatale Zorg 16 -- 3.2. REEDS VÓÓR DE GEBOORTE EEN PLAN OPSTELLEN VOOR ...
وصف الملف: A4
العلاقة: KCE Reports A; Health Services Research (HSR); Vignette : https://kce.docressources.info/thumbnail.php?type=1&id=3463Test; https://kce.docressources.info/index.php?lvl=notice_display&id=3463Test; 3463; urn:ISBN:D/2014/10.273/79
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4دورية أكاديمية
المؤلفون: Benahmed, Nadia
المساهمون: Devos, Carl, San Miguel, Lorena, Vinck, Imgard, Vankelst, Liesbeth, Verschueren, Marguerite, Obyn, Caroline, Paulus, Dominique, Christiaens, Wendy
مصطلحات موضوعية: Infant, Newborn, Length of Stay, Maternal Health Services, Postnatal care, Postpartum Period, Pregnancy, R232, statistics and numerical data [Subheading], WQ 500 General works. Postnatal care
جغرافية الموضوع: Study HSR 2013-15
الوقت: 2013-15
الوصف: 115 p. ; ill., ; SCIENTIFIC REPORT .8 -- 1 INTRODUCTION 8 -- 1.1 POSTNATAL CARE MATTERS FOR MANY 8 -- 1.2 THE TREND TOWARDS SHORTER HOSPITAL STAY AFTER CHILDBIRTH IN ITS SOCIETAL -- CONTEXT .9 -- 1.2.1 Shorter length of stay after childbirth 9 -- 1.2.2 The formalisation of support resources during the transition to parenthood 9 -- 1.2.3 Relevance of studying postnatal care 11 -- 1.3 SCOPE OF THE STUDY.11 -- 1.4 DEFINITIONS 11 -- 1.4.1 Healthy mothers and term infants 11 -- 1.4.2 Postnatal period 11 -- 1.4.3 Postnatal home care (Kraamzorg / Soins postnataux) .12 -- 1.4.4 Maternity home care assistance (Kraamhulp / Soutien maternel à domicile) 12 -- 1.4.5 Early discharge .12 -- 2 ORGANISATION, UPTAKE AND FINANCING OF POSTNATAL CARE IN BELGIUM 12 -- 2.1 ORGANISATION OF POSTNATAL CARE AND MATERNITY HOME CARE ASSISTANCE IN BELGIUM 12 -- 2.1.1 Postnatal care. 12 -- 2.1.2 Maternity home care assistance 16 -- 2.1.3 Agencies for prevention and support to young children and their parents .17 -- 2.1.4 Coordination initiatives at early discharge from the maternity clinic 20 -- 2.2 PATTERNS OF CARE USE DURING THE POSTNATAL PERIOD .22 -- 2.2.1 Data selection 22 -- 2.2.2 Total number of deliveries 23 -- 2.2.3 Place of childbirth .23 -- 2.2.4 Type of delivery .23 -- 2.2.5 Characteristics of inpatient postnatal care use .24 -- 2.2.6 Characteristics of outpatient postnatal care use 30 -- 3 PRESENT REGISTRATION OF PERINATAL DATA .35 -- 3.1 REGISTRATION OF PERINATAL DATA 35 -- 3.2 REGISTRATION OF NEONATAL (RE)ADMISSIONS .35 -- 4 POSTNATAL CARE IN BELGIUM THROUGH THE EYES OF HEALTH CARE PROFESSIONALS AND MOTHERS: A FOCUS GROUP STUDY .36 -- 4.1 INTRODUCTION .36 -- 4.2 METHODS 36 -- 4.2.1 Design 36 -- 4.2.2 Data collection 36 -- 4.2.3 Ethical approval .39 -- 4.2.4 Data-analysis .39 -- 4.3 FINDINGS FROM THE FOCUS GROUPS WITH PROFESSIONAL CARE PROVIDERS 40 -- 4.3.1 Mothers are not well prepared for and stand alone in the postnatal period 40 -- 4.3.2 Postnatal care starts during pregnancy 40 -- 4.3.3 Problems related to the length of ...
وصف الملف: A4
العلاقة: KCE Reports; Health Services Research (HSR); Vignette : https://kce.docressources.info/thumbnail.php?type=1&id=3459Test; https://kce.docressources.info/index.php?lvl=notice_display&id=3459Test; 3459; urn:ISBN:D/2014/10.273/82
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5دورية أكاديمية
المؤلفون: Benahmed, Nadia
المساهمون: Devos, Carl, San Miguel, Lorena, Vinck, Imgard, Vankelst, Liesbeth, Verschueren, Marguerite, Obyn, Caroline, Paulus, Dominique, Christiaens, Wendy
مصطلحات موضوعية: Infant, Newborn, Length of Stay, Maternal Health Services, Postnatal care, Postpartum Period, Pregnancy, R232, statistics and numerical data [Subheading], WQ 500 General works. Postnatal care
جغرافية الموضوع: Etude HSR 2013-15
الوقت: 2013-15
الوصف: 31 p. ; ill., ; Dans la proposition de budget des soins de santé du gouvernement, on trouve une mesure qui vise à raccourcir la durée du séjour en maternité après un accouchement. Cette proposition s’inscrit dans une tendance internationale qui voit les femmes quitter l’hôpital avec leur nouveau-né de plus en plus tôt après la naissance. D’après le Centre Fédéral d’Expertise des Soins de Santé (KCE), un tel modèle est effectivement possible en Belgique – où les durées moyennes de séjour sont plus longues que dans les autres pays occidentaux – mais cela implique une réorganisation fondamentale des soins postnatals. En se basant sur l’avis des mamans, des acteurs de terrain et sur l’exemple de quelques pays pionniers, le KCE propose de repenser l’ensemble de la période ‘grossesse et après-naissance’ comme une continuité et de recentrer le suivi postnatal sur le domicile. Il préconise également de développer des initiatives de soutien des parents dans leur nouveau rôle, avec une attention particulière pour les familles vulnérables. ; AVANT-PROPOS 1 -- RÉSUMÉ 2 -- CONTEXTE. 2 -- OBJECTIF 2 -- MÉTHODES 3 -- RÉSULTATS 3 -- ORGANISATION DES SOINS POSTNATALS EN BELGIQUE 3 -- COMMENT AMÉLIORER LES SOINS POSTNATALS EN BELGIQUE : ÉLÉMENTS CLÉS 4 -- CONCLUSIONS 4 -- SYNTHÈSE 5 -- 1. INTRODUCTION 7 -- 1.1. LES DURÉES DE SÉJOUR EN MATERNITÉ DIMINUENT 7 -- 1.1.1. Combien de naissances en Belgique ? 7 -- 1.1.2. Définitions et méthodes 8 -- 2. QUELS SONT LES PRINCIPAUX PROBLÈMES DANS L’ORGANISATION DES SOINS POSTNATALS EN BELGIQUE ? 9 -- 2.1. AU NIVEAU MACROSCOPIQUE 9 -- 2.2. À L’ÉCHELLE LOCALE 10 -- 3. RECOMMANDATIONS POUR DES SOINS POSTNATALS INTÉGRÉS ET CONTINUS 11 -- 3.1. PLANIFIER ET COORDONNER UNE TRAJECTOIRE GLOBALE DE LA GROSSESSE AU POSTPARTUM 13 -- 3.1.1. Un réseau multidisciplinaire périnatal autour de chaque (future) mère et son enfant 13 -- 3.1.2. Un dossier de maternité informatisé 13 -- 3.1.3. Un coordinateur de soins périnatals 15 -- 3.1.4. Une Plateforme Nationale de Soins Périnatals 16 -- 3.2. DÈS AVANT LA ...
وصف الملف: A4
العلاقة: KCE Reports B; Health Services Research (HSR); Vignette : https://kce.docressources.info/thumbnail.php?type=1&id=3462Test; https://kce.docressources.info/index.php?lvl=notice_display&id=3462Test; 3462; urn:ISBN:D/2014/10.273/80
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6
المؤلفون: Sun, Ying
المساهمون: Paulus, Dominique, Eyssen, Marijke, Maervoet, Johan, Saka, Ömer R.
مصطلحات موضوعية: Stroke, statistics and numerical data [Subheading], Journal Article, Humans, R181, W 1 Serials. Periodicals, Treatment outcome, Length of Stay, Hospital Units, Needs Assessment, 2011-20
الوصف: 11 p. BACKGROUND: The benefits of stroke unit care in terms of reducing death, dependency and institutional care were demonstrated in a 2009 Cochrane review carried out by the Stroke Unit Trialists' Collaboration. METHODS: As requested by the Belgian health authorities, a systematic review and meta-analysis of the effect of acute stroke units was performed. Clinical trials mentioned in the original Cochrane review were included. In addition, an electronic database search on Medline, Embase, the Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database (PEDro) was conducted to identify trials published since 2006. Trials investigating acute stroke units compared to alternative care were eligible for inclusion. Study quality was appraised according to the criteria recommended by Scottish Intercollegiate Guidelines Network (SIGN) and the GRADE system. In the meta-analysis, dichotomous outcomes were estimated by calculating odds ratios (OR) and continuous outcomes were estimated by calculating standardized mean differences. The weight of a study was calculated based on inverse variance. RESULTS: Evidence from eight trials comparing acute stroke unit and conventional care (general medical ward) were retained for the main synthesis and analysis. The findings from this study were broadly in line with the original Cochrane review: acute stroke units can improve survival and independency, as well as reduce the chance of hospitalization and the length of inpatient stay. The improvement with stroke unit care on mortality was less conclusive and only reached borderline level of significance (OR 0.84, 95% CI 0.70 to 1.00, P = 0.05). This improvement became statistically non-significant (OR 0.87, 95% CI 0.74 to 1.03, P = 0.12) when data from two unpublished trials (Goteborg-Ostra and Svendborg) were added to the analysis. After further also adding two additional trials (Beijing, Stockholm) with very short observation periods (until discharge), the difference between acute stroke units and general medical wards on death remained statistically non-significant (OR 0.86, 95% CI 0.74 to 1.01, P = 0.06). Furthermore, based on figures reported by the clinical trials included in this study, a slightly higher proportion of patients became dependent after receiving care in stroke units than those treated in general medical wards - although the difference was not statistically significant. This result could have an impact on the future demand for healthcare services for individuals that survive a stroke but became dependent on their care-givers. CONCLUSIONS: These findings demonstrate that a well-conducted meta-analysis can produce results that can be of value to policymakers but the choice of inclusion/exclusion criteria and outcomes in this context needs careful consideration. The financing of interventions such as stroke units that increase independency and reduce inpatient stays are worthwhile in a context of an ageing population with increasing care needs. One limitation of this study was the selection of trials published in only four languages: English, French, Dutch and German. This choice was pragmatic in the context of this study, where the objective was to support health authorities in their decision processes.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=od______1879::34f34f7fd9a81d3e660c9522b2f0215fTest
https://kce.docressources.info/index.php?lvl=notice_display&id=3727Test -
7دورية أكاديمية
المؤلفون: Neyt, Mattias
المساهمون: Cleemput, Irina, Thiry, Nancy, De Laet, Chris
مصطلحات موضوعية: Cost-Benefit Analysis, Epidemiologic Studies, Health Care Costs, Journal Article, Peer Review, Randomized Controlled Trials, statistics and numerical data [Subheading], Treatment outcome, W 1 Serials. Periodicals
الوصف: p. 207-210 ; Economic evaluations most often use results from randomised controlled trials (RCTs) to model effectiveness. Inconsiderate application of the absolute treatment effect from RCTs may result in unrealistic estimates of an intervention's benefit for the real-world target population. The baseline risk of events in this target population may differ significantly from the baseline risk in the RCT population. An approach to handle this problem is to combine observational data with evidence from RCTs. Reliable administrative or register data can provide an estimate of the real-world baseline risks. In combination with the relative treatment effect from well-performed RCTs this results in an estimate of the absolute benefit for the relevant target population. Applying this approach, one must remain cautious about the validity of the assumption of a constant relative treatment effect.
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8دورية أكاديمية
المؤلفون: Vrijens, France
المساهمون: Hulstaert, Frank, Devriese, Stephan, Van de Sande, Stefaan
مصطلحات موضوعية: Aged, Belgium, Case studies, Cross Infection, Epidemiology, Health Care Costs, Journal Article, Length of Stay, Mortality, Peer Review, statistics and numerical data [Subheading], W 1 Serials. Periodicals
الوصف: p. 126-136 ; Assessing the overall burden of disease which can be attributed to hospital-acquired infections (HAIs) remains a challenge. A matched cohort study was performed to estimate excess mortality, length of stay and costs attributable to HAIs in Belgian acute-care hospitals, using six matching factors (hospital, diagnosis-related group, age, ward, Charlson score, estimated length of stay prior to infection). Information was combined from different sources on the epidemiology and burden of HAIs to estimate the impact at national level. The total number of patients affected by a HAI each year was 125 000 (per 10·9 million inhabitants). The excess mortality was 2·8% and excess length of stay was 7·3 days, corresponding to a public healthcare cost of €290 million. A large burden was observed outside the intensive-care unit setting (87% of patients infected and extra costs, 73% of excess deaths).
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9دورية أكاديمية
المؤلفون: Franken, Margreet
المساهمون: le Polain, Maïté, Cleemput, Irina, Koopmanschap, Marc
مصطلحات موضوعية: W 1 Serials. Periodicals, Journal Article, Peer Review, R147, Cost-Benefit Analysis, Decision Making, Europe, Health Policy, Insurance, Health, Reimbursement, statistics and numerical data [Subheading], Quality of Life, Quality of Health Care
الوقت: 2009-19
الوصف: 3349-357 ; Objectives: The aim of our study is to compare five European drug reimbursement systems, describe similarities and differences, and obtain insight into their strengths and weaknesses and formulate policy recommendations. Methods: We used the analytical Hutton Framework to assess in detail drug reimbursement systems in Austria, Belgium, France, the Netherlands, and Sweden. We investigated policy documents, explored literature, and conducted fifty-seven interviews with relevant stakeholders. Results: All systems aim to balance three main objectives: system sustainability, equity and quality of care. System impact, however, is mainly assessed by drug expenditure. A national reimbursement agency evaluates reimbursement requests on a case-by-case basis. The minister has discretionary power to alter the reimbursement advice in Belgium, France, and the Netherlands. All systems make efforts to increase transparency in the decision-making process but none uses formal hierarchical reimbursement criteria nor applies a cost-effectiveness threshold value. Policies to deal with uncertainty vary: financial risk-sharing by price/volume contracts (France, Belgium) versus coverage with evidence development (Sweden, the Netherlands). Although case-by-case revisions are embedded in some systems for specific groups of drugs, systematic (group) revisions are limited. Conclusions: As shared strengths, all systems have clear objectives reflected in reimbursement criteria and all are prepared to pay for drugs with sufficient added value. However, all systems could improve the transparency of the decision-making process; especially appraisal lacks transparency. Systems could increase the use of (systematic) revisions and could make better use of HTA (among others cost-effectiveness) to obtain value for money and ensure system sustainability.
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10دورية أكاديمية
المؤلفون: Vrijens, France
المساهمون: Stordeur, Sabine, Beirens, Koen, Devriese, Stephan, Van Eycken, E., Vlayen, Joan
مصطلحات موضوعية: R150, Adult, Aged, 80 and over, Belgium, Breast Neoplasms, Hospital Mortality, statistics and numerical data [Subheading], Outcome Assessment (Health Care), Quality Indicators, Health Care, W 1 Serials. Periodicals
الوقت: 2008-52
الوصف: 261-266 ; PURPOSE: To compare processes of care and survival for breast cancer by hospital volume in Belgium, based on 11 validated process quality indicators. METHODS: Three databases were linked at the patient level: the Cancer Registry, the population and the claims databases. All women with a diagnosis of invasive breast cancer between 2004 and 2006 were selected. Hospitals were classified according to their annual volume of treated patients: <50 (very low), 50-99 (low), 100-149 (medium) and >/= 150 patients (high). Cox and logistic regression models were used to test differences in 5-year survival and in achievement of process indicators across volume categories, adjusting for age, tumor grade and stage. RESULTS: A total of 25178 women with invasive breast cancer were treated in 111 hospitals. Half of the hospitals (N=57) treated <50 patients per year. Six of eleven process indicators showed higher rates in high-volume hospitals: multidisciplinary team meeting, cytological and/or histological assessment before surgery, use of neoadjuvant chemotherapy, breast-conserving surgery rate, adjuvant radiotherapy after breast-conserving surgery, and follow-up mammography. Higher volume was also associated with improved survival. The 5-year observed survival rates were 74.9%, 78.8%, 79.8% and 83.9% for patients treated in very-low-, low-, medium- and high-volume hospitals respectively. After case-mix adjustment, patients treated in very-low- or low-volume hospitals had a hazard ratio for death of 1.26 (95% CI 1.12, 1.42) and 1.15 (95% CI 1.01, 1.30) respectively compared with high-volume hospitals. CONCLUSION: Survival benefits reported in high-volume hospitals suggest a better application of recommended processes of care, justifying the centralization of breast cancer care in such hospitals.
