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As a result of increasing digitisation of medical record keeping, electronic health records (EHRs) are an attractive source for data reuse. However, such record-based research is still suffering from poor quality of data stored in EHRs. Lack of consent for reuse of data also plays an impeding role, especially in retrospective record-based research. That said, increasing cooperation between healthcare institutions and current attention for EHR organisation also offer opportunities for record-based research. Patient data can be recorded in more standardised ways and in increasingly harmonised EHRs. In addition, if healthcare institutions were to establish a generic consent procedure - preferably with national scope - the potential of EHRs for scientific research could be exploited in considerably better ways.

Objective: To compare the effectiveness of two strategies to improve antibiotic use in patients with a complicated urinary tract infection., Design: Multicentre cluster randomised unblinded trial., Method: The departments of Internal Medicine and Urology from 19 hospitals in the Netherlands took part in this trial. Based on retrospective patient record investigations we performed baseline measurements on the scores of a validated set of quality indicators for antibiotic use in a minimum of 50 patients with a complicated urinary tract infection per department in 2009. A similar post-trial measurement took place in 2012. In 2010 we randomised the hospitals between 2 improvement strategies: a multifaceted strategy that included results of the baseline measurements, education, reminders and assistance with optional improvement interventions, and a competitive feedback strategy, in which the departments only received results of the baseline measurements and non-anonymous results from the other departments in this study arm. The primary outcome measure was improvement of the quality indicator scores. Secondary outcome measures were determinants of improvement of the indicators. (Netherlands Trial Register: NTR1742) RESULTS: The baseline and post-trial measurements were performed on 1,964 patients and 2,027 patients, respectively. Post-trial measurements revealed a significant, but limited, improvement of several indicators compared with baseline measurements. We found no significant difference in improvement between the two strategies for any indicator. The intensity with which the departments implemented improvement strategies was mostly suboptimal, but intensive implementation of a strategy was associated with greater improvement., Conclusion: The effectiveness of both improvement strategies was comparable, but limited. For real improvement in antibiotic use in patients with complicated urinary tract infections, improvement interventions should be developed and applied by local professionals themselves.

Objective: To gain an insight into the costs and health outcomes of effectiveness studies in obstetrics at a national level., Design: Budget impact analysis., Method: We searched for obstetric effectiveness studies. The possible budget impact of implementation in all patients in the Netherlands was calculated, as well as health benefits for mothers and their children., Results: We used eight multicentre randomized trials with almost 11,000 patients in total. The total potential cost reduction for these trials was € 9.6 million per year, on the basis of a one-time investment in the trials of € 3.1 million. When implementing the results of these studies, a health benefit is shown in women with hypertension or pre-eclampsia at term, women in whom labour is induced and women with fetal monitoring. This also applied to the children of these women. Furthermore, removal or non-implementation of interventions that have no positive effect on health such as prolonged tocolysis, the use of progestogens in twin pregnancies, intrauterine pressure catheters, and induction of labour in preterm ruptured membranes reduces care costs., Conclusion: Adequate application of the results of effectiveness studies in obstetrics should result in considerable health gains and cost reduction when compared with provision of non-scientifically supported care.

Objective: To gain insight into the guidelines established for the care of failed suicides in general hospitals, and into the degree to which these guidelines are observed in practice., Design: Descriptive, retrospective., Setting: Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands., Method: An inventory of guidelines for the care of failed suicides was made by interviewing seven psychiatrists on the staff of general hospitals. The inventory was limited to access (interval between admission and referral/consultation), and the coordination of the care (i.e. adjustment to the patient's condition, transfer of information). Subsequently, the cases of all failed suicides admitted to these hospitals in 1991 were studied to find out how these guidelines were observed in practice; use was made for this purpose of data from a more extensive European study., Results: All seven hospitals proved to have rules for coping with tailed suicides. Guidelines concerning accessibility of care were fairly similar in the various hospitals; regarding the coordination of care, more local variants were found to exist. The accessibility of care was found to be mostly in accordance with the guidelines. There were more deviations from the guidelines where the coordination of care was concerned; in addition, there were substantial differences between the hospitals in the degrees to which deviation from the guidelines occurred., Conclusion: Guidelines for the care of failed suicides admitted to general hospitals were not in all respects similar; the observance differed markedly, especially regarding the coordination of care.