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Background: In Northwestern Switzerland, recent legislation tackles the needs of community-dwelling older adults by creating Information and Advice Centers (IACs). IACs are a new service in the community that aims to assess the needs and provide information on age-related issues to community-dwelling older adults and their families. Previous studies reported difficulties in reaching community-dwelling older adults for community-based programs. We aimed to: 1) systematically identify implementation strategies to promote the IAC among community care providers, older adults and informal caregivers; 2) monitor the delivery of these strategies by the IAC management; and 3) describe the impact of those strategies on reach of community-dwelling older adults. This study was conducted as part of the TRANS-SENIOR project. Methods: As part of the INSPIRE feasibility assessment, we conducted a pre-test post-test study between March and September 2022. The sample included 8,840 older adults aged 65 + visiting/calling or being referred to the IAC for the first time. Implementation strategies were selected using implementation mapping and organized in bundles for each group of community care providers and older adults/caregivers. Our evaluation included: estimation of fidelity to the delivery of implementation strategies and bundles by the IAC management and their coverage; referral source of older adults to the IAC; and impact of the strategies on reach of the IAC on the 65 + population living in the care region. Adaptations to the strategies were documented using the FRAME-IS. Descriptive statistics were calculated and reported. Results: Seven implementation strategies were selected and organized in bundles for each community care provider and older adults and their caregivers. The lowest fidelity score was found in implementation strategies selected for nursing homes whereas the highest score corresponded to strategies targeting older adults and caregivers. "Informational visits" was the strategy with the lowest coverage (2.5% for nursing homes and 10.5% for hospitals and specialized clinics). The main referral sources were self-referrals and referrals by caregivers, followed by nursing homes. The IAC reach among the 65 + population was 5.4%. Conclusion: We demonstrated the use of implementation mapping to select implementation strategies to reach community-dwelling older adults. The reach was low suggesting that higher fidelity to the delivery of the strategies, and reflection on the causal pathway of the implementation strategies might be needed. [ABSTRACT FROM AUTHOR]

Aims This study aims to assess the prevalence of atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), chronic kidney disease (CKD), and their combined presence in type 2 diabetes (T2D) patients in primary care for whom the 2019 ADA/EASD consensus update "Management of Hyperglycemia in Type 2 Diabetes" recommends GLP-1 receptor agonists (GLP-1RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-I) as first-line medications after metformin. Methods Data were obtained in 2015 from Intego, a morbidity registration network of 111 general practitioners (GPs) working in 48 practices and including 123 261 registered patients. Results Of 123 261 patients, 9616 had T2D. Of these patients, 4200 (43.7%) presented with ASCVD and/or CKD and/or HF. Specifically, 3348 (34.8%) patients had ASCVD, 388 (4.0%) had heart failure, and 1402 (14.6%) had CKD. Compared to patients without any of these comorbidities, patients with at least 1 of these conditions were older (69.7 ±12.6 vs. 63.1±12.5 years), had higher LDL-C values (104.2±35.8 mg/dl vs. 97.2±37.7) and less frequently achieved the systolic blood pressure target of 140 mm Hg (53 vs. 61%) (all p<0.001). Comorbid patients also had significantly more other comorbidities, such as dementia or cancer; received more recommended medications, such as statins; and received less metformin. Most patients with HF (325; 3.4%) had ASCVD (114; 1.2%), CKD (76; 0.8%), or both (135; 1.4%). In total, 478 patients with CKD (5.0%) also had ASCVD. Conclusions At the primary care level, 44% of T2D patients suffer from ASCVD, CKD, and/or HF, and thus qualify for GLP-1RA or SGLT2-I therapy. [ABSTRACT FROM AUTHOR]

Background Intego is the only operational computerized morbidity registration network in Belgium based on general practice data. Intego collects data from over 90 general practitioners. All the information is routinely collected in the electronic health record during daily practice. Methods In this article we describe the design and methods used within the Intego network together with some of its basic results. The collected data, the quality control procedures, the ethicallegal aspects and the statistical procedures are discussed. Results Intego contains longitudinal information on 285 357 different patients, corresponding to over 2.3% of the Flemish population representative in terms of age and sex. More than 3 million diagnoses, 12 million drug prescriptions and 29 million laboratory tests have been recorded. Conclusions Intego enables us to present and compare data on health parameters, incidence and prevalence rates, laboratory results, and prescribed drugs for all relevant subgroups on a routine basis and is unique in Belgium. [ABSTRACT FROM AUTHOR]

Background Despite the efforts of the healthcare community to improve the quality of diabetes care, about 50% of people with type 2 diabetes do not reach their treatment targets, increasing the risk of future micro-and macro-vascular complications. Diabetes self-management education has been shown to contribute to better disease control. However, it is not known which strategies involving educational programs are cost-effective. Telehealth applications might support chronic disease management. Transferability of successful distant patient self-management support programs to the Belgian setting needs to be confirmed by studies of a high methodological quality. "The COACH Program" was developed in Australia as target driven educational telephone delivered intervention to support people with different chronic conditions. It proved to be effective in patients with coronary heart disease after hospitalization. Clinical and cost-effectiveness of The COACH Program in people with type 2 diabetes needs to be assessed. Design Randomized controlled trial in patients with type 2 diabetes. Patients were selected based on their medication consumption data and were recruited by their sickness fund. They were randomized to receive either usual care plus "The COACH Program" or usual care alone. The study will assess the difference in outcomes between groups. The primary outcome measure is the level of HbA1c. The secondary outcomes are: Total Cholesterol, LDL-Cholesterol, HDL-Cholesterol, Triglycerides, Blood Pressure, body mass index, smoking status; proportion of people at target for HbA1c, LDL-Cholesterol and Blood Pressure; self-perceived health status, diabetes-specific emotional distress and satisfaction with diabetes care. The follow-up period is 18 months. Within-trial and modeled cost-utility analyses, to project effects over life-time horizon beyond the trial duration, will be undertaken from the perspective of the health care system if the intervention is effective. Discussion The study will enhance our understanding of the potential of telehealth in diabetes management in Belgium. Research on the clinical effectiveness and the cost-effectiveness is essential to support policy makers in future reimbursement and implementation decisions. [ABSTRACT FROM AUTHOR]

Lyme disease has become a global public health problem and a prototype of an emerging infection. Both treatment-refractory infection and symptoms that are related to Borrelia burgdorferi infection remain subject to controversy. Because of the absence of solid evidence on prevalence, causes, diagnostic criteria, tools and treatment options, the role of autoimmunity to residual or persisting antigens, and the role of a toxin or other bacterial-associated products that are responsible for the symptoms and signs, chronic Lyme disease (CLD) remains a relatively poorly understood chronic disease construct. The role and performance of family medicine in the detection, integrative treatment, and follow-up of CLD are not well studied either. The purpose of this paper is to describe insights into the complexity of CLD as a multidimensional chronic disease construct and its relevance to family medicine by means of a systematic literature review. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate the effectiveness of a two-arm quality improvement program (QIP) to support general practice with limited tradition in chronic care on type 2 diabetes patient outcomes. Methods: During 18 months, we performed a cluster randomized trial with randomization of General Practices. The usual QIP (UQIP: 53 GPs, 918 patients) merged standard interventions including evidence-based treatment protocol, annual benchmarking, postgraduate education, case-coaching for GPs and patient education. The advanced QIP (AQIP: 67 GPs, 1577 patients) introduced additional interventions focussing on intensified follow-up, shared care and patient behavioural changes. Main outcomes were HbA1c, systolic blood pressure (SBP), and low density lipoprotein cholesterol (LDL-C), analyzed by generalized estimating equations and linear mixed models. Results: In UQIP, endpoints improved significantly after intervention: HbA1c −0.4%, 95% CI [−0.4; −0. 3]; SBP −3mmHg, 95% CI [−4; −1]; LDL-C −13mg/dl, 95% CI [−15; −11]. In AQIP, there were no significant additional improvements in outcomes: HbA1c −0.4%, 95% CI [−0.4; −0.3]; SBP −4mmHg, 95% CI [−5; −2]; LDL-C −14mg/dl, 95% CI [−15; −11]. Conclusions: A multifaceted program merging standard interventions in support of general practice induced significant improvements in the quality of diabetes care. Intensified follow-up in AQIP with focus on shared care and patient behaviour changes did not yield additional benefit. [Copyright &y& Elsevier]

Objectives: To explore views on high quality diabetes care based on an analysis of existing diversity in diabetes care programmes and related quality indicators. Methods: A review of systematic reviews was performed. Four databases (MEDLINE database of the National Library of Medicine, COCHRANE database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Database-CINAHL and Pre-Cinahl) were searched for English review articles published between November 1989 and December 2006. Methodological quality of the articles was assessed. A standardized extraction form was used to assess features of diabetes care programmes and diabetes quality indicators with special reference to those aspects that hinder the conceptualization of high quality diabetes care. Based on these findings the relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care was further explored. Results: Twenty-one systematic reviews met the inclusion criteria representing a total of 185 diabetes care programmes. Six elements were identified to produce a picture of diversity in diabetes care programmes and hinder their standardization: 1) the variety and relative absence of conceptual backgrounds in diabetes care programmes, 2) confusion over what is considered a constituent of a diabetes care program and components of the implementation strategy, 3) large variety in type of diabetes care programmes, settings and related goals, 4) a large number and variety in interventions and quality indicators used, 5) no conclusive evidence on effectiveness, 6) no systematic results on costs. Conclusions: There is large diversity in diabetes care programmes and related quality indicators. From this review and our analysis on the mutual relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care, we conclude that no single conceptual framework used to date provides a comprehensive overview of attributes of high quality diabetes care linked to quality indicators at the structure, process and outcome level. There is a need for a concerted action to develop a standardized framework on high quality diabetes care that is complemented by a practical tool to provide guidance to the design, implementation and evaluation of diabetes care programmes. [ABSTRACT FROM AUTHOR]

Background: Most quality improvement programs in diabetes care incorporate aspects of clinician education, performance feedback, patient education, care management, and diabetes care teams to support primary care physicians. Few studies have applied all of these dimensions to address clinical inertia. Aim: To evaluate interventions to improve adherence to evidence-based guidelines for diabetes and reduce clinical inertia in primary care physicians. Design: Two-arm cluster randomized controlled trial. Participants: Primary care physicians in Belgium. Interventions: Primary care physicians will be randomly allocated to 'Usual' (UQIP) or 'Advanced' (AQIP) Quality Improvement Programs. Physicians in the UQIP will receive interventions addressing the main physician, patient, and office system factors that contribute to clinical inertia. Physicians in the AQIP will receive additional interventions that focus on sustainable behavior changes in patients and providers. Outcomes: Primary endpoints are the proportions of patients within targets for three clinical outcomes: 1) glycosylated hemoglobin < 7%; 2) systolic blood pressure differences ≤130 mmHg; and 3) low density lipoprotein/cholesterol < 100 mg/dl. Secondary endpoints are individual improvements in 12 validated parameters: glycosylated hemoglobin, low and high density lipoprotein/cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, weight, physical exercise, healthy diet, smoking status, and statin and anti-platelet therapy. Primary and secondary analysis: Statistical analyses will be performed using an intent-to-treat approach with a multilevel model. Linear and generalized linear mixed models will be used to account for the clustered nature of the data, i.e., patients clustered withinimary care physicians, and repeated assessments clustered within patients. To compare patient characteristics at baseline and between the intervention arms, the generalized estimating equations (GEE) approach will be used, taking the clustered nature of the data within physicians into account. We will also use the GEE approach to test for differences in evolution of the primary and secondary endpoints for all patients, and for patients in the two interventions arms, accounting for within-patient clustering. Trial Registration: number: NTR 1369. [ABSTRACT FROM AUTHOR]

Reablement is considered a complex intervention due to its multicomponent, person-centered, holistic approach promoting older adults' active participation in daily activities. It is important to consider the unique context in which complex interventions are implemented, as contextual factors may interact and influence implementation outcomes. As part of the European TRANS-SENIOR project, this qualitative study aimed to gain insight into professionals' experiences with reablement implementation in Dutch community care. Using the Consolidated Framework for Implementation Research, four focus groups were conducted comprising 32 professionals. Two groups were formed: one at operational level, including therapists, nursing staff, social workers, and domestic support; and one at organizational/strategic level, including project leaders, managers, directors, municipality representatives and health insurers. Participating care organizations had at least 6 months of experience with deploying and implementing reablement. Findings reflected three themes: (1) strength of interdisciplinary collaboration; highlighting significance of sharing goals and beliefs, (2) integrating the reablement philosophy into the organization; underscoring managements role in fostering support across all organizational layers, and (3) achieving a culture change in the healthcare system; emphasizing current funding models impeding value-based care tailored to the individual's goals and needs. The results offer valuable insights for implementation of complex interventions, like reablement. [ABSTRACT FROM AUTHOR]

Background: The Belgian government program "Integrated Care for better health" www.integreo.be aims at a Nationwide Whole System Change in health and social care. This implies change in its structures, finances, processes and paradigms towards more Integrated Care IC. It concerns geographically defined pilot projects that should cover in 'full implementation" more than 3.670.000 people, about one third of the total Belgian Population. Pilot projects are both large-scale implementation projects and test cases. Each pilot aims at changing the organization of their loco-regional area network covering up to 150.000 inhabitants towards more IC. Changes are directed at 14 components, structured at three levels: 1 the patient level e.g. case management; 2 the inter-professional collaboration level e.g. shared medical file; and 3 the inter-organizational collaboration at loco-regional level e.g. quality culture The ultimate goal is to improve the 'Triple Aim' quality of care, equity and the work life of healthcare providers 'TA2+'. A scientific team was appointed to: design and implement an evaluation framework alongside the pilot-projects-in-development. function as a support mechanism to the pilot projects in assisting and accompanying them with their self-evaluation process. function as a support mechanism for the government agencies who induced and guide the change management program. Existing research on achieving sustainable change of loco-regional networks towards more IC and Triple Aim within a nation-wide program is scarce. Moreover, existing research is highly context specific. This need to be taken into account in the generalization process. Aim: To reflect with the target audience on the necessity of changing research paradigms towards theory driven appraisals when engaging into Whole System Change evaluation in healthcare. Format: Interactive workshop with both 'teasing' questions to the target audience and presentation of our lessons learned Speakers: Geert Goderis, Jean Macq, Nathan Charlier, Elien Colman. Target Audience: Researchers and professionals active in the field of IC and system change. Learnings: - System change towards IC cannot be conceived as a delineated intervention, but as a complex strategy or even a policy to innovate and implement long-lasting change. This complexity often manifests as shifting and unpredictable contexts, deep differences among perspectives, and even conflict among stakeholders. Scientific evaluation is necessary and imposes a paradigm change for the involved scientists. 'Laboratory like' methodologies type 'Randomized Controlled Trials' are unfit and must be replaced by theory driven approaches, describing the processes and contextual factors leading to desired outcomes. The evaluation should transcend the question 'what works?' towards questions on how, why, for whom and in what circumstances the program brings the desired outcomes, in order to allow upscaling of the program to a system change covering entire Belgian territory. - Scientists engage in a co-creative process producing new knowledge, in partnership with all other involved stakeholders like e.g. health professionals and government agents. This cocreation process disables the possibility to plan a fixed endpoint: the design is tribute to multiple issues that evolve over time. Meanwhile, the whole program serves as a leverage to create breakthroughs in these issues. [ABSTRACT FROM AUTHOR]

Background: The Belgian government program "Integrated Care for better health" (www.integreo.be) aims at a Nation-wide Whole System Change in health and social care towards Integrated Care (IC), by means of geographically defined pilot projects. Each of the +/- 20 pilot projects will implement IC in a loco-regional area covering up to 150.000 inhabitants. The ultimate goal is to improve the 'Triple Aim' quality of care, equity and healthcare professional work life ('TA2+'). Pilot projects will run for several years serving both as large-scale implementation projects and test cases. Successful projects will be upscaled to cover - ultimately - the entire Belgian territory. A scientific team was appointed for evaluation of the projects. A priority task for this team is to set up sustainable monitoring tools that can evaluate the projects in a longitudinal way. To evaluate the impact of Integreo on TA2+, both content (outcome indicators) and methods of data collection must be defined. However, the scale of the projects - both concerning the number of included persons and the duration of the project - is incompatible with the usual approach of data collection and analysis. Aim: To reflect with the target audience on the process and dynamics of selecting outcome indicators and data collection methods for such large-scale projects. Format: Interactive workshop with 'teasing' questions to the target audience combind with presentation of the lessons learned. This workshop follows Part I and - if necessary - both can be given in one workshop. Speakers on behalf of the research group: Elien Colman, Elias Van Deun, Jean Macq, Geert Goderis Target Audience: Researchers and professionals active in the field of IC and system change. Learnings: 1- On the indicator selection - Define their utility: the quantitative evaluation of the indicators alone will not allow to determine causal relationships, but must be part of a global analysis, including qualitative research methods and implementation evaluation. - Set goals: first define the indicator set by evaluating the added value for measuring the change objectives. - Find an equilibrium between ambition and feasibility. The impossibility to use usual data collection methods has a direct impact on the indicator selection itself. - Define transversal indicators first as a common base for all projects. Afterwards, add project-specific indicators in full co-creation. 2- On the research methodology - The methods of data collection must be routinely applicable and sustainable in the long running. - The collected data from hospitals, General Practice, Patient Reported Outcomes, etc., must also be as much as possible routinely collected and automatically merged with claims data at patient level. - Plan with a clear time line: -- Evolving technological, legal and practical issues determine the data collection possibilities -- Each new database adds complexity to an already complex project: therefore, start small, plan expansion at the appropriate moment. 3- On the co-creation process - It requires time and organization to involve all necessary actors, allowing them to review and process the data. - Moving from existing logics of intra-organisational data-analysis (e.g. in hospitals), towards inter-organisational data-analysis. [ABSTRACT FROM AUTHOR]

Background: The highly increased prevalence of chronic conditions challenges the actual health care systems. The Flemish governments has adopted the Chronic Care Model as the mainframe for health policy changes. However until now, there was no major practice change in the way how health care is provided in primary care. Most providers continue to work in the classic way on their own with few multidisciplinary contacts, presence of silos between primary and secondary care, lack of planned population management, little use of existing guidelines... Therefore, the Flemish government ordered Domus Medica, the Flemish General Practice professional organisation, to develop an action research project. The aim of the project was 1. To promote and spread the chronic care model amongst Flemish health care workers; 2. To evaluate both barriers and facilitators towards its implementation. Method: Domus Medica organised a large survey in 16 Flemish regions. Therefore it put up 1 national and 16 regional steering committees. Each regional steering had to involve as many health care workers in the process as possible. Each committee was free to use its own methods. In total, six different methods were used: electronic survey, survey on paper, face to face interviews, workshops, seminars and 'world cafes'. Most regions used a 'mixed method' approach. Each region had to write down the results into a report. The collected reports were analysed. Barriers and facilitators were listed for each region and then brought together. This 'long' list was analysed by an expert who used the 'Implementation model' (Grol, Wensing) to filter the most relevant items. These results were fed back for validation towards the involved stakeholders: respondents had to mark their agreement on a Likert scale from 1 (strongly disagree) to 4 (strongly agree). Only those items that obtained a score of 3 or 4 by more than 70% of all respondents were selected. This lead to a 'short list' summed up according to the pillars of the Chronic Care Model. Finally the results were thoroughly discussed leading to a report with recommendations. Results: 598 people responded to the written surveys and interviews and 943 people participated to the workshops, seminars and world cafes. There was some overlap but in total, more than 1300 different persons participated including about 400 General Practitioners and nurses and 200 physiotherapists and pharmacists. 166 people participated in the validation process. The 'long list' contained 349 barriers and 167 facilitators and the short 'short list' 63 barriers and 39 facilitators. The report for the Flemish Minister of health contained 17 core recommendations. Main barriers remain the concept of patient empowerment and health promotion, multidisciplinary teamwork, integration and continuity between hospital and primary care and between health care and social welfare. Evidence Based Medicine is inadequately acquired, especially by non-physicians. ICT is experienced as thé necessary tool for integration and communication. However in practice it is a source of major concern because systems are often unstable, necessary knowledge to use the systems and to resolve technical problems are lacking and ICT investment is both expensive and time consuming. Two major structural barriers that hamper all evolution towards integrated chronic care were put forward: the payment system that enables a comfortable revenue by fee for service and unfitted organisational structures in primary care, both at micro level (too small business units) as at meso-level (a patchwork of different organisations with overlapping competences). Finally, health care providers would like to be more involved in government initiatives and campaigns. Major facilitators put forward were the existing and well developed health services as well as the recent initiatives to promote chronic care and spread ICT. As such, the existing structures and initiatives must be considered as the basement of future change. The professional commitment of the providers towards their patients and the open mind towards the upcoming change were also put forward as essential facilitators. Finally, providers experience the patients' tendencies to more empowerment and independence as a positive evolution. Discussion: The strength of this project is the involvement of a large number of Flemish primary care providers into a movement for better chronic care. It also listed essential barriers towards its implementation as well as key facilitators. Its major weakness is its scope, only based on the experience of primary health care providers without involvement of neither social workers, nor secondary care and expert opinion. However, the project enabled a landmark report for the Ministry of Health with key recommendations to successful future nation-wide implementation of chronic care. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper was to describe the time trends in the prevalence of multimorbidity and polypharmacy in Flanders (Belgium) between 2000 and 2015, while controlling for age and sex. Methods: Data were available from Intego, a Flemish-Belgian general practice-based morbidity registration network. The practice population between 2000 and 2015 was used as the denominator, representing a mean of 159,946 people per year. Age and gender-standardised prevalence rates were used for the trends of multimorbidity and polypharmacy in the total population and for subgroups. Joinpoint regression analyses were used to analyse the time trends and breaks in trends, for the entire population as well as for specific age and sex groups. Results: Overall, in 2015, 22.7% of the population had multimorbidity, while the overall prevalence of polypharmacy was 20%. Throughout the study period the standardised prevalence rate of multimorbidity rose for both sexes and in all age groups. The largest relative increase in multimorbidity was observed in the younger age groups (up to the age of 50 years). The prevalence of polypharmacy showed a significant increase between 2000 and 2015 for all age groups except the youngest (0–25 years). Conclusion: For all adult age groups multimorbidity and polypharmacy are frequent, dynamic over time and increasing. This asks for both epidemiological and interventional studies to improve the management of the resulting complex care. [ABSTRACT FROM AUTHOR]

Background: Intego is the only operational computerized morbidity registration network in Belgium based on general practice data. Intego collects data from over 90 general practitioners. All the information is routinely collected in the electronic health record during daily practice.Methods: In this article we describe the design and methods used within the Intego network together with some of its basic results. The collected data, the quality control procedures, the ethical-legal aspects and the statistical procedures are discussed.Results: Intego contains longitudinal information on 285 357 different patients, corresponding to over 2.3% of the Flemish population representative in terms of age and sex. More than 3 million diagnoses, 12 million drug prescriptions and 29 million laboratory tests have been recorded.Conclusions: Intego enables us to present and compare data on health parameters, incidence and prevalence rates, laboratory results, and prescribed drugs for all relevant subgroups on a routine basis and is unique in Belgium. [ABSTRACT FROM AUTHOR]

Introduction: Frail older adults frequently experience transitions from hospital to home due to their complex care needs. Transitional care models (TCMs) are recommended to tackle adverse outcomes in frail patients. This review summarizes the use of integrated care components in addressing transitional care from hospital to home, provides an overview on reported outcomes and describes the impact of identified components on the outcomes hospital readmission and emergency department visit. Methods: This study is part of the European TRANS-SENIOR project. PubMed, CINAHL and Embase were searched for studies in English, German and Dutch that describe a TCM for frail older patients including both pre- and post-discharge components. Results: Seventeen studies, covering 15 TCMs were included. All TCMs describe a personcentred, tailored, pro-active and continuous transitional care service. Components like a small sized care team, intensive follow-up, shared decision making and informal caregiver involvement are likely to be associated with reduced hospital readmission and ED visits. Twenty-seven transitional care outcomes were reported: 19 service outcomes, six patient outcomes and two provider outcomes. Conclusion: Heterogeneity in content and outcomes complicates between-study comparison, yet several components were identified that improved care outcomes. Patient and provider outcomes should be included in future research. [ABSTRACT FROM AUTHOR]

Introduction: In Belgium, 12 integrated care pilot projects (Integreo) have been started in beginning 2018. Triple Aim is used as evaluation framework: improving the health of populations, patient experience of care and reducing the per capita cost of healthcare (Stiefel & Nolan, 2012). To make evaluation sustainable in the long term and limit registration workload, we will evaluate if relevant Triple Aim measures can be calculated based on claims data, which are already systematically collected. One of the most important routine health databases in Belgium is the Inter Mutualistic Agency (IMA) database. This database contains all the claims for the compulsory health insurance in Belgium including doctor and hospital visits, technical interventions and drug deliveries. As such the IMA database is very useful to picture healthcare related processes and trajectories, but also to create accurate proxy parameters for a range of patient conditions (Vaes et al., 2018). Theory/Methods: In a first stage, we created a list of "Triple Aim Claims Indicators" (TACI). To do this, we used the list of Triple Aim measures from the systematic review of Hendrikx et al. (2016). In parallel, we analysed the list of available data in the IMA-database. We combined the two lists to identify the Triple Aim measures that can be calculated based on the IMA-data. This exercise resulted in the TACI-list. Selection criteria were applied. The selection process was double blinded. Differences were resolved by consensus. In a second stage, we validated this list. Hypothesis was that the TACI's were able to discriminate care with high from care with low added value. As such these TACI's should be useful to evaluate healthcare for subpopulations of patients and for comparing different regions and settings. To validate the list, we evaluated the TACI-list in the population with at least one chronic condition, compared to the total Belgian population. Results: Out of the list of 865 Triple Aim measures identified by Hendrikx et al. (2016), we were able to identify a list of 662 measures, including hospital admissions, disease prevalence and cost. This list need to be further checked, for ea. project specific measures and incompatibilities with the Belgian health system. Discussion: A rough check of what is available in the IMA-database for measuring Triple Aim, provides the following pre-analysis: IMA has health outcome information through proxies, although these need to be handled with care (dimension 1) There is very limited information on patient experiences (dimension 2) IMA provides an extensive range of cost information (dimension 3) Conclusions: Triple Aim can partially be measured through claims data, although not all dimensions to the same extent, especially the patient experience of care. Cost is the most easy to track. Lessons learned: New data collections are not always necessary. Making good use of already available data can create important efficiency gains. Limitations: This research is limited to the Belgian IMA-database. Suggestions for future research: Checking the TACI-list against claims data in other countries. Checking the list of Triple Aim measures with other (routine) databases. [ABSTRACT FROM AUTHOR]

Background: The electronic health record (EHR) of the general physician (GP) is an important tool that can be used to assess and improve the quality of healthcare. However, there are some problems when (re) using the data gathered in the EHR for quality assessments. One problem is the lack of data completeness in the EHR. Audit and feedback (A&F) is a well-known quality intervention that can improve the quality of healthcare. We hypothesize that an automated A&F intervention can be adapted to improve the data completeness of the EHR of the GP, more specifically, the number of correctly registered diagnoses of type 2 diabetes and chronic kidney disease.Methods: This study is a pragmatic cluster randomized controlled trial with an intervention at the level of GP practice. The intervention consists of an audit and extended electronically delivered feedback with multiple components that will be delivered 4 times electronically to general practices over 12 months. The data will be analyzed on an aggregated level (per GP practice). The primary outcome is the percentage of correctly registered diagnoses of type 2 diabetes. The key secondary outcome is the registration of chronic kidney disease. Exploratory secondary outcomes are the registration of heart failure, biometric data and lifestyle habits, and the evolution of 4 different EHR-extractable quality indicators.Discussion: This cluster randomized controlled trial intends to primarily improve the registration of type 2 diabetes in the EHR of the GP and to secondarily improve the registration of chronic kidney disease. In addition, the registration of heart failure, lifestyle parameters, and biometric data in the EHR of the GP are explored together with 4 EHR-extractable quality indicators. By doing so, this study aims to improve the data completeness of the EHR, paving the way for future quality assessments.Trial Registration: ClinicalTrials.gov NCT04388228 . Registered on May 14, 2020. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this systematic review was (i) to assess whether electronic audit and feedback (A&F) is effective in primary care and (ii) to evaluate important features concerning content and delivery of the feedback in primary care, including the use of benchmarks, the frequency of feedback, the cognitive load of feedback and the evidence-based aspects of the feedback.Data Sources: The MEDLINE, Embase, CINAHL and CENTRAL databases were searched for articles published since 2010 by replicating the search strategy used in the last Cochrane review on A&F.Study Selection: Two independent reviewers assessed the records for their eligibility, performed the data extraction and evaluated the risk of bias. Our search resulted in 8744 records, including the 140 randomized controlled trials (RCTs) from the last Cochrane Review. The full texts of 431 articles were assessed to determine their eligibility. Finally, 29 articles were included.Data Extraction: Two independent reviewers extracted standard data, data on the effectiveness and outcomes of the interventions, data on the kind of electronic feedback (static versus interactive) and data on the aforementioned feedback features.Results Of Data Synthesis: Twenty-two studies (76%) showed that electronic A&F was effective. All interventions targeting medication safety, preventive medicine, cholesterol management and depression showed an effect. Approximately 70% of the included studies used benchmarks and high-quality evidence in the content of the feedback. In almost half of the studies, the cognitive load of feedback was not reported. Due to high heterogeneity in the results, no meta-analysis was performed.Conclusion: This systematic review included 29 articles examining electronic A&F interventions in primary care, and 76% of the interventions were effective. Our findings suggest electronic A&F is effective in primary care for different conditions such as medication safety and preventive medicine. Some of the benefits of electronic A&F include its scalability and the potential to be cost effective. The use of benchmarks as comparators and feedback based on high-quality evidence are widely used and important features of electronic feedback in primary care. However, other important features such as the cognitive load of feedback and the frequency of feedback provision are poorly described in the design of many electronic A&F intervention, indicating that a better description or implementation of these features is needed. Developing a framework or methodology for automated A&F interventions in primary care could be useful for future research. [ABSTRACT FROM AUTHOR]

Background: Various methods exist to estimate disease prevalences. The aim of this study was to determine whether dispensed, self-reported and prescribed medication data could be used to estimate the prevalence of diabetes mellitus and thyroid disorders. Second, these pharmaco-epidemiological estimates were compared with prevalences based on self-reported diagnoses and doctor-registered diagnoses. Methods: Data on medication for diabetes and thyroid disorders were obtained from three different sources in Flanders (Belgium) for 2008: a purely administrative database containing data on dispensed medication, the Belgian National Health Interview Survey for self-reported medication and diagnoses, and a patient record database for prescribed medication and doctor- registered diagnoses. Prevalences were estimated based on medication data and compared with each other. Cross-tabulations of dispensed medication and self-reported diagnoses, and prescribed medication and doctor-registered diagnoses, were investigated. Results: Prevalences based on dispensed medication were the highest (4.39 and 2.98% for diabetes and thyroid disorders, respectively). The lowest prevalences were found using prescribed medication (2.39 and 1.72%, respectively). Cross-tabulating dispensed medication and self-reported diagnoses yielded a moderate to high sensitivity for diabetes (90.4%) and thyroid disorders (77.5%), while prescribed medication showed a low sensitivity for doctor-registered diagnoses (56.5 and 43.6%, respectively). The specificity remained above 99% in all cases. Conclusions: This study was the first to perform cross-tabulations for disease prevalence estimates between different databases and within (sub)populations. Purely administrative database was shown to be a reliable source to estimate disease prevalence based on dispensed medication. Prevalence estimates based on prescribed or self-reported medication were shown to have important limitations. [ABSTRACT FROM AUTHOR]

Objective:To assess the quality of antibiotic prescribing in primary care in Belgium, the Netherlands and Sweden using European disease-specific antibiotic prescribing quality indicators (APQI) and taking into account the threshold to consult and national guidelines. Design:A retrospective observational database study. Setting:Routine primary health care registration networks in Belgium, the Netherlands and Sweden. Subjects:All consultations for one of seven acute infections [upper respiratory tract infection (URTI), sinusitis, tonsillitis, otitis media, bronchitis, pneumonia and cystitis] and the antibiotic prescriptions in 2012 corresponding to these diagnoses. Main outcome measures:Consultation incidences for these diagnoses and APQI values (a) the percentages of patients receiving an antibiotic per diagnosis, (b) the percentages prescribed first-choice antibiotics and (c) the percentages prescribed quinolones. Results:The consultation incidence for respiratory tract infection was much higher in Belgium than in the Netherlands and Sweden. Most of the prescribing percentage indicators (a) were outside the recommended ranges, with Belgium deviating the most for URTI and bronchitis, Sweden for tonsillitis and the Netherlands for cystitis. The Netherlands and Sweden prescribed the recommended antibiotics (b) to a higher degree and the prescribing of quinolones exceeded the proposed range for most diagnoses (c) in Belgium. The interpretation of APQI was found to be dependent on the consultation incidences. High consultation incidences were associated with high antibiotic prescription rates. Taking into account the recommended treatments from national guidelines improved the results of the APQI values for sinusitis in the Netherlands and cystitis in Sweden. Conclusion:Quality assessment using European disease-specific APQI was feasible and their inter-country comparison can identify opportunities for quality improvement. Their interpretation, however, should take consultation incidences and national guidelines into account. Differences in registration quality might limit the comparison of diagnosis-linked data between countries, especially for conditions such as cystitis where patients do not always see a clinician before treatment.Key pointsThe large variation in antibiotic use between European countries points towards quality differences in prescribing in primary care. • The European disease-specific antibiotic prescribing quality indicators (APQI) provide insight into antibiotic prescribing, but need further development, taking into account consultation incidences and country-specific guidelines. • The incidence of consultations for respiratory tract infections was almost twice as high in Belgium compared to the Netherlands and Sweden. • Comparison between countries of diagnosis-linked data were complicated by differences in data collection, especially for urinary tract infections. [ABSTRACT FROM PUBLISHER]

Background: People with diabetes have a high risk of developing micro- and macrovascular complications associated with diminished life expectancy and elevated treatment costs. Patient education programs can improve diabetes control in the short term, but their cost-effectiveness is uncertain. Our study aimed to analyze the lifelong cost-effectiveness of a nurse-led telecoaching program compared to usual care in people with type 2 diabetes from the perspective of the Belgian healthcare system. Methods: The UKPDS Outcomes Model was populated with patient-level data from an 18-month randomized clinical trial in the Belgian primary care sector involving 574 participants; trial data were extrapolated to 40 years; Quality Adjusted Life Years (QALYs), treatment costs and Incremental Cost-Effectiveness Ratio (ICER) were calculated for the entire cohort and the subgroup with poor glycemic control at baseline (“elevated HbA1c subgroup”) and the associated uncertainty was explored. Results: The cumulative mean QALY (95% CI) gain was 0.21 (0.13; 0.28) overall and 0.56 (0.43; 0.68) in elevated HbA1c subgroup; the respective incremental costs were €1,147 (188; 2,107) and €2,565 (654; 4,474) and the respective ICERs €5,569 (€677; €15,679) and €4,615 (1,207; 9,969) per QALY. In the scenario analysis, repeating the intervention for lifetime had the greatest impact on the cost-effectiveness and resulted in the mean ICERs of €13,034 in the entire cohort and €7,858 in the elevated HbA1c subgroup. Conclusion: Taking into account reimbursement thresholds applied in West-European countries, nurse-led telecoaching of people with type 2 diabetes may be considered highly cost-effective within the Belgian healthcare system. Trial registration: [ABSTRACT FROM AUTHOR]