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Objectives To assess the reporting and methodological quality of early-life policy intervention papers that applied difference-in-differences (DiD) analysis.Study design Systematic review.Data sources Papers applying DiD of early-life policy interventions in high-income countries as identified by searching Medline, Embase and Scopus databases up to December, 2022.Study eligibility criteria, participants and interventions Studies evaluating policy interventions targeting expectant mothers, infants or children up to two years old and conducted in high income countries were included. We focused on seven critical conditions of DiD as proposed in a comprehensive checklist: data requirements, parallel trends, no-anticipation, standard statistical assumptions, common shocks, group composition and spillover.Results The DiD included studies (n=19) evaluating early-life policy interventions in childhood development (n=4), healthcare utilisation and providers (n=4), nutrition programmes (n=3) and economic policies such as prenatal care expansion (n=8). Although none of the included studies met all critical conditions, the most reported and adhered to critical conditions were data requirements (n=18), standard statistical assumptions (n=11) and the parallel trends assumption (n=9). No-anticipation and spillover were explicitly reported and adhered to in two studies and one study, respectively.Conclusions This review highlights current deficiencies in the reporting and methodological quality of studies using DiD to evaluate early-life policy interventions. As the validity of study conclusions and consequent implications for policy depend on the extent to which critical conditions are met, this shortcoming is concerning. We recommend that researchers use the described checklist to improve the transparency and validity of their evaluations. The checklist should be further refined by adding order of importance or knock-out criteria and may also help facilitate uniform terminology. This will hopefully encourage reliable DiD evaluations and thus contribute to better policies relating to expectant mothers, infants and children.

Introduction Integrated care is seen as an enabling strategy in organising healthcare to improve quality, finances, personnel and sustainability. Developments in the organisation of maternity care follow this trend. The way care is organised should support the general aims and outcomes of healthcare systems. Organisation itself consists of a variety of smaller ‘elements of organisation’. Various elements of organisation are implemented in different organisations and networks. We will examine which elements of integrated maternity care are associated with maternal and neonatal health outcomes, experiences of women and professionals, healthcare spending and care processes.Methods and analysis We will conduct this review using the JBI methodology for scoping reviews and the reporting guideline PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews). We will undertake a systematic search in the databases PubMed, Scopus, Cochrane and PsycINFO. A machine learning tool, ASReview, will be used to select relevant papers. These papers will be analysed and classified thematically using the framework of the Rainbow Model of Integrated Care (RMIC). The Population Concept Context framework for scoping reviews will be used in which ‘Population’ is defined as elements of the organisation of integrated maternity care, ‘Context’ as high-income countries and ‘Concepts’ as outcomes stated in the objective of this review. We will include papers from 2012 onwards, in Dutch or English language, which describe both ‘how the care is organised’ (elements) and ‘outcomes’.Ethics and dissemination Since this is a scoping review of previously published summary data, ethical approval for this study is not needed. Findings will be published in a peer-reviewed international journal, discussed in a webinar and presented at (inter)national conferences and meetings of professional associations.The findings of this scoping review will give insight into the nature and effectiveness of elements of integrated care and will generate hypotheses for further research.

BackgroundGlobally, the burden of cancer on population health is growing. Recent trends such as increasing survival rates have resulted in a need to adapt cancer care to ensure a good care experience and manageable expenditures. eHealth is a promising way to increase the quality of cancer care and support patients and survivors. ObjectiveThe aim of this systematic review was 2-fold. First, we aimed to provide an overview of eHealth interventions and their characteristics for Dutch patients with and survivors of cancer. Second, we aimed to provide an overview of the empirical evidence regarding the impact of eHealth interventions in cancer care on population health, quality of care, and per capita costs (the Triple Aim domains). MethodsThe electronic databases Web of Science, PubMed, Cochrane, and Ovid PsycINFO were searched using 3 key search themes: eHealth interventions, cancer care, and the Netherlands. The identified interventions were classified according to predetermined criteria describing the intervention characteristics (eg, type, function, and target population). Their impact was subsequently examined using the Triple Aim framework. ResultsA total of 38 interventions were identified. Most of these were web portals or web applications functioning to inform and self-manage, and target psychosocial factors or problems. Few interventions have been tailored to age, disease severity, or gender. The results of this study indicate that eHealth interventions could positively affect sleep quality, fatigue, and physical activity of patients with and survivors of cancer. Inconclusive results were found regarding daily functioning and quality of life, psychological complaints, and psychological adjustment to the disease. ConclusionseHealth can improve outcomes in the Triple Aim domains, particularly in the population health and quality of care domains. Cancer-related pain and common symptoms of active treatment were not targeted in the included interventions and should receive more attention. Further research is needed to fully understand the impact of eHealth interventions in cancer care on participation, accessibility, and costs. The latter can be examined in economic evaluations by comparing eHealth interventions with care as usual.

Zorgverzekeraars en zorgaanbieders maken meestal contractafspraken op basis van een vergoeding per verrichting. Dat stimuleert echter volume van zorg in plaats van uitkomsten. Daarom passen zorgverzekeraars en zorgaanbieders steeds vaker ‘bundelinkoop’ als bekostiging toe. Dan wordt een bedrag per patiënt afgesproken. We beschrijven wat bundelinkoop is en introduceren de contractelementen. De impact van zorgbundels is dat ze door een andere verdeling van (financiële) verantwoordelijkheden uitkomsten centraal stellen, schotten doorbreken en innovatie stimuleren. Opschalen van deze methode van zorginkoop vraagt om standaardisatie van de contractelementen en uniformiteit van de bundeldefinitie per aandoening anders nemen de administratieve lasten voor zorgaanbieders toe.

Background: Better integrated clinical models of care with close cooperation between hospital-based specialists and community practitioners are fundamental to effective chronic disease management. Yet despite integrated care being an international priority for over 20 years, sustained at-scale integration outcomes are still uncommon. Aims and Objectives: To allow clinician researchers with over a decade of service implementation at scale in Europe and Australia, to identify key integration success factors and barriers across diverse settings and business models. To involve the symposium audience in understanding and applying them in their own settings. To summarise learning and service integration development relevant to workshop participants. Format: Introduction, aims, task (5 minutes) Presentations (3 x 10 minutes) Group work, case discussion & questions (45 minutes) Summing up (10 minutes) Speakers: Caroline Nicholson, Director Mater/University of Queensland Centre for Integrated Care & Innovation (Chair), ‘Utilising the governance elements for integrated health care –the impact of a frailty team on system outcomes’. Dr Albert Alonso, Hospital Clinic of Barcelona Research and Innovation Directorate ‘Safely transferring hospital COPD care into the community’. Dr Jeroen Struijs, National Institute of Public Health and the Environment, Leiden University Medical Center Campus the Hague. Integrating care by payment reforms. The Symposium will highlight the challenges faced in implementing models of integrated care and how they may be overcome. Practice, organisational and external factors including clinician leadership and resourcing are critical for translation of evidence into ongoing practice. It will also highlight the importance of the external environment in creating the framework to allow effective adoption of health system innovation. Participants will apply frameworks to their own settings using facilitated small-group work. Target audience: clinicians, researchers, consumers, policy makers, and health care organisations working at the community/ hospital interface. Learnings/take away messages: To understand the key enablers and barriers in large scale integration interventions. To apply these in diverse settings internationally

Introduction: In 2017, the Dutch Ministry of Health introduced bundled payments for birth care on a voluntary basis. This is designed to improve value by increased collaboration among midwives, gynecologists and other maternity care providers. Traditionally, these providers are reimbursed via a fee-for-service payment model. The new payment model aims to shift financial and clinical accountability to a new provider-led entity (a so called integrated birth care organization(ibco)) which functions as a general contractor. In that manner, bundled payments incentivize better coordination of care and reduce the incentives for overuse, duplicated services and low-value care. Currently, within seven regions bundled payment contracts are signed and more contracts are expected in 2019. Objective: To give insight in: 1- the performance of ibco’s who implemented the payment reform versus regions who did not (in terms of health outcomes, utilization and spending) in the period prior to the payment reform, 2- the first experiences of implementing bundled payments in the first year after the payment reform. Outline of the workshop (60+20 min) Performance of birth care organizations prior to the payment reform in terms of health outcomes, utilization and spending (presenter: EdV: 20+5 min) First, the national developments specific for the Dutch situation will be outlined. The early adapters differ from the birth care organization who did not implement bundled payments in 2017 in terms of birth care related spending and caesarean section and epidural rates, while no differences in health outcomes were observed. First experiences of bundled payments (presenter HvD (20+5 min)) Similarities and differences in the set-up of the first ibco will be laid out. This includes the development, content and implications of bundled payment contracts and the found ‘safety net clauses’ around tariffs. Importantly, boundaries for non-integrated birth care organisations and the contributions of bundled payment by experience of professionals in the field are highlighted. These insights are drawn from over 55 semi-structured interviews from all disciplines in and associated with birth care. At the end of the workshop, a discussion on international differences, development of quality indicators and implications of research findings will be encouraged. Fitting with the congress themes Building a stronger integrated primary care Defining measures and outcomes that matter to people Creating shared cultures, norms and values across organisations, professionals and people Learnings/take away messages: - An overview of processes leading to implementation of the first bundled payments in Dutch birth care - National database containing medical spending, health outcomes and quality on an individual level as a foundation for a virtual cohort - From data to knowledge, what does a combined database entail - To understand the Dutch bundled payment model for birth care and how this has been implemented - Insight in the key facilitators and barriers for implementing bundled payment for birth care

Introduction: Despite the expected beneficial effects on quality of care, patient involvement in diabetes care groups, which deliver a bundled paid integrated care programme for diabetes type 2, seems to be limited. The aim of this study was to gain insight into levels and methods of patient involvement, into facilitators and barriers, and into the future preferences of care groups and patient representatives. Theory and methods: Semi-structured interviews were held with 10 representatives of care groups and 11 representatives of patient advocacy groups. An adapted version of Arnstein's ladder of citizen participation was used to define five levels of patient involvement. Results: Patient involvement in care groups was mostly limited to informing and consulting patients. Higher levels, i.e., advising, co-producing and decision-making, were less frequently observed. Care groups and patient representatives perceived largely the same barriers and facilitators and had similar preferences regarding future themes and design of patient involvement. Conclusion: Constructive collaboration between diabetes care groups and patient representatives to enhance patient involvement in the future seems viable. Several issues such as the lack of evidence for effectiveness of patient involvement, differences in viewpoints on the role and responsibilities of care groups and perceived barriers need to be addressed.

Background: The patient assessment of chronic illness care (PACIC) is a promising instrument to evaluate the chronic care experiences of patients, yet additional validation is needed to improve its usefulness.Methods: A total of 1941 patients with diabetes completed the questionnaire. Reliability coefficients and factor analyses were used to psychometrically test the PACIC and PACIC+ (i.e., PACIC extended with six additional multidisciplinary team functioning items to improve content validity). Intra-Class Correlations were computed to identify the extent to which variation in scores can be attributed to GP practices. Results: The PACIC and PACIC+ showed a good psychometric quality (Cronbach's alpha's > 0.9). Explorative factor analyses showed inconclusive results. Confirmative factor analysis showed that none of the factor structures had an acceptable fit (RMSEA > 0.10). In addition, 5.1 to 5.4 percent of the total variation was identified at the GP practice level. Conclusion: The PACIC and PACIC+ are reliable instruments to measure the chronic care management experiences of patients. The PACIC+ is preferred because it also includes multidisciplinary coordination and cooperation - one of the central pillars of chronic care management - with good psychometric quality. Previously identified subscales should be used with caution. Both PACIC instruments are useful in identifying GP practice variation.