This article describes a measure developed to assess fidelity of working with the Boston University approach to Psychiatric Rehabilitation (BPR) in Dutch mental health care. The instrument is intended to measure and improve BPR adherence and clinician competence on an individual level and within individual rehabilitation processes. https://www.ncbi.nlm.nih.gov/pubmed/28771017
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Background: The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. Method: In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n=90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. Results: Total costs per participant at 12-month follow-up were e 12,886 in BPR and e 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to e190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. Conclusions: This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.
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Background: People with severe mental illnesses (SMIs) have difficulty participating in society through work or other daily activities. Aims: To establish the effectiveness with which the Boston University Approach to Psychiatric Rehabilitation (BPR) improves the level of social participation in people with SMIs, in the Netherlands. Method: In a randomized controlled trial involving 188 people with SMIs, we compared BPR (n = 98) with an Active Control Condition (ACC, n = 90) (Trial registration ISRCTN88987322). Multilevel modeling was used to study intervention effects over two six-month periods. The primary outcome measure was level of social participation, expressed as having participated in paid or unpaid employment over the past six months, as the total hours spent in paid or unpaid employment, and as the current level of social participation. Secondary outcome measures were clients’ views on rehabilitation goal attainment, Quality of Life (QOL), personal recovery, self-efficacy, and psychosocial functioning. Results: During the study, social participation, QOL, and psychosocial functioning improved in patients in both groups. However, BPR was not more effective than ACC on any of the outcomes. Better social participation was predicted by previous work experience and a lower intensity of psychiatric symptoms. Conclusions: While ACC was as effective as BPR in improving the social participation of individuals with SMIs, much higher percentages of participants in our sample found (paid) work or other meaningful activities than in observational studies without specific support for social participation. This suggests that focused rehabilitation efforts are beneficial, irrespective of the specific methodology used.
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Objective: A key aspect of psychiatric rehabilitation is supporting individuals with serious mental illness in reaching personal goals. This study aimed to investigate whether various aspects of the working alliance predict successful goal attainment and whether goal attainment improves subjective quality of life, independent of the ehabilitation approach used. Methods: Secondary analyses were conducted of data from a Dutch randomized clinical trial on goal attainment by individuals supported with the Boston University approach to psychiatric rehabilitation (N=80) or a generic approach (N=76). Working alliance was measured with the Working Alliance Inventory (WAI) from the practitioner’s perspective. Rehabilitation practitioners had backgrounds in social work, nursing, or vocational rehabilitation. Multiple logistic regression and multiple regression analyses explored effects of working alliance on goal attainment and of goal attainment on subjective quality of life at 24 months. Analyses were controlled for client- and process-related predictors, baseline quality of life, and rehabilitation approach. Results: The WAI goal subscale predicted goal attainment at 24 months. No effect was found for the bond or task subscale. Goal attainment significantly predicted quality of life at 24 months. These effects were independent of the rehabilitation approach used. Conclusions: A good bond between client and practitioner is not enough to attain successful rehabilitation outcomes. Findings suggest that it is important to discuss clients’ wishes and ambitions and form an agreement on goals. Attaining rehabilitation goals directly influenced the subjective quality of life of individuals with serious mental illness, which underscores the importance of investing in these forms of client support.
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De markt voor Business Process Management (BPM) software groeit razend snel. Voor 2010 wordt er een marktomvang voorspeld van tussen de 1 tot 6 miljard dollar, dit betekend dat deze markt sinds 2005 meer dan verdubbeld is. BPM krijgt ook in toenemende mate publiciteit in de markt echter dan gaat het veelal om wat BPM nu precies wel en niet is en niet over hoe het toegepast kan worden. Hetzelfde geldt voor BPM software, beter bekend als Business Process Management Systemen (BPMS). Het onderzoek beschreven in dit proefschrift focust op BPMS, het ontstaan, waar het naartoe gaat en wat er allemaal komt kijken bij de invoering en het gebruik ervan. De hoofdonderzoeksvraag in dit proefschrift is: Welke factoren en competenties bepalen het succes van de implementatie van Business Process Management Systemen in een specifieke situatie? Centraal in dit proefschrift staan de volgende onderzoeksvragen: 1. Wat zijn de succes factoren bij de implementatie van Business Process Management Systemen? 2. Welke competenties hebben stakeholders in een Business Process Management Systeem implementatie project nodig? 3. Hoe ziet een Business Process Management Systeem implementatie methodiek eruit welke rekening houdt met de omgevingsfactoren van een organisatie?
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No summary available Rechthebbende: Universiteit Utrecht
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Currently the advances in the field of 3D printing are causing a revolution in the (bio-)medical field. With applications ranging from patient-specific anatomical models for surgical preparation to prosthetic limbs and even scaffolds for tissue engineering, the possibilities seem endless. Today, the most widely used method is FDM printing. However, there is still a limited range of biodegradable and biocompatible materials available. Moreover, printed implants like for instance cardiovascular stents require higher resolution than is possible to reach with FDM. High resolution is crucial to avoid e.g. bacterial growth and aid to mechanical strength of the implant. For this reason, it would be interesting to consider stereolithography as alternative to FDM for applications in the (bio-) medical field. Stereolithography uses photopolymerizable resins to make high resolution prints. Because the amount of commercially available resins is limited and hardly biocompatible, here we investigate the possibility of using acrylates and vinylesters in an effort to expand the existing arsenal of biocompatible resins. Mechanical properties are tailorable by varying the crosslink density and by varying the spacer length. To facilitate rapid production of high-resolution prints we use masked SLA (mSLA) as an alternative to conventional SLA. mSLA cures an entire layer at a time and therefore uses less time to complete a print than conventional SLA. Additionally, with mSLA it takes the same time to make 10 prints as it would to make only one. Several formulations were prepared and tested for printability and mechanical strength.
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For the integrated implementation of Business Process Management and supporting information systems many methods are available. Most of these methods, however, apply a one-size fits all approach and do not take into account the specific situation of the organization in which an information system is to be implemented. These situational factors, however, strongly determine the success of any implementation project. In this paper a method is provided that establishes situational factors of and their influence on implementation methods. The provided method enables a more successful implementation project, because the project team can create a more suitable implementation method for business process management system implementation projects.
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This paper describes a business process and organizational re-design and implementation project for an e-government service organization. In this project the initial process execution time of a Virtual Private Network (VPN) connection request has been reduced from some 60 days to 2 days. This has been achieved by the use of a new business process reengineering (BPR) implementation approach that was developed by the Utrecht University. The implementation approach is based on a combination of Enterprise Information Architecture (EIA), Business Process Modeling (BPM), Knowledge Management and Management Control methodologies and techniques. The method has been applied to improve the performance of a Dutch e-government service department (DeGSD). DeGSD is an e-government service department that supports and promotes electronic communication. It can be described as an electronic mail office for consumers that provides the ICT infrastructure to communicate with the government. The goal is to reduce administrative activities for both the government and consumers. Also supporting technology and part of the process is outsourced. In our approach we used EIA as a starting point because it describes all relations and information exchange with all stakeholders. This is different compared to more traditional approaches which (when it comes to automation) tend to have a main focus on the internal processes whereas our approach aligns the processes and systems across different participants, such as suppliers and customers, in the supply chain. Also included in the implementation approach are management control design mechanisms to ensure that the organizations strategy is in sync with its processes and activities that are performed by the employees. Management control is crucial in enabling the continuous measuring and improving of the organizational performance. Although the proposed BPR implementation approach worked in the project at DeGSD, further validation is necessary. Therefore we suggest that more case studies are performed at both government and profit organizations.
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