Objectives: Hospital admission in older adults is associated with unwanted outcomes such as readmission, institutionalization, and functional decline. To reduce these outcomes, the Netherlands introduced an alternative to hospital-based care: the Acute Geriatric Community Hospital (AGCH). The AGCH is an acute care unit situated outside of a hospital focusing on early rehabilitation and comprehensive geriatric assessment. The objective of this study was to evaluate if AGCH care is associated with decreasing unplanned readmissions or death compared with hospital-based care. Design: Prospective cohort study controlled with a historic cohort. Setting and Participants: A (sub)acute care unit (AGCH) and 6 hospitals in the Netherlands; participants were acutely ill older adults. Methods: We used inverse propensity score weighting to account for baseline differences. The primary outcome was 90-day readmission or death. Secondary outcomes included 30-day readmission or death, time to death, admission to long-term residential care, occurrence of falls and functioning over time. Generalized logistic regression models and multilevel regression analyses were used to estimate effects. Results: AGCH patients (n = 206) had lower 90-day readmission or death rates [odds ratio (OR) 0.39, 95% CI 0.23-0.67] compared to patients treated in hospital (n = 401). AGCH patients had a lower risk of 90-day readmission (OR 0.38, 95% CI 0.21-0.67) but did not differ on all-cause mortality (OR 0.89, 95% CI 0.44-1.79) compared with the hospital control group. AGCH patients had lower 30-day readmission or death rates. Secondary outcomes did not differ. Conclusions and Implications: AGCH patients had lower rates of readmission and/or death than patients treated in a hospital. Our results support further research on the implementation and cost-effectiveness of AGCH in the Netherlands and other countries seeking alternatives to hospital-based care.
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During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for “difficult to reach” children and adolescents with severe mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are undertaken to strengthen the patient’s motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions, enhance cost-effectiveness, stimulate social participation and support, and reduce stigma. ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions.
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Abstract Background One of the most problematic expression of ageing is frailty, and an approach based on its early identification is mandatory. The Sunfrail-tool (ST), a 9-item questionnaire, is a promising instrument for screening frailty. Aims • To assess the diagnostic accuracy and the construct validity between the ST and a Comprehensive Geriatric Assessment (CGA), composed by six tests representative of the bio-psycho-social model of frailty; • To verify the discriminating power of five key-questions of the ST; • To investigate the role of the ST in a clinical-pathway of falls’ prevention. Methods In this retrospective study, we enrolled 235 patients from the Frailty-Multimorbidity Lab of the University-Hospital of Parma. The STs’ answers were obtained from the patient’s clinical information. A patient was considered frail if at least one of the CGAs’ tests resulted positive. Results The ST was associated with the CGA’s judgement with an Area Under the Curve of 0.691 (CI 95%: 0.591–0.791). Each CGA’s test was associated with the ST total score. The five key-question showed a potential discriminating power in the CGA’s tests of the corresponding domains. The fall-related question of the ST was significantly associated with the Short Physical Performance Battery total score (OR: 0.839, CI 95%: 0.766–0.918), a proxy of the risk of falling. Discussion The results suggest that the ST can capture the complexity of frailty. The ST showed a good discriminating power, and it can guide a second-level assessment to key frailty domains and/or clinical pathways. Conclusions The ST is a valid and easy-to-use instrument for the screening of frailty.
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The focus of this project is on improving the resilience of hospitality Small and Medium Enterprises (SMEs) by enabling them to take advantage of digitalization tools and data analytics in particular. Hospitality SMEs play an important role in their local community but are vulnerable to shifts in demand. Due to a lack of resources (time, finance, and sometimes knowledge), they do not have sufficient access to data analytics tools that are typically available to larger organizations. The purpose of this project is therefore to develop a prototype infrastructure or ecosystem showcasing how Dutch hospitality SMEs can develop their data analytic capability in such a way that they increase their resilience to shifts in demand. The one year exploration period will be used to assess the feasibility of such an infrastructure and will address technological aspects (e.g. kind of technological platform), process aspects (e.g. prerequisites for collaboration such as confidentiality and safety of data), knowledge aspects (e.g. what knowledge of data analytics do SMEs need and through what medium), and organizational aspects (what kind of cooperation form is necessary and how should it be financed).
The focus of this project is on improving the resilience of hospitality Small and Medium Enterprises (SMEs) by enabling them to take advantage of digitalization tools and data analytics in particular. Hospitality SMEs play an important role in their local community but are vulnerable to shifts in demand. Due to a lack of resources (time, finance, and sometimes knowledge), they do not have sufficient access to data analytics tools that are typically available to larger organizations. The purpose of this project is therefore to develop a prototype infrastructure or ecosystem showcasing how Dutch hospitality SMEs can develop their data analytic capability in such a way that they increase their resilience to shifts in demand. The one year exploration period will be used to assess the feasibility of such an infrastructure and will address technological aspects (e.g. kind of technological platform), process aspects (e.g. prerequisites for collaboration such as confidentiality and safety of data), knowledge aspects (e.g. what knowledge of data analytics do SMEs need and through what medium), and organizational aspects (what kind of cooperation form is necessary and how should it be financed).Societal issueIn the Netherlands, hospitality SMEs such as hotels play an important role in local communities, providing employment opportunities, supporting financially or otherwise local social activities and sports teams (Panteia, 2023). Nevertheless, due to their high fixed cost / low variable business model, hospitality SMEs are vulnerable to shifts in consumer demand (Kokkinou, Mitas, et al., 2023; Koninklijke Horeca Nederland, 2023). This risk could be partially mitigated by using data analytics, to gain visibility over demand, and make data-driven decisions regarding allocation of marketing resources, pricing, procurement, etc…. However, this requires investments in technology, processes, and training that are oftentimes (financially) inaccessible to these small SMEs.Benefit for societyThe proposed study touches upon several key enabling technologies First, key enabling technology participation and co-creation lies at the center of this proposal. The premise is that regional hospitality SMEs can achieve more by combining their knowledge and resources. The proposed project therefore aims to give diverse stakeholders the means and opportunity to collaborate, learn from each other, and work together on a prototype collaboration. The proposed study thereby also contributes to developing knowledge with and for entrepreneurs and to digitalization of the tourism and hospitality sector.Collaborative partnersHZ University of Applied Sciences, Hotel Hulst, Hotel/Restaurant de Belgische Loodsensociëteit, Hotel Zilt, DM Hotels, Hotel Charley's, Juyo Analytics, Impuls Zeeland.
ALE organised an event with Parktheater Eindhoven and LSA-citizens (the Dutch umbrella organisation for active citizens). Five ALE students from the minor Imagineering and business/social innovation took responsibility for concept and actual organisation. On Jan 18th, they were supported by six other group members of the minor as volunteers. An IMEM-team of 5 students gathered materials for a video that can support the follow-up actions of the organisers. The students planned to deliver their final product on February 9th. The theatre will critically assess the result and compare it to the products often realised by students from different schools or even professional ones, like Veldkamp productions. Time will tell whether future opportunities will come up for IMEM. The collaboration of ALE and IMEM students is possible and adding value to the project.More than 180 visitors showed interest in the efforts of 30 national and local citizen initiatives presenting themselves on the market square in the theatre and the diverse speakers during the plenary session. The students created a great atmosphere using the qualities of the physical space and the hospitality of the theatre. Chair of the day, Roland Kleve, kicked off and invited a diverse group of people to the stage: Giel Pastoor, director of the theatre, used the opportunity to share his thoughts on the shifting role of theatre in our dynamic society. Petra Ligtenberg, senior project manager SDG NL https://www.sdgnederland.nl/sdgs/ gave insights to the objectives and progress of the Netherlands. Elly Rijnierse, city maker and entrepreneur from Den Haag, presented her intriguing efforts in her own neighbourhood in the city to create at once both practical and social impacts on SDG 11 (sustainable city; subgoal 3.2). Then the alderman Marcel Oosterveer informed the visitors about Eindhoven’s efforts on SDGs. The plenary ended with very personal interviews of representatives of two impressive citizen initiatives (Parkinson to beat; Stichting Ik Wil). In the two workshop rounds, ALE took responsibility for two workshops. Firstly the workshop: Beyond SDG cherrypicking: using the Economy for the common good’, in cooperation with citizen initiative Ware winst Brabant en Parktheater (including Social innovation-intern Jasper Box), secondly a panel dialogue on local partnerships (SDG 17) for the sustainable city (SDG 11) addressing inclusion (SDG 10) and the livability (SDG 3) with 11 representatives from local/provincial government, companies, third sector and, of course: citizen initiatives.
