The objective of the study described in this paper is to define safety metrics that are based on the effectiveness of risk controls. Service providers define and implement such risk controls in order to prevent hazards developing into an accident. The background of this research is a specific need of the aviation industry where small and medium-sized enterprises lack large amounts of safety-related data to measure and demonstrate their safety performance proactively. The research department of the Aviation Academy has initiated a 4-year study, which will test the possibility to develop new safety indicators that will be able to represent safety levels proactively without the benefit of large data sets. As part of the development of alternative safety metrics, safety performance indicators were defined that are based on the effectiveness of risk controls. ICAO (2013) defines a risk control as “a defence with specific mitigation actions, preventive controls or recovery measures put in place to prevent the realization of a hazard or its escalation into an undesirable consequence”. Examples of risk controls are procedures, education and training, a piece of equipment etc. It is crucial for service providers to determine whether the introduced risk controls are indeed effective in reducing the targeted risk. ICAO (2013) describes the effectiveness of risk control as "the extent to which the risk control reduces or eliminates the safety risks”, but does not provide guidance on how to measure the effectiveness of risk control. In this study, a generic metrics for the effectiveness of risk controls based on their effectiveness was developed. The definition of the indicators allows, for each risk control, derivation of specific indicators based on the generic metrics. The suitability of the metrics will subsequently be tested in pilot studies within the aviation industry.
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.
Background: Patient education, advice on returning to normal activities and (home-based) exercise therapy are established treatment options for patients with non-specific low back pain (LBP). However, the effectiveness of physiotherapy interventions on physical functioning and prevention of recurrent events largely depends on patient self-management, adherence to prescribed (home-based) exercises and recommended physical activity behaviour. Therefore we have developed e-Exercise LBP, a blended intervention in which a smartphone application is integrated within face-to-face care. E-Exercise LBP aims to improve patient self-management skills and adherence to exercise and physical activity recommendations and consequently improve the effectiveness of physiotherapy on patients’ physical functioning. The aim of this study is to investigate the short- (3 months) and long-term (12 and 24 months) effectiveness on physical functioning and cost-effectiveness of e-Exercise LBP in comparison to usual primary care physiotherapy in patients with LBP. Methods: This paper presents the protocol of a prospective, multicentre cluster randomized controlled trial. In total 208 patients with LBP pain were treated with either e-Exercise LBP or usual care physiotherapy. E-Exercise LBP is stratified based on the risk for developing persistent LBP. Physiotherapists are able to monitor and evaluate treatment progress between face-to-face sessions using patient input from the smartphone application in order to optimize physiotherapy care. The smartphone application contains video-supported self-management information, video-supported exercises and a goal-oriented physical activity module. The primary outcome is physical functioning at 12-months follow-up. Secondary outcomes include pain intensity, physical activity, adherence to prescribed (home-based) exercises and recommended physical activity behaviour, self-efficacy, patient activation and health-related quality of life. All measurements will be performed at baseline, 3, 12 and 24months after inclusion. An economic evaluation will be performed from the societal and the healthcare perspective and will assess cost-effectiveness of e-Exercise LBP compared to usual physiotherapy at 12 and 24months. Discussion: A multi-phase development and implementation process using the Center for eHealth Research Roadmap for the participatory development of eHealth was used for development and evaluation. The findings will provide evidence on the effectiveness of blended care for patients with LBP and help to enhance future implementation of blended physiotherapy.
Alcohol use disorder (AUD) is a major problem. In the USA alone there are 15 million people with an AUD and more than 950,000 Dutch people drink excessively. Worldwide, 3-8% of all deaths and 5% of all illnesses and injuries are attributable to AUD. Care faces challenges. For example, more than half of AUD patients relapse within a year of treatment. A solution for this is the use of Cue-Exposure-Therapy (CET). Clients are exposed to triggers through objects, people and environments that arouse craving. Virtual Reality (VRET) is used to experience these triggers in a realistic, safe, and personalized way. In this way, coping skills are trained to counteract alcohol cravings. The effectiveness of VRET has been (clinically) proven. However, the advent of AR technologies raises the question of exploring possibilities of Augmented-Reality-Exposure-Therapy (ARET). ARET enjoys the same benefits as VRET (such as a realistic safe experience). But because AR integrates virtual components into the real environment, with the body visible, it presumably evokes a different type of experience. This may increase the ecological validity of CET in treatment. In addition, ARET is cheaper to develop (fewer virtual elements) and clients/clinics have easier access to AR (via smartphone/tablet). In addition, new AR glasses are being developed, which solve disadvantages such as a smartphone screen that is too small. Despite the demand from practitioners, ARET has never been developed and researched around addiction. In this project, the first ARET prototype is developed around AUD in the treatment of alcohol addiction. The prototype is being developed based on Volumetric-Captured-Digital-Humans and made accessible for AR glasses, tablets and smartphones. The prototype will be based on RECOVRY, a VRET around AUD developed by the consortium. A prototype test among (ex)AUD clients will provide insight into needs and points for improvement from patient and care provider and into the effect of ARET compared to VRET.
Een goede voorbereiding is het halve werk, ook voor patiënten op de wachtlijst voor een chirurgische ingreep. We onderzoeken hoe de e-health-applicatie 'Beter Voorbereid' mensen helpt om sterker aan de start van een operatie te staan en zo sneller te herstellen.
In order to achieve much-needed transitions in energy and health, systemic changes are required that are firmly based on the principles of regard for others and community values, while at the same time operating in market conditions. Social entrepreneurship and community entrepreneurship (SCE) hold the promise to catalyze such transitions, as they combine bottom-up social initiatives with a focus on financially viable business models. SCE requires a facilitating ecosystem in order to be able to fully realize its potential. As yet it is unclear in which way the entrepreneurial ecosystem for social and community entrepreneurship facilitates or hinders the flourishing and scaling of such entrepreneurship. It is also unclear how exactly entrepreneurs and stakeholders influence their ecosystem to become more facilitative. This research programme addresses these questions. Conceptually it integrates entrepreneurial ecosystem frameworks with upcoming theories on civic wealth creation, collaborative governance, participative learning and collective action frameworks.This multidisciplinary research project capitalizes on a unique consortium: the Dutch City Deal ‘Impact Ondernemen’. In this collaborative research, we enhance and expand current data collection efforts and adopt a living-lab setting centered on nine local and regional cases for collaborative learning through experimenting with innovative financial and business models. We develop meaningful, participatory design and evaluation methods and state-of-the-art digital tools to increase the effectiveness of impact measurement and management. Educational modules for professionals are developed to boost the abovementioned transition. The project’s learnings on mechanisms and processes can easily be adapted and translated to a broad range of impact areas.
