Objective To explore predictors of district nursing care utilisation for community-living (older) people in the Netherlands using claims data. To cope with growing demands in district nursing care, knowledge about the current utilisation of district nursing care is important. Setting District nursing care as a part of primary care. Participants In this nationwide study, claims data were used from the Dutch risk adjustment system and national information system of health insurers. Samples were drawn of 5500 pairs of community-living people using district nursing care (cases) and people not using district nursing care (controls) for two groups: all ages and aged 75+ years (total N=22 000). Outcome measures The outcome was district nursing care utilisation and the 114 potential predictors included predisposing factors (eg, age), enabling factors (eg, socioeconomic status) and need factors (various healthcare costs). The random forest algorithm was used to predict district nursing care utilisation. The performance of the models and importance of predictors were calculated. Results For the population of people aged 75+ years, most important predictors were older age, and high costs for general practitioner consultations, aid devices, pharmaceutical care, ambulance transportation and occupational therapy. For the total population, older age, and high costs for pharmaceutical care and aid devices were the most important predictors. Conclusions People in need of district nursing care are older, visit the general practitioner more often, and use more and/or expensive medications and aid devices. Therefore, close collaboration between the district nurse, general practitioner and the community pharmacist is important. Additional analyses including data regarding health status are recommended. Further research is needed to provide an evidence base for district nursing care to optimise the care for those with high care needs, and guide practice and policymakers’ decision-making.
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Nationwide and across the globe, the quality, affordability, and accessibility of home-based healthcare are under pressure. This issue stems from two main factors: the rapidly growing ageing population and the concurrent scarcity of healthcare professionals. Older people aspire to live independently in their homes for as long as possible. Additionally, governments worldwide have embraced policies promoting “ageing in place,” reallocating resources from institutions to homes and prioritising home-based services to honour the desire of older people to continue living at home while simultaneously addressing the rising costs associated with traditional institutional care.Considering the vital role of district nursing care and the fact that the population of older people in need of assistance at home is growing, it becomes clear that district nursing care plays a crucial role in primary care. The aim of this thesis is twofold: 1) to strengthen the evidence base for district nursing care; and 2) to explore the use of outcomes for learning and improving in district nursing care. The first part of this thesis examines the current delivery of district nursing care and explores its challenges during the COVID-19 pandemic to strengthen the evidence base and get a better understanding of district nursing care. Alongside the goal of strengthening the evidence for district nursing care, the second part of this thesis explores the use of patient outcomes for learning and improving district nursing care. It focuses on nurse-sensitive patient outcomes relevant to district nursing care, their current measurement in practice, and what is needed to use outcomes for learning and improving district nursing practice.
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In een multiculturele groep is elke docent een taaldocent, welk vak hij ook verzorgt. Deze uitspraak hoor je op steeds meer scholen voor voortgezet onderwijs en middelbaar beroepsonderwijs. Nieuwe leerstof bespreken en de ontwikkeling van nieuwe competenties begeleiden impliceert immers dat docenten en leerlingen begrippen en verbanden in taal onderling verhelderen. Maar niet elke vakdocent is zomaar een goede taaldocent: dit vergt een omslag in de didactiek die niet vanzelf gaat. Deze publicatie bevat het verslag van het onderzoek dat Annelies Riteco uitvoerde in een ROC. Zij beschrijft aan de hand van lesobservaties en interviews twee verschillende docenten en hun opvattingen over taal, leerprocessen en hun eigen rol daarin. De beschrijvingen leveren aanknopingspunten voor gerichte professionalisering en opleiding.
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Dit onderzoek meet de ervaren effecten van de pilottraining 'Doorbreek eenzaamheid en sociaal isolement' voor vrijwillige en professionele ondersteuners die plaatsvond in de periode september 2014 - maart 2015 op zes locaties in Nederland. Het doel van de pilottraining en bijbehorend werkboek, inmiddels getiteld Eenzaam ben je niet alleen. Samen werken aan een nieuwe visie op eenzaamheid en sociaal isolement, is professionals en vrijwilligers te ondersteunen bij vragen rondom eenzaamheid en sociaal isolement. Uitgangspunt is een geïntegreerde werkwijze die uitgaat van de vraag van de persoon die kampt met eenzaamheid of sociaal isolement. Zo werd tijdens de pilot getraind op het: signaleren, bespreekbaar maken, de vraag verhelderen en het maken van een persoonlijk (actie)plan. In dit onderzoek is de handelingsbekwaamheid rondom eenzaamheid en sociaal isolement van de deelnemers aan de pilottraining gemeten en niet de effecten van de training voor de persoon die met eenzaamheid of sociaal isolement kampt.
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Voor een minor als Migratievraagstukken, waar het delen van (levens)verhalen en ervaringen een heel belangrijk element is, betekende het ontbreken van ‘echt contact’ met de groep een groot gemis. Desalniettemin kunnen we constateren dat er in het contact dat er wel mogelijk was veel is gedeeld en met oprechte interesse in de leef- en denkwereld van de medestudenten is geluisterd naar elkaar en de studenten elkaar hebben bevraagd. Aan het einde van de collegereeks hoorden we vaak dat de lessen de studenten hadden verrijkt omdat het een inkijkje bood in de levens van leeftijdsgenoten, een inkijkje die anders nooit zou hebben plaatsgevonden.
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AbstractObjective: Many older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect onmobility and unplanned hospital readmission is unclear. Therefore, a systematic review and meta-analysis were conducted on this topic.Data Sources: Medline OVID, Embase OVID, and CINAHL were searched from their inception until February 22, 2018.Study Selection: OOHS (ie, skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect ofmultidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age 65y) after discharge from hospitalafter an acute illness.Data Extraction: Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias.Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospitalreadmission within 3 months of discharge.Data Synthesis: A total of 15 studies (1255 patients) were included in the systematic review and 12 were included in the meta-analysis (7assessing mobility using the 6-minute walk distance [6MWD] test and 7 assessing unplanned hospital readmission). Based on the 6MWD, patientsreceiving rehabilitation walked an average of 23 m more than controls (95% confidence interval [CI]Z: 1.34 to 48.32; I2: 51%). Rehabilitationdid not lower the 3-month risk of unplanned hospital readmission (risk ratio: 0.93; 95% CI: 0.73-1.19; I2: 34%). The risk of bias was present,mainly due to the nonblinded outcome assessment in 3 studies, and 7 studies scored this unclearly.Conclusion: OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged fromhospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge.However, the wide 95% CIs indicate that the evidence is not robust.
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