A5024286516- Acute Ischemic Stroke Management
- Stroke Rehabilitation and Recovery
- Clinical practice guidelines implementation
- Venous Thromboembolism Diagnosis and Management
- Peripheral Artery Disease Management
- Healthcare Operations and Scheduling Optimization
- Chronic Disease Management Strategies
- Health Systems, Economic Evaluations, Quality of Life
- Mobile Health and mHealth Applications
- Frailty in Older Adults
- Telemedicine and Telehealth Implementation
- Cerebrovascular and Carotid Artery Diseases
- Business Process Modeling and Analysis
- Cardiac, Anesthesia and Surgical Outcomes
- Geriatric Care and Nursing Homes
- Technology Use by Older Adults
- Healthcare Systems and Practices
- Healthcare Systems and Public Health
- Dementia and Cognitive Impairment Research
- Digital Mental Health Interventions
- Healthcare innovation and challenges
- Electronic Health Records Systems
- Medical Coding and Health Information
- Simulation Techniques and Applications
- Primary Care and Health Outcomes
University Medical Center Groningen
2016-2025
University of Groningen
2016-2025
Hanoi University of Pharmacy
2023
Institute of Technology Assessment
2022
Rijksmuseum
2020
Background and Purpose— Today, treatment of acute stroke consists tissue-type plasminogen activator (tPA), admission to a unit, aspirin. Although tPA is the most effective, there substantial undertreatment. Centralized care may affect rate, timing, outcome thrombolysis compared decentralized in community hospitals. The present study aimed assess impact organizational models on proportion patients undergoing treatment. Methods— A prospective, multicenter, observational among 13 hospitals...
Objectives Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design case identification. The principal objective the study was to analyse five health-risk strategies indicators used in regions participating Advancing Care Coordination Telehealth Deployment (ACT) programme ( http://www.act-programme.eu ). second purpose elaborate on toward enhanced predictive modelling clinical...
Abstract Background Remote home monitoring might fill the perceived surveillance gap after hospital discharge. However, it is unclear whether older oncologic patients will be able to use required new digital technologies. The study aimed assess feasibility of postoperative remote for this population. Methods This observational cohort recruited aged 65 years or scheduled surgery. used a mobile application and activity tracker preoperatively until 3 months postoperatively. A subset additional...
Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability both healthcare policies services in the transition toward coordinated service delivery scenario. To this end, manuscript articulates four different protocols aiming at assessing large-scale implementation care, which are being developed within umbrella regional project Nextcare (2016-2019), undertaken foster innovation technologically-supported for...
Alteplase is widely used as an intravenous thrombolytic drug in acute ischemic stroke (AIS). Recently however, tenecteplase, a modified form of tissue plasminogen activator, has been shown to increase early recanalization rate and proven be non-inferior with similar safety profile compared alteplase. This study aims evaluate the cost-effectiveness 0.25 mg/kg tenecteplase versus 0.9 alteplase for thrombolysis AIS patients from Dutch healthcare payer perspective.A Markov decision-analytic...
Treatment with tissue plasminogen activator (tPA) is the most effective treatment in acute brain infarction. However, estimated worldwide rates are <10%, many barriers hampering broad implementation. Organization and resource-intense randomized controlled trials cannot address all potential simultaneously. Simulation, however, may provide an efficient research means for testing interventions aimed at resolving along care pathway.A simulation-based approach reflecting setup of a regional...
Background and Purpose- Direct transportation to a center with facilities for endovascular treatment might be beneficial patients acute ischemic stroke, but it can also cause harm by delay of intravenous treatment. Our aim was determine the optimal prehospital strategy individual assess which factors influence this decision. Methods- We constructed decision tree model compare outcome stroke after primary versus more distant intervention center. The estimated based on patient characteristics,...
IntroductionRecovery of physical activity is an important functional outcome measure after cancer surgery. However, objective data on for older patients scarce. The aims this study were to quantify perioperative levels, assess recovery three months surgery, and characterise who achieved recovery.Materials methodsThis observational cohort analysed collected from aged >65 scheduled surgery between May 2018 July 2019. Perioperative daily step count was measured using a Fitbit device. primary...
Abstract Background Postoperative home monitoring could potentially detect complications early, but evidence in oncogeriatric surgery is scarce. Therefore, we evaluated whether post-discharge physical activity, vital signs, and patient-reported symptoms are related to hospital readmissions older patients undergoing cancer surgery. Methods In this observational cohort study, monitored (≥65 years of age) surgery, for 2 weeks using tablet-based applications connected devices. Outcome measures...
Introduction: Long term (>36 months) recovery after endovascular treatment (EVT) remains largely understudied in acute ischemic stroke (AIS) patients. Previously, we have shown that long-term white matter microstructure damage, iron deposition and atrophy within/remote to the 24-hour lesion could influence long quality of life. However, role baseline characteristics on status perform daily activities is unknown. Methods: We executed a quantitative 3T MRI protocol (FLAIR, diffusion MRI,...
Various studies demonstrate better patient outcome and higher thrombolysis rates achieved by centralized stroke care compared to decentralized care, i.e. community hospitals. It remains largely unclear how improve rate in care. The aim of this simulation study was assess the impact previously identified success factors a central model on when implemented for decentral model.Based prospectively collected dataset 1084 ischemic patients, used replicate current practice estimate effect...
This paper considers the development of multi-use simulation models for cost-effectiveness studies reperfusion treatments in acute ischemic stroke. The consistent and accurate a specific health domain allow cross-comparison interpretation findings. Furthermore, modelling efficiencies may benefit from exploiting system similarities. To explore requirements models, scoping review was performed to characterise analysis stroke treatments. Findings were used define mixed model structure covering...
In a drive-the-doctor (DD) paradigm, an interventionalist travels from comprehensive stroke centre (CSC) to primary centres (PSCs) perform endovascular thrombectomy (EVT) for acute ischaemic due large vessel occlusion (LVO). The DD paradigm may reduce time delays onset recanalisation. This study aimed analyse the cost-effectiveness of versus drip-and-ship (DS) where LVO patients are transferred PSCs CSC EVT in northern Netherlands. Economic evaluation was performed using simulation model...
Abstract Background Self‐management is an important asset in helping older adults remain independent and control for as long possible. There no reliable valid measurement instrument to evaluate self‐management behaviour of adults. Objective This study aims design a instrument, that the Partners Health scale ( PIH ‐ OA ), assess knowledge community‐living examine its psychometric properties Dutch context. Methods/design The original was translated into adapted context adults, resulting . Data...
We define a domain specific modelling framework for decision support in stroke.• Domain frameworks improve reuse and efficiency of studies.• the requirements conceptual framework.• propose an extended endovascular therapy.• illustrate use with real world example.
Centralisation of thrombolysis may offer substantial benefits. The aim this study was to assess short term costs and effects centralisation optimised care in a decentralised system.Using simulation modelling, three scenarios improve settings the North Netherlands were compared from perspective policy maker current care: (1) improving stroke at nine separate hospitals, (2) centralising treatment four, (3) two hospitals. Outcomes annual mean incremental per patient up with thrombolysis,...
Patients with acute ischemic stroke due to large vessel occlusion (LVO) deemed eligible for endovascular thrombectomy (EVT) are transferred from the emergency room angiography suite undergo procedure. Recently, strategy of direct transfer patients suspected LVO (DTAS) has been shown improve functional outcomes. This study aims evaluate cost-effectiveness DTAS vs initial (Rapid Arterial Occlusion Evaluation score >4 and NIH Stroke Scale >10) (ITER).
Integrated care has been suggested as a promising solution to the disparities in access and sustained high quality long-term emerging Europe's ageing population. We aim gain better understanding of context-specific barriers facilitators implementation integrated by doing retrospective assessment seven years Embrace. This Dutch person-centred health service for older adults was based on two evidence-based models (the Chronic Care Model Kaiser Permanente Triangle). Despite successful...
Objectives To assess potential increases in intravenous thrombolysis (IVT) rates given particular interventions the stroke care pathway. Design Simulation modelling was used to compare performance of current pathway, best practices based on literature review and an optimised model. Setting Four hospitals located North Netherlands, as part a centralised organisational Participants Ischaemic patients prospectively ascertained from February August 2010. Intervention The investigated included...
The Dutch university medical centres (UMC's) are on the forefront when it comes to validation, implementation and research of telemonitoring. To aid UMC's in their effort, Government has supported by fostering 'Citrien eHealth program'. This program aims at nationwide upscaling telemonitoring via a collaborative network. quantify success this program, study provide insights into current adoption health care professionals (HCP) within UMC's.