Gert P Westert

Gert P Westert
Radboud University | RU · IQ healthcare (Scientific Center for Quality of Healthcare)

MSc (Res), PhD

About

445
Publications
66,780
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
11,203
Citations
Introduction
Prof. Gert Westert (MSc, PhD) is director of IQ healthcare and full professor Quality of Health Care and Health Services Research at Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. IQ healthcare is a scientific centre for research, education and support of quality, safety and innovation in healthcare and one of the leading scientific institutes in this field in Europe.
Additional affiliations
January 2011 - December 2012
Radboud University
Position
  • Radboud University Nijmegen Medical Centre
January 2011 - June 2016
Radboud University
Position
  • Professor (Full)
January 2011 - June 2016
Radboud University
Position
  • Research Director

Publications

Publications (445)
Article
The Rutte IV administration can and will spend much less on healthcare than its predecessor. A difficult task. Providing less low-value care, that is healthcare with no or little benefit for the patient given the alternatives, by physicians is one way to improve quality and reduce costs. Less low-value care will therefore play a crucial role in the...
Article
Tussen 2002 en 2020 verdriedubbelde de incidentie van euthanasie in Nederland. Lijken de percentages landelijk nog betrekkelijk laag, regionaal blijken de verschillen veel groter. Het euthanasiepercentage in de 3 gemeenten met de meeste euthanasieën ligt 25 maal zo hoog als in de 3 gemeenten met het laagste percentage. Die verschillen hangen samen...
Article
Full-text available
Background: Low-value pharmaceutical care exists in general practice. However, the extent among Dutch GPs remains unknown. Aim: To assess the prevalence of low-value pharmaceutical care among Dutch GPs. Design and setting: Retrospective cohort study using data from patient records. Method: The prevalence of three types of pharmaceutical care...
Article
Background National Dutch guidelines have been introduced to improve suboptimal perioperative care. A multifaceted implementation programme (IMPlementatie Richtlijnen Operatieve VEiligheid [IMPROVE]) has been developed to support hospitals in applying these guidelines. This study evaluated the effectiveness of IMPROVE on guideline adherence and the...
Article
Full-text available
Objectives A cost-effectiveness analysis of a multicenter randomized-controlled trial comparing restrictive strategy versus usual care in patients with gallstones showed that savings by restrictive strategy could not compensate for the lower proportion of pain-free patients. However, four subgroups based on combined stratification factors resulted...
Article
Full-text available
Background The study objective was to analyse the implementation challenges experienced in carrying out the IMPROVE programme. This programme was designed to implement checklist-related improvement initiatives based on the national perioperative guidelines using a stepped-wedge trial design. A process analysis was carried out to investigate the inv...
Article
Background Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the...
Article
Background: Around the world, policies and interventions are used to encourage clinicians to reduce low-value care. In order to facilitate this, we need a better understanding of the factors that lead to low-value care. We aimed to identify the key factors affecting low-value care on a national level. In addition, we highlight differences and simi...
Preprint
Full-text available
Background Advance Care Planning (ACP) enables physicians to align healthcare with patients wishes, reduces burdensome life-prolonging medical interventions, and potentially improves the quality of life of patients in the last phase of life. However, little objective information is available about the extent to which structured ACP conversations ar...
Article
Full-text available
Background Overuse of diagnostic testing substantially contributes to healthcare expenses and potentially exposes patients to unnecessary harm. Our objective was to systematically identify and examine studies that assessed the prevalence of diagnostic testing overuse across healthcare settings to estimate the overall prevalence of low-value diagnos...
Article
Importance: Diagnostic yield of upper gastrointestinal (GI) tract endoscopy for uninvestigated dyspepsia is low, and its clinical implications are limited. There is an unmet need for better strategies to reduce the volume of upper GI tract endoscopic procedures for dyspepsia. Objective: To study the effectiveness of a web-based educational inter...
Article
Full-text available
Sciatica is a common back problem with a generally positive natural course. This interview study was performed to gain increased insight into ambivalent and reluctant medicalization on the interactional level regarding the perceptions of Dutch patients and physicians about sciatica and its treatment options as a case study. While the concept of med...
Book
Zeven grote topklinische ziekenhuizen die transparant zijn over behandel resultaten en vanuit onderling vertrouwen van elkaar leren. Artsen en verpleegkundigen die bij elkaar in de keuken kijken en elkaar inspireren. Dat is de kracht van Santeon. Wat is echt belangrijk voor patiënten? We streven ernaar om dát inzichtelijk te maken met goede data....
Article
Full-text available
Background Uniform criteria for performing hip replacement surgery in hip osteoarthritis patients are currently lacking. As a result, variation in surgery, questions about appropriateness of care and under- and overuse may occur. The aim of this study was to develop a consensus-based decision tool to support the decision-making process for hip repl...
Article
Full-text available
Background The annual incidence of euthanasia in the Netherlands as a percentage of all deaths rose from 1.9% in 1990 to 4.4% in 2017. Scarce literature on regional patterns calls for more detailed insight into the geographical variation in euthanasia and its possible explanations. Objectives This paper (1) shows the geographical variation in the...
Preprint
BACKGROUND Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the...
Article
Full-text available
Strategies to increase appropriateness of EoL care, such as shared decision making (SDM), and advance care planning (ACP) are internationally embraced, especially since the COVID-19 pandemic. However, individuals preferences regarding EoL care may differ internationally. Current literature lacks insight in how preferences in EoL care differ between...
Article
Full-text available
Background: In the Netherlands most patients are currently seen in an outpatient clinic after an anterior cervical discectomy, which is an effective neurosurgical procedure with relatively low rate of severe complications. In this back sight, the need for patients returning to the post-operative outpatient clinic could be questioned. The aim of th...
Article
Full-text available
Objective General practitioners have an important role in reducing low-value care as gatekeepers of the health system. The aim of this study was to assess the experiences of Dutch general practitioners regarding low-value care and to identify their needs to decrease low-value primary care. Design We performed a cross-sectional study. Participants...
Article
Full-text available
Background: To improve perioperative patient safety, guidelines for the preoperative, peroperative, and postoperative phase were introduced in the Netherlands between 2010 and 2013. To help the implementation of these guidelines, we aimed to get a better understanding of the barriers and drivers of perioperative guideline adherence and to explore...
Article
Full-text available
Background: Measuring and improving outcomes is a central element of value-based health care. However, selecting improvement interventions based on outcome measures is complex and tools to support the selection process are lacking. The goal was to present strategies for the systematic identification and selection of improvement interventions appli...
Article
Full-text available
Objective: To examine the regional variation in hospital care utilization in the last 6 months of life of Dutch patients with lung cancer and to test whether higher degrees of hospital utilization coincide with less general practitioner (GP) and long-term care use. Design: Cross-sectional claims data study. Setting: The Netherlands. Participa...
Article
Full-text available
Background: There have been contributions to quantify the volume of low-value care practices in the USA, Canada and Australia but we have no knowledge about the volume in Europe. The purpose of this study was to assess the volume and variation of Dutch low-value care practices. Methods: We conducted a cross-sectional study with data of a Dutch h...
Article
De vorming van zorgnetwerken wordt alom gezien als de oplossing voor de fragmentatie van de moderne zorg.
Article
Full-text available
Background: Medicalization has been a topic of discussion and research for over four decades. It is a known concept to researchers from a broad range of disciplines. Medicalization appears to be a concept that speaks to all, suggesting a shared understanding of what it constitutes. However, conceptually, the definition of medicalization has evolve...
Article
Full-text available
Patient characteristics have been linked to prevalence and quality of shared decision-making (SDM) behaviors across diverse studies of varied size and focus. We aim to evaluate the extent to which patient characteristics are associated with patient-rated SDM scores as measured by collaboRATE and whether or not collaboRATE varies at the provider gro...
Article
Full-text available
Shared decision-making (SDM) between clinicians and patients is a key component of patient experience, but measurement efforts have been hampered by a lack of valid and reliable measures that are feasible for routine use. In this study, we aim to investigate collaboRATE’s reliability, calculate required sample sizes for reliable measurement, and co...
Article
Full-text available
Background: For older adults, a good transition from hospital to the primary or long-term care setting can decrease readmissions. This paper presents the 6-month post-discharge healthcare utilization of older adults and describes the numbers of readmissions and deaths for the most frequently occurring aftercare arrangements as a starting point in...
Article
Full-text available
Background: Value-based healthcare (VBHC) is a concept that focuses on outcome measurement to contribute to quality improvement. However, VBHC does not offer a systematic approach for implementing improvement as implementation science does. The aim is to, firstly, investigate the implementation of improvement initiatives in the context of VBHC and...
Article
Full-text available
Aims: This study aimed to determine the characteristics of patients with heart failure and high costs (top 1% and top 2-5% highest costs in perspective of the general population) and to explore the longitudinal health care utilization and persistency of high costs. Methods and results: Longitudinal observational study using claims data from 2006...
Chapter
Evidence-based medicine is currently state of the art also within neurosurgery. However, most of the known techniques and approaches have been developed before the nineties of the former century. Series of cases were published reporting the success of a method. These were supported by personal views of charismatic leading neurosurgeons. For example...
Chapter
The previous chapters of this book have shown that becoming an evidence-based neurosurgeon is not a simple task. Both the editors and the authors have tried to take the next step in the synthesis of higher-level evidence for practicing neurosurgeons. The chapters are organized around common clinical scenarios taken from real-life experience. The re...
Article
Full-text available
Background: Multimorbidity poses a challenge for decision-making processes and requires that more attention is paid to patient goals, preferences and needs; however, goal setting is not yet widely recognised as a core aspect of the shared decision-making (SDM) approach. This study aims to analyse clinician perceptions of the concept of goal settin...
Article
Full-text available
Objectives The objective of this exploratory study was to see how the Patient-Reported Apnea Questionnaire (PRAQ) may impact the daily clinical practice of sleep centres, and why it may or may not work as expected. The hypotheses were tested that this patient-reported outcome measure makes patients more aware of which of their health complaints may...
Article
Full-text available
Objective: Patient-reported outcomes (PROs) are aspects of a patient's health status and are considered important for stimulating patient-centered care. Current outcome measures in clinical care for patients with aneurysmal subarachnoid hemorrhage (aSAH) are insufficient to capture PROs. In this systematic review, we aimed to summarize the evidenc...
Article
Full-text available
Value Based competition in Health Care (VBHC) has become a guiding principle in the quest for high quality health care for acceptable costs. Current literature lacks substantial ethical evaluation of VBHC. In this paper we describe how a single-minded focus on VBHC may cause serious infringements upon at least four medical ethical principles: 1) it...
Article
Full-text available
Objectives Readmissions are used widespread as an indicator of the quality of care within hospitals. Including readmissions to other hospitals might have consequences for hospitals. The aim of our study is to determine the impact of taking into account readmissions to other hospitals on the readmission ratio. Design and setting We performed a cros...
Article
Background International guidelines advise laparoscopic cholecystectomy to treat symptomatic, uncomplicated gallstones. Usual care regarding cholecystectomy is associated with practice variation and persistent post-cholecystectomy pain in 10–41% of patients. We aimed to compare the non-inferiority of a restrictive strategy with stepwise selection w...
Article
Full-text available
Understanding the overuse and underuse of health-care services in the end-of-life (EoL) phase for patients with lung cancer (LC) and colorectal cancer (CRC) is important, but knowledge is limited. To help identify inappropriate care, we present the health-care utilization profiles for hospital care at the EoL of patients with LC (N = 25 553) and CR...
Book
This book covers spinal, cranial and peripheral nerve surgeries. Each chapter has a uniform format for ease of reading, including a description of the problem, a literature summary and analysis, and conclusions made using evidence-based medicine (including the GRADE method). The scientific evidence for a selection of neurosurgical procedures for we...
Article
Full-text available
Background Using outcome measures to advance healthcare continues to be of widespread interest. The goal is to summarize the results of studies which use outcome measures from clinical registries to implement and monitor QI initiatives. The second objective is to identify a) facilitators and/or barriers that contribute to the realization of QI effo...
Article
Full-text available
Background It is not clear which part of the variation in hospital readmissions can be attributed to the standard of care hospitals provide. This is in spite of their widespread use as an indicator of a lower quality of care. The aim of this study is to assess the variation in readmissions on the hospital level after adjusting for case-mix factors....
Article
Background: Examining variation in patterns of re-admissions between countries can be valuable for mutual learning in order to reduce unnecessary re-admissions. The aim of this study was to compare re-admission rates and reasons for re-admissions between England and the Netherlands. Methods: We used data from 85 Dutch hospitals (1 355 947 admiss...
Article
Full-text available
Background Cholecystectomy is the preferred treatment for symptomatic cholecystolithiasis. However, persistent pain after cholecystectomy for symptomatic cholecystolithiasis is reported in up to 40% of patients. The aim of the SECURE trial is to compare the effectiveness of usual care with a restrictive strategy using a standardized work-up with st...
Article
Full-text available
Background Audits are increasingly used for patient safety governance purposes. However, there is little insight into the factors that hinder or stimulate effective governance based on auditing. The aim of this study is to quantify the factors that influence effective auditing for hospital boards and executives. Methods A questionnaire of 32 facto...
Article
Full-text available
Objectives To investigate the characteristics and healthcare utilisation of high-cost patients and to compare high-cost patients across payers and countries. Design Systematic review. Data sources PubMed and Embase databases were searched until 30 October 2017. Eligibility criteria and outcomes Our final search was built on three themes: ‘high-c...
Article
Full-text available
Objective: To identify factors that explain the observed effects of internal auditing on improving patient safety. Design setting and participants: A process evaluation study within eight departments of a university medical centre in the Netherlands. Intervention(s): Internal auditing and feedback for improving patient safety in hospital care....
Article
Full-text available
Background: We previously developed the preliminary version of the Patient-Reported Apnea Questionnaire (PRAQ), a questionnaire measuring health-related quality of life in patients with (suspected) obstructive sleep apnea (OSA). This questionnaire was developed for clinical practice, where it can potentially serve two goals: use on an individual p...
Article
Background: Low-value care provides little or no benefit to the patient, causes harm and wastes limited resources. Reducing it is therefore important for safer and more sustainable care. Objectives: We systematically assessed nursing low-value care practices in Dutch clinical practice guidelines with the aim to facilitate and stimulate nurses to...