Guus Schrijvers’s research while affiliated with Utrecht University and other places

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Publications (35)


The perceptions of medical specialists on the influence of Electronic Medical Record use on the quality of hospital care.
  • Preprint
  • File available

March 2020

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56 Reads

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Guus Schrijvers

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Albert Boonstra

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Background: Numerous publications show that Electronic Medical Record (EMR) systems may provide an important contribution to increasing the quality and effectiveness of care. There are indications that particularly the medical specialist plays an important role in the implementation of EMR systems in hospitals. Our goal in this study is to answer the question: which positive or negative factors influence, in the perception of medical specialists, the relation between the EMR use and the quality of medical care? Methods: To answer this question, a qualitative study was conducted in the period August until October 2018. Semi-structured interviews of around 90 minutes were held with twelve medical specialists of twelve different Dutch hospitals. For the analysis of the answers, we used the classification of factors that can influence the implementation of EMR systems based on a previously published taxonomy. Results: The participating interviewees were experienced medical specialists. Their experience within the hospitals concerned varies between 5 and 27 years. There is a spread across different types of hospitals and specialisms. When the answers received are categorised using a previously published taxonomy, the medical specialist considered technical factors the most significant barriers for EMR use to have a positive effect on quality of care, followed by the suboptimal change processes surrounding implementation. The categories ‘social’ and ‘psychological’ and ‘time’ come in at a shared third place. On the positive side, they also identified potential technical facilitators, particularly in the assured availability of information to all health professionals involved in the care of a patient. They see promise in using EMRs for medical decision support to improve quality of care, but consider these capabilities currently lacking. Conclusions: In comparison with the paper record, the interviewed medical specialists consider the digitalised record a great leap forward. Every involved health professional can access the patient data if desired at any time they need it. However, in practice, real quality improvement lags behind as long as, for instance, no one uses decision support no one uses decision support, good integrated analytic tools are missing, and the organisation of care is not adapted to these new possibilities.

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Fig. 2 Structure of the workshop's working groups
“Be an ambassador for change that you would like to see”: a call to action to all stakeholders for co-creation in healthcare and medical research to improve quality of life of people with a neuromuscular disease

December 2019

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51 Reads

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7 Citations

Orphanet Journal of Rare Diseases

A Ambrosini

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VA Sansone

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[...]

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A Zittersteijn

BACKGROUND: Patient and public involvement for co-creation is increasingly recognized as a valuable strategy to develop healthcare research targeting patients’ real needs. However, its practical implementation is not as advanced and unanimously accepted as it could be, due to cultural differences and complexities of managing healthcare programs and clinical studies, especially in the rare disease field. MAIN BODY: The European Neuromuscular Centre, a European foundation of patient organizations, involved its key stakeholders in a special workshop to investigate the position of the neuromuscular patient community with respect to healthcare and medical research to identify and address gaps and bottlenecks. The workshop took place in Milan (Italy) on January 19–20, 2018, involving 45 participants who were mainly representatives of the patient community, but also included experts from clinical centers, industry and regulatory bodies. In order to provide practical examples and constructive suggestions, specific topics were identified upfront. The first set of issues concerned the quality of life at specific phases of a patient’s life, such as at the time of diagnosis or during pediatric to adult transition, and patient involvement in medical research on activities in daily living including patient reported outcome measures. The second set of issues concerned the involvement of patients in the management of clinical research tools, such as registries and biobanks, and their participation in study design or marketing authorization processes. Introductory presentations were followed by parallel working group sessions, to gain constructive contributions from all participants. The concept of shared decision making was used to ensure, in discussions, a partnership-based identification of the wishes and needs of all stakeholders involved, and the “ladder of participation” tool served as a model to evaluate the actual and the desired level of patients’ involvement in all topics addressed. A general consensus on the outcome of the meeting was collected during the final plenary session. This paper reports the outcome of the workshop and the specific suggestions derived from the analysis of the first set of topics, related to quality of life. The outcomes of the second set of topics are reported elsewhere and are only briefly summarized herein for the sake of completeness. CONCLUSIONS: The neuromuscular community proved to be very active and engaged at different levels in the healthcare initiatives of interest. The workshop participants critically discussed several topics, providing practical examples where different stakeholders could play a role in making a change and bridging gaps. Overall, they indicated the need for education of all stakeholders for better communication, where everyone should become an ambassador to promote real change. Support should also come from institutions and healthcare bodies both at structural and economic level.


Fig. 2 Structure of the workshop's working groups
“Be an ambassador for change that you would like to see”: a call to action to all stakeholders for co-creation in healthcare and medical research to improve quality of life of people with a neuromuscular disease

June 2019

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166 Reads

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15 Citations

Orphanet Journal of Rare Diseases

Background Patient and public involvement for co-creation is increasingly recognized as a valuable strategy to develop healthcare research targeting patients’ real needs. However, its practical implementation is not as advanced and unanimously accepted as it could be, due to cultural differences and complexities of managing healthcare programs and clinical studies, especially in the rare disease field. Main body The European Neuromuscular Centre, a European foundation of patient organizations, involved its key stakeholders in a special workshop to investigate the position of the neuromuscular patient community with respect to healthcare and medical research to identify and address gaps and bottlenecks. The workshop took place in Milan (Italy) on January 19–20, 2018, involving 45 participants who were mainly representatives of the patient community, but also included experts from clinical centers, industry and regulatory bodies. In order to provide practical examples and constructive suggestions, specific topics were identified upfront. The first set of issues concerned the quality of life at specific phases of a patient’s life, such as at the time of diagnosis or during pediatric to adult transition, and patient involvement in medical research on activities in daily living including patient reported outcome measures. The second set of issues concerned the involvement of patients in the management of clinical research tools, such as registries and biobanks, and their participation in study design or marketing authorization processes. Introductory presentations were followed by parallel working group sessions, to gain constructive contributions from all participants. The concept of shared decision making was used to ensure, in discussions, a partnership-based identification of the wishes and needs of all stakeholders involved, and the “ladder of participation” tool served as a model to evaluate the actual and the desired level of patients’ involvement in all topics addressed. A general consensus on the outcome of the meeting was collected during the final plenary session. This paper reports the outcome of the workshop and the specific suggestions derived from the analysis of the first set of topics, related to quality of life. The outcomes of the second set of topics are reported elsewhere and are only briefly summarized herein for the sake of completeness. Conclusions The neuromuscular community proved to be very active and engaged at different levels in the healthcare initiatives of interest. The workshop participants critically discussed several topics, providing practical examples where different stakeholders could play a role in making a change and bridging gaps. Overall, they indicated the need for education of all stakeholders for better communication, where everyone should become an ambassador to promote real change. Support should also come from institutions and healthcare bodies both at structural and economic level.


The Position of Neuromuscular Patients in Shared Decision Making. Report from the 235th ENMC Workshop: Milan, Italy, January 19-20, 2018

January 2019

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36 Reads

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8 Citations

Journal of Neuromuscular Diseases

In the era of patient-centered medicine, shared decision-making (SDM) - in which healthcare professionals and patients exchange information and preferences and jointly reach a decision - has emerged as the gold standard model for the provision of formal healthcare. Indeed, in many geographical settings, patients are frequently invited to participate in choices concerning the design and delivery of their medical management. From a clinical perspective, benefits of this type of patient involvement encompass, for example, enhanced treatment satisfaction, improved medical compliance, better health outcomes, and maintained or promoted quality of life. Yet, although the theory and enactment of SDM in healthcare are well-described in the literature [1-3], comparatively less attention has been devoted to contextualizing questions relating to if, when, and how to include patients in decisions within medical research. In this context, patient involvement would be expected to be potentially relevant for and applicable to a wide range of activities and processes, from the identification of research priorities and development of grant applications, to the design of patient information and consent procedures, formulation of interventions, identification and recruitment of study sample populations, feasibility of a clinical trial, identification, selection, and specification of endpoints and outcomes in clinical trials and observational studies, data collection and analysis, and dissemination of results. To this end, 45 clinicians, healthcare professionals, researchers, patients, caregivers, and representatives from regulatory authorities and pharmaceutical companies from 15 different countries met to discuss the level of involvement of patients with neuromuscular diseases, specifically in the following settings of medical research for neuromuscular diseases: i) registries and biobanks; ii) clinical trials; and iii) regulatory processes. In this report, we present summaries of the talks that were given during the workshop, as well as discussion outcomes from the three topic areas listed above.


Professionals' Use of a Multidisciplinary Communication Tool for Patients With Dementia in Primary Care

January 2018

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19 Reads

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6 Citations

CIN Computers Informatics Nursing

In this descriptive study, the use of a professional e-communication tool, Congredi, is evaluated. Ninety-six Congredi records of patients with dementia could be divided into the subgroups low-complex care (n = 43) and high-complex care (n = 53). If Congredi is an adequate communication tool for professionals, the changing involvement of caregivers must also be reflected within the two subgroups. We hypothesized that use would be more intensive in the high-complex group in comparison with the low-complex group. Data were gathered during 42 weeks. Results showed that the mean number of care activities in the high-complex group was significantly higher than in the low-complex group (10.43 vs 5.61, P = .001). The number of professionals involved with the high-complex care group (3.58) was higher compared to the low-complex care group (2.51) (P = .000). The most frequent use was by case managers and nurses (43.4%) in the high-complex group and by several case managers (41.9%) in the low-complex group. It was concluded that professionals used Congredi adequately in the multidisciplinary care of patients with dementia because the changing involvement of caregivers and the level of care activities were reflected in the use of Congredi.


The challenge of involving elderly patients in primary care by using an electronic communication tool with their professionals: a mixed methods study

November 2017

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85 Reads

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5 Citations

Journal of Innovation in Health Informatics

Background: Elderly patients in primary care often have multiple health problems,with different healthcare professionals involved. For consistency in care, it is required that communication amongst professionals and patient-systems (patient and informal-carers) be well tuned. Electronic-communication can make it easier for patient-system to be active in care. Objective: To examine whether an e-communication tool (Congredi) designed for professionals, including a care plan and secure e-mail, is usable for patient-systems and what their experiences are. Methods: In a multi-method study, home-dwelling elderly patients with two or more professionals were invited to use Congredi; data were gathered from the system after 42 weeks. Also semi-structured interviews were undertaken with patient-systems with topics retrieved from literature. Analysis took place by two researchers independently; the themes were extracted together by consensus. Results: Data about actual use of the tool were gathered from 22 patients. Four profiles of Congredi-users were distinguished, varying in intensity of use. Data from interviews with members of patient-systems (n = 7) showed that they were motivated and able to use Congredi. Barriers in daily use were limited participation of professionals, unanswered e-mail and not being alerted about actions. Despite limitations, patient-systems retained their motivation. Conclusion: Congredi was usable for patient-systems. The barriers found seem not to be tool-related but primarily user-related. An important barrier for daily use was limited active participation of involved professionals in a complete feedback loop. Potential for future implementation was found, as patient-systems were intrinsically motivated for better feedback with the professionals, even though in this study it only partly met their expectations.


Case-Managers and Integrated Care

July 2017

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22 Reads

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2 Citations

This chapter on case management starts with a case story about Julia, a person with dementia, and her case manager, John (Sect. 4.1). It shows six innovations which are necessary to introduce case managers. Julia and John live in the year 2025, in a rich western country with a health system that supports integrated care by means of adequate financing and digitalization of care. Section 4.2 introduces a definition of the concept of case management and discusses important terms in it. Then (Sect. 4.3), two specific competences of case managers are discussed: (1) the assessments of care and social needs and (2) empowering interviewing of clients. The chapter continues (Sect. 4.4) with the comparison of the “ideal world” in the case story in 2025 with the real world in 2015 by focusing on case management practices in The Netherlands and France. The chapter ends (Sect. 4.5) by offering theories to support the implementation of the case manager. The chapter emphasises that case managers are not only for clients with dementia but are relevant as an approach to support other people with health, educational and financial problems; clients with developmental delays; patients with severe mental illness; patients with cancer and metastases; and persons with more than one chronic condition. In this chapter, the words clients, patients and persons are used as synonyms occurring in different care contexts.


The theoretical model
Level of Digitization in Dutch Hospitals and the Lengths of Stay of Patients with Colorectal Cancer

April 2017

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153 Reads

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22 Citations

Journal of Medical Systems

A substantial amount of research has been published on the association between the use of electronic medical records (EMRs) and quality outcomes in U.S. hospitals, while limited research has focused on the Western European experience. The purpose of this study is to explore the association between the use of EMR technologies in Dutch hospitals and length of stay after colorectal cancer surgery. Two data sets were leveraged for this study; the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAMSM) and the Dutch surgical colorectal audit (DSCA). The HIMSS Analytics EMRAM score was used to define a Dutch hospital’s electronic medical records (EMR) capabilities while the DSCA was used to profile colorectal surgery quality outcomes (specifically total length of stay (LOS) in the hospital and the LOS in ICU). A total of 73 hospitals with a valid EMRAM score and associated DSCA patients (n = 30.358) during the study period (2012–2014) were included in the comparative set. A multivariate regression method was used to test differences adjusted for case mix, year of surgery, surgical technique and for complications, as well as stratifying for academic affiliated hospitals and general hospitals. A significant negative association was observed to exist between the total LOS (relative median LOS 0,974, CI 95% 0.959–0,989) of patients treated in advanced EMR hospitals (high EMRAM score cohort) versus patients treated at less advanced EMR care settings, once the data was adjusted for the case mix, year of surgery and type of surgery (laparoscopy or laparotomy). Adjusting for complications in a subgroup of general hospitals (n = 39) yielded essentially the same results (relative median LOS 0,934, CI 95% 0,915–0,954). No consistent significant associations were found with respect to LOS on the ICU. The findings of this study suggest advanced EMR capabilities support a healthcare provider’s efforts to achieve desired quality outcomes and efficiency in Western European hospitals.


Figure 1. The eHealth Enhanced Chronic Care Model. ACO: accountable care organizations; RHIO: regional health information organization; EHR: electronic health record; PHR: electronic patient health record or patient portal.  
Figure 2. Congredi problem inventory: problems listed in text and in the social, functional, mental, physical, and communication (SFMPC) domains.  
Figure 3. Congredi care plan: problems, aims and actions shown in social, functional, mental, physical, and communication (SFMPC) action blocks.  
Figure 4. Congredi email module: secure email for professionals about their patients.
How Professionals Share an E-Care Plan for the Elderly in Primary Care: Evaluating the Use of an E-Communication Tool by Different Combinations of Professionals

November 2016

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488 Reads

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18 Citations

Journal of Medical Internet Research

Background: Home-dwelling elderly patients with multimorbidity are at risk of fragmentation of care because of the many different professionals involved and a potentially unclear level of communication. Multidisciplinary communication seems to occur incidentally. Mutual feedback is needed for a professional team to provide consistent care and adequate support to the patient system. eHealth technology can improve outcomes. Objective: The aim of this study was to evaluate the use of a tool, Congredi, for electronic communication by professionals for the care of home-dwelling elderly patients. Methods: The research group was recruited through general practices and home care organizations. Congredi, a tool designed for multidisciplinary communication, was made available for professionals in primary care. It consists of a care plan and a communication channel (secure emailing). Professionals opened Congredi records for elderly patients who had 2 or more professionals involved. The records were the unit of analysis. Data were gathered from the Congredi system over a period of 42 weeks. Results: An inclusion rate of 21.4% (203/950) was achieved; nearly half of the participants were nurses. During the study, professionals were active in 448 patient records; female professionals were prevalent. In the patient records, 3 types of actions (care activities, emailing, and process activities) were registered. Most activities occurred in the multidisciplinary records (mean 12.2), which had twice the number of activities of monodisciplinary records (6.35), and solo records had a mean of 3.43 activities. Most activities were care activities (mean 9.14), emailing had a mean of 0.89 activities, and process activities had a mean of 0.29. Conclusions: An e-communication tool (Congredi) was usable for improving multidisciplinary communication among professionals. It even seemed to yield results for 40% of the professionals who used the e-care plan on their own. The content of the tool provided an active communication practice, with significant increases observed in the actions that must be shared for the effective coordination of care.



Citations (20)


... This market constellation creates a significant power asymmetry, marked by a high difference in resources, interests, and influence between the public sector entities and the individuals who ultimately use the technology (Iakovleva, Oftedal, & Bessant, 2019). Consequently, overlooking user involvement or insufficient or tokenistic inclusion in the innovation process can result in technologies that fail to meet user needs (Fischer, Peine, & Östlund, 2020), Greenalgh et al., 2017;Scarbrough, & Kyratsis, 2022Van Leersum et al., 2022Ambrosini et al., 2019). ...

Reference:

Superpower or kryptonite?: To innovate by involving users
“Be an ambassador for change that you would like to see”: a call to action to all stakeholders for co-creation in healthcare and medical research to improve quality of life of people with a neuromuscular disease

Orphanet Journal of Rare Diseases

... Of these deliverables, 78% were implemented in the field, bringing state-of-the-art knowledge and new collaborations to researchers and clinicians, improving the designs of clinical trials, and innovating tools to make accurate diagnoses. Workshop reports are amongst the most cited articles in the Neuromuscular Disorders journal [48][49][50][51][52][53][54]. ...

“Be an ambassador for change that you would like to see”: a call to action to all stakeholders for co-creation in healthcare and medical research to improve quality of life of people with a neuromuscular disease

Orphanet Journal of Rare Diseases

... The benefits of interprofessional communication tools were confirmed in this study, including the potential to divide tasks, enabling more efficient and safer information exchange, replacing some less important face-to-face meetings or telephone calls, and improving caregiver involvement (Finney Rutten et al., 2014;Madara Marasinghe, 2016;Munro & Swartzman, 2013;Stille et al., 2005). In our study, we found great variety in frequency of use, which is common in using digital tools (de Jong et al., 2018). Several caregivers and professionals indicated that use was mainly dependent on the current health situation of the older adult. ...

Professionals' Use of a Multidisciplinary Communication Tool for Patients With Dementia in Primary Care
  • Citing Article
  • January 2018

CIN Computers Informatics Nursing

... 11 For these systems to be effective, the literature suggests that they should incorporate a Complete Feedback Loop (CFL). 12 This CFL comprises a five-stage communicative process, involving both healthcare professionals and patient systems playing an active role. These stages are as follows: (1) conveying data and information about the health status of patients, (2) analyzing the data and information with the help of existing knowledge or wisdom and applying evidence-based standards, (3) addressing the unique needs of each patient, (4) providing prompt feedback to the patient that addresses their specific needs, and (5) routinely repeating the CFL. ...

The challenge of involving elderly patients in primary care by using an electronic communication tool with their professionals: a mixed methods study

Journal of Innovation in Health Informatics

... Similarly, Van Poelgesst et al. assess the correlation between EMRAM stages and different composite measures for overall quality, medical care, patient orientation, and effective treatment [16]. Another 3 Dutch observational study examines the relationship between EMRAM stages and the length of stay of colorectal cancer patients [17]. ...

Level of Digitization in Dutch Hospitals and the Lengths of Stay of Patients with Colorectal Cancer

Journal of Medical Systems

... Other digital applications are mHealth (30)(31)(32)(33)(34), involving health apps (30) and tablet (31); telehealth and telemedicine (35)(36)(37)(38)(39)(40)(41)(42); EHRs (26, 43,44); arti cial intelligence (45)(46)(47)(48); and integrating websites (49)(50)(51) . Web-based applications often require combined usage (Mobile and Website) (52,53), such as QR codes and websites (54), ambient assisted living technologies (55), and smart home technology (56), incorporating computers with internet access and X10-based smart home technology (Table 1). ...

How Professionals Share an E-Care Plan for the Elderly in Primary Care: Evaluating the Use of an E-Communication Tool by Different Combinations of Professionals

Journal of Medical Internet Research

... A more explicit role for patients, carers and families is essential to improve medication safety in transitions of care. 4 There have been attempts to include patients in electronic discharge, [40][41][42] and WHO has developed a free 'Medsafe' app (https://www.iapo.org.uk/news/ 2019/jul/18/who-medsafe-app) to support patients holding an up-to-date medicines record. ...

Exploring the effects of patients taking a vigilant role in collaborating on their e-Medication Administration Record
  • Citing Article
  • January 2016

International Journal of Medical Informatics

... However, a study investigating the relationship between IT applications and the quality and safety of hospital care revealed no inherent positive correlation between advanced electronic medical record capabilities and improvements in healthcare quality and safety in the Netherlands. Consequently, the impact of IT applications on the medical field requires further validation through diverse mathematical models, while also considering a broader range of influential factors [25]. ...

The Association between eHealth Capabilities and the Quality and Safety of Health Care in the Netherlands: Comparison of HIMSS Analytics EMRAM data with Elsevier's 'The Best Hospitals' data

Journal of Medical Systems

... Placing a family member in a nursing home is for many family carers one of the most painful and morally difficult decisions to make, 1 and it may be an intensely emotional experience. 2 Several studies on the determinants of nursing home placement have been published. 1,[3][4][5][6][7][8][9][10] These are all focused on the perceptions and reactions of members of specific cultural groups. Other researchers focus on the physical, emotional, psychological and social burdens of being caregivers, [11][12][13] or on familism or collectivism and the shame and stigma of not being able to care for the elderly family dependent on oneself. ...

How spouses evaluate Nursing Home Placement of their demented partner: A study about the end of perseverance time
  • Citing Article
  • April 2014

Scandinavian Journal of Caring Sciences

... Intensity of caregiving was measured using an adapted version of the intensity of informal care questionnaire, which assessed the hours of support with household tasks, support with self-care tasks, emotional support, and practical support (Hoefman et al., 2013). Perseverance time is a validated single-question instrument that asks informal caregivers to report "if the informal care situation stays as it is now, how long will you be able to cope with the care?" (Kraijo et al., 2014;Richters et al., 2016). For the purpose of this study, the response categories were dichotomized for the perseverance time variable. ...

The Perseverance Time of Informal Carers of Dementia Patients: Validation of a New Measure to Initiate Transition of Care at Home to Nursing Home Care
  • Citing Article
  • February 2014