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  • 1
    Online Resource
    Online Resource
    Rationale and design for studying organisation of care for intra-arterial thrombectomy in the Netherlands: simulation modelling study
    BMJ ; 2020
    In:  BMJ Open Vol. 10, No. 1 ( 2020-01), p. e032754-
    Details
    In: BMJ Open, BMJ, Vol. 10, No. 1 ( 2020-01), p. e032754-
    Abstract: The introduction of intra-arterial thrombectomy (IAT) challenges acute stroke care organisations to provide fast access to acute stroke therapies. Parameters of pathway performance include distances to primary and comprehensive stroke centres (CSCs), time to treatment and availability of ambulance services. Further expansion of IAT centres may increase treatment rates yet could affect efficient use of resources and quality of care due to lower treatment volume. The aim was to study the organisation of care and patient logistics of IAT for patients with ischaemic stroke in the Netherlands. Methods and analyses Using a simulation modelling approach, we will quantify performance of 16 primary and CSCs offering IAT in the Netherlands. Patient data concerning both prehospital and intrahospital pathway logistics will be collected and used as input for model validation. A previously validated simulation model for intravenous thrombolysis (IVT) patients will be expanded with data of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry and trials performed in the Collaboration for New Treatments in Acute Stroke consortium to represent patient logistics, time delays and outcomes in IAT patients. Simulation experiments aim to assess effectiveness and efficiency of alternative network topologies, that is, IAT with or without IVT at the nearest primary stroke centre (PSC) versus centralised care at a CSC. Primary outcomes are IAT treatment rates and clinical outcome according to the modified Rankin Scale. Secondary outcomes include onset-to-treatment time and resource use. Mann-Whitney U and Fisher’s exact tests will be used to estimate differences for continuous and categorical variables. Model and parameter uncertainty will be tested using sensitivity analyses. Ethics and dissemination This will be the first study to examine the organisation of acute stroke care for IAT delivery on a national scale using discrete event simulation. There are no ethics or safety concerns regarding the dissemination of information, which includes publication in peer-reviewed journals and (inter)national conference presentations. Trial registration number ISRCTN99503308 , ISRCTN76741621 , ISRCTN19922220 , ISRCTN80619088 , NCT03608423 ; Pre-results.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2019-032754
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2599832-8
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  • 2
    Online Resource
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    Expediting workflow in the acute stroke pathway for endovascular thrombectomy in the northern Netherlands: a simulation model
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 4 ( 2022-04), p. e056415-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 4 ( 2022-04), p. e056415-
    Abstract: The objective of this study is to identify barriers for the timely delivery of endovascular thrombectomy (EVT) and to investigate the effects of potential workflow improvements in the acute stroke pathway. Design Hospital data prospectively collected in the MR CLEAN Registry were linked to emergency medical services data for each EVT patient and used to build two Monte Carlo simulation models. The ‘mothership (MS) model’, reflecting patients who arrived directly at the comprehensive stroke centre (CSC); and the ‘drip and ship’ (DS) model, reflecting patients who were transferred to the CSC from primary stroke centres (PSCs). Setting Northern region of the Netherlands. One CSC provides EVT, and its catchment area includes eight PSCs. Participants 248 patients who were treated with EVT between July 2014 and November 2017. Outcome measures The main outcome measures were total delay from stroke onset until groin puncture, functional independence at 90 days (modified Rankin Scale 0–2) and mortality. Results Barriers identified included fast-track emergency department routing, prealert for transfer to the CSC, reduced handover time between PSC and ambulance, direct transfer from CSC arrival to angiography suite entry, and reducing time to groin puncture. Taken together, all workflow improvements could potentially reduce the time from onset to groin puncture by 59 min for the MS model and 61 min for the DS model. These improvements could thus result in more patients—3.7% MS and 7.4% DS—regaining functional independence after 90 days, in addition to decreasing mortality by 3.0% and 5.0%, respectively. Conclusions In our region, the proposed workflow improvements might reduce time to treatment by about 1 hour and increase the number of patients regaining functional independence by 6%. Simulation modelling is useful for assessing the potential effects of interventions aimed at reducing time from onset to EVT.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-056415
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 3
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    Variations in Modeling for Treating All Patients With Stroke With Suspected Large Vessel Occlusion
    American Medical Association (AMA) ; 2019
    In:  JAMA Neurology Vol. 76, No. 5 ( 2019-05-01), p. 624-
    Details
    In: JAMA Neurology, American Medical Association (AMA), Vol. 76, No. 5 ( 2019-05-01), p. 624-
    Type of Medium: Online Resource
    ISSN: 2168-6149
    DOI: 10.1001/jamaneurol.2019.0348
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2019
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  • 4
    Online Resource
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    Simulation modelling to assess prehospital thrombolysis
    Elsevier BV ; 2016
    In:  The Lancet Neurology Vol. 15, No. 13 ( 2016-12), p. 1305-1306
    Details
    In: The Lancet Neurology, Elsevier BV, Vol. 15, No. 13 ( 2016-12), p. 1305-1306
    Type of Medium: Online Resource
    ISSN: 1474-4422
    URL: Article
    DOI: 10.1016/S1474-4422(16)30288-5
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
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  • 5
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    Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review
    Springer Science and Business Media LLC ; 2023
    In:  BMC Health Services Research Vol. 23, No. 1 ( 2023-03-30)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-03-30)
    Abstract: Reducing delays along the acute stroke pathway significantly improves clinical outcomes for acute ischemic stroke patients eligible for reperfusion treatments. The economic impact of different strategies reducing onset to treatment (OTT) is crucial information for stakeholders in acute stroke management. This systematic review aimed to provide an overview on the cost-effectiveness of several strategies to reduce OTT. Methods A comprehensive literature search was conducted in EMBASE, PubMed, and Web of Science until January 2022. Studies were included if they reported 1/ stroke patients treated with intravenous thrombolysis and/or endovascular thrombectomy, 2/ full economic evaluation, and 3/ strategies to reduce OTT. The Consolidated Health Economic Evaluation Reporting Standards statement was applied to assess the reporting quality. Results Twenty studies met the inclusion criteria, of which thirteen were based on cost-utility analysis with the incremental cost-effectiveness ratio per quality-adjusted life year gained as the primary outcome. Studies were performed in twelve countries focusing on four main strategies: educational interventions, organizational models, healthcare delivery infrastructure, and workflow improvements. Sixteen studies showed that the strategies concerning educational interventions, telemedicine between hospitals, mobile stroke units, and workflow improvements, were cost-effective in different settings. The healthcare perspective was predominantly used, and the most common types of models were decision trees, Markov models and simulation models. Overall, fourteen studies were rated as having high reporting quality (79%-94%). Conclusions A wide range of strategies aimed at reducing OTT is cost-effective in acute stroke care treatment. Existing pathways and local characteristics need to be taken along in assessing proposed improvements.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-023-09310-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2050434-2
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  • 6
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    Post-discharge Telemonitoring of Physical Activity, Vital Signs, and Patient-Reported Symptoms in Older Patients Undergoing Cancer Surgery
    Springer Science and Business Media LLC ; 2021
    In:  Annals of Surgical Oncology Vol. 28, No. 11 ( 2021-10), p. 6512-6522
    Details
    In: Annals of Surgical Oncology, Springer Science and Business Media LLC, Vol. 28, No. 11 ( 2021-10), p. 6512-6522
    Abstract: 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 post-discharge complications and hospital readmissions in older patients undergoing cancer surgery. Methods In this observational cohort study, we monitored older patients (≥65 years of age) undergoing cancer surgery, for 2 weeks post-discharge using tablet-based applications and connected devices. Outcome measures were post-discharge complications and readmissions; physical activity and patient-reported symptoms over time; and threshold violations for physical activity (step count 〈 1000 steps/day), vital signs (temperature 〈 36°C or 〉 38°C; blood pressure 〈 100/60 mmHg or 〉 150/100 mmHg; heart rate 〈 50 bpm or 〉 100 bpm; weight −5% or +5% of weight at discharge); and patient-reported symptoms (pain score greater than the previous day; presence of dyspnea, vomiting, dizziness, fever). Results Of 58 patients (mean age 72 years), 24 developed a post-discharge complication and 13 were readmitted. Measured parameters indicated 392 threshold violations out of 5379 measurements (7.3%) in 40 patients, mostly because of physical inactivity. Patients with readmissions had lower physical activity at discharge and at day 9 after discharge and violated a physical activity threshold more often. Patients with post-discharge complications had a higher median pain score compared with patients without these adverse events. No differences in threshold violations of other parameters were observed between patients with and without post-discharge complications and readmissions. Conclusion Our results show the potential of telemonitoring older patients after cancer surgery but confirm that detecting post-discharge complications is complex and multifactorial.
    Type of Medium: Online Resource
    ISSN: 1068-9265 , 1534-4681
    URL: Article
    DOI: 10.1245/s10434-021-09707-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2074021-9
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  • 7
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    Remote Home Monitoring of Older Surgical Cancer Patients: Perspective on Study Implementation and Feasibility
    Springer Science and Business Media LLC ; 2021
    In:  Annals of Surgical Oncology Vol. 28, No. 1 ( 2021-01), p. 67-78
    Details
    In: Annals of Surgical Oncology, Springer Science and Business Media LLC, Vol. 28, No. 1 ( 2021-01), p. 67-78
    Abstract: 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 the required new digital technologies. The study aimed to assess the feasibility of postoperative remote home monitoring for this population. Methods This observational cohort study recruited patients aged 65 years or older scheduled for oncologic surgery. The study patients used a mobile application and activity tracker preoperatively until 3 months postoperatively. A subset of the patients used additional devices (thermometer, blood pressure monitor, weight scale) and completed electronic health questionnaires 2 weeks after hospital discharge. Feasibility was assessed by the study completion rate, compliance in using components of the information technology system, acceptability [Net Promotor Score (NPS)] and usability [System Usability Scale (SUS)] . The NPS score varied from − 100 to + 100. An SUS higher than 68 was considered above average. Results Of 47 participants (mean age, 72 years; range, 65–85 years), 37 completed a follow-up assessment, yielding a completion rate of 79%. Compliance in using the activity tracker ( n  = 41) occurred a median of 81 days [interquartile range (IQR), 70–90 days] out of 90 post-discharge days. Compliance in measuring vital signs and completing health questionnaires varied from a median of 10.5 days (IQR, 4.5–14.0 days) to 12 days (IQR, 5–14 days) out of 14 days. The NPS was + 29.7%, and the mean SUS was 74.4 ± 19.3. Conclusion Older oncologic patients in the study considered postoperative home monitoring acceptable and usable. Once they consented to participate, the patients were compliant, and the completion rate was high.
    Type of Medium: Online Resource
    ISSN: 1068-9265 , 1534-4681
    URL: Article
    DOI: 10.1245/s10434-020-08705-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2074021-9
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  • 8
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    Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects
    Springer Science and Business Media LLC ; 2017
    In:  BMC Medical Research Methodology Vol. 17, No. 1 ( 2017-12)
    Details
    In: BMC Medical Research Methodology, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2017-12)
    Type of Medium: Online Resource
    ISSN: 1471-2288
    URL: Article
    DOI: 10.1186/s12874-016-0275-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2017
    detail.hit.zdb_id: 2041362-2
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  • 9
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    Optimising acute stroke care organisation: a simulation study to assess the potential to increase intravenous thrombolysis rates and patient gains
    BMJ ; 2020
    In:  BMJ Open Vol. 10, No. 1 ( 2020-01), p. e032780-
    Details
    In: BMJ Open, BMJ, Vol. 10, No. 1 ( 2020-01), p. e032780-
    Abstract: To assess potential increases in intravenous thrombolysis (IVT) rates given particular interventions in the stroke care pathway. Design Simulation modelling was used to compare the performance of the current pathway, best practices based on literature review and an optimised model. Setting Four hospitals located in the North of the Netherlands, as part of a centralised organisational model. Participants Ischaemic stroke patients prospectively ascertained from February to August 2010. Intervention The interventions investigated included efforts aimed at patient response and mode of referral, prehospital triage and intrahospital delays. Primary and secondary outcome measures The primary outcome measure was thrombolysis utilisation. Secondary measures were onset-treatment time (OTT) and the proportion of patients with excellent functional outcome (modified Rankin scale (mRS) 0–1) at 90 days. Results Of 280 patients with ischaemic stroke, 125 (44.6%) arrived at the hospital within 4.5 hours, and 61 (21.8%) received IVT. The largest improvements in IVT treatment rates, OTT and the proportion of patients with mRS scores of 0–1 can be expected when patient response is limited to 15 min (IVT rate +5.8%; OTT −6 min; excellent mRS scores +0.2%), door-to-needle time to 20 min (IVT rate +4.8%; OTT −28 min; excellent mRS scores+3.2%) and 911 calls are increased to 60% (IVT rate +2.9%; OTT −2 min; excellent mRS scores+0.2%). The combined implementation of all potential best practices could increase IVT rates by 19.7% and reduce OTT by 56 min. Conclusions Improving IVT rates to well above 30% appears possible if all known best practices are implemented.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2019-032780
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2599832-8
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  • 10
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    Developing an ML pipeline for asthma and COPD: The case of a Dutch primary care service
    Hindawi Limited ; 2021
    In:  International Journal of Intelligent Systems Vol. 36, No. 11 ( 2021-11), p. 6763-6790
    Details
    In: International Journal of Intelligent Systems, Hindawi Limited, Vol. 36, No. 11 ( 2021-11), p. 6763-6790
    Type of Medium: Online Resource
    ISSN: 0884-8173 , 1098-111X
    URL: Issue
    URL: Article
    DOI: 10.1002/int.v36.11
    DOI: 10.1002/int.22568
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2021
    detail.hit.zdb_id: 2002369-8
    SSG: 24,1
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