The aim of this research was to test the test-retest reliability of two new indicators for quality of health care and compare these indicators with an indicator based on outcome of healthcare that...Show moreThe aim of this research was to test the test-retest reliability of two new indicators for quality of health care and compare these indicators with an indicator based on outcome of healthcare that has already been found reliable. These new indicators are based on the ratio between outcome and costs of treatment and the ratio between outcome and duration in days of treatment. The reliability of the three indicators is assessed with the Intra Class Correlation coefficient from data (N = 633) of a division of a mental health care institution specialized in the treatment of post-traumatic stress disorder. Outcome of the treatment was assessed with a pre- and posttest measurement of the severity of complaints, as measured with the symptomatic distress subscale of the Outcome Questionnaire 45.2. The reliability of the original indicator, based solely on outcome, was good (ICC = 0.613). The reliability of the indicator based on outcome and duration of treatment was fair (ICC = 0.549) and the reliability of the indicator based on outcome and costs was poor (ICC = 0.088). Presumably, these lower ICC values on the enriched indicators are a result of instability over time of the cost and duration components of the indicators in combination with a disproportionate increase of costs and days of treatment in comparison with outcome of treatment. The research suffered from low statistical power and this precludes definite conclusions about the statistical significance of differences in reliability among the indicators. For a better comparison of the test-retest reliability between the indicators with a statistical test, replication of this research with a larger set of evaluable treatments is necessary.Show less
Current mental health care systems evaluate the quality of care mainly based on the outcome of treatment. However, for patients, the time spent to achieve this outcome is a relevant factor which is...Show moreCurrent mental health care systems evaluate the quality of care mainly based on the outcome of treatment. However, for patients, the time spent to achieve this outcome is a relevant factor which is often overlooked in modern health care systems. For insurance providers, the incurred cost of treatment is an important criterion for quality of mental health care. In order to offer truly valuable care in the eyes of both of these parties, the result of treatment must measure up to its required effort, both temporal and financial. Including cost and duration in the evaluation of health care will ultimately benefit all parties involved. Therefore, the present study tests the validity of two new quality indicators based on the principle of value-based health care. Value here is defined as outcome relative to cost or outcome relative to duration. Data used was collected by Routine Outcome Monitoring at several outpatient clinics providing specialized mental health care in the Netherlands. MANOVA testing revealed that the two new quality indicators showed larger differences in quality of care than outcome alone. These results were supported by differences among clinics in the cost and duration of treatment per improved and recovered patient. Based on the results of this study, the use of quality indicators of value-based health care over outcome alone in the mental health care sector is advised.Show less
De huidige financiering van zorg stimuleert eerder tot het verlenen van meer zorg dan tot betere zorg. Bij het streven naar de best mogelijke zorg, zijn goede indicatoren nodig om de kwaliteit te...Show moreDe huidige financiering van zorg stimuleert eerder tot het verlenen van meer zorg dan tot betere zorg. Bij het streven naar de best mogelijke zorg, zijn goede indicatoren nodig om de kwaliteit te meten. Het doel van dit onderzoek is het bepalen en vergelijken van de testhertestbetrouwbaarheid van drie indicatoren voor het meten van kwaliteit van zorg bij persoonlijkheidsstoornissen: de uitkomst van de behandeling en twee nieuwe indicatoren: de uitkomst in verhouding tot kosten en tot duur. De gegevens zijn aangeleverd door het Nederlands Psychoanalytisch Instituut, onderdeel van Arkin. De test-hertestbetrouwbaarheid van de indicatoren is bepaald middels de Intraclass Correlatie Coëfficiënt (ICC) en is berekend door herhaalde verstelling van de kwaliteit bij 14 groepen die zijn gekozen op basis van locatie, het niveau van functioneren en pre-test ernstniveau. De betrouwbaarheid van de behandeluitkomst indicator ICC = ,494, de kostenindicator ICC = ,516 en duurindicator ICC = ,480. De ICC’s van de indicatoren verschilden niet significant van elkaar, vanwege de grote betrouwbaarheidsintervallen van de drie indicatoren, die onderling een aanzienlijke overlap vertoonden. Het verrijken van de uitkomst indicator met een kosten of een duur component hebben niet tot statisch significant betrouwbaardere indicatoren geleid. Vanwege het geringe aantal groepen waar kwaliteit van zorg bij kon worden vastgesteld was er onvoldoende statistische power voor een redelijke kans op het vinden van een significant verschil in betrouwbaarheid tussen de indicatoren. Vervolgonderzoek met meer evalueerbare behandelingen is nodig om te bepalen of het verrijken van de behandeluitkomst indicator tot een betrouwbaardere indicator leidt.Show less
Een veelgebruikte indicator van kwaliteit van zorg is de uitkomst van de behandeling. Dit geld ook zo in de GGZ. Afname van psychische klachten of verbeteren van functioneren, is ook het doel...Show moreEen veelgebruikte indicator van kwaliteit van zorg is de uitkomst van de behandeling. Dit geld ook zo in de GGZ. Afname van psychische klachten of verbeteren van functioneren, is ook het doel waarvoor cliënten in behandeling komen. Het is belangrijk voor de cliënt dat klachten zo snel mogelijk verminderen, en er zo snel mogelijk resultaat te zien is van de behandeling. Snel herstel impliceert gewonnen levensgeluk. Daarnaast zijn voor de financiers (zorgverzekeraar en de overheid) de kosten van een behandeling een belangrijk aspect van de kwaliteit van de zorg. Vanuit de waarde gedreven zorg beweging is er dan ook voor gepleit naast uitkomst ook de gepleegde inspanning en kosten op te nemen in de kwaliteitsindicator. Door de variabelen duur en kosten te betrekken in een indicator zou er een veel vollediger beeld van de kwaliteit van zorg ontstaan. Deze stelling wordt in dit onderzoek onderzocht: of de kwaliteitsindicatoren duur-efficiëntie en kosten-efficiëntie valide zijn. Duur-efficiëntie wordt hier gedefinieerd als uitkomst gedeeld door duur; kosten-efficiëntie als uitkomst gedeeld door kosten. De kwaliteitsindicatoren zijn valide wanneer ze duidelijker verschil aantonen tussen natuurlijke groepen cliënten die op verschillende locaties van een GGZ instelling zijn behandeld dan uitkomst alleen. Er is data gebruikt van de instelling Arkin in Amsterdam. MANOVA testen lieten zien dat door het toevoegen van kwaliteitsindicatoren er een groter verschil wordt gezien tussen de groepen. Uit de MANOVA bleek dat zowel de indicator gebaseerd op uitkomst alleen als de indicator voor kosten-efficiëntie onderscheid significant maakte tussen de diverse groepen; de groepen verschilden niet op de indicator voor duur-efficiëntie. Vervolgonderzoek is nodig, met betere indeling in te vergelijken groepen, om na te gaan of de toevoegingen van duur en kosten aan de kwaliteitsindicatoren tot betere indicatoren leidt.Show less
Het beoordelen van de prestatie van de aanbieders van geestelijke gezondheidszorg (GGZ) op alleen hun uitkomst (mate van genezing en herstel) is niet voldoende. Factoren zoals kosten en duur,...Show moreHet beoordelen van de prestatie van de aanbieders van geestelijke gezondheidszorg (GGZ) op alleen hun uitkomst (mate van genezing en herstel) is niet voldoende. Factoren zoals kosten en duur, zouden ook meegenomen moeten worden voor een zinvolle en allesomvattende beoordeling van de kwaliteit van deze zorg. Dit onderzoek richt zich op het vergelijken van de betrouwbaarheid van een kwaliteitsindicator op basis van behandeluitkomst met twee nieuwe kwaliteitsindicatoren; behandeluitkomst gedeeld door kosten en behandeluitkomst gedeeld door duur. Uitkomstgegevens van patiënten met een depressie of angststoornis van de organisatie PuntP zijn gebruikt. Met behulp van deze data is de test-hertest betrouwbaarheid vastgesteld door middel van de Intraclass Correlatie Coëfficiënt (ICC) en vergeleken tussen de al bestaande kwaliteitsindicator en de nieuwe kwaliteitsindicatoren. Uit de resultaten bleek dat de hoogste betrouwbaarheid werd gevonden bij de uitkomstindicator (ICC = .466); de duurindicator (ICC = .230) en de kostenindicator (ICC = .112) hadden een lagere test-hertest betrouwbaarheid. De betrouwbaarheidsindicatoren verschillen onderling niet significant van elkaar aangezien de betrouwbaarheidsintervallen overlappen. Oorzaak hiervan zou de aanzienlijke kans op een Type II fout kunnen zijn, vanwege een lage statistische power. Vervolgonderzoek met een groter aantal te evalueren groepen zal moeten uitwijzen of het verrijken van de behandeluitkomst indicator daadwerkelijk tot een hogere betrouwbaarheid leidt.Show less
Empathic accuracy and eye contact form the foundation of everyday human social interaction. Here, the association between the duration of eye gaze fixation of the perceiver on the eye region of the...Show moreEmpathic accuracy and eye contact form the foundation of everyday human social interaction. Here, the association between the duration of eye gaze fixation of the perceiver on the eye region of the target and the level of empathic accuracy when presented with dynamic emotional video stimuli was examined and it was determined whether gender plays a role in this association. In this study, 110 participants had their gaze behavior tracked while watching ten 180-seconds during videoclips of strangers telling an emotional autobiographical story. Participants had to rate the target’s feelings at the moment of recording the videoclip and their own feelings. It was hypothesized that people that spend more time fixating on the eye region of strangers have a higher level of empathic accuracy than people that spend less time fixating on the eye region of strangers and that this relationship differs between males and females. Linear regression analyses did not reveal significant evidence for a relationship between eye gaze behavior and empathic accuracy that is moderated by gender. Gaining more insight in the topic of eye gaze behavior, gender and empathic accuracy is still so valuable for the improvement in treatment for empathy-related difficulties and atypical gaze patterns that some individuals have to deal with in their daily life.Show less
Recent research has only shown little evidence for a relationship between patient characteristics and treatment outcome. It is proposed that patients with a higher need of Mental Health Care due to...Show moreRecent research has only shown little evidence for a relationship between patient characteristics and treatment outcome. It is proposed that patients with a higher need of Mental Health Care due to higher psychopathologic complexity receive more treatment compared to others to reach a comparatively good treatment result. The treatment dose in more complex patients might therefore be significantly higher than in less complex patients. According to that, treatment dose should mediate the relationship between complexity and outcome. Thereby, the main purpose of this study is the investigation of a proposed mediation effect by treatment dose, operationalized as treatment duration in minutes and treatment length in days. Clinical Complexity was based on the degree of psychopathological severity and treatment outcome was measured with the self-report questionnaire Outcome Questionnaire-45. This investigation is based on a sample of patients in ambulatory treatment, who suffer from anxiety disorders, originated from the GGZ institution Arkin, an MHC provider in the Netherlands. Finally, no mediation effect has been shown and no evidence for an existent triadic relationship between complexity, outcome and treatment dose has been found. Besides, treatment duration correlated positively with complexity. Patients with higher complexity also tend to have a less favorable treatment outcome compared with patients of lower complexity. The results of this study should be interpreted and dealt with caution due to potential threats to internal and external validity. In future research alternative complexity and treatment dose indicators need further investigation to assess the prognostic value of patient characteristics for treatment outcome.Show less
Background: Questionnaires for anxiety disorders come in different lengths, scales and with varying interpretation guidelines. This may hamper therapist-patient communication when discussing the...Show moreBackground: Questionnaires for anxiety disorders come in different lengths, scales and with varying interpretation guidelines. This may hamper therapist-patient communication when discussing the score and the interpretation of where a patient can be placed on a severity scale. Expressing scores on a standardized common metric can facilitate the communication between therapist and patient. This thesis aims for a method that enables an easier interpretation of scores and in addition produces scores with a normal distribution. Method: Using the data of four anxiety questionnaires, namely the Brief Scale for Anxiety (BSA), the PADUA Inventory Revised (PI-R), the Panic Appraisal Inventory (POL/PAI) and the Impact of Events Scale Revised (IES-R), theta-based T-scores were calculated with the Item-Response Theory and deployed as a basis for crosswalk tables to look up T-scores from raw scores. Based on these crosswalk tables, transformation formulas were established to calculate T-scores. To validate these, calculated T-scores were compared to theta-based T-scores. Results: Most of the calculated T-scores had a normal distribution and the correlations between both methods to arrive at the T-scores were significant, the highest correlation was found for the BSA and the IES-R. Discussion: Due to a significant correlation and a large sample size a new method to arrive at a common metric was established by linking every raw score on a T-score metric. This provides a way to facilitate the interpretation and discussion of outcome scores. Further, with this new method disorder severity can be calculated and looked up due to tangible cut-off scores.Show less
Background: Brua is an Afro-Caribbean set of spiritual beliefs found on the ABC Islands (Aruba, Bonaire, and Curaçao), which are part of the Dutch Antilles. Psychiatric patients from these islands...Show moreBackground: Brua is an Afro-Caribbean set of spiritual beliefs found on the ABC Islands (Aruba, Bonaire, and Curaçao), which are part of the Dutch Antilles. Psychiatric patients from these islands may believe that their mental health is influenced by Brua-related practices. It is therefore important that mental health professionals are knowledgeable of Brua, but it is not yet known to what extent they are. Goal: This study investigated the knowledge of Brua among psychologists, psychiatrists, and psychiatrists in training in The Netherlands. Methods: All psychologists, psychiatrists, and psychiatrists in training in the service of Parnassia Psychiatric Institute were contacted to fill out a tailor-made survey on knowledge of Brua. Sufficient knowledge of Brua was defined as a score of 6 or higher out of 10. Three potential predictors of knowledge of Brua were investigated, namely work experience, ethnicity, and inquiry into religious beliefs in the clinical practice. Results: Out of the 152 participants, 13.2% scored a sufficient score on knowledge of Brua. Work experience did not predict total score on the survey. There were too few participants of non-Caucasian ethnicities to investigate the relationship between ethnicity and knowledge of Brua. Practitioners who often inquired into religious beliefs in the clinical practice did not score higher than practitioners who sometimes inquired into religious beliefs. Conclusion: Knowledge of Brua among psychologists, psychiatrists, and psychiatrists in training in The Netherlands is limited. Informational or educational campaigns on how to assess the role of Brua in clinical practice are recommended.Show less
One-sided premature termination of the treatment may generate serious implications to patients and health system in general. Patients not recover fully or sufficiently to qualify for good end-state...Show moreOne-sided premature termination of the treatment may generate serious implications to patients and health system in general. Patients not recover fully or sufficiently to qualify for good end-state criteria; treatments that did not work or had to be repeated because of insufficient sessions attended increase waiting list times; early phases of treatment cost a considerable amount of money and resources. All this is likely to not pay off, since a larger number of sessions significantly correlates with improvement from PTSD and depression and an average number of sessions attended by early responders is between 6-7. The aim of this study is to investigate in which phase of the treatment do most of the dropouts occur, which patient and clinical factors are associated with the dropout and whether various types of treatment modality have different dropout rates. Sample contains 3084 patients getting treatment for post-traumatic stress disorder in Sinai center in Amsterdam. Bivariate regression analyses were conducted to examine relationship between demographic, clinical ant treatment variables in treatment dropouts and completers. Out of 3084 patients 2369 (76.8%) patients successfully completed the treatment, 715 (23.2%) dropped out, from those, 78 patients dropped out early. Contrary to predictions, more dropouts took place in later stages. Analysis showed that age was the only significant predictor variable of dropout.Show less
Although there are indications that parental anxiety is related to the development of anxiety among children, direct evidence for the specific mechanisms that underlie the parent-child transmission...Show moreAlthough there are indications that parental anxiety is related to the development of anxiety among children, direct evidence for the specific mechanisms that underlie the parent-child transmission of anxiety is limited. The interaction between anxious parents and their infant is a potentially important mechanism for the transmission of fear from the parent to the infant. This study aims to investigate the relationship between parental anxiety (mothers and fathers) and infants’ attention bias towards fearful faces (vs. happy faces). Both mothers (N = 155) and fathers (N = 74) were included in the study and parental anxiety was measured with the DASS questionnaire. Attention bias towards fearful faces (vs. happy faces) was measured with an eye-tracker in infants between 5 and 19 months old (N = 220; 112 girls, 108 boys). Results show that infants looked longer at fearful faces than at happy faces. However, no relation between parental anxiety and infants’ attention bias towards fearful faces was found. Moreover, the gender of the parent did not influence the relationship between parental anxiety and an infant’s attention bias. The findings do not support the notion that attention bias in infants is a mechanism that could explain the transmission of anxiety from parents to their children. Our study contributes to the literature about the transmission of anxiety from parents to their children and the role of infants’ attention bias in this transmission.Show less
Background: Translating scores to a common metric provides advantages that support the applied collaborative care model in the Netherlands. McCall's T-score is frequently used, and the optimal...Show moreBackground: Translating scores to a common metric provides advantages that support the applied collaborative care model in the Netherlands. McCall's T-score is frequently used, and the optimal approach to obtain this score is through Item Response Theory (IRT). However, IRT is complicated, requires dedicated software, and a large dataset. This study aimed to validate an alternative procedure to obtain T-scores from IRT. Methods: This study used data from an existing study, which comprised a population-based sample and a patient sample. We estimated the relation between raw scores and IRT-based T-scores with curve fitting and established conversion formulas to transform raw scores into calculated T-scores. We illustrated the process with raw scores from the Beck Depression Inventory, the Inventory of Depressive Symptomatology - Self Rated, and the Montgomery-Åsberg Depression Rating Scale. We performed a correlational analysis to assess the validity of the calculated T-scores. We also determined cut-off values using ROC analysis. Results: The curve-fitting procedure resulted in third-order polynomial regression equations to use as conversion formulas. The validity of calculated T-scores was supported by their high correlation with theta-based T-scores. ROC analysis provided cut-off values, which were comparable to the previous studies, using raw scale scores. Conclusion: The curve-fitting procedure yielded sufficiently valid calculated T-scores for all instruments in comparison to the theta-based T-scores from IRT. The resulting cut-off values demonstrated that calculated T-scores were able to distinguish patients from the general population. The practical use of the results is discussed.Show less
