In this PhD thesis, we aimed to improve understanding of the study progression and success of autistic students in higher education by comparing them to students with other disabilities and students without disabilities. We studied their background and enrollment characteristics, whether barriers in progression existed, how and when possible barriers manifested themselves in their student journey, and how institutions should address these issues. We found autistic students to be different from their peers but not worse as expected based on existing findings. We expect we counterbalanced differences because we studied a large data set spanning seven cohorts and performed propensity score weighting. Most characteristics of autistic students at enrollment were similar to those of other students, but they were older and more often male. They more often followed an irregular path to higher education than students without disabilities. They expected to study full time and spend no time on extracurricular activities or paid work. They expected to need more support and were at a higher risk of comorbidity than students with other disabilities. We found no difficulties with participation in preparatory activities. Over the first bachelor year, the grade point averages (GPAs) of autistic students were most similar to the GPAs of students without disabilities. Credit accumulation was generally similar except for one of seven periods, and dropout rates revealed no differences. The number of failed examinations and no-shows among autistic students was higher at the end of the first semester. Regarding progression and degree completion, we showed that most outcomes (GPAs, dropout rates, resits, credits, and degree completion) were similar in all three groups. Autistic students had more no-shows in the second year than their peers, which affected degree completion after three years. Our analysis of student success prediction clarified what factors predicted their success or lack thereof for each year in their bachelor program. For first-year success, study choice issues were the most important predictors (parallel programs and application timing). Issues with participation in pre-education (absence of grades in pre-educational records) and delays at the beginning of autistic students’ studies (reflected in age) were the most influential predictors of second-year success and delays in the second and final year of their bachelor program. Additionally, academic performance (average grades) was the strongest predictor of degree completion within three years. Our research contributes to increasing equality of opportunities and the development of support in higher education in three ways. First, it provides insights into the extent to which higher education serves the equality of autistic students. Second, it clarifies which differences higher education must accommodate to support the success of autistic students during their student journey. Finally, we used the insights into autistic students’ success to develop a stepped, personalized approach to support their diverse needs and talents, which can be applied using existing offerings.
LINK
Rationale, aims and objective: Primary Care Plus (PC+) focuses on the substitution of hospital-based medical care to the primary care setting without moving hospital facilities. The aim of this study was to examine whether population health and experience of care in PC+ could be maintained. Therefore, health-related quality of life (HRQoL) and experienced quality of care from a patient perspective were compared between patients referred to PC+ and to hospital-based outpatient care (HBOC). Methods: This cohort study included patients from a Dutch region, visiting PC+ or HBOC between December 2014 and April 2018. With patient questionnaires (T0, T1 and T2), the HRQoL and experience of care were measured. One-to-two nearest neighbour calliper propensity score matching (PSM) was used to control for potential selection bias. Outcomes were compared using marginal linear models and Pearson chi-square tests. Results: One thousand one hundred thirteen PC+ patients were matched to 606 HBOC patients with well-balanced baseline characteristics (SMDs <0.1). Regarding HRQoL outcomes, no significant interaction terms between time and group were found (P > .05), indicating no difference in HRQoL development between the groups over time. Regarding experienced quality of care, no differences were found between PC+ and HBOC patients. Only travel time was significantly shorter in the HBOC group (P ≤ .001). Conclusion: Results show equal effects on HRQoL outcomes over time between the groups. Regarding experienced quality of care, only differences in travel time were found. Taken as a whole, population health and quality of care were maintained with PC+ and future research should focus more on cost-related outcomes.
Background: A hospital group is an organizational integration strategy that has recently been widely implemented in Chinese urban health systems to promote integrated care. This study aims to evaluate the effect of hospital group on integrated care from the perspectives of both patients and care professionals. Methods: Two cross-sectional surveys were conducted in Shenzhen city of China, in June 2018 and July 2021. All 30 community health stations (CHSs) in the hospital group were included in the intervention group, with 30 CHSs in the same district selected as the control group by simple random sampling. All care professionals within both the intervention and the control groups were invited to participate in the surveys. Twelve CHSs were selected from 30 CHSs in the intervention and the control groups by simple random sampling, and 20 patients with type 2 diabetes mellitus (T2DM) were selected from each of these selected CHSs to participate in the survey by systematic sampling. The Chinese version Rainbow Model of Integrated Care Measurement Tool (C-RMIC-MT) was used to assess integrated care. Propensity score matching and difference-in-differences regression (PSM-DID) were used to evaluate the effect of the hospital group on integrated care. Results: After matching, 528 patients and 1896 care professionals were included in the DID analysis. Results from care professionals indicated that the hospital group significantly increased technical competence of the health system by 0.771 points, and cultural competence by 1.423 points. Results from patients indicated that the hospital group significantly decreased organizational integration of the health system by 0.649 points. Conclusion: The results suggests that the effect of the hospital group on integrated care over and above routine strategies for integrated care is limited. Therefore, it is necessary to pay attention to implementing professional, clinical and other integration strategies beyond establishing hospital groups, in urban Chinese health systems.
