Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
AbstractQuality problem: Unplanned hospital readmissions frequently occur and have profound implications for patients. This study explores chronically ill patients' experiences and perceptions of being discharged to home and then acutely readmitted to the hospital to identify the potential impact on future care transition interventions.Initial assessment and implementation: Twenty-three semistructured interviews were conducted with chronically ill patients who had an unplanned 30-day hospital readmission at a university teaching hospital in the Netherlands.Choice of solution: A constructive grounded theory approach was used for data analysis.Evaluation: The core category identified was 'readiness for hospital discharge,' and the categories related to the core category are 'experiencing acute care settings' and 'outlook on the recovery period after hospital discharge.' Patients' readiness for hospital discharge was influenced by the organization of hospital care, patients' involvement in decision-making and preparation for discharge. The experienced difficulties during care transitions might have influenced patients' ability to cope with challenges of recovery and dependency on others.Lessons learned: The results demonstrated the importance of assessing patients' readiness for hospital discharge. Health care professionals are recommended to recognize patients and guide them through transitions of care. In addition, employing specifically designated strategies that encourage patient-centered communication and shared decision-making can be vital in improving care transitions and reduce hospital readmissions. We suggest that health care professionals pay attention to the role and capacity of informal caregivers during care transitions and the recovery period after hospital discharge to prevent possible postdischarge problems.
BACKGROUND: Acute admission to an intensive care unit (ICU) can negatively affect quality of life for patients and their relatives. Relatives play an important caregiving role after the patient's admission. More knowledge and understanding of their needs are necessary as the patient transitions home.AIM: This study aims to explore relatives' experiences of acutely admitted ICU patients' transition from the ICU to a general ward and then home.STUDY DESIGN: A qualitative study with a phenomenological approach was conducted. Interviews were in-depth and featured open-ended questions. The interviews took place after the patients transitioned from ICU to home and were conducted online by videoconference. Data were analysed using Colaizzi's seven-step method.RESULTS: Twelve relatives of acutely admitted ICU patients were interviewed. Five main themes emerged: (1) mixed feelings, (2) sense of not being involved, (3) limited information provision, (4) lack of acknowledgement as a caregiver, and (5) an uncertain future perspective. Relatives experience major uncertainties during transitions and prefer to be actively involved in care and care decisions.CONCLUSIONS: This study indicates that relatives of ICU patients experience a lack of guidance during the transitions from the ICU to a general ward and to home, or a follow-up facility. More focus is needed on the themes of mixed feelings, the sense of not being involved, limited information provision, lack of acknowledgement as a caregiver, and an uncertain future perspective. This increased focus might improve the guidance during these transitions.RELEVANCE TO CLINICAL PRACTICE: The insights from this study may help to improve the care of patients and their relatives during the transitions.
This project addresses the critical issue of staff shortages and training inefficiencies in the hospitality industry, particularly focusing on the hotel sector. It connects with the urgent need for innovative, and effective training solutions to equip (inexperienced) staff with hospitality skills, thereby improving service quality and sustainable career prospects in the hotel industry. The project develops and tests immersive technologies (augmented and virtual reality, AR/VR) tailored to meet specific training needs of hotels. Traditional training methods such as personal trainings, seminars, and written manuals are proving inadequate in terms of learning effectiveness and job readiness, leading to high working pressure and poor staff well-being. This project aims to break this cycle by co-creating immersive training methods that promise to be more engaging and effective. Hotelschool The Hague has initiated steps in this direction by exploring AR and VR technologies for hotel staff training. This project builds on these efforts, aiming to develop accessible, immersive training tools specifically designed for the hotel sector. Specifically, this project aims to explore the effectiveness of these immersive trainings, an aspect largely overlooked in the rapid development of immersive technology solutions. The central research question is: How do immersive AR and VR training methods impact job readiness and learning effectiveness in the hotel sector? The one-year KIEM project period involves co-creating, implementing, and evaluating immersive training in collaboration with Hotelschool The Hague and Hyatt Andaz Amsterdam Prinsengracht Hotel in real-life settings. The partnership with Warp Industries, a leader in immersive technology, is crucial for the project’s success. Our findings will be co-created and multiplied through relevant sector associations such as House of Hospitality. This project aligns with the MV’s Impact Level 1: Transitions by promoting innovative training strategies that can lead to a fundamental shift in the hospitality industry, thereby enhancing social earning capacities.
My research investigates the concept of permacomputing, a blend of the words permaculture and computing, as a potential field of convergence of technology, arts, environmental research and activism, and as a subject of future school curricula in art and design. This concept originated in online subcultures, and is currently restricted to creative coding communities. I study in what way permacomputing principles may be used to redefine how art and design education is taught. More generally, I want to research the potential of permacomputing as a critical, sustainable, and practical alternative to the way digital technology is being taught in art education, where students mostly rely on tools and techniques geared towards maximising productivity and mass consumption. This situation is at odds with goals for sustainable production and consumption. I want to research to what degree the concept of permacomputing can be broadened and applied to critically revised, sustainable ways of making computing part of art and design education and professional practice. This research will be embedded in the design curriculum of Willem de Kooning Academy, focused on redefining the role of artists and designers to contribute to future modes of sustainable organisation and production. It is aligned with Rotterdam University of Applied Sciences sectorplan masters VH, in particular managing and directing sustainable transitions. This research builds upon twenty years of experience in the creative industries. It is an attempt to generalise, consolidate, and structure methods and practices for sustainable art and design production experimented with while I was course director of a master programme at WdKA. Throughout the research I will be exchanging with peers and confirmed interested parties, a.o.: Het Nieuwe Instituut (NL), RUAS Creating 010 kenniscentrum (NL), Bergen Centre for Electronic Arts (NO), Mikrolabs (NO), Varia (NL), Media Arts department at RHU (UK), Media Studies at UvA (NL).
