Diagnosis Treatment Combination Research Articles

Individual product determination in the new Dutch DBC system: how to make the system transparent for its users

On January 1st, 2012, the Dutch declaration system (diagnosis treatment combination), which was introduced in 2005, will be converted. The initial development of this conversion was begun in 2007/2008. In all phases of the conversion, Information technology has supported and will continue to support the system (that is, in early development, in transition, and from 2012 on into production). In our presentation, we would like to detail information regarding the development of this new system and the support given its development by information technology.

Managing the demand for laboratory testing: Options and opportunities

The possibilities for ordering laboratory testing in hospitals inevitably need to be managed, given physicians' knowledge on the use of laboratory testing, their attitudes towards test ordering, the constant increase in testing and the limited resources available. On the assumption that some tests may not be strictly necessary or are even redundant, this paper reviews various methods to manage the demand for laboratory tests, evaluating the extent to which these methods are applicable and effective in daily practice. The most promising new management tools seem to be computerised laboratory management systems (CDSS), a reimbursement system based on the diagnosis-treatment combination (as in The Netherlands), and the allocation of laboratory budget to those requesting laboratory services.

Chronische zorg in Nederland anno 2010: leidt verandering tot verbetering?

Care for chronic patients is subject to transformation in many countries. This paper discusses recent transformations of chronic care in the Netherlands to answer the question: to what extent do these changes result in improvements? Important policy measures of the Ministry of Health, Welfare and Sports to improve chronic care are a programmatic approach for the organisation of care by means of so called standards of care, and integral financing of chronic care by means of diagnosis treatment combinations. In daily practice, both policy measures are implemented on the level of health problems like diabetes and vascular risk management. Notwithstanding the adequacy of the approach to improve chronic care in the Netherlands, its impact is unclear. It is argued that the policy measures need to be implemented on the level of patients. For this to happen, two recommendations are suggested: to make use of the building blocks of the chronic care model in an integrated fashion and aimed at the needs of patients, and to evaluate care transformations not in isolation and by making use of adequate performance indicators. Keywords: chronic care, health policy, chronic care model, quality improvement, patient

Chain DTC Diabetes: new payment system to stimulate integrated care in the Netherlands

Purpose: To examine if the free negotiable chain diagnosis treatment combination (DTC) will stimulate (cost) effective and well organised diabetes care by integrated care groups. Context: The chain DTC diabetes contains the care in accordance with the medical care standard of the Dutch Diabetes Federation. The care group negotiates the price of the DTC with the insurer. This should stimulate the professionals involved to collaborate as efficient as possible and the insurer to negotiate the lowest price possible. Case description: By order of the Ministry of Health, ZonMw (The Netherlands organisation for health research and development) has carried out a program with 10 diabetes care groups, who have experimented the past two years with the chain DTC diabetes and with the organising of integrated care. Data sources: The program will be evaluated by the RIVM (The National Institute for Public Health and the Environment) on the basis of quantitative and qualitative data. The quantitative data comprise the medical outcome and the organising process of integrated care. The qualitative data comprise open-ended interviews with involved professionals, insurers and patients about their experiences and satisfaction with this way of organising, paying and consuming integrated care. Preliminary conclusions: The DTC has indeed facilitated the forming of diabetes care groups. The quality of care seems to be improved, the costs differ between the groups and the place of the patient in the care process differs as well. (Final results expected around November 2009.) Discussion: The chain DTC seems to be a good instrument for improving diabetes care. Applicability for other chronic diseases provokes questions about the total macro costs for chronic care, paying and organising care for multi morbidity and the transition between prevention and care.

Longitudinal analysis on the development of hospital quality management systems in the Netherlands

Many changes have been initiated in the Dutch hospital sector to optimize health-care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment combinations, intensified monitoring of quality and a multi-layered organizational development programme based on quality improvement collaboratives. The objective is to answer the question as to whether these changes were accompanied by a further development of hospital quality management systems and to what extent did the development within the multi-layered programme hospitals differ from that in other hospitals. Longitudinal data were collected in 1995, 2000, 2005 and 2007 using a validated questionnaire. Descriptive analyses and multi-level modelling were applied to test whether: (1) quality management system development stages in hospitals differ over time, (2) development stages and trends differ between hospitals participating or not participating in the multi-layered programme and (3) hospital size has an effect on development stage. Dutch hospital sector between 1995 and 2007. Hospital organizations. Changes through time. Quality management system development stage. Since 1995, hospital quality management systems have reached higher development levels. Programme participants have developed their quality management system more rapidly than have non-participants. However, this effect is confounded by hospital size. Study results suggest that the combination of policy measures at macro level was accompanied by an increase in hospital size and the further development of quality management systems. Hospitals are entering the stage of systematic quality improvement.

One-year mortality after a first visit to a cardiology outpatient clinic: a useful performance indicator?

In 2003 the Dutch Health Care Inspectorate introduced performance indicators to monitor and compare quality of care in Dutch hospitals. In 2007, the new performance indicator 'one-year mortality after a first visit to a cardiology outpatient clinic' was introduced. We set out to evaluate this new indicator in three Dutch teaching hospitals. Using electronic medical records, information was collected retrospectively of patients aged >/=70 years who visited the cardiology outpatient clinic of Medical Centre Alkmaar, Meander Medical Centre Amersfoort and Deventer Hospital between 1 January 2006 and 31 January 2006. Diagnoses were based on the diagnosis treatment combination (DBC) coding system. 547 patients (mean age 78.0 years, 53% men) were included, 35 (6.4%) of whom had died after one year. Cardiovascular disease was the most frequent cause of death (22/35, 62.9%). The oneyear mortality among the three hospitals varied from 5.0 to 7.3% (NS). One-year mortality after the first visit to a cardiology outpatient clinic amounted to 6.4% in patients aged >/=70 years and did not differ significantly between the three Dutch teaching hospitals. The administrative load to obtain the necessary information was considerable. One-year mortality should be regarded as an 'outcome' parameter rather than a 'performance' indicator. (Neth Heart J 2009;17:52-5.).

Cutting Back on Computed Tomography Scan Frequency in Curative Oncology: Get the Picture

Cutting Back on Computed Tomography Scan Frequency in Curative Oncology: Get the Picture

Integrated Diagnosis Treatment Combinations To Improve Cure.

A diagnosis treatment combination is defined as a combination of compounds or treatment modalities that is prescribed at diagnosis of a disease or disease condition. Combinations are administered when a synergistic or additive effect is known or a protection can be anticipated. In hematological malignancies the highest probability of disease free survival can be obtained by a fast remission-induction and consolidation of complete response at diagnosis followed by an allogeneic transplant in first complete remission to eradicate residual malignant cells. Effects of treatment that induce side effects are to be controlled to reduce treatment risks. Therefore, ablative allogeneic transplants are more and more replaced by non-myeloablative reduced intensity conditioning transplants. In acute leukemia these transplants have a much more dramatic course than in more indolent hematological malignancies and solid tumors. In the Netherlands reimbursement for treatment components such as remission induction chemotherapy, an autologous transplant and an allogeneic transplant are currently reimbursed as independent diagnosis treatment combinations. Review of epidemiological data of cancer incidence and death in the Netherlands reveal that treatment of hematological malignancies are poor compared to projections in the United States. In the period 1997 to 2003 treatment results in the Netherlands are more or less stable except for Hodgkin’s disease; allogeneic transplantation has mainly been reserved for hematological malignancies (figure 1). Epidemiological data show that no improvement was achieved. In particular leukemia’s do poor. American Cancer Society projections show that there is a trend towards improvement in the USA for leukemias, non-Hodgkin lymphoma and in myeloma in the period 1997–2005 (figure 2). Non-myeloablative reduced intensity conditioning autologous and/or allogeneic transplants are the curative element for transplantable diseases not curable by standard or intensified cytotoxic cytoreductive therapy. Critical also is rapid remission induction. Delay of transplantation to later stage than first complete remission only increases costs and risk of treatment or disease related mortality. We will present our protocol full of treatment plans to support in improving cure internationally. (www.transplantcreations.com). Death/incidence ratio per 100.000/annum Netherlands Death/incidence ratio per 100.000/annum Netherlands Death/incidence ratio per 100.000/annum USA Death/incidence ratio per 100.000/annum USA

Cost assessment and price setting of inpatient care in the Netherlands. The DBC case-mix system

In February 2005, a case-mix system based on 'diagnosis treatment combinations' (DBCs) was introduced in The Netherlands for the registration and reimbursement of hospital and medical specialist care. This paper describes the characteristics of the DBC system and how it is used for the reimbursement of hospitals. Prices for reimbursement are either based on fixed tariffs ('list A') or negotiated between health insurers and hospitals ('list B') and are partly based on information about unit costs of health care services. Because the DBC system is still under development we will describe the current situation (March 2006), but also focus on the most likely future developments.