Papers by Betty Steenkamer
International Journal of Integrated Care, Dec 27, 2023
Population Health Management, Feb 1, 2017
Population health management (PHM) has increasingly been mentioned as a concept to realize improv... more Population health management (PHM) has increasingly been mentioned as a concept to realize improvements in population health and quality of care while reducing cost growth (the so-called Triple Aim). The concept of PHM has been used in various settings and has been defined in different ways. This study compared the definitions of PHM used in the literature in order to improve the understanding and interpretation of the concept of PHM. A scoping literature search was performed for papers published between January 2000 and January 2015 that defined PHM. PHM definitions were summarized, focusing on: (1) overall aim, (2) PHM activities, and (3) contextual factors. Eighteen articles were retrieved. The overall aim was defined in terms of health (N = 14), costs (N = 8), and/or quality of care (N = 10). Definitions varied regarding the description of PHM activities, though all definitions contained elements in common with disease management and health promotion. Data management, Triple Aim assessment, risk stratification, evaluation, and feedback cycles were less likely to be mentioned. Contextual factors were scarcely brought forward in the definitions. Moderate variations were found across definitions in the way PHM was conceptualized. Frequently, essential elements of PHM were not specified. Differences in conceptualizations of PHM should be taken into account when comparing PHM initiatives that are working toward improvements in population health, (experienced) quality of care, and reduction of costs. (Population Health Management 20xx;xx:xxx-xxx)
BMC Health Services Research, Jun 20, 2023
Background Although there are already success stories, population health management in Belgium is... more Background Although there are already success stories, population health management in Belgium is still in its infancy. A health system transformation approach such as population health management may be suited to address the public health issue of atherosclerotic cardiovascular disease, as this is one of the main causes of mortality in Belgium. This article aims to raise awareness about population health management in Belgium by: (a) eliciting barriers and recommendations for its implementation as perceived by local stakeholders; (b) developing a population health management approach to secondary prevention of atherosclerotic cardiovascular disease; and (c) providing a roadmap to introduce population health management in Belgium. Methods Two virtual focus group discussions were organized with 11 high-level decision makers in medicine, policy and science between October and December 2021. A semi-structured guide based on a literature review was used to anchor discussions. These qualitative data were studied by means of an inductive thematic analysis. Results Seven interrelated barriers and recommendations towards the development of population health management in Belgium were identified. These related to responsibilities of different layers of government, shared responsibility for the health of the population, a learning health system, payment models, data and knowledge infrastructure, collaborative relationships and community involvement. The introduction of a population health management approach to secondary prevention of atherosclerotic cardiovascular disease may act as a proof-ofconcept with a view to roll out population health management in Belgium. Conclusions There is a need to instill a sense of urgency among all stakeholders to develop a joint populationoriented vision in Belgium. This call-to-action requires the support and active involvement of all Belgian stakeholders, both at the national and regional level.
BMC Health Services Research
Background Although there are already success stories, population health management in Belgium is... more Background Although there are already success stories, population health management in Belgium is still in its infancy. A health system transformation approach such as population health management may be suited to address the public health issue of atherosclerotic cardiovascular disease, as this is one of the main causes of mortality in Belgium. This article aims to raise awareness about population health management in Belgium by: (a) eliciting barriers and recommendations for its implementation as perceived by local stakeholders; (b) developing a population health management approach to secondary prevention of atherosclerotic cardiovascular disease; and (c) providing a roadmap to introduce population health management in Belgium. Methods Two virtual focus group discussions were organized with 11 high-level decision makers in medicine, policy and science between October and December 2021. A semi-structured guide based on a literature review was used to anchor discussions. These qual...
Interview guideline (DOCX 54 kb)
Characteristics of the nine Dutch PHM initiatives (DOCX 16 kb)
Supplemental material, HSR907359 Supplemental Material for Reorganizing and integrating public he... more Supplemental material, HSR907359 Supplemental Material for Reorganizing and integrating public health, health care, social care and wider public services: a theory-based framework for collaborative adaptive health networks to achieve the triple aim by Betty Steenkamer, Hanneke Drewes, Kim Putters, Hans van Oers and Caroline Baan in Journal of Health Services Research & Policy
Journal of health organization and management, Jan 9, 2018
Purpose A range of strategies to improve pharmaceutical care has been implemented by population h... more Purpose A range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying collaborative strategies to improve pharmaceutical care and the contextual factors and mechanisms through which these principles operate. Design/methodology/approach The evaluation was informed by a realist methodology examining the links between PHM strategies, their outcomes and the contexts and mechanisms by which these strategies operate. Guiding principles were identified by grouping context-specific strategies with specific outcomes. Findings In total, ten guiding principles were identified: create agreement and commitment based on a long-term vision; foster cooperation and representation at the board level; use layered governance structures; create awareness at all levels; enable interpersonal links a...
Tijdschrift voor gezondheidswetenschappen, 2011
BMC Health Services Research, 2010
Background: Many patients with chronic heart failure (CHF) receive treatment in primary care, but... more Background: Many patients with chronic heart failure (CHF) receive treatment in primary care, but data have shown that the quality of care for these patients needs to be improved. We aimed to evaluate the impact and feasibility of a programme for improving primary care for patients with CHF. Methods: An observational study was performed in 19 general practices in the southeastern part of the Netherlands, evaluation involving 15 general practitioners and 77 CHF patients. The programme for improvement comprised educational and organizational components and was delivered by a trained practice visitor to the practices. The evaluation was based on case registration forms completed by health professionals and telephone interviews. Results: Management relating to diet and physical exercise seemed to have improved as eight patients were referred to dieticians and five to physiotherapists. The seasonal influenza vaccination rate increased from 94% to 97% (75/77). No impact on smoking was observed. Pharmaceutical treatment was adjusted according to guideline recommendations in 12% of the patients (9/77); 7 patients started recommended medication and 2 patients received dosage adjustments. General practitioners perceived the programme to be feasible. Clinical task delegation to nurses and assistants increased in some practices, but collaboration with other healthcare providers remained limited. Conclusions: The improvement programme proved to have moderate impact on patient care. Its effectiveness should be tested in a larger rigorous evaluation study using modifications based on the pilot experiences.
Tijdschrift voor gezondheidswetenschappen, 2010
Dit artikel beschrijft een casestudie op het gebied van beleidsontwikkeling in de gezondheidszorg... more Dit artikel beschrijft een casestudie op het gebied van beleidsontwikkeling in de gezondheidszorg in Midden Holland. In deze regio hebben het RIVM, de GGD Hollands Midden en de zorgaanbieders een unieke verzameling aan data op het gebied van gezondheid, preventie en de huidige en toekomstige zorgvraag en zorgaanbod samengebracht in het rapport ''Groeien in Gezondheid: Gezondheid en zorg in Midden Holland, nu en in de toekomst''. Deze casestudie geeft inzicht in de totstandkoming en verspreiding van het rapport en de bevorderende factoren voor het gebruik van de onderzoeksresultaten binnen beleidsontwikkeling door drie gebruikersgroepen: ambtenaren, GGD-ers en zorgaanbieders. Deze processen zijn met behulp van documentenanalyse, interviews, groepsdiscussies en schriftelijke vragenlijsten in kaart gebracht en getoetst aan een conceptueel model voor het gebruik van onderzoeksresultaten binnen beleidsontwikkeling. Tegen de verwachting van het model in leek de interactie tussen de onderzoekers en de gebruikers geen centrale rol te spelen bij de drie bestudeerde gebruikersgroepen. Verder verschilde het verklarende mechanisme voor de doorwerking van het gebruik van onderzoeksresultaten binnen beleidsontwikkeling per gebruikersgroep. Vooral de inhoudelijke breedte van het rapport, de media-aandacht, tijdsaspecten en de persoonsfactoren van de gebruikers hebben bijgedragen aan het gebruik van het rapport.
Population Health Management, 2017
Population health management (PHM) has increasingly been mentioned as a concept to realize improv... more Population health management (PHM) has increasingly been mentioned as a concept to realize improvements in population health and quality of care while reducing cost growth (the so-called Triple Aim). The concept of PHM has been used in various settings and has been defined in different ways. This study compared the definitions of PHM used in the literature in order to improve the understanding and interpretation of the concept of PHM. A scoping literature search was performed for papers published between January 2000 and January 2015 that defined PHM. PHM definitions were summarized, focusing on: (1) overall aim, (2) PHM activities, and (3) contextual factors. Eighteen articles were retrieved. The overall aim was defined in terms of health (N = 14), costs (N = 8), and/or quality of care (N = 10). Definitions varied regarding the description of PHM activities, though all definitions contained elements in common with disease management and health promotion. Data management, Triple Aim assessment, risk stratification, evaluation, and feedback cycles were less likely to be mentioned. Contextual factors were scarcely brought forward in the definitions. Moderate variations were found across definitions in the way PHM was conceptualized. Frequently, essential elements of PHM were not specified. Differences in conceptualizations of PHM should be taken into account when comparing PHM initiatives that are working toward improvements in population health, (experienced) quality of care, and reduction of costs. (Population Health Management 20xx;xx:xxx-xxx)
International Journal of Integrated Care, 2018
In the Netherlands, the concept of population health management PHM is increasingly embraced to r... more In the Netherlands, the concept of population health management PHM is increasingly embraced to realize a sustainable and more integrated provision of prevention, health and social care for the population. Adding to this, a new playing field between municipalities, health care professionals, insurers and citizens is introduced by the transition towards a more decentralized organization of health and social services. This requires cross-sector collaboration between all actors, such as health care providers, citizens, insurers and municipalities on a local/regional level. Over the past years, a number of initiatives based on regional cross-sector collaboration have been introduced. In this development, stakeholders face the difficult challenge of developing strategies that will encourage the cross-sector collaboration. Furthermore, although community engagement is seen as key to achieving citizen-centered and cross-sectoral collaborative healthcare systems, many initiatives are still ...
In Nederland zijn regionaal diverse samenwerkingsinitiatieven ontstaan om het zorgsysteem toekoms... more In Nederland zijn regionaal diverse samenwerkingsinitiatieven ontstaan om het zorgsysteem toekomstbestendig te maken. Het doel van deze initiatieven is om de gezondheid van de bevolking en de kwaliteit van zorg te verbeteren en de groei in (zorg)uitgaven te beperken (Triple Aim). Aangezien gezondheid niet alleen vanuit het zorgdomein wordt beinvloedt, werken in deze initiatieven meerdere partijen zoals zorgverzekeraars, zorgaanbieders, burgervertegenwoordiging en gemeenten in wisselende samenstelling samen om de overgang naar een ‘gezondheidssysteem’ te bewerkstelligen. Om dit te bereiken worden tal van interventies en strategieen ingezet, zoals een burgercooperatie, inzet van medisch specialisten in de huisartspraktijk en een data- en kennisinfrastructuur voor de regio. Het ministerie van Volksgezondheid, Welzijn en Sport (VWS) heeft in 2013 negen regio’s benoemd tot ‘proeftuinen’. Het RIVM heeft tussen 2013 en 2018 in opdracht van het ministerie de ontwikkeling van deze proeftuine...
Health Policy, 2020
INTRODUCTION Population Health Management initiatives are increasingly introduced, aiming to deve... more INTRODUCTION Population Health Management initiatives are increasingly introduced, aiming to develop towards sustainable health and wellbeing systems. Yet, little is known about which strategies to implement during this development. This study provides insights into which strategies are used, why, and when, based on the experiences of nine Dutch Population Health Management initiatives. METHODS The realist evaluation approach was used to gain an understanding of the relationships between context, mechanisms and outcomes when Population Health Management strategies were implemented. Data were retrieved from three interview rounds (n = 207) in 2014, 2016 and 2017. Data was clustered into guiding principles, underpinned with strategy-context-mechanism-outcome configurations. RESULTS The Dutch initiatives experienced different developments, varying between immediate large-scale collaborations with eventual relapse, and incremental growth towards cross-sector collaboration. Eight guiding principles for development towards health and wellbeing systems were identified, focusing on: 1. Shared commitment for a Population Health Management-vision; 2. Mutual understanding and trust; 3. Accountability; 4. Aligning politics and policy; 5. Financial incentives; 6. A learning cycle based on a data-infrastructure; 7. Community input and involvement; and 8. Stakeholder representation and leadership. CONCLUSION Development towards a sustainable health and wellbeing system is complex and time-consuming. Its success not only depends on the implementation of all eight guiding principles, but is also influenced by applying the right strategies at the right moment in the development.
Journal of Health Organization and Management
PurposeThe purpose of this paper is to gain insight into how population health management (PHM) s... more PurposeThe purpose of this paper is to gain insight into how population health management (PHM) strategies can successfully integrate and reorganize public health, health care, social care and community services to improve population health and quality of care while reducing costs growth, this study compared four large-scale transformation programs: Greater Manchester Devolution, Vancouver Healthy City Strategy, Gen-H Cincinnati and Gesundes Kinzigtal.Design/methodology/approachFollowing the realist methodology, this explorative comparative case-study investigated PHM initiatives' key features and participants' experiences of developing such initiatives. A semi-structured interview guideline based on a theoretical framework for PHM guided the interviews with stakeholders (20) from different sectors.FindingsFive initial program theories important to the development of PHM were formulated: (1) create trust in a shared vision and understanding of the PHM rationale to establish ...
Journal of Health Services Research & Policy
Objective Population health management (PHM) refers to large-scale transformation efforts by coll... more Objective Population health management (PHM) refers to large-scale transformation efforts by collaborative adaptive health networks that reorganize and integrate services across public health, health care, social care and wider public services in order to improve population health and quality of care while at the same time reducing cost growth. However, a theory-based framework that can guide place-based approaches towards a comprehensive understanding of how and why strategies contribute to the development of PHM is lacking, and this review aims to contribute to closing this gap by identifying the key components considered to be key to successful PHM development. Methods We carried out a scoping realist review to identify configurations of strategies (S), their outcomes (O), and the contextual factors (C) and mechanisms (M) that explain how and why these outcomes were achieved. We extracted theories put forward in included studies and that underpinned the formulated strategy-contex...
Uploads
Papers by Betty Steenkamer