Climate change leads to more days with extremely hot temperatures. Previous analyses of heat waves have documented a short-term rise in mortality. The results on the relationship between high temperatures and hospitalisations, especially in vulnerable patients admitted to nursing homes, are inconsistent. The objective of this research was to examine the discrepancy between heat-related mortality and morbidity in nursing homes. A time-stratified case-crossover study about the impact of heat waves on mortality and hospitalisations between 1 January 2013 and 31 December 2017 was conducted in 10 nursing homes over 5 years in Flanders, Belgium. In this study, the events were deaths and hospitalisations. We selected our control days during the same month as the events and matched them by day of the week. Heat waves were the exposure. Conditional logistic regression models were applied. The associations were reported as odds ratios at lag 0, 1, 2, and 3 and their 95% confidence intervals. In the investigated time period, 3048 hospitalisations took place and 1888 residents died. The conditional logistic regression showed that odds ratios of mortality and hospitalisations during heat waves were 1.61 (95% confidence interval 1.10–2.37) and 0.96 (95% confidence interval 0.67–1.36), respectively, at lag 0. Therefore, the increase in mortality during heat waves was statistically significant, but no significant changes in hospitalisations were obtained. Our result suggests that heat waves have an adverse effect on mortality in Flemish nursing homes but have no significant effect on the number of hospitalisations.

Background: Early detection and treatment of chronic kidney disease (CKD) can prevent further deterioration and complications. Previous studies suggested that the diagnosis is often made when advanced renal failure occurs. The aims of this study were to describe the prevalence of unregistered CKD stages 3–5 in a Belgian General Practitioner population, to determine risk factors for under-registration and to investigate the diagnostic delay. Methods: The analyses were carried out in the INTEGO database, a Flanders general practice-based morbidity registration network. The study used INTEGO data from the year 2018 for all patients ≥18 years old. CKD was defined as two consecutive eGFR laboratory measurements (eGFR <60 mL/min/1.73m²) at least three months apart during the baseline period. Registered CKD was characterised by a documented diagnosis of CKD (ICPC2 U99) during the ≥12-month lookback period before the first eGFR measurement and up to six months after the second eGFR in the EHR. The prevalence of unregistered CKD and the median time of diagnostic delay were estimated. Baseline characteristics were described. A multivariate cross-sectional logistic regression analysis was conducted to identify determinants of unregistered CKD. We estimated the odds ratios and their 95% confidence interval. Results: Among included patients, there were 10 551 patients (5.5%) meeting the criteria of CKD. The prevalence of unregistered CKD was 68%. The mean diagnostic delay was 1.94 years (Standard deviation 0.93). Being a male, a concurrent diagnosis of diabetes, stroke, heart failure and hypertension, and more severe CKD (stages 3b, 4 and 5) independently increased the chance on registered CKD. Conclusion: The proportion of patients who had no registered CKD code in the EHR was substantial. The differences between registered and unregistered patients make thinking about solutions to facilitate registration in the EHR imperative.

Audit and feedback (A&F) is a widely used implementation strategy to evaluate and improve medical practice. The optimal design of an A&F system is uncertain and structured process evaluations are currently lacking. This study aimed to develop and validate a questionnaire to evaluate the use of automated A&F systems. Based on the Clinical Performance Feedback Intervention Theory (CP-FIT) and the REFLECT-52 (REassessing audit & Feedback interventions: a tooL for Evaluating Compliance with suggested besT practices) evaluation tool a questionnaire was designed for the purpose of evaluating automated A&F systems. A Rand-modified Delphi method was used to develop the process evaluation and obtain validation. Fourteen experts from different domains in primary care consented to participate and individually scored the questions on a 9-point Likert scale. Afterwards, the questions were discussed in a consensus meeting. After approval, the final questionnaire was compiled. A 34-question questionnaire composed of 57 items was developed and presented to the expert panel. The consensus meeting resulted in a selection of 31 questions, subdivided into 43 items. A final list of 30 questions consisting of 42 items was obtained. A questionnaire consisting of 30 questions was drawn up for the assessment and improvement of automated A&F systems, based on CP-FIT and REFLECT-52 theory and approved by experts. Next steps will be piloting and implementation of the questionnaire.

Objective: Patients with impaired kidney function and increased albuminuria are at risk of developing cardiovascular disease (CVD). Previous research has revealed that a substantial proportion of patients with chronic kidney disease (CKD) do not get a registered diagnosis in the electronic health record of the general practitioner. The aim of this study was to investigate the association between non-registration of CKD and all-cause mortality and cardiovascular outcome. Design and setting: A retrospective study in primary care. Methods: The analyses were carried out in the INTEGO database, a general practice-based morbidity registration network in Flanders, Belgium. The study used INTEGO data from the year 2018 for all patients ≥18 years old, including 10 551 patients. To assess the risk of mortality and CVD, a time-to-event analysis was performed. Cox proportional hazard model was used to evaluate the association between non-registration and incidence of all-cause mortality and cardiovascular events with mortality as a competing risk. Subgroup analyses were performed for estimated glomerular filtration rate stages (3A, 3B, 4 and 5). Multiple imputation was done following the methodology of Mamouris et al. Results: Mortality was higher in patients with non-registered CKD compared with patients with registered CKD (HR 1.29, 95% CI 1.19 to 1.41). Non-registration of CKD was not associated with an increased risk for the development of CVD (HR 0.92, 95% CI 0.77 to 1.11). Conclusion: An association between non-registration and all-cause mortality was identified, although no such association was apparent for CVD.

Objectives: To design and implement an automated audit and feedback (A&F) tool for Belgian Electronic Medical Record (EMR) systems to assess and improve the quality of primary care for chronic kidney disease (CKD). Methods: 36 quality indicators (QIs) for primary CKD care were translated into conjugations and queries programmable within EMR systems. In the development phase, executable queries were constructed, taking into account technical constraints and the reliability of available data. The Intego database, a Belgian general practice-based morbidity registration network and A&F implementation laboratory, was used to test the feasibility and pilot the intervention. Visual feedback dashboards were designed using SAS Enterprise Guide and SAS Visual Analytics. Results: A final set of 80 queries that could be built into EMR systems was developed, allowing for an automated audit. The design of visual feedback and follow-up queries to make the feedback actionable was described. During the selection process 16 of the 36 indicators were excluded and 10 were adapted for the audit and/or feedback due to technical limitations or unreliable data. The final feedback included 14 indicators presented to clinicians through interactive dashboards. Discussion: This study describes the design of an automated A&F tool to improve the quality of primary CKD care in Belgium. Challenges included data accuracy within EMRs, the variability in data completeness and limitations in EMR query functionality. Future improvements in EMR systems and coding practices, such as the implementation of the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and improving feedback accessibility, could enhance the effectiveness of the tool. Conclusion: This study provides building blocks for implementing automated A&F interventions in Belgian EMR systems to improve primary CKD care quality. These building blocks could be applied internationally after validating the QIs.

Background/Objectives: The Belgian healthcare system is currently organised from a single-disease point of view, which poses a unique challenge for patients suffering from two or more long-term physical and/or mental conditions (multimorbidity) and their healthcare providers. To search for strategies that respond to the constantly changing medical landscape and the complexity of multimorbid care. Patient-centred care programmes for multimorbid patients in primary care were investigated and their intervention elements were assessed as to whether or not they have a positive effect on the Triple Aim. Methods: A scoping review was performed and reported following the PRISMA-ScR guidelines. Online databases (PubMed, Cochrane, Embase) were used to identify papers published between January 2000 and August 2023, supplemented by reference tracking and a manual search in the grey literature. Studies were included if they assessed the efficacy of patient-centred intervention in primary care for multimorbid adult patients. Results: From the 7020 papers identified, 39 were selected and included in the review. Interventions took place at three levels (patient, professional and organisational). The efficacy of the studies included was heterogeneous. The different intervention elements had a more frequent positive effect on healthcare experience than on health status and behaviour. The only intervention that appeared to score partially positive results across all Triple Aim domains was a care coordinator. Conclusions: This scoping review provides an overview of existing patient-centred interventions for multimorbidity. Findings could be used to assist in the development of a framework for multimorbid patient care. Future studies should recognise the importance of patient experience and formulate and evaluate sufficient outcomes within this domain.