Positive impact of the introduction of low-emission zones in Antwerp and Brussels on air quality, socio-economic disparities and health: a quasi-experimental study.

Low emission zones (LEZ) manage traffic entering cities by granting access only to vehicles that meet certain emission standards. This study evaluated if implementation of LEZs in Antwerp (2017) and Brussels (2018) improved air pollution within the boundaries of the defined zones, if spatial spillover effects occurred, if socioeconomic inequality in air pollution exposure changed over time, and if health was affected. The study population comprised 420,007 individuals living within the LEZs, within seventeen control cities or within adjacent areas of these cities.

Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay.

Objectives: To study between-hospital variation in mortality, readmissions and prolonged length of stay across Belgian hospitals.

Design: A retrospective nationwide observational study.

Setting: Secondary and tertiary acute-care hospitals in Belgium.

Rates Of Patient Safety Indicators In Belgian Hospitals Were Low But Generally Higher Than In US Hospitals, 2016-18.

More than two decades ago, the Agency for Healthcare Research and Quality developed its Patient Safety Indicators (PSIs) to monitor potentially preventable and severe adverse events within hospitals. Application of PSIs outside the US was explored more than a decade ago, but it is uncertain whether they remain relevant within Europe, as no up-to-date assessments of overall PSI-associated adverse event rates or interhospital variability can be found in the literature. This article assesses the nationwide occurrence and variability of thirteen adverse events for a case study of Belgium.

Patterns of Antipsychotic Use in Belgian Nursing Homes 2017-2022: Admission is a Decision Point.

Objectives: Chronic antipsychotic use among nursing home (NH) residents carries risks with uncertain benefits. Despite guidelines recommending restricted use, these agents remain widely prescribed. This study investigates chronic antipsychotic use in Belgian NHs.

Call for Action to Target Interhospital Variation in Cardiovascular Mortality, Readmissions, and Length-of-Stay: Results of a National Population Analysis.

Background: Excessive interhospital variation threatens healthcare quality. Data on variation in patient outcomes across the whole cardiovascular spectrum are lacking. We aimed to examine interhospital variability for 28 cardiovascular All Patient Refined-Diagnosis-related Groups (APR-DRGs).

Intra/inter-observer reliability of cystoscopic sphincter evaluation in men undergoing sling surgery.

Objectives: To assess the intra/inter-observer reliability of cystoscopic sphincter evaluation (CSE) in men undergoing sling surgery for urinary incontinence and if possible to evaluate its correlation with the final clinical decision.

Patients And Methods: Two expert urologists prospectively filmed and recorded, incontinent patient's cystoscopies according to a standard scenario. Anonymised recordings where randomly offered to the same observer twice.

Engaging leadership and nurse well-being: the role of the work environment and work motivation-a cross-sectional study.

Background: Healthcare literature suggests that leadership behavior has a profound impact on nurse work-related well-being. Yet, more research is needed to better conceptualize, measure, and analyse the concepts of leadership and well-being, and to understand the psychological mechanisms underlying this association. Combining Self-Determination and Job Demands-Resources theory, this study aims to investigate the association between engaging leadership and burnout and work engagement among nurses by focusing on two explanatory mechanisms: perceived job characteristics (job demands and resources) and intrinsic motivation.

Measuring in-hospital quality multidimensionally by integrating patients', kin's and healthcare professionals' perspectives: development and validation of the FlaQuM-Quickscan.

Background: Measuring quality is essential to drive improvement initiatives in hospitals. An instrument that measures healthcare quality multidimensionally and integrates patients', kin's and professionals' perspectives is lacking. We aimed to develop and validate an instrument to measure healthcare quality multidimensionally from a multistakeholder perspective.

What makes nurses flourish at work? How the perceived clinical work environment relates to nurse motivation and well-being: A cross-sectional study.

Background: Literature shows that the work environment is a main determinant of nurses' well-being and psychological strain; yet, the (psychological) mechanisms underlying this relationship remain understudied.

Objective: This study explored the underlying (psychological) mechanisms (why) and boundary conditions (when) by which characteristics present in the clinical work environment influence nurses' well-being. We investigated the mediating role of intrinsic motivation in the relationship of job demands and job resources with burnout vs.

Convergent Validity of 2 Widely Used Methodologies for Calculating the Hospital Standardized Mortality Ratio in Flanders, Belgium.

Objectives: To assess their construct validity, we compared results from 2 models used for estimating hospital standardized mortality ratios (HSMRs) in Belgium. The method of the Flemish Hospital Network (FHN) is based on a logistic regression for each of the 64 All Patient Refined Diagnosis-Related Groups that explain 80% of mortality and uses the Elixhauser score to correct for comorbidities. (H)SMRs published on the 3M-Benchmark-Portal are calculated by a simpler indirect standardization for All Patient Refined Diagnosis-Related Groups and risk of mortality (ROM) at discharge.

Association of air pollution and green space with all-cause general practitioner and emergency room visits: A cross-sectional study of young people and adults living in Belgium.

Background: Residing in areas with lower levels of air pollution and higher green space is beneficial to physical and mental health. We investigated associations of PM, tree cover and grass cover with in-hours and out-of-hours GP visits and ER visits, for young people and adults. We estimated potential cost savings of GP visits attributable to high PM.

A combined multilevel factor analysis and covariance regression model with mixed effects in the mean and variance structure.

Li et al developed a multilevel covariance regression (MCR) model as an extension of the covariance regression model of Hoff and Niu. This model assumes a hierarchical structure for the mean and the covariance matrix. Here, we propose the combined multilevel factor analysis and covariance regression model in a Bayesian framework, simultaneously modeling the MCR model and a multilevel factor analysis (MFA) model.

Improving hospital nurse staffing during the pandemic: Implementation of the 2019 Fund for Health Care Staff in Belgium.

Chronic hospital nurse understaffing is a pre-existing condition of the COVID-19 pandemic. With nurses on the frontline against the pandemic, safe nurse staffing in hospitals is high on the political agenda of the responsible ministers of Health. This paper presents a recent Belgian policy reform to improve nurse staffing levels.

Cornerstones of a sustainable national quality policy: A qualitative study based on international expert opinions.

Background: National initiatives launched to improve the quality of care have grown exponentially over the last decade. Public reporting, accreditation and governmental inspection form the basis for quality in Flemish (Belgian) hospitals. Due to the lack of evidence for these national initiatives and the questions concerning their sustainability, our research aims to identify cornerstones of a sustainable national quality policy for acute-care hospitals based on international expert opinion.

The cost of a first and second hospital-wide accreditation in Flanders, Belgium.

Background: Hospital accreditation is a popular and widely used quality control and improvement instrument. Despite potential benefits, ques-tions are raised whether it constitutes appropriate use of hospitals' limited financial resources.

Objective: This study aims to calculate the cost of preparing for and undergoing a first and second accreditation by the Joint Commission International or Qualicor Europe in acute-care hospitals.

A co-creation roadmap towards sustainable quality of care: A multi-method study.

Objective: Hospitals demonstrated increased efforts into quality improvement over the past years. Their growing commitment to quality combined with a heterogeneity in perceptions among healthcare stakeholders cause concerns on the sustainable incorporation of quality into the daily workflow. Questions are raised on the drivers for a sustainable hospital quality policy.

Short-Term exposure to ambient air pollution and onset of work incapacity related to mental health conditions.

The OECD estimates that greater work absenteeism is one of the main drivers behind the impact of air pollution on gross domestic product loss, but research linking air pollution with work absenteeism is scarce. With air pollution increasingly being linked to poor mental health, and poor mental health having become one of the main reasons for work absenteeism, we examined whether the onset of work incapacity related to mental health conditions is associated with short-term fluctuations in ambient black carbon (BC), nitrogen dioxide (NO), ozone (O), and particulate matter 2.5 (PM), estimating the contributions of these pollutants jointly, while accounting for relative humidity, total solar radiation and temperature.

Unwarranted Between-hospital Variation in Mortality, Readmission, and Length of Stay of Urological Admissions: An Important Trigger for Prioritising Quality Targets.

Background: Unwarranted between-hospital variation is a persistent health care quality issue. It is unknown whether urology patients are prone to this variation.

Objective: To examine between-hospital variation in mortality, readmission, and length of stay for all 22 urological All Patient Refined Diagnosis Related Groups (APR-DRGs).

The future of hospital quality of care policy: A multi-stakeholder discrete choice experiment in Flanders, Belgium.

Background: Collaboration between policymakers, patients and healthcare workers in hospital quality of care policy setting can improve the integration of new initiatives. The aim of this study was to quantify preferences for various characteristics of a future quality policy in a broad group of stakeholders.

Materials And Methods: 450 policymakers, clinicians, nurses, patient representatives and hospital board members in Flanders (Belgium) participated in five discrete choice experiments (DCE) on quality control, quality improvement, inspection, patient incidents and transparency.

Invariance of the WHO violence against women instrument among Kenyan adolescent girls and young women: Bayesian psychometric modeling.

Introduction: To make valid comparisons across groups, a measurement instrument needs to be measurement invariant across those groups. The present study evaluates measurement invariance for experience of violence among adolescent girls and young women (AGYW) in two informal settlements in Nairobi, Kenya.

Methods: We used survey data collected from 1,081 AGYW aged 15-22 years from two Nairobi's informal settlements of Korogocho (n = 617) and Viwandani (n = 464) in 2017 through DREAMS (an initiative aimed at reducing HIV incidence among AGYW with a core package of evidence-based interventions) impact evaluation project.

Quality indicators in the treatment of geriatric hip fractures: literature review and expert consensus.

Purpose: Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practice variance in Europe call for a list of benchmarking indicators that allow for quality improvement initiatives for the rapid recovery of fragile hip fractures (RR-FHF).

A decade of commitment to hospital quality of care: overview of and perceptions on multicomponent quality improvement policies involving accreditation, public reporting, inspection and pay-for-performance.

Background: Quality improvement (QI) initiatives such as accreditation, public reporting, inspection and pay-for-performance are increasingly being implemented globally. In Flanders, Belgium, a government policy for acute-care hospitals incorporates aforementioned initiatives. Currently, questions are raised on the sustainability of the present policy.