{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T05:48:04Z","timestamp":1767764884010,"version":"3.48.0"},"reference-count":36,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Dutch Nurses\u2019 Association on behalf of The Dutch Ministry of Health, Welfare and Sport","award":["330024"],"award-info":[{"award-number":["330024"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,10]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Objectives<\/jats:title>\n While needs assessment is the starting point of good quality care, there is anecdotal evidence of patients receiving different care in similar circumstances. This study aims to investigate whether practice variation exists in needs assessments conducted by home care nurses and to identify the factors influencing these assessments.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A cross-sectional, quantitative retrospective study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Primary care; home care nursing in the Netherlands in 2023.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Sampling was based on criterion sampling. Home care organisations were approached based on the following inclusion criteria: organisations providing home care nursing in the Netherlands, organisations from various regions of the country and organisations offering different types of home care nursing (eg, paediatric or palliative care), funded under the Dutch Health Insurance Act (Zvw). Organisations were excluded if they provided home care nursing funded by sources other than the Dutch Health Insurance Act. Home care nurses were recruited from participating organisations, each of whom had recently assessed the care needs of at least five patients. In total, 28 organisations and 258 home care nurses participated in this study, thereby yielding data from 1615\u2009patients.<\/jats:p>\n <\/jats:sec>\n \n Primary and secondary outcome measures<\/jats:title>\n Assessed and delivered minutes of home care per patient per week.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Variation was primarily associated with patient-related factors. After accounting for these factors, 83% (assessed minutes) and 88% (delivered minutes) of the total variation was attributed to the patient level, 8% (assessed minutes) and 10% (delivered minutes) to the home care nurses\u2019 level and 9% (assessed minutes) and 2% (delivered minutes) to the organisational level. Due to inadequate documentation in electronic health records, many missing values were identified.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The lack of nursing documentation suggests that missing factors may have contributed to variations in needs assessments. Thus, further research should comprehensively explore the patient-related factors currently absent from nursing documentation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-096547","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T05:15:28Z","timestamp":1767762928000},"page":"e096547","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Is practice variation determined in the needs assessments performed by Dutch home care nurses? A cross-sectional multilevel analysis"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7752-9672","authenticated-orcid":false,"given":"Jos\u00e9 IE","family":"van Dorst","sequence":"first","affiliation":[{"name":"Department of Health Services Research, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"},{"name":"Living Lab in Ageing and Long-Term Care, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marit","family":"Schwenke","sequence":"additional","affiliation":[{"name":"Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, Utrecht, Netherlands"},{"name":"University of Applied Sciences HU, Utrecht, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels","family":"Hameleers","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"},{"name":"Living Lab in Ageing and Long-Term Care, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nienke","family":"Bleijenberg","sequence":"additional","affiliation":[{"name":"Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, Utrecht, Netherlands"},{"name":"Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne EM","family":"Brabers","sequence":"additional","affiliation":[{"name":"Netherlands Institute for Health Services Research Knowledge Centre and Library, Utrecht, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith D","family":"de Jong","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"},{"name":"Netherlands Institute for Health Services Research Knowledge Centre and Library, Utrecht, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"},{"name":"Living Lab in Ageing and Long-Term Care, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne OE","family":"van den Bulck","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"},{"name":"Living Lab in Ageing and Long-Term Care, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra MG","family":"Zwakhalen","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"},{"name":"Living Lab in Ageing and Long-Term Care, Maastricht University Care and Public Health Research Institute, Maastricht, Limburg, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"2026010621150794000_16.1.e096547.1","unstructured":"Spasova S , Baeten R , Coster S , et al . State of Health in the EU Country Health Profile 2019. Brussels: European Social Policy Network (ESPN) European Commission, 2018."},{"key":"2026010621150794000_16.1.e096547.2","doi-asserted-by":"crossref","first-page":"719","DOI":"10.5334\/ijic.ICIC23609","article-title":"How can skill-mix innovations support the implementation of integrated care for people with chronic conditions and multimorbidity?","volume":"23","author":"Winkelmann","year":"2022","journal-title":"Int J Integr Care"},{"key":"2026010621150794000_16.1.e096547.3","unstructured":"Kringos D , Boerma W , Hutchinson A , et al . Building primary care in a changing europe. In: The European Observatory on health systems and policies, Nivel. Copenhagen, Denmark, Utrecht, 2015."},{"key":"2026010621150794000_16.1.e096547.4","unstructured":"Organization WH . Quality of care. World Health Organization; 2025. Available: https:\/\/www.who.int\/health-topics\/quality-of-care#tab=tab_1"},{"key":"2026010621150794000_16.1.e096547.5","first-page":"1","article-title":"Germany: Health system review","volume":"16","author":"Busse","year":"2014","journal-title":"Health Syst Transit"},{"key":"2026010621150794000_16.1.e096547.6","unstructured":"Genet N , Boerma W , Kroneman M , et al . Home care across europe. current structure and future challenges. Copenhagen, Denmark World Health Organization; 2013.978."},{"key":"2026010621150794000_16.1.e096547.7","first-page":"1","article-title":"United Kingdom: Health System Review","volume":"17","author":"Cylus","year":"2015","journal-title":"Health Syst Transit"},{"key":"2026010621150794000_16.1.e096547.8","unstructured":"Nederlandse Zorgautoriteit (NzA) . Advies bekostiging wijkverpleging 2015. overheveling extramurale verpleging van de awbz naar de zvw [advice on financing community nursing 2015. In: Transfer of extramural nursing from the AWBZ to the Zvw]. Utrecht, 2014."},{"key":"2026010621150794000_16.1.e096547.9","unstructured":"Ministerie van Volksgezondheid, Welzijn en Sport (VWS) . Ministry of health, welfare and sports. Available: https:\/\/www.regelhulp.nl\/onderwerpen\/van-wmo-zvw-naar-wlz\/verschillen [Accessed Jan 2025]."},{"key":"2026010621150794000_16.1.e096547.10","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ijnurstu.2017.09.013","article-title":"Organizational home care models across Europe: A cross sectional study","volume":"77","author":"Van Eenoo","year":"2018","journal-title":"Int J Nurs Stud"},{"key":"2026010621150794000_16.1.e096547.11","unstructured":"Van Den Bulck AOE . Differences That Matter. Understanding Case-Mix and Quality for Prospective Payment of Home Care. Maastricht: Maastricht University, 2022."},{"key":"2026010621150794000_16.1.e096547.12","unstructured":"WH Organization . Integrated Care for Older People ICOPE. Guidance for Person-Centred Assessment and Pathways in Primary Care. 2nd edn. Geneva: WHO, 2024."},{"key":"2026010621150794000_16.1.e096547.13","unstructured":"Rosendal H . Expertisegebied Wijkverpleegkundige (Community Nurses\u2019 Area of Expertise). V&VN, 2019."},{"key":"2026010621150794000_16.1.e096547.14","unstructured":"V&VN . Normenkader Indiceren En Organiseren van Verpleging En Verzorging in de Eigen Omgeving [Six Standards Framework on Assessing and Organising Home Care Nursing. Utrecht: V&VN, 2014."},{"key":"2026010621150794000_16.1.e096547.15","unstructured":"Zwakhalen S , Bleijenberg N , Jong J , et al . Onderzoek praktijkvariatie indicatiestelling wijkverpleging. In: Research on Practice Variation in Home Care Needs Assessment. Maastricht, Nivel, Hogeschool Utrecht: Maastricht University, 2019."},{"key":"2026010621150794000_16.1.e096547.16","doi-asserted-by":"crossref","first-page":"3426","DOI":"10.1111\/jan.15680","article-title":"Defining practice variation and exploring influencing factors on needs assessment in home care nursing: A Delphi study","volume":"79","author":"Van Dorst","year":"2023","journal-title":"J Adv Nurs"},{"key":"2026010621150794000_16.1.e096547.17","doi-asserted-by":"publisher","DOI":"10.1300\/J027v22n03_03"},{"key":"2026010621150794000_16.1.e096547.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1446.1996.tb00240.x"},{"key":"2026010621150794000_16.1.e096547.19","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1046\/j.1365-2648.2000.01252.x","article-title":"A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice","volume":"31","author":"Cowley","year":"2000","journal-title":"J Adv Nurs"},{"key":"2026010621150794000_16.1.e096547.20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s12468-017-0019-3","article-title":"Classificeren met Omaha versus Nanda. Maakt het uit wat je gebruikt? [Classifying with Omaha or Nanda. Does it matter what you use?","volume":"2","author":"Van Dorst","year":"2017","journal-title":"Nederlands Tijdschrift Voor Evidence Based Practice"},{"key":"2026010621150794000_16.1.e096547.21","doi-asserted-by":"crossref","DOI":"10.1007\/s43999-024-00048-8","article-title":"Practice variation in home care nursing: mapping potential explanations through a scoping review of the literature","volume":"3","author":"Brabers","year":"2024","journal-title":"Res Health Serv Reg"},{"key":"2026010621150794000_16.1.e096547.22","doi-asserted-by":"crossref","DOI":"10.1177\/1178632919837632","article-title":"Signs of Inequality? Variations in Providing Home Health Care Across Care Organizations and Across European Countries in the IBenC Study","volume":"12","author":"van Hout","year":"2019","journal-title":"Health Serv Insights"},{"key":"2026010621150794000_16.1.e096547.23","doi-asserted-by":"crossref","DOI":"10.1111\/nup.12257","article-title":"Rationing of nursing care, a deviation from holistic nursing: A systematic review","volume":"21","author":"Mandal","year":"2020","journal-title":"Nurs Philos"},{"key":"2026010621150794000_16.1.e096547.24","unstructured":"Polit D , Research BCN . Generating and Assessing Evidence for Nursing Practice. 11th edn. Wolters Kluwer Health, 2020."},{"key":"2026010621150794000_16.1.e096547.25","first-page":"1570","volume-title":"Encyclopaedia of Statistics in Behavioural Science","volume":"3","author":"Snijders","year":"2005"},{"key":"2026010621150794000_16.1.e096547.26","doi-asserted-by":"crossref","unstructured":"Leyland A , Groenewegen P . Multilevel Modelling for Public Health and Health Services Research: Health in Context. Springer International Publishing, 2020:293","DOI":"10.1007\/978-3-030-34801-4"},{"key":"2026010621150794000_16.1.e096547.27","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1027\/1614-2241.1.3.86","article-title":"Sufficient Sample Sizes for Multilevel Modeling","volume":"1","author":"Maas","year":"2005","journal-title":"Methodology (Gott)"},{"key":"2026010621150794000_16.1.e096547.28","unstructured":"Moussa K . \u2018Meten van organisatiecultuur\u2019 kwantitatief en of kwalitatief? Een onderzoek naar kwaliteitscriteria voor metingen van organisatiecultuur in de praktijk. [Measuring organisational culture\u2019 \u2019quantitative or qualitative? A study on quality criteria for measuring organisational culture in practice. Erasmus University Rotterdam 2007."},{"key":"2026010621150794000_16.1.e096547.29","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1186\/1472-6920-14-214","article-title":"A validation study of the psychometric properties of the Groningen Reflection Ability Scale","volume":"14","author":"Andersen","year":"2014","journal-title":"BMC Med Educ"},{"key":"2026010621150794000_16.1.e096547.30","doi-asserted-by":"crossref","first-page":"141","DOI":"10.47260\/amae\/1467","article-title":"Examining organisational culture with the OCAI model, with the example of a higher education institution","volume":"14","author":"Lee","year":"2024","journal-title":"Advances in Management and Applied Economics"},{"key":"2026010621150794000_16.1.e096547.31","doi-asserted-by":"crossref","first-page":"106690","DOI":"10.1016\/j.nedt.2025.106690","article-title":"Factor Analytic Adaptation Study of the Groningen Reflection Ability Scale (GRAS) in Senior Nursing Students","volume":"150","author":"Akba\u015f","year":"2025","journal-title":"Nurse Educ Today"},{"key":"2026010621150794000_16.1.e096547.32","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053"},{"key":"2026010621150794000_16.1.e096547.33","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.325.7370.961"},{"key":"2026010621150794000_16.1.e096547.34","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1097\/ACM.0000000000004667","article-title":"Will Any Road Get You There? Examining Warranted and Unwarranted Variation in Medical Education","volume":"97","author":"Holmboe","year":"2022","journal-title":"Acad Med"},{"key":"2026010621150794000_16.1.e096547.35","doi-asserted-by":"crossref","first-page":"86","DOI":"10.12968\/bjon.2022.31.2.86","article-title":"Self-management support for older adults with chronic illness: implications for nursing practice","volume":"31","author":"Byrne","year":"2022","journal-title":"Br J Nurs"},{"key":"2026010621150794000_16.1.e096547.36","doi-asserted-by":"crossref","DOI":"10.1186\/s12912-022-00811-7","article-title":"Nursing documentation and its relationship with perceived nursing workload: a mixed-methods study among community nurses","volume":"21","author":"De Groot","year":"2022","journal-title":"BMC Nurs"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-096547","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T05:15:39Z","timestamp":1767762939000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-096547"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,6]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjopen-2024-096547"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-096547","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}