Prevention, population and disease management

The research within our LUMC departments is conducted within departmental research programmes. The research programme below is embedded within the department of Public Health and Primary Care.

Aim and focus

The prevalence of chronic conditions such as cardiometabolic diseases, chronic lung diseases and psychosocial problems, is dramatically increasing. This requires a shift in health care strategy: from a curative approach, to a population health management approach, including both preventive and disease management activities. Within this research program, the department of Public Health and Primary Care of the LUMC seeks to initiate and carry out methodologically sound and innovative research. 

Main topics are: 

  • Developing pro-active approaches to identify and reach individuals/groups with an increased risk of chronic disease or adverse health conditions. 
  • Developing and evaluating indicated prevention and disease management programs 
  • Developing strategies for and evaluating the implementation of (cost)effective structured care programs 

Two umbrella themes in this research are the use and linkage of various medical routine registries in the development of population health management, and the use and development of eHealth technologies in prevention and disease management. 

Much of our research takes place in relation to general practice and youth health care in deprived and multi-ethnic urban neighbourhoods. A third emerging umbrella theme relates to increasing evidence of clustering and synergistic interaction of problems manifesting as multi-morbidity at the level of the individual and as uneven distribution of the burden of disease at the population level in these neighbourhoods. 

Position in international context

Within this research program strong synergy is created between public health, primary and long term care, medical anthropology, health psychology and implementation science. This multidisciplinary group provides the methodological ability to address relatively complicated new research questions and is, therefore, nationally and internationally an important asset. The research group is well equipped in a variety of research methods and analysis techniques; for example data-mining techniques, mixed methods (combining quantitative and qualitative methods), multi-level analysis techniques and structural equation modelling techniques.

Content / highlights / achievements

Various research proposals have been granted to this group as principal applicant and co-applicant, among which core partnership positions and projects in four Academic Collaborations (Public Health, Youth, Consortium for an Integrated Approach Overweight (CIAO) & Consortium Pregnancy and Delivery), as well as several large projects in disease management (RECODE, eVITA, FRESH AIR), testifying to the societal valorisation of the program’s research focus. Currently a central position in primary care and population health research and education is successfully being developed in the LUMC Campus The Hague of Leiden University, co-financed by several parties, focusing on “Population Health Management”. Another core position is developing in the Medical Delta cooperative around eHealth and its implementation, leading to the establishment of a National eHealth Living Lab in 2018.

This on-going research encompasses studies aimed at (a) developing a pro-active approach to identify mental and physical health problems in populations, (b) improving the participation of vulnerable groups sharing defined risks in interventions such as parenting support programs, prevention consultations in primary care, (c) development and testing of structured proactive interventions in urban risk groups (“hot spotters”, frequent consulters, medically unexplained physical symptoms and complex care needing risk groups like community dwelling elderly), (d) improving self-management and disease-management of individuals with a (high risk of) chronic disease, such as self-management interventions for patients with COPD, cardio-metabolic diseases and pregnant women, and (d) improving the implementation of programs, such as smoking cessation care, a community approach to prevent overweight, and evaluating the implementation of eHealth tools for COPD.

Future themes

Due to societal processes of substitution of secondary care with primary care and the increasing focus on (indicated) prevention with populations at risk, the distinct boundaries between prevention and care strategies will be reduced. This asks for a redesign of healthcare structures and paradigms. In this redesigning of care the following themes are or remain important in the coming years:

  • Population health management evolving towards panel management of subpopulations sharing defined risks, a proactive approach to prevention and health care: instead of focusing on the management of many individual patient visits, the health care professional seeks to reduce risks and improve the overall health of defined populations before deterioration or inadequate healthcare seeking behaviour occurs.
  • eHealth technology and tailored medicine, applying techniques of co-creation and action research within the National eHealth Living Lab.
  • The increasing knowledge on the influence of biomarkers, genetics and exposomics on health and its implications for prevention and care
  • The use of transgenerational and life-course approaches for prevention and care, including the role of culture in the trans-generational transference of vulnerabilities (University research profile ‘Health, prevention and the human life cycle’).
  • The use of a syndemics approach to investigate exacerbated burdens of disease due to synergistic interactions between diseases and between diseases and social contexts, thereby strengthening our interdisciplinary and comprehensive investigation of health across the range of risk identification and prevention to the design, implementation and evaluation of interventions. 

Cohesion within LUMC

PrePod Research directed at older people is developed and conducted in close collaboration with the principal investigators of the research program entitled “Geriatrics in Primary Care” (31201) at our department and the LUMC profile area “Ageing”. Next, the research program of PrePoD fits very well within the current LUMC profile ‘Innovation in health strategy and quality of care’ in which the department of Public Health & Primary Care has a leading role.  Both research programs will evolve towards the new LUMC societal outreach profile Population Health, with the themes Life course and Prevention. The research program is also strongly connected to the University research profile ‘Health, prevention and the human life cycle’, especially on the subject of eHealth applications and their implementation and influence on health behaviour. This profile includes several research networks including various LUMC departments, and departments from the Faculty of Social sciences. Our initiative to develop a regional multidisciplinary database platform that starts with anonymized routine primary care data and will be linked to various routine data form specialist medical, pharmaceutical and welfare registries of about 400.000 individuals in and around Leiden and The Hague is supported by a large University grant from this profile area and from LUMC. This facility will be an important instrument in the development of research within the PrePoD program and has only recently become available.

PrePoD collaborates with several other departments at the LUMC, such as the departments of lung diseases, medical decision-making, gynaecology, paediatrics, (child) psychiatry, cardiology, oncology, gastroenterology, infectious diseases, endocrinology (diabetes), clinical epidemiology and biostatistics. Several studies are conducted within the Academic Collaboration Public health Northern South-Holland (www.awpnzh.nl). This is a collaborative infrastructure between LUMC, the regional community health services, the University of Leiden and TNO (Research Institute for Applied Science). Concerning the Big Data and datamining techniques, we cooperate with LIACS (Computer Science Leiden University) and the department of Artificial Intelligence of VU, Amsterdam. Population Health Management research and education is the focus in the LUMC Campus The Hague program, leading to increasing cooperation with the local hospitals and other healthcare providers in the The Hague area. 

An international network is already in place, making use of existing connections (for example WONCA [World Organization of Family Doctors] Europe, the Oxford International Leadership Programme, the European Health Psychology Society, the European Public Health Association, the International Primary Care Respiratory Group, the European Respiratory Society, the European Society of Primary Care Gastroenterology, EPIC (European Prognostic study Into Cancer), CA-PRI (Cancer in Primary Care) and the WHO Global Alliance Against Respiratory Disease. We are collaborating with Newcastle University, University of Edinburgh (prof. Dr. Sheikh), Imperial College London, University of Southampton, University of Aberdeen, UK;  Harvard Chan school of public health, Boston, USA, Medical Faculty, PJ Safarik University in Kosice Slovakia, University of Crete, Greece, Makarere University, Uganda; Anton de Kom University of Surinam; the Children’s Institute, University of Cape Town & the University of the Western Cape, South Africa; BRAC University, School of Public Health, Bangladesh; University of Ho Chi Minh City, Vietnam; and the Respiratory Research Institute at Fudan University, Shanghai, China.

In the next years we aim to start and intensify collaborations with other important research institutes in amongst others the UK, Canada, India, China, Singapore and Australia.