'Ziektelastmeter' has positive effect on quality of care

The 'Ziektelastmeter' (assessment of burden) tool has a positive effect on perceived quality of care and gives patients knowledge, skills and confidence in being able to manage their disease and their health. This appears from research by Maastricht University. This research was partly funded by a grant from the IMDI programme.

More than half of the people in the Netherlands have a chronic condition. This figure is likely to increase as we continue to live longer and less healthy lives. In order to ensure good, accessible and affordable healthcare in the future, we must promote a healthy lifestyle and support people in self-management as well as possible. But how do you do that in everyday practice? The 'Ziektelastmeter' tool, an innovative instrument that measures and visually reproduces one’s integral state of health, could help us do this.

Working on health with the 'Ziektelastmeter'

  • The 'Ziektelastmeter' is a device for personalised healthcare that enables patients to play a greater role in their treatment.
  • The instrument measures and visualises burden of disease, integrates this in a dialogue based on the principles of joint decision-making, and helps patients and clinicians establish goals and action plans jointly.
  • The 'Ziektelastmeter' of COPD tool has been expanded into the 'Ziektelastmeter' of Chronic Conditions, with modules for, amongst others, type 2 diabetes, heart failure and asthma.

The 'Ziektelastmeter' tool has a positive effect on perceived quality of care and patient activation.

Personalised care

The purpose of the 'Ziektelastmeter' tool is to make care as personalised as possible. It gives the healthcare provider and the patient insight into the perceived burden of disease, the factors that might play a role in this, and what they can do to reduce symptoms. The 'Ziektelastmeter' tool includes a questionnaire for the patient to fill in prior to their consultation. The questions cover symptoms and physical limitations, as well as social and emotional aspects that might play a role in the perceived burden of disease. The patient might want to follow a healthier diet but not be able to do so due to stress at work or financial concerns. This must be properly identified before goals can be drawn up. During the consultation between the healthcare provider and a patient, the results are then presented in a visually pleasing manner. Balloons are used in the illustration (see the figure below). The green balloons higher up indicate that a particular domain is going well, and red balloons lower down indicate that a great deal of improvement is possible. This allows the healthcare provider and the patient to easily see what someone experiences as a burden and the areas in which health improvements might be achieved. The balloons can be discussed, and you can click on a balloon; this opens suggestions for treatment. Thereupon, with the help of the healthcare provider, the patient formulates goals and action plans him/herself. In this way, the patient is actively involved during the consultation, and can take concrete steps to reduce the burden of disease at home. This contributes towards autonomy and self-management.

Resultaten die met ballonnen in de Ziektelastmeter worden getoond.
Figure 1: Example of the outcomes of a person with asthma

The 'Ziektelastmeter' of Chronic Conditions tool

The 'Ziektelastmeter' tool was initially developed for COPD at the initiative of the Lung Alliance of the Netherlands (Long Alliantie Nederland, LAN). Research showed that use of the 'Ziektelastmeter' of COPD tool resulted in improved quality of life and perceived quality of care [1]. From interviews with patients and healthcare providers, it appeared that the 'Ziektelastmeter' tool makes a valuable contribution to everyday practice [2]. Due to the positive results and demand from the field, it was decided to expand the 'Ziektelastmeter' tool into a tool that can also be used by people with other chronic conditions: the 'Ziektelastmeter' of Chronic Conditions tool. This consists of a generic section, with questions that might be relevant for anyone with a chronic condition, such as fatigue, physical limitations and sexuality. There are also questions about lifestyle, such as smoking habits and exercise. One or more disease-specific sections are added to the generic section and the lifestyle section. In this way, care for patients with multiple chronic conditions is integrated and fragmentation of care can be addressed. There currently are modules for COPD, asthma, heart failure and type 2 diabetes. The development of modules for osteoarthritis and cardiovascular risk management is in full swing.

Researcher Esther Boudewijns, who was recently awarded a PhD at Maastricht University for the 'Ziektelastmeter' tool, developed the 'Ziektelastmeter' of Chronic Conditions tool together with her colleagues by carrying out literature studies, holding interviews with patients and healthcare providers, and holding meetings with groups of experts [3]. Their research showed the 'Ziektelastmeter' tool to be a valid and reliable instrument [4]. They also conducted a major study in 55 general medical practices with 237 patients in the Netherlands to evaluate the effect of the 'Ziektelastmeter' tool [5]. Patients with COPD, asthma, heart failure and type 2 diabetes participated in the study. The study showed that the 'Ziektelastmeter' of Chronic Conditions tool has a significant positive effect on the perceived quality of care. Additionally, the patients who had used the 'Ziektelastmeter' tool were more actively engaged with health and disease than the control group.

Application in everyday practice

Building on the evidence of the effectiveness of the 'Ziektelastmeter' of Chronic Conditions tool, the next step is to implement the tool in everyday practice. Maastricht University is studying how the 'Ziektelastmeter' tool can best be implemented. Great effort is being made to make the 'Ziektelastmeter' of Chronic Conditions tool available for everyday care as soon as possible. This involves work on the implementation of the 'Ziektelastmeter' tool in various GP, chain and hospital information systems and patient portals. Demand from healthcare providers has a key part to play here. It would stimulate IT suppliers to start offering the 'Ziektelastmeter' tool, and stimulate care groups to promote the use of the 'Ziektelastmeter' tool. After all, the greater the demand from the field, the greater the incentive to implement the 'Ziektelastmeter' tool widely in everyday practice. This, in turn, contributes to the ambition of getting patients to manage their care together with the healthcare provider.


Dr Esther Boudewijns – Maastricht University, Family Medicine Department

Dr Annerika Gidding-Slok – Maastricht University, Family Medicine Department

Prof. Onno van Schayck – Maastricht University, Family Medicine Department

Esther Boudewijns was awarded a PhD on 15 June 2023 for her thesis ‘Optimising care for people with chronic conditions: the 'Ziektelastmeter' of Chronic Conditions tool’


  1. Slok A.H.M., Kotz D, van Breukelen G., et al. (2016). Effectiveness of the 'Ziektelastmeter' of COPD (ABC) tool on health-related quality of life in patients with COPD: a cluster randomised controlled trial in primary and hospital care. BMJ open6(7), e011519.
  2. Slok A.H.M., Twellaar M., Jutbo L., et al. (2016). To use or not to use: experiences of healthcare professionals and patients with the 'Ziektelastmeter' of COPD (ABC) tool. Slok et al. npj Primary Care Respiratory Medicine, 17;26:16074.
  3. Boudewijns E.A., Claessens D., van Schayck O.C.P., et al. (2020). ABC-tool reinvented: development of a disease-specific ‘Ziektelastmeter' of Chronic Conditions (ABCC)-tool’ for multiple chronic conditions. BMC Family Practice, 21(1), 1-7
  4. Claessens D., Boudewijns E.A., Keijsers L.C.E.M., et al. (2023). Validity and reliability of the 'Ziektelastmeter' of Chronic Conditions (ABCC)-scale in the Netherlands. Annals of Family Medicine: 21(2); 103-111.
  5. Boudewijns E.A., Claessens D., van Schayck O.C.P., et al. Effectiveness of the 'Ziektelastmeter' of Chronic Conditions (ABCC)-tool in patients with COPD, asthma, type 2 diabetes mellitus, and heart failure: a pragmatic clustered quasiexperimental study in the Netherlands. Submitted.