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Colombani F, Sibé M, Kret M, Quintard B, Ravaud A, Saillour-Glénisson F. EPOCK study protocol: a mixed-methods research program evaluating cancer care coordination nursing occupations in France as a complex intervention. BMC Health Serv Res 2019; 19:483. [PMID: 31299966 PMCID: PMC6626323 DOI: 10.1186/s12913-019-4307-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background Facing the increasing cancer incidence and cancer survivorship, many national strategic cancer plans have identified cancer care coordination as a priority for health service improvement. However, the high variability of practices, the diversity of definitions and underlying concepts increases the existing difficulty to standardise, replicate, transpose and assess care coordination within the French health system context. The EPOCK national study aims at evaluating practices and the working context of hospital-based cancer care coordination nurses, based on a previously designed reference framework for care coordination within the French health system context. Methods EPOCK is based on a comprehensive evaluation of nursing professions in cancer care coordination, considered as a complex intervention. Phase 1 (theoretical phase) will define and design a theoretical reference framework for care coordination in France through an international literature review, aiming to identify relevant models and all components of the expected framework and a structured consensus method, the Nominal group technique, aiming to select and prioritise the most relevant components already found in the literature review with regard to the French healthcare system; phase 2 (Operational phase) will consist in an in-depth analysis of practices, contexts, perceptions and attitudes related to care coordination occupations by nurses in oncology and all stakeholders (related professionals, patients and their caregivers) through a multicentric cross-sectional mixed-method evaluative study. The observed practices and contexts will be finally compared with the theoretical reference framework using both inductive and deductive approaches. Discussion This study will result in an evaluation framework identifying key models and key elements relative to cancer care coordination interventions that can be used to guide management of cancer care coordination nursing occupations within the French healthcare system. EPOCK would also assist in public decision-making to identify optimal targets, skills profiles and scope of actions for cancer coordination professions. Finally, EPOCK will describe typology of nurse practices in cancer care coordination and thus obtain precise preliminary information essential for drafting a medico-economic evaluation study of these new nursing professions’ impact. Trial registration Clinicaltrial.gov registration: NCT03350776, 11/22/2017.
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Affiliation(s)
- F Colombani
- Centre de Coordination en Cancérologie (3C), CHU de Bordeaux (Bordeaux University Hospital), Groupe hospitalier Saint-André, 1 rue Jean Burguet, F-33000, Bordeaux, France. .,Economie et Management des Organisations de Santé (EMOS), INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.
| | - M Sibé
- Economie et Management des Organisations de Santé (EMOS), INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,ISPED (Bordeaux School of Public Health), Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, F-33000, Bordeaux, France
| | - M Kret
- Service d'Information médicale, Unité de soutien méthodologique à la recherche clinique (USMR), CHU de Bordeaux, Pôle de Santé publique, F-33000, Bordeaux, France
| | - B Quintard
- Faculté de Psychologie, Laboratoire EA 4136 Handicap, Activité, Cognition, Santé, Université de Bordeaux, F-33000, Bordeaux, France
| | - A Ravaud
- Centre de Coordination en Cancérologie (3C), CHU de Bordeaux (Bordeaux University Hospital), Groupe hospitalier Saint-André, 1 rue Jean Burguet, F-33000, Bordeaux, France.,Pôle de cancérologie, Service d'Oncologie Médicale, CHU de Bordeaux, F-33000, Bordeaux, France
| | - F Saillour-Glénisson
- Economie et Management des Organisations de Santé (EMOS), INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,ISPED (Bordeaux School of Public Health), Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, F-33000, Bordeaux, France.,Pôle de santé publique, Service d'Information Médicale, Unité Méthodes d'Evaluation en Santé, CHU de Bordeaux, F-33000, Bordeaux, France
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Lawal AK, Groot G, Goodridge D, Scott S, Kinsman L. Development of a program theory for clinical pathways in hospitals: protocol for a realist review. Syst Rev 2019; 8:136. [PMID: 31176372 PMCID: PMC6556023 DOI: 10.1186/s13643-019-1046-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the increased utilization of clinical pathways (CPWs) as a strategy to improve patient and system outcomes in hospitals, there remain ongoing challenges with their conceptualization, implementation, and evaluation. Theories that explain how CPWs work in hospitals are lacking, making it difficult to identify important factors for sustaining changes arising from CPWs implemented in hospitals. The objective of this realist review is to develop a program theory for CPWs in hospitals. METHODS This is a protocol for a realist review. The review will use a six-step iterative process to develop a program theory for CPWs in hospitals: (1) development of a preliminary program theory; (2) search strategy and literature search; (3) study selection and appraisal; (4) data extraction; (5) data analysis and synthesis; and (6) stakeholder engagement. In addition to searching the gray literature and contacting authors, we will search electronic databases such as MEDLINE, NHSEED, CINAHL EBSCO, HMIC, and PsycINFO. Studies will be included based on their ability to provide data that test some aspect of the program theory. Two independent reviewers will select, screen, and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome heuristics that explains how CPWs implemented in hospitals translates to better health system outcomes. DISCUSSION Overall, the review aims to develop a program theory for CPWs in hospitals and to explore how, why, to what extent, and in what contexts does the implementation of CPWs in hospitals contribute to better health system outcomes. As a result, the review will provide a theoretical framework of how CPWs work in hospitals. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018103220.
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Affiliation(s)
- Adegboyega K Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
| | - Gary Groot
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Donna Goodridge
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Shannon Scott
- Faculty of Nursing, University of Alberta Edmonton, Edmonton, Canada
| | - Leigh Kinsman
- University of Newcastle and Mid-North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, Australia
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Løhre ET, Thronæs M, Brunelli C, Kaasa S, Klepstad P. An in-hospital clinical care pathway with integrated decision support for cancer pain management reduced pain intensity and needs for hospital stay. Support Care Cancer 2019; 28:671-682. [PMID: 31123870 DOI: 10.1007/s00520-019-04836-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE A clinical care pathway for pain management in a palliative care unit was studied with outcomes related to patients, physicians, and health care service. Mandatory use of patient-reported outcome measures (PROMs) and physician-directed decision support (DS) were integrated parts of the pathway. METHODS Adult cancer patients with pain intensity (PI) ≥ 5 (NRS 0-10) at admission were eligible. The patients reported average and worst PI at admission, day four, and discharge. The physicians completed the DS at admission and day four. The DS presented potential needs for treatment changes based on pain severity and pathophysiology. The physicians reported treatment changes due to input from the DS system. The two primary outcomes were average and worst PI changes from admission to discharge. Hospital length of stay (LOS) was registered. RESULTS Of 52 included patients, 41 were discharged alive. For those, the mean average PI at admission and at discharge was 5.8 and 2.4, respectively, a reduction of 3.4 points (CI 95% 2.7-4.1). The corresponding worst pain intensities were 7.9 and 3.8, a reduction of 4.1 points (CI 95% 3.4-4.8). The physicians completed DS forms for all patients. Fifty-five percent (CI 95% 41-69) of the patients had pain intervention changes based on the DS. A significant reduction in LOS (4.4 days, CI 95% 0.5-8.3) was observed during the study period. CONCLUSIONS The interventions were implemented according to the intentions and PI was reduced as hypothesized. For evaluation of generalizability, the interventions should be studied in other settings and with a controlled design.
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Affiliation(s)
- Erik Torbjørn Løhre
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology , N-7491, Trondheim, Norway. .,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Morten Thronæs
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology , N-7491, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,European Palliative Care Research Centre (PRC), Department of Oncology and Institute of Clinical Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Stein Kaasa
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology , N-7491, Trondheim, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology and Institute of Clinical Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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104
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Lisanti AJ, Fitzgerald J, Helman S, Dean S, Sorbello A, Griffis H. Nursing Practice With Transthoracic Intracardiac Catheters in Children: International Benchmarking Study. Am J Crit Care 2019; 28:174-181. [PMID: 31043397 DOI: 10.4037/ajcc2019350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Transthoracic intracardiac catheters are central catheters placed in the operating room at the conclusion of cardiac surgery for infants and children. Complications associated with these catheters (eg, bleeding, migration, premature removal, infection, leakage, and lack of function) have been described. However, no researchers have addressed the nursing management of these catheters in the intensive care unit, including catheter dressing and securement, mobilization of patients, and flushing the catheters, or the impact of these interventions on patients' outcomes. OBJECTIVES To internationally benchmark current nursing practice associated with care of infants and children with transthoracic intracardiac catheters. METHODS In a cross-sectional, descriptive study of nursing practice in infants and children with transthoracic intracardiac catheters, a convenience sample of bedside and advanced practice nurses was recruited to complete an online survey to benchmark current practice. The survey included questions on criteria for catheter insertion and removal, dressing care, flushing practice, securement, and mobilization of patients. RESULTS Transthoracic intracardiac catheters are used by most centers that provide care for infants and children after open heart surgery. A wide range of practices was reported. CONCLUSIONS Standardizing the use and care of transthoracic intracardiac catheters can improve the safety and efficacy of their use in infants and children and promote safe and early postoperative mobilization of patients.
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Affiliation(s)
- Amy Jo Lisanti
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia.
| | - Jamie Fitzgerald
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia
| | - Stephanie Helman
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia
| | - Spencer Dean
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia
| | - Andrea Sorbello
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia
| | - Heather Griffis
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia
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105
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de Burlet KJ, Ing AJ, Larsen PD, Dennett ER. Systematic review of diagnostic pathways for patients presenting with acute abdominal pain. Int J Qual Health Care 2019; 30:678-683. [PMID: 29668935 DOI: 10.1093/intqhc/mzy079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 04/03/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose Abdominal pain is the most common reason for surgical referral. Imaging, aids early diagnosis and treatment. However unnecessary requests are associated with increased costs, radiation exposure and increased length of stay. Pathways can improve the quality of the diagnostic process. The aim of this systematic review was to identify the current evidence for diagnostic pathways and their use of imaging and effect on final outcomes. Data sources A systematic search of Embase, Medline and Cochrane databases was performed using keywords and MeSH terms for abdominal pain. Study selection All papers describing a pathway and published between January 2000 and January 2017 were included. Data extraction Data was obtained about the use of imaging, complications and length of stay. Quality assessment was performed using MINORS and Level of Evidence. Results Ten articles were included, each describing a different pathway. Five studies based the pathway on literature reviews alone and five studies on the results of their prospective study. Of the latter five studies, four showed that routine imaging increased diagnostic accuracy, but without showing a reduction in length of stay, complication rate or mortality. None of the studies included evaluated use of hospital resources or costs. Conclusion Pathways incorporating routine imaging will improve early diagnosis, but has not been proven to reduce complication rates or hospital length of stay. On the basis of this systematic review conclusions can therefore not be drawn about the pathways described and their benefit to the diagnostic process for patients presenting with abdominal pain.
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Affiliation(s)
- Kirsten J de Burlet
- Department of General Surgery, Capital and Coast DHB Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Andrew J Ing
- Department of General Surgery, Capital and Coast DHB Wellington, New Zealand
| | - Peter D Larsen
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Elizabeth R Dennett
- Department of General Surgery, Capital and Coast DHB Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
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Ibeziako P, Brahmbhatt K, Chapman A, De Souza C, Giles L, Gooden S, Latif F, Malas N, Namerow L, Russell R, Steinbuchel P, Pao M, Plioplys S. Developing a Clinical Pathway for Somatic Symptom and Related Disorders in Pediatric Hospital Settings. Hosp Pediatr 2019; 9:147-155. [PMID: 30782623 PMCID: PMC11034856 DOI: 10.1542/hpeds.2018-0205] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Somatic symptom and related disorders (SSRDs) are commonly encountered in pediatric hospital settings. There is, however, a lack of standardization of care across institutions for youth with these disorders. These patients are diagnostically and psychosocially complex, posing significant challenges for medical and behavioral health care providers. SSRDs are associated with significant health care use, cost to families and hospitals, and risk for iatrogenic interventions and missed diagnoses. With sponsorship from the American Academy of Child and Adolescent Psychiatry and input from multidisciplinary stakeholders, we describe the first attempt to develop a clinical pathway and standardize the care of patients with SSRDs in pediatric hospital settings by a working group of pediatric consultation-liaison psychiatrists from multiple institutions across North America. The authors of the SSRD clinical pathway outline 5 key steps from admission to discharge and include practical, evidence-informed approaches to the assessment and management of children and adolescents who are medically hospitalized with SSRDs.
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Affiliation(s)
- Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts;
| | - Khyati Brahmbhatt
- Langley Porter Psychiatric Institute
- Department of Psychiatry, Weill Institute for Neurosciences, and Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Andrea Chapman
- Department of Psychiatry, British Columbia Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Claire De Souza
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Lisa Giles
- Department of Psychiatry and Behavioral Health, Primary Children's Hospital and School of Medicine, The University of Utah, Salt Lake City, Utah
| | - Shanti Gooden
- Department of Psychiatry, Weill Institute for Neurosciences, and Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Finza Latif
- Department of Psychiatry and Behavioral Sciences, Children's National Medical Center and The George Washington University, Washington, District of Columbia
| | - Nasuh Malas
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, C.S. Mott Children's Hospital, University of Michigan Hospital Systems, Ann Arbor, Michigan
| | - Lisa Namerow
- Department of Psychiatry, Connecticut Children's Medical Center and Institute of Living, School of Medicine, University of Connecticut, Hartford, Connecticut
| | - Ruth Russell
- Department of Psychiatry, Montreal Children's Hospital and McGill University, Montreal, Canada
| | - Petra Steinbuchel
- Department of Psychiatry, Weill Institute for Neurosciences, and Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Maryland Pao
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland; and
| | - Sigita Plioplys
- Department of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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107
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Swegal WC, Iwata AJ, Chang SS. Developing a patient driven head and neck cancer care pathway. Head Neck 2019; 41:1094-1095. [PMID: 30693589 DOI: 10.1002/hed.25590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 12/05/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Warren C Swegal
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Ayaka J Iwata
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Steven S Chang
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan
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108
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Mohammed J, Aljurf M, Althumayri A, Almansour M, Alghamdi A, Hamidieh AA, ElHaddad A, Othman TB, Bazarbachi A, Almohareb F, Alzahrani M, Alkindi SS, Alsharif F, Da'na W, Alhashmi H, Bekadja MA, Al-Shammari SH, El Quessar A, Satti TM, Aljohani N, Rasheed W, Ghavamzadeh A, Chaudhri N, Hashmi SK. Physical therapy pathway and protocol for patients undergoing hematopoietic stem cell transplantation: Recommendations from The Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) Group. Hematol Oncol Stem Cell Ther 2019; 12:127-132. [PMID: 30653940 DOI: 10.1016/j.hemonc.2018.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients undergoing hematopoietic stem cell transplantation (HSCT) are often referred for physical therapy (PT) to help improve their quality of life. However, to our knowledge there is no clear PT pathway to guide therapists and patients before, during, and after HSCT. METHODS A comprehensive literature review was carried out exploring the role and benefits of PT in HSCT patients. The current evidence was comlimented with recommendations and opinions from the experts in the field, which included PT's and hematology consultants from PTAGVHD and the EMBMT group. RESULT A clear pathway and protocol as a working guide for rehabilitation professionals working with the HSCT patient's was developed. CONCLUSION This paper not only reviews the current evidence on safe PT practice but also puts forward a protocol and pathway for HSCT rehabilitation, highlights the importance of individualized exercise intervention for HSCT patients, and outlines safe practice guidelines for the physical therapists working in this field.
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Affiliation(s)
- Jaleel Mohammed
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Rehabilitation department, Physical Therapy Association for Graft Versus Host Disease, Swindon, UK.
| | - Mahmoud Aljurf
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Rehabilitation department, Physical Therapy Association for Graft Versus Host Disease, Swindon, UK
| | - Abdulaziz Althumayri
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Muntaha Almansour
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Alghamdi
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Amir Ali Hamidieh
- Stem Cell Transplantation, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Alaa ElHaddad
- Oncology, National Cancer Institute, Cairo University, Giza, Egypt
| | - Tarek Ben Othman
- Hematology, Centre National De Greffe De La Moelle Osseuse, Tunis, Tunisia
| | - Ali Bazarbachi
- Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fahad Almohareb
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- Hepatology & Hematology, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Salam S Alkindi
- Hematology, Sultan Qaboos University Hospital, Al-Khoud, Oman
| | - Fahad Alsharif
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Waleed Da'na
- Implantalogy/Hematology, King Hussein Cancer Center, Amman, Jordan
| | - Hani Alhashmi
- Adult Hematology and Stem Cell Transplantation, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mohamed A Bekadja
- Department of Hematology and Cell Therapy, University Hospital EHU 1er November, Oran, Algeria
| | | | - Asma El Quessar
- Hematology and Oncology Pediatric Department, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Tariq M Satti
- Bone Marrow Transplant, Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Naif Aljohani
- Adult Bone Marrow Transplant, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Walid Rasheed
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ardeshir Ghavamzadeh
- Stem Cell Transplantation, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Naeem Chaudhri
- Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Shahrukh K Hashmi
- Rehabilitation department, Physical Therapy Association for Graft Versus Host Disease, Swindon, UK; Hematology/Oncology, Mayo Clinic, Rochester, MN, USA
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109
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Schultz K, Carroll L, Mainey K, Dent E. Identification of service improvement opportunities in an Australian community transition care program. Aging Clin Exp Res 2018. [PMID: 29525939 DOI: 10.1007/s40520-018-0923-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Transition care programs (TCPs) are designed to optimise functional recovery and independence in older adults post-hospitalisation. These programs are under high demand, and understanding inefficiencies in patient flow are a key step towards service improvement. AIMS To identify service improvement opportunities in an Australian community TCP service. METHODS An in-depth retrospective study of 113 community TCP clients. RESULTS TCP occupancy was high (94%) and client functional level improved across the program. Inefficiencies experienced included: admission delays to the program; low completion rates (61%) predominantly due to re-hospitalisation; variable response times by Allied Health services (5-20 days); and discharge delays-the latter attributed to waiting for services such as Home Care Packages through Non-Government Organisations. DISCUSSION This study identified several opportunities for service improvement in a community TCP service. Health practitioners should be regularly provided with up-to-date information on efficiency of TCP services.
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110
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Identifying and classifying indicators affected by performing clinical pathways in hospitals: a scoping review. INT J EVID-BASED HEA 2018; 16:3-24. [PMID: 29176429 DOI: 10.1097/xeb.0000000000000126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM To analyse the evidence regarding indicators affected by clinical pathways (CPW) in hospitals and offer suggestions for conducting comprehensive systematic reviews. METHODS We conducted a systematic scoping review and searched the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, OVID, Science Direct, ProQuest, EMBASE and PubMed. We also reviewed the reference lists of included studies. The criteria for inclusion of studies included experimental and quasi-experimental studies, implementing CPW in secondary and tertiary hospitals and investigating at least one indicator. Quality of included studies was assessed by two authors independently using the Critical Appraisal Skills Program for clinical trials and cohort studies and the Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies. RESULTS Forty-seven out of 2191 studies met the eligibility and inclusion criteria. The majority of included studies had pretest-posttest quasi-experimental design and had been done in developed countries, especially the United States. The investigation of evidence resulted in identifying 62 indicators which were classified into three categories: input indicators, process and output indicators and outcome indicators. Outcome indicators were more frequent than other indicators. Complication rate, hospital costs and length of hospital stay were dominant in their own category. Indicators such as quality of life and adherence to guidelines have been considered in studies that were done in recent years. CONCLUSION Implementing CPW can affect different types of indicators such as input, process, output and outcome indicators, although outcome indicators capture more attention than other indicators. Patient-related indicators were dominant outcome indicators, whereas professional indicators and organizational factors were considered less extensively. WHAT IS KNOWN ABOUT THE TOPIC?: WHAT DOES THIS ARTICLE ADD?
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111
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Burstein B, Gravel J, Aronson PL, Neuman MI. Emergency department and inpatient clinical decision tools for the management of febrile young infants among tertiary paediatric centres across Canada. Paediatr Child Health 2018; 24:e142-e154. [PMID: 31110465 DOI: 10.1093/pch/pxy126] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/10/2018] [Indexed: 01/06/2023] Open
Abstract
Objectives With no nationally-endorsed guidelines and the emergence of newer diagnostic tools, there exists significant variation in the management of febrile infants <90 days. We sought to evaluate the prevalence and content of clinical decision tools (CDTs) for the emergency department (ED) and inpatient management of febrile young infants across Canada. Methods We undertook a cross-sectional analysis of febrile young infant CDTs from ED and inpatient units at all 16 Canadian tertiary paediatric hospitals. Additional data were collected using an electronic survey of ED and inpatient representatives, characterizing their clinical settings and diagnostic test availability. Content of all existent CDTs was independently reviewed using list items determined a priori. The primary outcome was the proportion of EDs and inpatient units with CDTs. Results Information regarding CDTs was gathered from all 16 EDs and 16 inpatient units. CDTs were infrequently available (9/32, 28%), and were more common in the ED than inpatient setting (8/16 versus 1/16, P=0.02). Review of existing CDTs revealed inter-centre differences for inclusion ages, treatment regimens, lumbar puncture recommendations, diagnostic testing and normal laboratory values. Despite availability reported at nearly all centres, C-reactive protein and respiratory virus testing were recommended in 3/9 and 5/9 CDTs, respectively. Procalcitonin testing was available at only 2/16 (13%) centres, and not incorporated into any CDTs. Conclusions CDTs for the management of febrile young infants are infrequently available among Canadian tertiary paediatric centres, and rarely incorporate newer diagnostic tests. Heterogeneity among existent CDTs highlights the need for evidence-based unified ED and inpatient national guidelines.
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Affiliation(s)
- Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec.,T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec
| | - Paul L Aronson
- Departments of Pediatrics and of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Mark I Neuman
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Mincarone P, Leo CG, Trujillo-Martín MDM, Manson J, Guarino R, Ponzini G, Sabina S. Standardized languages and notations for graphical modelling of patient care processes: a systematic review. Int J Qual Health Care 2018; 30:169-177. [PMID: 29346638 DOI: 10.1093/intqhc/mzx197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 12/22/2017] [Indexed: 11/12/2022] Open
Abstract
Purpose The importance of working toward quality improvement in healthcare implies an increasing interest in analysing, understanding and optimizing process logic and sequences of activities embedded in healthcare processes. Their graphical representation promotes faster learning, higher retention and better compliance. The study identifies standardized graphical languages and notations applied to patient care processes and investigates their usefulness in the healthcare setting. Data sources Peer-reviewed literature up to 19 May 2016. Information complemented by a questionnaire sent to the authors of selected studies. Study selection Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data extraction Five authors extracted results of selected studies. Results of data synthesis Ten articles met the inclusion criteria. One notation and language for healthcare process modelling were identified with an application to patient care processes: Business Process Model and Notation and Unified Modeling Language™. One of the authors of every selected study completed the questionnaire. Users' comprehensibility and facilitation of inter-professional analysis of processes have been recognized, in the filled in questionnaires, as major strengths for process modelling in healthcare. Conclusion Both the notation and the language could increase the clarity of presentation thanks to their visual properties, the capacity of easily managing macro and micro scenarios, the possibility of clearly and precisely representing the process logic. Both could increase guidelines/pathways applicability by representing complex scenarios through charts and algorithms hence contributing to reduce unjustified practice variations which negatively impact on quality of care and patient safety.
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Affiliation(s)
- Pierpaolo Mincarone
- National Research Council of Italy, Institute for Research on Population and Social Policies, URT Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy
| | - Carlo Giacomo Leo
- National Research Council of Italy, Institute of Clinical Physiology, Unit of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.,Tufts Medical Center, Department of Medicine, 800 Washington Street, Boston, MA 02111, USA
| | - Maria Del Mar Trujillo-Martín
- Canary Foundation of Health Research, Camino Candelaria, 44 C.S. San Isidro-El Chorrillo, 38109 El Rosario, Canary Islands, Spain
| | - Jan Manson
- Scottish Medicines Consortium, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK
| | - Roberto Guarino
- National Research Council of Italy, Institute of Clinical Physiology, Unit of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy
| | - Giuseppe Ponzini
- National Research Council of Italy, Institute for Research on Population and Social Policies, URT Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy
| | - Saverio Sabina
- National Research Council of Italy, Institute of Clinical Physiology, Unit of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy
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Haldeman S, Johnson CD, Chou R, Nordin M, Côté P, Hurwitz EL, Green BN, Cedraschi C, Acaroğlu E, Kopansky-Giles D, Ameis A, Adjei-Kwayisi A, Ayhan S, Blyth F, Borenstein D, Brady O, Brooks P, Camilleri C, Castellote JM, Clay MB, Davatchi F, Dunn R, Goertz C, Griffith EA, Hondras M, Kane EJ, Lemeunier N, Mayer J, Mmopelwa T, Modic M, Moss J, Mullerpatan R, Muteti E, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Randhawa K, Shearer H, Sönmez E, Torres C, Torres P, Verville L, Vlok A, Watters W, Wong CC, Yu H. The Global Spine Care Initiative: care pathway for people with spine-related concerns. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:901-914. [PMID: 30151811 DOI: 10.1007/s00586-018-5721-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally. METHODS The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used. RESULTS After three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatment; invasive treatment; psychological and social intervention; prevention and public health; specialty care and interprofessional management), and outcomes. The care pathway can be used to guide the management of patients with any spine-related concern (e.g., back and neck pain, deformity, spinal injury, neurological conditions, pathology, spinal diseases). The pathway is simple and can be incorporated into educational tools, decision-making trees, and electronic medical records. CONCLUSION A care pathway for the management of individuals presenting with spine-related concerns includes evidence-based recommendations to guide health care providers in the management of common spinal disorders. The proposed pathway is person-centered and evidence-based. The acceptability and utility of this care pathway will need to be evaluated in various communities, especially in low- and middle-income countries, with different cultural background and resources. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
- World Spine Care, Santa Ana, CA, USA
| | - Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA.
- Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology and Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA
- World Spine Care Europe, Holmfirth, UK
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA
- Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Christine Cedraschi
- Division of General Medical Rehabilitation and Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | | | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, North York, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Arthur Ameis
- Faculty of Medicine Certification Program in Insurance Medicine and MedicoLegal Expertise, University of Montreal, Toronto, ON, Canada
| | - Afua Adjei-Kwayisi
- Ridge Regional Hospital, Ghana World Spine Care, Accra, Greater Accra, Ghana
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - Fiona Blyth
- Concord Clinical School, University of Sydney, Concord, NSW, Australia
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Toorak, Melbourne, VIC, Australia
| | | | - Juan M Castellote
- National School of Occupational Medicine, Carlos III Institute of Health and Physical Medicine and Rehabilitation, University of Complutense, Madrid, Madrid, Spain
| | - Michael B Clay
- Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Robert Dunn
- Department of Orthopaedic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Christine Goertz
- Palmer College of Chiropractic, Davenport, IA, USA
- The Spine Institute for Quality, Davenport, IA, USA
| | | | - Maria Hondras
- Department of Anesthesiology, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Edward J Kane
- College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, CA, USA
| | | | - John Mayer
- U.S. Spine & Sport Foundation, San Diego, CA, USA
| | - Tiro Mmopelwa
- ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana
| | - Michael Modic
- Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Jean Moss
- Canadian Memorial Chiropractic College, President Emerita, Toronto, ON, Canada
| | - Rajani Mullerpatan
- Mahatma Gandhi Mission Institute of Health Sciences, MGM School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | - Elijah Muteti
- Moi University/Moi Teaching & Referral Hospital, Eldoret, Kenya
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Heather Shearer
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Erkin Sönmez
- Department of Neurological Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Carlos Torres
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Leslie Verville
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Adriaan Vlok
- Division of Neurosurgery, University of Stellenbosch, Bellville, Western Cape, South Africa
| | - William Watters
- Department of Orthopedic Weill Cornell Medical School and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
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Kaiser SV, Rodean J, Bekmezian A, Hall M, Shah SS, Mahant S, Parikh K, Auerbach AD, Morse R, Puls HT, McCulloch CE, Cabana MD. Effectiveness of Pediatric Asthma Pathways for Hospitalized Children: A Multicenter, National Analysis. J Pediatr 2018; 197:165-171.e2. [PMID: 29571931 DOI: 10.1016/j.jpeds.2018.01.084] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/03/2018] [Accepted: 01/31/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine if clinical pathways affect care and outcomes for children hospitalized with asthma using a multicenter study. STUDY DESIGN This was a retrospective, multicenter cohort study using an administrative database, the Pediatric Health Information System. We evaluated the impact of inpatient pediatric asthma pathways on children age 2-17 years admitted for asthma from 2006 to 2015 in 42 children's hospitals. Date of pathway implementation for each hospital was collected via survey. Using generalized estimating equations with an interrupted time series approach (to account for secular trends), we determined the association of pathway implementation with length of stay (LOS), 30-day readmission, chest radiograph utilization, ipratropium administration >24 hours, and administration of bronchodilators, systemic steroids, and antibiotics. All analyses were risk-adjusted for patient and hospital characteristics. RESULTS Clinical pathway implementation was associated with an 8.8% decrease in LOS (95% CI 6.7%-10.9%), 3.1% decrease in hospital costs (95% CI 1.9%-4.3%), increased odds of bronchodilator administration (OR 1.53[1.21-1.95]) and decreased odds of antibiotic administration (OR 0.93[0.87-0.99]) (n = 189 331). We found no associations between pathway implementation and systemic steroid administration, ipratropium administration for >24 hours, chest radiograph utilization, or 30-day readmission. CONCLUSIONS Clinical pathways can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.
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Affiliation(s)
- Sunitha V Kaiser
- Department of Pediatrics, University of California, San Francisco, CA.
| | - Jonathan Rodean
- Division of Research, Children's Hospital Association, Lenexa, KS
| | - Arpi Bekmezian
- Department of Pediatrics, University of California, San Francisco, CA
| | - Matt Hall
- Division of Research, Children's Hospital Association, Lenexa, KS
| | - Samir S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Sanjay Mahant
- Department of Pediatrics, University of Toronto, SickKids Research Institute, Toronto, Ontario, Canada
| | - Kavita Parikh
- Department of Pediatrics, Children's National Health System and George Washington University School of Medicine, Washington, DC
| | - Andrew D Auerbach
- Department of Internal Medicine, University of California, San Francisco, CA
| | - Rustin Morse
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Michael D Cabana
- Department of Pediatrics, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
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Kwon H, Lee JH, Woo J, Lim W, Moon BI, Paik NS. Efficacy of a clinical pathway for patients with thyroid cancer. Head Neck 2018; 40:1909-1916. [PMID: 29637689 DOI: 10.1002/hed.25175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/06/2017] [Accepted: 02/15/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Clinical pathways have been proposed as a way to improve organizational efficiency and maximize patient outcomes. However, little is known as to whether a clinical pathway is effective for thyroid cancer. METHODS The study subjects included 216 patients who were managed after clinical pathway implementation and 145 control patients. Length of stay, cost per patient, and nurses' satisfaction were compared in the 2 groups. RESULTS Mean length of stay was 0.8 days shorter in the clinical pathway group than in the control group (2.9 vs 3.7 days; P = .023). Cost per patient was also lower in the clinical pathway than in the control group (USD $3953.00 vs USD $4636.00; P < .001). Nurses' overall satisfaction scores improved from 71.6% before to 82.5% after implementation of the clinical pathway and their job characteristics scores increased from 61.1% to 75.0%. CONCLUSION Implementation of a clinical pathway for thyroid cancer can improve nurses' satisfaction with reduction of hospital stay and costs.
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Affiliation(s)
- Hyungju Kwon
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Joon-Hyop Lee
- Thyroid and Endocrine Surgery Section, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Joohyun Woo
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Woosung Lim
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung-In Moon
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Nam Sun Paik
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
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Bonkowski SL, Gagne JCD, Cade MB, Bulla SA. Evaluation of a Pain Management Education Program and Operational Guideline on Nursing Practice, Attitudes, and Pain Management. J Contin Educ Nurs 2018; 49:178-185. [DOI: 10.3928/00220124-20180320-08] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 02/09/2018] [Indexed: 11/20/2022]
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Filiatreault S, Hodgins M, Witherspoon R. An umbrella review of clinical practice guidelines for the management of patients with hip fractures and a synthesis of recommendations for the pre-operative period. J Adv Nurs 2018; 74:1278-1288. [PMID: 29473189 DOI: 10.1111/jan.13550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
Abstract
AIM The aim of this review was to locate, retrieve and critically appraise practice guidelines for the management of hip fractures. Given increasing evidence that the early recognition and management of these fractures is integral to achieving optimal outcomes, recommendations for the pre-operative period were synthesized and compared. BACKGROUND Hip fractures are associated with high rates of adverse outcomes and high healthcare costs which has resulted in the development of multiple practice guidelines to inform clinical decision-making. DESIGN An umbrella review of practice guidelines was conducted which included a critical appraisal using the Appraisal of Guidelines, Research and Evaluation-II instrument and a synthesis of pre-operative management recommendations. DATA SOURCES Multi-phased search for practice guidelines published in English using three bibliographic databases; three guideline network websites and three healthcare safety and quality organization websites with no date limit applied. Search was supplemented by contacting front-line knowledge users and content experts. REVIEW METHODS Steps for evidence-informed practice were followed: form question then search for, appraise and synthesize the evidence. RESULTS Five practice guidelines were appraised revealing significant variability in quality. The largest variability was in "rigour of development". Recommendations for pre-operative management were grouped into six categories: timing of surgery, expedited patient management, identification and treatment of correctable co-morbidities, pain management, preventative measures and multidisciplinary management. CONCLUSION Results of this review illustrate that not all practice guidelines are of equal quality. Given the costs associated with the development and maintenance of high-quality practice guidelines, such work may be more efficiently completed through international collaborations and then adapted for national and regional healthcare contexts.
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Affiliation(s)
- Sarah Filiatreault
- Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada
| | - Marilyn Hodgins
- Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada
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Furuhata H, Araki K, Ogawa T, Ikeda M. Effect on Completion of Clinical Pathway for Improving Clinical Indicator: Cases of Hospital Stay, Mortality Rate, and Comprehensive-Volume Ratio. J Med Syst 2017; 41:206. [PMID: 29134334 DOI: 10.1007/s10916-017-0857-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/01/2017] [Indexed: 12/26/2022]
Abstract
Many studies have analyzed the effects of clinical pathways, but most have considered only single diseases. The purpose of the present study was to exploratively analyze electronic medical records related to the use of clinical pathways, seeking trends that could usefully benefit clinical activity. From the data warehouse of University of Miyazaki Hospital, collected from April 2014 to March 2016, we retrospectively identified 6523 patients for whom a clinical pathway was applied. Other inclusion criteria were single hospitalization, the type of medical fee was comprehensive, and data were available so that all clinical indicators could be calculated. Two types of deviation from the clinical pathway were defined: cancellation (described in the clinical pathway but not implemented) and addition (not described in the clinical pathway but nevertheless implemented). If the code of International Classification of Diseases describing the clinical pathway differed from that describing where the medical resource was mostly spent, we considered this as indicating a complication. We compared principal clinical indicators (length of hospital stay, mortality rate, and comprehensive-volume ratio) by completion rate for the clinical pathway. Regardless of whether patients had complications, completing the clinical pathway was associated with a significant reduction in length of hospital stay. This finding indicated that length of hospital stay could be shortened if all medical treatments described in the clinical pathway were implemented. Our results demonstrated that it is possible to shorten the length of hospital stay by improving clinical pathways to include medical treatment for preventing complications.
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Affiliation(s)
- Hiroki Furuhata
- School of Knowledge Science, Japan Advanced Institute of Science and Technology, Ishikawa, Japan.
- Department of Medical Informatics, University of Miyazaki Hospital, Miyazaki, Japan.
| | - Kenji Araki
- Department of Medical Informatics, University of Miyazaki Hospital, Miyazaki, Japan
| | - Taisuke Ogawa
- Department of Medical Informatics, University of Miyazaki Hospital, Miyazaki, Japan
| | - Mitsuru Ikeda
- School of Advanced Science, Japan Advanced Institute of Science and Technology, Ishikawa, Japan
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Ronellenfitsch U, Böckler D, Schwarzbach M. Klinische Pfade zum Prozessmanagement in der Gefäßchirurgie. GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00772-017-0317-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Nilsson K, Bååthe F, Andersson AE, Wikström E, Sandoff M. Experiences from implementing value-based healthcare at a Swedish University Hospital - an longitudinal interview study. BMC Health Serv Res 2017; 17:169. [PMID: 28241823 PMCID: PMC5330026 DOI: 10.1186/s12913-017-2104-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/18/2017] [Indexed: 11/18/2022] Open
Abstract
Background Implementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013. Methods An explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis. Results Value for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients’ means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant’s guidance. This period included intensive work identifying outcome measurements based on patients’ and professionals’ perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical. Conclusions Healthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients’ voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.
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Affiliation(s)
- Kerstin Nilsson
- Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Göteborg, Sweden.
| | - Fredrik Bååthe
- Sahlgrenska University Hospital, Göteborg, Sweden/Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Annette Erichsen Andersson
- Sahlgrenska University Hospital, Göteborg, Sweden/Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Ewa Wikström
- Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Göteborg, Sweden
| | - Mette Sandoff
- Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Göteborg, Sweden
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Plishka C, Rotter T, Kinsman L, Hansia MR, Lawal A, Goodridge D, Penz E, Marciniuk DD. Effects of clinical pathways for chronic obstructive pulmonary disease (COPD) on patient, professional and systems outcomes: protocol for a systematic review. Syst Rev 2016; 5:135. [PMID: 27516179 PMCID: PMC4981985 DOI: 10.1186/s13643-016-0311-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/02/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a respiratory syndrome characterized by progressive, partially reversible airway obstruction and lung hyperinflation. COPD has a substantial burden which is seen in both patient quality of life and healthcare costs. One proposed method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs aim to guide evidence-based practice and improve the interaction between health services. They bring the best available evidence to a range of healthcare professionals by adapting evidence-based clinical guidelines to a local context and detailing the essential steps in the assessment and care of patients. METHODS The aim of this systematic review is to synthesize existing literature on the effects of CPWs for the treatment or management of COPD. We will screen search hits from search strategies developed for a Cochrane Effective Practice and Organisation of Care (EPOC) systematic review on the use of CPWs in primary care and a Cochrane EPOC review on the use of CPWs in hospitals. These searches were run in a range of databases. Studies will be screened independently by two reviewers. All studies identified by our search strategy will be considered regardless of study design as long as they meet the operational definition for clinical pathways developed by Kinsman et al. (BMC Medicine 8, 2010) and focus on the treatment or management of COPD. All included studies will be evaluated for risk of bias utilizing methodologies set out by the Cochrane collaboration. Data regarding patient, professional and systems outcomes will be extracted from all included studies. Data will be presented in both narrative and tabular form. DISCUSSION The systematic review outlined in this protocol aims to identify, assess and synthesise all available evidence on the effects of CPWs regarding the treatment and management of COPD. As a result, this review will provide an evidence base for decision makers regarding the practicality, cost effectiveness, patient benefit and best practices regarding the implementation of CPWs for the care of COPD.
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Affiliation(s)
- Christopher Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan, E3315 Health Sciences Building, Saskatoon, SK S7N 5E5 Canada
| | - Thomas Rotter
- College of Pharmacy and Nutrition, University of Saskatchewan, E3315 Health Sciences Building, Saskatoon, SK S7N 5E5 Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Organisation (North), Launceston, Tasmania Australia
| | | | - Adegboyega Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, E3315 Health Sciences Building, Saskatoon, SK S7N 5E5 Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Erika Penz
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Darcy D. Marciniuk
- Respirology, Critical Care and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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