151
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Hansen J, Schäfer W, Black N, Groenewegen P. European priorities for research on health care organizations and service delivery. J Health Serv Res Policy 2011; 16 Suppl 2:16-26. [PMID: 21737526 DOI: 10.1258/jhsrp.2011.011040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To provide an overview of the principal areas of research on health care organization and service delivery and to identify priority areas from a European comparative perspective. Given the large quantity of articles produced on health care organizations, we focus on primary care and hospital care. METHOD A combination of methods was used for describing past and current research: (i) bibliometric analyses of published research in Pubmed and Embase 2000-09; (ii) a further classification of research based on a sample of 1,010 articles; and (iii) an identification of relevant EU-funded projects over the period 2000-10. An online survey of experts was carried out to identify priorities. The results were refined through conference discussions. RESULTS Research into health care organizations varies considerably across Europe. This is only partly associated with differences in countries' gross domestic product or population. Studies were categorized into four main domains: intra-organizational control; inter-organizational relations; patient relations; and governance and accountability. Past and current research may not reflect future priorities as the domain of 'inter-organizational relations' is regarded by most experts as the top priority for the future, while the smallest share in the sample of published research and EU-funded projects fell into that category. Expert views show considerable homogeneity, regardless of their role in the health care system or their country. Specific future priorities include the integration of care across organizational boundaries (including the relationship between primary and secondary care), patient involvement and participation and workforce skill-mix. CONCLUSIONS The research priorities identified in this study relate to important shared challenges in Europe's health care systems. This makes cross-border learning important, especially given the clear geographical variation in health services research (HSR) funding and capacity in Europe.
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Affiliation(s)
- Johan Hansen
- NIVEL, Netherlands Institute for Health Services Research, Utrecht University, Netherlands.
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152
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Hartveit M, Biringer E, Vanhaeht K, Haug K, Aslaksen A. The Western Norway mental health interface study: a controlled intervention trial on referral letters between primary care and specialist mental health care. BMC Psychiatry 2011; 11:177. [PMID: 22081994 PMCID: PMC3261816 DOI: 10.1186/1471-244x-11-177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 11/14/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Referral letters are the main communication means between Primary and Specialised Mental Health Care. However, studies of referral letters reveal that they lack important information, and how this lack of information affects the care for patients is unknown. This study aims to explore if and to what degree the quality of referral letters within Mental Health Care for adults can be improved and the potential improvement's impact on defined patient, professional and organisational related outcomes. METHODS AND DESIGN A controlled study with pre and post test will be prepared and accomplished to explore the correlation between the content of referral letters and outcomes of the care for the referred patients. The study is performed in accordance with the guideline of the Medical Research Council on development and evaluation of complex interventions. Using a mixed method design, a stepwise model will be conducted: Firstly, process and outcome measures will be developed and tested. Secondly, by these measures, the results from an intervention group of General Practitioners (GPs) who receive a complex quality improvement intervention will be compared with results from a control group who perform "care as usual". Compliance to the introduced guideline will be measured as a mediator. DISCUSSION The Western Norway Mental Health Interface Study is among the first trials to evaluate the impact of the quality of referral letters on the organization of care. This study will provide information that will be usable for healthcare managers and clinicians in both Primary and Specialised Care settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT01374035.
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Affiliation(s)
- Miriam Hartveit
- Research network of Integrated Care in Western Norway, Helse Fonna HF, Haugesund, Norway
- Department of Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Eva Biringer
- Research network of Integrated Care in Western Norway, Helse Fonna HF, Haugesund, Norway
- Research section, Division of Mental Health Care, Helse Fonna HF, Haugesund Norway
| | - Kris Vanhaeht
- Research network of Integrated Care in Western Norway, Helse Fonna HF, Haugesund, Norway
- Center for Health Services and Nursing Research, School of Public Health, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
- European Pathway Association, Belgium
| | - Kjell Haug
- Department of Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Aslak Aslaksen
- Division of Radiology, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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153
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Andreae C, Ekstedt M, Snellman I. Patients' participation as it appears in the nursing documentation, when care is ruled by standardized care plans. ISRN NURSING 2011; 2011:707601. [PMID: 22007324 PMCID: PMC3169373 DOI: 10.5402/2011/707601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 05/20/2011] [Indexed: 11/23/2022]
Abstract
This study aimed to describe inpatients with myocardial infarction and their participation in care as documented in the nursing records when standardized care plans are used in care. The use of standardized care plans not only has increased the quality of medical treatment but has also overlooked patients' opportunities to participate in their own care. There is a lack of knowledge about how standardized care plans influence patients' participation in nursing care. Data were collected from thirteen patients' records with diagnoses of myocardial infarction. Participation in the decision-making process and participation associated with “sharing with others” were searched for in the analysis. The analytical process was guided by content analysis. The findings were grouped into two categories: patients' intermediary participation and patients' active participation. The main results indicated that patients' intermediary participation depended on healthcare professionals' power to rule the nursing care situation.
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154
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Seawright AH, Taylor L. A systematic approach to postoperative management of deceased donor kidney transplant patients with a clinical pathway. Prog Transplant 2011. [PMID: 21485942 DOI: 10.7182/prtr.21.1.7902850750u0001p] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
CONTEXT Clinical pathways have been used in many acute hospital settings. OBJECTIVES To develop a systematic approach to postoperative care of adult recipients of deceased donor kidney transplants at the University of Mississippi Medical Center. DESIGN AND SETTING A pilot quality improvement project that uses implementation of a clinical pathway 24 hours after surgery for adult recipients of a deceased donor kidney transplant for 7 months. Charts from the same 7 months of the preceding year were retrospectively reviewed for comparison. The project occurred on the transplant floor in an acute care hospital and did not include any patients admitted to the intensive care unit. MAIN OUTCOME MEASURES To demonstrate that clinical pathways can (1) promote a method for standardizing postoperative care, (2) decrease postoperative length of stay, and (3) contain costs by minimizing hospital charges related to laboratory and room fees and promote efficient medication use in adult recipients of a deceased donor kidney transplant. RESULTS All 24 patients in the clinical pathway group met daily goals of the implemented clinical pathway. The clinical pathway group had statistically significant decreases in postoperative length of stay, use of laboratory tests, and use of intravenous medications compared with the comparison group. The 2 groups were similar in race, sex, age, and body mass index. Surgical readmissions did not differ significantly between the 2 groups.
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Affiliation(s)
- Ashley Heath Seawright
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
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155
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Vanhaecht K, Ovretveit J, Elliott MJ, Sermeus W, Ellershaw J, Panella M. Have We Drawn the Wrong Conclusions About the Value of Care Pathways? Is a Cochrane Review Appropriate? Eval Health Prof 2011; 35:28-42. [DOI: 10.1177/0163278711408293] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kris Vanhaecht
- School of Public Health, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
| | - John Ovretveit
- Medical Management Center, Karolinska Institute, Stockholm, Sweden
| | - Martin J. Elliott
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Walter Sermeus
- School of Public Health, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
| | - John Ellershaw
- Marie Currie Palliative Care Center, University of Liverpool, Liverpool, UK
| | - Massimiliano Panella
- School of Public Health, Faculty of Medicine, University of Eastern Piedmont, Novarra, Italy
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156
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Healthcare professionals' experiences of the implementation of integrated care pathways. Int J Health Care Qual Assur 2011; 24:334-47. [DOI: 10.1108/09526861111139179] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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157
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Rotter T, Kinsman L, James E, Machotta A, Willis J, Snow P, Kugler J. The effects of clinical pathways on professional practice, patient outcomes, length of stay, and hospital costs: Cochrane systematic review and meta-analysis. Eval Health Prof 2011; 35:3-27. [PMID: 21613244 DOI: 10.1177/0163278711407313] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper is a summary version of the previously published Cochrane review. It may increase the reach of the topic to health researchers and practitioners and encourage further discussion. The systematic review aims to summarize the evidence and assess the effect of clinical pathways on professional practice, patient outcomes, length of hospital stay, and hospital costs. The authors searched the Database of Abstracts of Reviews of Effectiveness, the Effective Practice and Organisation of Care Register, the Cochrane Central Register of Controlled Trials and bibliographic databases including MEDLINE, EMBASE, CINAHL, NHS EED, and Global Health. Twenty-seven studies considering a total of 11,398 participants were included for analysis. The main results were a reduction in in-hospital complications (odds ratio 0.58: 95% CI [0.36, 0.94] and improved documentation (odds ratio 11.95: 95% CI [4.72, 30.30]) associated with clinical pathways. Considerable variation in study design and settings prevented statistical pooling of results for length of stay (LOS) and hospital costs. The authors concluded that clinical pathways are associated with reduced in-hospital complications and improved documentation.
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Affiliation(s)
- Thomas Rotter
- Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.
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158
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Seawright AH, Taylor L. A Systematic Approach to Postoperative Management of Deceased Donor Kidney Transplant Patients with a Clinical Pathway. Prog Transplant 2011; 21:43-52. [DOI: 10.1177/152692481102100106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Context Clinical pathways have been used in many acute hospital settings. Objectives To develop a systematic approach to postoperative care of adult recipients of deceased donor kidney transplants at the University of Mississippi Medical Center. Design and Setting A pilot quality improvement project that uses implementation of a clinical pathway 24 hours after surgery for adult recipients of a deceased donor kidney transplant for 7 months. Charts from the same 7 months of the preceding year were retrospectively reviewed for comparison. The project occurred on the transplant floor in an acute care hospital and did not include any patients admitted to the intensive care unit. Main Outcome Measures To demonstrate that clinical pathways can (1) promote a method for standardizing postoperative care, (2) decrease postoperative length of stay, and (3) contain costs by minimizing hospital charges related to laboratory and room fees and promote efficient medication use in adult recipients of a deceased donor kidney transplant. Results All 24 patients in the clinical pathway group met daily goals of the implemented clinical pathway. The clinical pathway group had statistically significant decreases in postoperative length of stay, use of laboratory tests, and use of intravenous medications compared with the comparison group. The 2 groups were similar in race, sex, age, and body mass index. Surgical readmissions did not differ significantly between the 2 groups.
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Affiliation(s)
- Ashley Heath Seawright
- University of Mississippi Medical Center, Jackson, Mississippi (AHS), Johns Hopkins University School of Nursing, Baltimore, Maryland (AHS, LT)
| | - Laura Taylor
- University of Mississippi Medical Center, Jackson, Mississippi (AHS), Johns Hopkins University School of Nursing, Baltimore, Maryland (AHS, LT)
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159
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Harris R, Bridgman C. Introducing care pathway commissioning to primary dental care: the concept. Br Dent J 2010; 209:233-9. [PMID: 20829864 DOI: 10.1038/sj.bdj.2010.770] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2010] [Indexed: 11/09/2022]
Abstract
Care pathways are defined as 'a methodology for the mutual decision making and organisation of care for a well-defined group of patients during a well-defined period'. Although most often used in Europe as a tool to improve the quality of care and to aid the continuity of care between disciplines and settings, care pathways also have an application in underpinning the commissioning process. This paper describes the development of a new model of commissioning for general dental practice services based on a need and risk assessment linked to specified care pathways for preventive care. In this system dentists are monitored on adherence to care protocols based on nationally accepted guidelines for preventive care interventions as well as recommended recall intervals for routine dental examinations. A traffic light system to distinguish between patients with different levels of need and risk of disease is being used.
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Affiliation(s)
- R Harris
- School of Dental Sciences, The University of Liverpool, Pembroke Place, Liverpool, L3 5PS.
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160
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van de Klundert J, Gorissen P, Zeemering S. Measuring clinical pathway adherence. J Biomed Inform 2010; 43:861-72. [DOI: 10.1016/j.jbi.2010.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 07/28/2010] [Accepted: 08/02/2010] [Indexed: 11/27/2022]
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161
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Rechel B, Wright S, Barlow J, McKee M. Hospital capacity planning: from measuring stocks to modelling flows. Bull World Health Organ 2010; 88:632-6. [PMID: 20680129 DOI: 10.2471/blt.09.073361] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 12/19/2009] [Accepted: 01/05/2010] [Indexed: 11/27/2022] Open
Abstract
The metric of "bed numbers" is commonly used in hospital planning, but it fails to capture key aspects of how hospital services are delivered. Drawing on a study of innovative hospital projects in Europe, we argue that hospital capacity planning should not be based on beds, but rather on the ability to deliver processes. We propose using approaches that are based on manufacturing theory such as "lean thinking" that focuses on the value that different processes add for the primary customer, i.e. the patient. We argue that it is beneficial to look at the hospital, not from the perspective of beds or specialties, but rather from the path taken by the patients who are treated in them, the respective processes delivered by health professionals and the facilities appropriate to those processes. Systematized care pathways seem to offer one avenue for achieving these goals. However, they need to be underpinned by a better understanding of the flows of patients, work and goods within a hospital, the bottlenecks that occur, and translation of this understanding into new capacity planning tools.
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Affiliation(s)
- Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, England.
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162
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de Blok C, Luijkx K, Meijboom B, Schols J. Improving long-term care provision: towards demand-based care by means of modularity. BMC Health Serv Res 2010; 10:278. [PMID: 20858256 PMCID: PMC2955018 DOI: 10.1186/1472-6963-10-278] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 09/21/2010] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. METHODS Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. RESULTS Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. CONCLUSION The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further enable demand-based provision of long-term care by means of modularity.
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Affiliation(s)
- Carolien de Blok
- Amsterdam Centre for Service Innovation (AMSI), University of Amsterdam, the Netherlands
| | - Katrien Luijkx
- Department of Tranzo, Tilburg University, the Netherlands
| | - Bert Meijboom
- Department of Tranzo, Tilburg University, the Netherlands
- Department of Organization and Strategy, Tilburg University, the Netherlands
| | - Jos Schols
- Department of Tranzo, Tilburg University, the Netherlands
- Department of General Practice, Maastricht University, the Netherlands
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163
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Gill P, McKenna P, O'Neill H, Thompson J, Timmons D. Pillars and pathways: foundations of recovery in Irish forensic mental health care. ACTA ACUST UNITED AC 2010. [DOI: 10.5042/bjfp.2010.0423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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164
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Evans-Lacko S, Jarrett M, McCrone P, Thornicroft G. Facilitators and barriers to implementing clinical care pathways. BMC Health Serv Res 2010; 10:182. [PMID: 20584273 PMCID: PMC2912894 DOI: 10.1186/1472-6963-10-182] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 06/28/2010] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The promotion of care pathways in the recent Governmental health policy reports of Lord Darzi is likely to increase efforts to promote the use of care pathways in the NHS. Evidence on the process of pathway implementation, however, is sparse and variations in how organisations go about the implementation process are likely to be large. This paper summarises what is known about factors which help or hinder clinicians in adopting and putting care pathways into practice, and which consequently promote or hinder the implementation of scientific evidence in clinical practice. DISCUSSION Care pathways can provide patients with clear expectations of their care, provide a means of measuring patient's progress, promote teamwork on a multi-disciplinary team, facilitate the use of guidelines, and may act as a basis for a payment system. In order to achieve adequate implementation, however, facilitators and barriers must be considered, planned for, and incorporated directly into the pathway with full engagement among clinical and management staff. Barriers and/or facilitators may be present at each stage of development, implementation and evaluation; and, barriers at any stage can impede successful implementation. Important considerations to be made are ensuring the inclusion of all types of staff, plans for evaluating and incorporating continuous improvements, allowing for organisational adaptations and promoting the use of multifaceted interventions. SUMMARY Although there is a dearth of information regarding the successful implementation of care pathways, evidence is available which may be applied when implementing a care pathway. Multifaceted interventions which incorporate all staff and facilitate organisational adaptations must be seriously considered and incorporated alongside care pathways in a continuous manner. In order to better understand the mechanism upon which care pathways are effective, however, more research specifically addressing conditions under which providers become engaged in using care pathways is needed.
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Affiliation(s)
- Sara Evans-Lacko
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Manuela Jarrett
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Paul McCrone
- Centre for the Economics of Mental Health, Health Service and Population Research Department, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
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165
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Romeyke T, Stummer H. Kosteneffizienz und Qualitätssicherung durch „Klinische Behandlungspfade“? ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s16024-010-0126-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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166
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Vanhaecht K, Sermeus W, Peers J, Deneckere S, Lodewijckx C, Leigheb F, Panella M. The European Quality of Care Pathway (EQCP) Study: history, project management and approach. ACTA ACUST UNITED AC 2010. [DOI: 10.1258/jicp.2010.010015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The European Quality of Care Pathway (EQCP) study is the first, international, cluster randomized controlled trial launched to study the effect of the implementation of care pathways and to study why and under what circumstances pathways work. The study will be performed in Belgium, Italy, Ireland and Portugal and will include individual studies: a trial including chronic obstructive pulmonary disease patients, a trial including proximal femur fracture patients and a trial focusing on multidisciplinary teamwork within both populations. The study is managed by the European Pathway Association in close collaboration with a multidisciplinary team of the Catholic University Leuven (Belgium), the University of Eastern Piedmont (Italy), the National School of Public Health Lisbon (Portugal) and the Health Services Executive in Dublin (Ireland). This paper will describe the history, project management and overall approach of this international study.
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Affiliation(s)
- K Vanhaecht
- Center for Health Services and Nursing Research, Faculty of Medicine, Catholic University, Leuven, Belgium
| | - W Sermeus
- Center for Health Services and Nursing Research, Faculty of Medicine, Catholic University, Leuven, Belgium
| | - J Peers
- Center for Health Services and Nursing Research, Faculty of Medicine, Catholic University, Leuven, Belgium
| | - S Deneckere
- Center for Health Services and Nursing Research, Faculty of Medicine, Catholic University, Leuven, Belgium
| | - C Lodewijckx
- Center for Health Services and Nursing Research, Faculty of Medicine, Catholic University, Leuven, Belgium
| | - F Leigheb
- Department of Clinical and Experimental Medicine, Faculty of Medicine, University of Eastern Piedmont ‘Amedeo Avogadro’, Novara, Italy
| | - M Panella
- Department of Clinical and Experimental Medicine, Faculty of Medicine, University of Eastern Piedmont ‘Amedeo Avogadro’, Novara, Italy
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167
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Kinsman L, Rotter T, James E, Snow P, Willis J. What is a clinical pathway? Development of a definition to inform the debate. BMC Med 2010; 8:31. [PMID: 20507550 PMCID: PMC2893088 DOI: 10.1186/1741-7015-8-31] [Citation(s) in RCA: 233] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 05/27/2010] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This paper describes efforts made by a team of Cochrane Review authors to develop criteria to assist in the objective identification of clinical pathway studies from the literature. METHODS We undertook a four-stage process aiming to develop criteria to define a clinical pathway: (1) identify publications exploring the definition of a clinical pathway; (2) derive draft criteria; (3) pilot test the criteria; and (4) modify criteria to maximise agreement between review authors. RESULTS Previous literature and liaison with the European Pathways Association resulted in five criteria being used to define a clinical pathway: (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions'; (4) the intervention had timeframes or criteria-based progression; and (5) the intervention aimed to standardise care for a specific clinical problem, procedure or episode of healthcare in a specific population. After pilot testing it was decided that if an intervention met the first criteria (a structured multidisciplinary plan of care) plus three out of the other four criteria then it was included as a clinical pathway for the purposes of this review. In all, 27 studies were included in the final review. The authors of the included studies referred to these interventions as 'clinical pathways', 'protocols', 'care model', 'care map', 'multidisciplinary care', evidence-based care' and 'guideline'. CONCLUSIONS The criteria used for the identification of relevant studies for this Cochrane Review can be used as a foundation for the development of a standardised, internationally accepted definition of a clinical pathway.
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Affiliation(s)
- Leigh Kinsman
- School of Rural Health, Monash University, Bendigo, Victoria, Australia.
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168
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Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J, Snow P, Kugler J. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev 2010:CD006632. [PMID: 20238347 DOI: 10.1002/14651858.cd006632.pub2] [Citation(s) in RCA: 294] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Clinical pathways are structured multidisciplinary care plans used by health services to detail essential steps in the care of patients with a specific clinical problem. They aim to link evidence to practice and optimise clinical outcomes whilst maximising clinical efficiency. OBJECTIVES To assess the effect of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs. SEARCH STRATEGY We searched the Database of Abstracts of Reviews of Effectiveness (DARE), the Effective Practice and Organisation of Care (EPOC) Register, the Cochrane Central Register of Controlled Trials (CENTRAL) and bibliographic databases including MEDLINE, EMBASE, CINAHL, NHS EED and Global Health. We also searched the reference lists of relevant articles and contacted relevant professional organisations. SELECTION CRITERIA Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies comparing stand alone clinical pathways with usual care as well as clinical pathways as part of a multifaceted intervention with usual care. DATA COLLECTION AND ANALYSIS Two review authors independently screened all titles to assess eligibility and methodological quality. Studies were grouped into those comparing clinical pathways with usual care and those comparing clinical pathways as part of a multifaceted intervention with usual care. MAIN RESULTS Twenty-seven studies involving 11,398 participants met the eligibility and study quality criteria for inclusion. Twenty studies compared stand alone clinical pathways with usual care. These studies indicated a reduction in in-hospital complications (odds ratio (OR) 0.58; 95% confidence interval (CI) 0.36 to 0.94) and improved documentation (OR 13.65: 95%CI 5.38 to 34.64). There was no evidence of differences in readmission to hospital or in-hospital mortality. Length of stay was the most commonly employed outcome measure with most studies reporting significant reductions. A decrease in hospital costs/ charges was also observed, ranging from WMD +261 US$ favouring usual care to WMD -4919 US$ favouring clinical pathways (in US$ dollar standardized to the year 2000). Considerable heterogeneity prevented meta-analysis of length of stay and hospital cost results. An assessment of whether lower hospital costs contributed to cost shifting to another health sector was not undertaken.Seven studies compared clinical pathways as part of a multifaceted intervention with usual care. No evidence of differences were found between intervention and control groups. AUTHORS' CONCLUSIONS Clinical pathways are associated with reduced in-hospital complications and improved documentation without negatively impacting on length of stay and hospital costs.
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Affiliation(s)
- Thomas Rotter
- Department of Public Health, Dresden Medical School, University of Dresden, Dresden, Germany, D-01307
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169
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Affiliation(s)
- Massimiliano Panella
- Department of Clinical and Experimental Medicine, Faculty of Medicine, University of Eastern Piedmont ‘Amedeo Avogadro’, Novaro, Italy
| | - Kris Vanhaecht
- Center for Health Services and Nursing Research, School of Public Health, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
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170
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Lyckner S, Sjöberg PB, Engström G. Critical pathway for patients undergoing aortic-surgery: Impact on postoperative care at an intensive care unit in Sweden. ACTA ACUST UNITED AC 2010. [DOI: 10.1258/jicp.2009.009018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In January 2007, the intensive care unit (ICU) at a Swedish hospital introduced a critical pathway for patients undergoing aortic-surgery. The aim of this study is to evaluate the impact of this initiative, with regard to postoperative care in an ICU. A comparison of two patient groups - 17 patients treated one year before and 20 patients treated one year after the introduction of the pathway - was performed, and considered nasogastric tube, intake of clear fluids, intake of nutrition drink or meal, breathing exercise and mobilization. No statistically significant differences in mean age, gender, anaesthetic risk factors, peroperative bleeding, length of surgery and length of mechanic ventilation between the groups existed. The patients in the pathway group had their nasogastric tube removed significantly earlier (P < 0.05) and received intake of clear fluids and nutrition drink or meal significantly (P < 0.05) earlier than patients in the control group. Critical pathway for patients undergoing aortic-surgery has a positive impact on postoperative care. Aortic-surgery patients treated in accordance with the pathway at the ICU received nursing interventions earlier than patients who were treated without pathway, which is crucial for the quality of care and optimal outcome.
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Affiliation(s)
- Sara Lyckner
- Department for Anesthesiology, Mälarhospital, Eskilstuna
| | | | - Gabriella Engström
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
- Christine E Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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171
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172
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Abstract
AIM Clinical pathways are used worldwide to (re)organize care processes. They are used by multidisciplinary teams in their search towards excellence. The goal of this study is (1) to assess differences in the perception of health professionals in their evaluation of care processes; (2) to assess whether care processes supported by clinical pathways perform better than those not supported by clinical pathways; and (3) to assess the sensitivity and specificity of clinical pathways in predicting well-organized care processes. METHODS A cross-sectional, multi-centre study was performed comprising 309 healthcare workers, 103 care processes and 49 hospitals. The Care Process Self Evaluation Tool (CPSET) was used to score care processes according to their organization. Processes were also scored according to the level of pathway implementation. RESULTS (1) Significant differences between healthcare professionals were found on two of five CPSET subscales. No significant differences were found among the overall CPSET scores. (2) Care processes supported by pathways had the highest CPSET scores. Nonetheless, continuous follow-up is necessary. (3) Clinical pathways have significant impact on the coordination of care (odds ratio: 8.92), follow-up (odds ratio: 6.65) and overall CPSET score (odds ratio: 4.26). Clinical pathways have a positive impact on the organization of care processes. Not all pathways have high CPSET scores, and care processes without pathways can also be well organized. Continuous evaluation is essential. This is the first study to analyse how healthcare teams perceive the organization of care processes with respect to clinical pathways. Our findings are important for other quality improvement methods.
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Affiliation(s)
- Kris Vanhaecht
- Center for Health Services and Nursing Research, Catholic University Leuven, Leuven, Belgium.
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173
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Rolley JX, Davidson PM, Salamonson Y, Fernandez R, Dennison CR. Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approach. J Clin Nurs 2009; 18:2394-405. [PMID: 19538559 DOI: 10.1111/j.1365-2702.2008.02768.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention. BACKGROUND. Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management. DESIGN Systematic review. METHOD The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage). RESULTS Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri-percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase. CONCLUSIONS Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design. RELEVANCE TO CLINICAL PRACTICE To improve the care given to individuals undergoing percutaneous coronary intervention, it is important to base practice on high-level evidence. Where this is lacking, clinicians need to arrive at a consensus as to appropriate standards of practice while also engaging in developing evidence. This must be considered, however, from the central perspective of the patient and their family.
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Affiliation(s)
- John X Rolley
- School of Nursing & Midwifery, College of Health Science, Curtin University of Technology, Level 7, 39 Regent Street, Chippendale, Sydney, NSW, Australia.
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Abstract
The clinical pathways for craniosynostosis and nonsynostotic skull deformity are entirely different. At the Dutch Craniofacial Center (DCFC), all patients were assessed in the same multidisciplinary craniofacial clinic, a common practice in countries with developed health care. However, the high volume of referrals of nonsynostotic cases frequently resulted in the capacity of these clinics being exceeded, with some patients being assessed in the general pediatric plastic surgery clinic instead. In these general clinics, not all the multidisciplinary team members are routinely present, so patients with craniosynostosis had to make a second journey for further assessment, causing inconvenience, expense, and potential delay in treatment. With triage at the community level unreliable and triage at clinic level inefficient, we decided to trial a triage system to increase efficiency and to ensure patients enter the correct clinical pathway earlier.The 2 craniofacial secretaries were issued with a flowchart to be completed for each new referral. The flowcharts were designed to triage the patients into true craniosynostosis with an appointment for the multidisciplinary clinic or nonsynostotic deformity with an appointment with the craniofacial nurse practitioner (CNP). During a 3-month period, 107 referrals were made. The triage category listed on the initial flowchart for each patient was compared, with the final diagnosis made in the multidisciplinary and CNP clinics.None of the patients triaged as nonsynostotic deformity on the flowcharts were found to be true craniosynostosis after clinical assessment by the CNP. Radiographic assessment or assessment by the craniofacial surgeons in the DCFC confirmed this.The flowchart questionnaire used at the DCFC is a highly sensitive and therefore safe method for detecting craniosynostosis. It has helped to improve efficiency by ensuring patients are seen in an appropriate setting.
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175
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Broekhuis M, de Blok C, Meijboom B. Improving client-centred care and services: the role of front/back-office configurations. J Adv Nurs 2009; 65:971-80. [DOI: 10.1111/j.1365-2648.2009.05014.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee TY, Chan T, Chang CS, Lan JL. Introducing a clinical pathway for acute peptic ulcer bleeding in general internal medicine wards. Scand J Gastroenterol 2009; 43:1169-76. [PMID: 18609139 DOI: 10.1080/00365520802130191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Management of acute peptic ulcer bleeding (PUB) is expensive and there is little evidence to prove the cost-effectiveness of a clinical pathway. The purpose of this study was to introduce a clinical pathway in hospitalized patients with acute PUB to evaluate its impact on costs and other outcomes. MATERIAL AND METHODS The clinical pathway was designed for and implemented in hospitalized patients, and a physicians reminder system that included chief residents, checklists, and case review meetings was also utilized. Use of medicine for acid suppression, length of hospital stay (LOS), and treatment costs were compared between patients before and after implementation of the clinical pathway. Outcome measures included the rate of recurrent bleeding, rate of repeat upper gastrointestinal (UGI) endoscopy, and rate of readmission within 30 days of discharge. RESULTS This clinical pathway significantly reduced the use of intravenous medicine for acid suppression from 88% to 34%, with mean LOS down from 6.7 to 3.6 days, mean cost of medications decreased from New Taiwan Dollars (NTD) 8768 to NTD 3940 (cost down 55.1%), mean cost of diagnostic tests lowered from NTD 12,560 to NTD 9493 (cost down 24.4%), and mean total hospital cost down from NTD 33,142 to NTD 19,519 (cost down 41.1%). Outcome measures were not significantly different. CONCLUSIONS Introduction of a clinical pathway is an effective method for reducing costs while maintaining quality of care in the management of PUB.
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Affiliation(s)
- Teng-Yu Lee
- Department of Internal Medicine, Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.
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177
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Broers CJM, Sinclair N, van der Ploeg TJ, Jaarsma T, van Veldhuisen DJ, Umans VAWM. The post-infarction nurse practitioner project: A prospective study comparing nurse intervention with conventional care in a non-high-risk myocardial infarction population. Neth Heart J 2009; 17:61-7. [PMID: 19247468 PMCID: PMC2644381 DOI: 10.1007/bf03086219] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To confirm the feasibility of nurse practitioner interventionin non-high-risk patients with recent myocardial infarction (MI). DESIGN Observational study. SETTING Acute coronary care unit in a teaching hospital. METHODS We performed an open-label feasibility study to identify non-high-risk MI patients and evaluate the outcome of a new nurse practitioner intervention programme. The initial pilot phase served to identify the non-high-risk population. In the subsequent confirmation phase, 500 consecutive non-high-risk post-MI patients with preserved LV function without heart failure were included to receive nurse practitioner management. The nurse practitioner intervention started on transfer from the coronary care unit to the cardiology ward and continued thereafter for up to 30 days. MAIN OUTCOME MEASURES Time to first event analysis of death from all causes or repeat myocardial infarction. RESULTS 500 Patients without signs of heart failure or depressed LV function were identified as nonhigh- risk and eligible for inclusion in the nurse practitioner intervention programme. In the implementation phase, none of the patients died and 0.9% developed a repeat myocardial infarction after 30 days of follow-up. Compared with the pilot phase, patients in the implementation phase spent fewer days in hospital (mean 11.1 versus 6.2 days; p<0.001). CONCLUSION It is feasible to identify non-high-risk post-MI patients, who can be managed adequately by a nurse practitioner. Embedding experienced nurse practitioners within critical care pathways may result in significant decreases in length of hospital stay. (Neth Heart J 2009;17:61-7.Neth Heart J 2009;17:61-7.).
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Affiliation(s)
- C J M Broers
- Department of Cardiology, Medical Centre Alkmaar, Alkmaar, the Netherlands
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178
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Cardoen B, Demeulemeester E. Capacity of clinical pathways--a strategic multi-level evaluation tool. J Med Syst 2009; 32:443-52. [PMID: 19058648 DOI: 10.1007/s10916-008-9150-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this paper we strategically evaluate the efficiency of clinical pathways and their complex interdependencies with respect to joint resource usage and patient throughput. We propose a discrete-event simulation approach that allows for the simultaneous evaluation of multiple clinical pathways and the inherent uncertainty (resource, duration and arrival) that accompanies medical processes. Both the consultation suite and the surgery suite may be modeled and examined in detail by means of sensitivity or scenario analyses. Since each medical facility can somehow be represented as a combination of clinical pathways, i.e. they are conceptually similar, the simulation model is generic in nature. Next to the formulation of the model, we illustrate its applicability by means of a case study that was conducted in a Belgian hospital.
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Affiliation(s)
- Brecht Cardoen
- Faculty of Business and Economics, Department of Decision Sciences and Information Management, Research Center for Operations Management, Katholieke Universiteit Leuven, Naamsestraat 69, 3000 Leuven, Belgium.
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179
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Application of standard operating procedures accelerates the process of trauma care in patients with multiple injuries. Eur J Emerg Med 2008; 15:311-7. [DOI: 10.1097/mej.0b013e3283036ce6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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180
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MacLean A, Fuller RM, Jaffrey EG, Hay AJ, Ho-Yen DO. Integrated care pathway for Clostridium difficile helps patient management. ACTA ACUST UNITED AC 2008. [DOI: 10.1177/1469044608098324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A pilot study using an integrated care pathway (ICP) when caring for patients suffering from Clostridium difficile associated disease (CDAD) was undertaken over a six-month period within six wards in two hospitals. The aim was to standardise practice and improve communications for this group of patients. There was increased staff knowledge and understanding with 91% of nursing staff reporting that the use of a CDAD ICP had improved patient care and treatment. Seventy-seven per cent of staff expressed that communications had improved since using the ICP and 77% felt that accessibility of patient information had improved. Lastly 86% of the staff felt better equipped to nurse patients with CDAD. A literature review yielded no other documented evidence of the use of an ICP for this patient group.
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Affiliation(s)
| | - Rachel M Fuller
- Department of Nursing & Midwifery, Raigmore Hospital, Inverness
| | - Elizabeth G Jaffrey
- Clinical Effectiveness Department, NHS Highland, John Dewar Building, Inverness
| | - Andrew J Hay
- Microbiology Department, Raigmore Hospital, Inverness,
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181
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Joosten TCM, Bongers IMB, Meijboom IBR. Care programmes and integrated care pathways. Int J Health Care Qual Assur 2008; 21:472-86. [PMID: 18785346 DOI: 10.1108/09526860810890440] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The article discusses how care programmes and integrated care pathways can be linked, finding ways to improve healthcare process professional and logistical quality from a supply chain and a network point-of-view. DESIGN/METHODOLOGY/APPROACH The authors argue that owing to cost containment goals and increasing healthcare demand, healthcare services systems are challenged to improve service quality, whilst at the same time finding ways to improve delivery processes. It explores if the combination of two instruments, care programmes and integrated care pathways, can meet both goals. This combination is illustrated by an example from the Institute of Mental Health Care Eindhoven en de Kempen. FINDINGS Analysis suggests that care programmes can be combined with integrated care pathways, leading to a situation where both quality and process improvement can be reached. These instruments are complementary. RESEARCH LIMITATIONS/IMPLICATIONS The article is largely conceptual; ideas are presented to stimulate thinking rather than to prove an argument. PRACTICAL IMPLICATIONS Combining care programmes and integrated care pathways has implications for the way we think about and organise healthcare processes. ORIGINALITY/VALUE There have been few publications on instruments combining both a network and a supply chain approach to describe and understand healthcare processes.
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Affiliation(s)
- Tom C M Joosten
- Institute of Mental Health Care Eindhoven en de Kempen (GGzE), AX Eindhoven, The Netherlands.
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182
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Lauck S, Mackay M, Galte C, Wilson M. A New Option for the Treatment of Aortic Stenosis: Percutaneous Aortic Valve Replacement. Crit Care Nurse 2008. [DOI: 10.4037/ccn2008.28.3.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Sandra Lauck
- Sandra Lauck is a clinical nurse specialist in interventional cardiology, Martha Mackay is a clinical nurse specialist in cardiology, Carol Galte is a nurse practitioner, and Margot Wilson is operations leader at the Heart Centre, St. Paul’s Hospital, Vancouver, British Columbia, Canada. Mackay, Galte, and Wilson are also adjunct professors at the School of Nursing, University of British Columbia, in Vancouver
| | - Martha Mackay
- Sandra Lauck is a clinical nurse specialist in interventional cardiology, Martha Mackay is a clinical nurse specialist in cardiology, Carol Galte is a nurse practitioner, and Margot Wilson is operations leader at the Heart Centre, St. Paul’s Hospital, Vancouver, British Columbia, Canada. Mackay, Galte, and Wilson are also adjunct professors at the School of Nursing, University of British Columbia, in Vancouver
| | - Carol Galte
- Sandra Lauck is a clinical nurse specialist in interventional cardiology, Martha Mackay is a clinical nurse specialist in cardiology, Carol Galte is a nurse practitioner, and Margot Wilson is operations leader at the Heart Centre, St. Paul’s Hospital, Vancouver, British Columbia, Canada. Mackay, Galte, and Wilson are also adjunct professors at the School of Nursing, University of British Columbia, in Vancouver
| | - Margot Wilson
- Sandra Lauck is a clinical nurse specialist in interventional cardiology, Martha Mackay is a clinical nurse specialist in cardiology, Carol Galte is a nurse practitioner, and Margot Wilson is operations leader at the Heart Centre, St. Paul’s Hospital, Vancouver, British Columbia, Canada. Mackay, Galte, and Wilson are also adjunct professors at the School of Nursing, University of British Columbia, in Vancouver
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183
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Abstract
District nurses use care pathways to ensure the efficient delivery of evidence-based high quality care. However, many health professionals, including district nurses have expressed concern that comparing the actual care delivered with a care pathway makes them more susceptible to litigation should the patient suffer harm during the course of treatment. In this article Richard Griffith considers the legal implications of care pathways.
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184
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Step by step development of clinical care pathways for older cancer patients: necessary or desirable? Eur J Cancer 2007; 43:2170-8. [PMID: 17870519 DOI: 10.1016/j.ejca.2007.08.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 07/31/2007] [Accepted: 08/01/2007] [Indexed: 02/07/2023]
Abstract
Medical and nursing staff in oncology for older cancer patients are confronted with a range of problems including co-morbidity, poly-pharmacy, cognitive impairments, emotional problems, functional limitations, sensory impairment and a lack of social support. Comprehensive geriatric assessment identifies many of the existing problems and can be used to estimate life expectancy and tolerance of treatment. However, health care providers have to interpret and apply the medical and nursing information and must deal with specific problems and care needs throughout the continuum of cancer care. Imperfect interdisciplinary communication, cooperation and patient-provider communication may further complicate the care actually delivered. A clinical care pathway aims to improve continuity, increase multidisciplinary tuning and deliver appropriate patient education, treatment and care for vulnerable older cancer patients. This paper gives an overview of common problems in older cancer patients and addresses communication barriers through the development of clinical care pathways in geriatric oncology.
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185
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Muñoz-Solomando A, Williams RJW. Care pathways for young people who misuse substances: using the evidence to design services. Curr Opin Psychiatry 2007; 20:330-6. [PMID: 17551346 DOI: 10.1097/yco.0b013e3281c10a97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review a selection of the literature on the nature and contents of care pathways. We examine recent work on current trends in intervening to meet the needs of young people who misuse substances. RECENT FINDINGS The recent and growing literature encourages us to adopt care pathways as structured models for service delivery. The increased prevalence and the severity and complexity of the problems experienced by young people who misuse substances evidence the requirement for specialist services for them. SUMMARY The literature argues for using care pathways to manage better services for intervening with young people who use or misuse substances and recommends their contents. We conclude that care pathways should be based on strategic models of care; however, there remain areas of uncertainty, including those about the balance of services that should be delivered, adoption of prevention programmes, and development of audit tools to monitor the impacts and effectiveness of care pathways. This review provides our recommended list of contents for models of care on which we recommend that associated care pathways should be based.
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Affiliation(s)
- Antonio Muñoz-Solomando
- School of Medicine, Department of Psychological Medicine, Section of Child and Adolescent Psychiatry, Cardiff University, Cardiff, UK.
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186
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Hurley KF, Abidi SSR. Ontology Engineering to Model Clinical Pathways: Towards the Computerization and Execution of Clinical Pathways. ACTA ACUST UNITED AC 2007. [DOI: 10.1109/cbms.2007.79] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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187
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Lee KH, Anderson YM. The association between clinical pathways and hospital length of stay: a case study. J Med Syst 2007; 31:79-83. [PMID: 17283925 DOI: 10.1007/s10916-006-9045-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clinical pathways are the treatment protocol in order to reduce or eliminate variation of care by specifying to nursing and medical staff. The effectiveness of the clinical pathways to accomplish this goal, however, is in question. With the implementation of the clinical pathways in 2001, this study evaluates the effectiveness of clinical pathway in reducing the inpatient length of stay in a rural hospital in a Midwestern state. All inpatient cases were used with the primary diagnoses of chronic obstructive pulmonary disease, congestive heart failure, diabetes, myocardial infarction, and pneumonia from the years of 1999-2003. By controlling for gender, age, insurance type, and year, this study employs a multiple regression analysis to evaluate the association between clinical pathways and the length of stay. Only one (the clinical pathway for myocardial infarction) out of the five pathways studied showed an association with a statistical significance in decreasing the length of stay. Health care administrators should consider other aspects as well as the hospital length of stays when implementing clinical pathways in their facility.
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Affiliation(s)
- Keon-Hyung Lee
- Health Services Administration Program, Department of Health Professions, College of Health and Public Affairs, University of Central Florida, Orlando 32816, USA.
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188
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Abstract
AIM To determine whether clinical/care pathway audit tools can identify the characteristics of well-organized care processes. BACKGROUND Although pathways are used worldwide, confusion exists about the concept and impact. Evaluation Search of OVID-Medline, Cinahl, British Nursing Index; manual search of the Journal of Integrated Care Pathways; contact with Smartgroup on Clinical Pathways and board members of the European Pathway Association and Google search. KEY ISSUES We selected seven of 15 clinical pathway audit tools for this review. Through content analysis, we identified 17 characteristics and grouped them using the realistic evaluation paradigm. The Integrated Care Pathway Appraisal Tool is the most appropriate audit tool to assess clinical pathway documents. CONCLUSIONS It is astonishing that so little research on clinical pathway audit tools has been underwent, given the prevalent use of clinical pathways. Because the concept of clinical pathways remains unclear, a variety of audit tools are needed to help clarify the concept. Further research on the construct and criterion validity of pathway audit tools is necessary to fully understand why and under which circumstances pathways lead to improved care.
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Affiliation(s)
- Kris Vanhaecht
- Centre for Health Services and Nursing Research, School of Public Health, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium.
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