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Aziz Alimul Hidayat A, Chen WL, Nor RM, Uliyah M, Badriyah FL, Ubudiyah M. The determinants of patient care manager role and the implementation of COVID-19 clinical pathway: a cross-sectional study. PeerJ 2022; 10:e13764. [PMID: 35910779 PMCID: PMC9332306 DOI: 10.7717/peerj.13764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/30/2022] [Indexed: 01/17/2023] Open
Abstract
Objective This study aims to determine the factors associated with patient care manager role and the implementation of the clinical pathway among nurses in private hospitals. Methods This study was conducted from January-July 2021 using the cross-sectional approach. The sample consisted of 168 nurses working in a private hospital in Surabaya City, East Java, Indonesia. Meanwhile, the data were collected using the Patient Care Manager Role Scale (PCMRS) and analyzed by multiple logistic regression to find the correlation between the variables. Results A higher percentage of nurses namely 64.3% had compliance in COVID-19 clinical pathways with an average PCMRS score of 27.81 ± 2.43. Nurses with a high-level patient care manager role level had a significant compliance risk with odds ratio [OR] 440.137, 95% confidence interval [CI] [51.850-3736.184], and p-value = 0.000 compared to those with a low role. Conclusion The role of patient care manager and compliance with COVID-19 clinical pathways correlated significantly. Based on the results, several actions are needed for the early identification of patient service managers' roles to ensure compliance with COVID-19 clinical pathways and reduce the number of cases in Indonesia.
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Affiliation(s)
| | - Wen-Ling Chen
- Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung, Taiwan
| | - Rahimah Mohd Nor
- Faculty of Health & Life Sciences, Management & Science University, Selangor, Selangor, Malaysia
| | - Musrifatul Uliyah
- Nursing, University Muhammadiyah of Surabaya, Surabaya, East Jawa, Indonesia
| | | | - Masunatul Ubudiyah
- Nursing, Universitas Muhammadiyah Lamongan, Lamongan, East Java, Indonesia
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Patel S, McClintock C, Booth C, Merchant S, Heneghan C, Bankhead C. Variations in Care and Real World Outcomes in those with Rectal Cancer: A protocol for the Ontario Rectal Cancer Cohort (OntaReCC) (Preprint). JMIR Res Protoc 2022; 11:e38874. [PMID: 35930352 PMCID: PMC9391972 DOI: 10.2196/38874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with rectal cancer require a number of pretreatment investigations, often require multidisciplinary treatment, and require ongoing follow-ups after treatment is completed. Due to the complexity of treatments, large variations in practice patterns and outcomes have been identified. At present, few comprehensive, population-level data sets are available for assessing interventions and outcomes in this group. Objective Our study aims to create a comprehensive database of individuals with rectal cancer who have been treated in a single-payer, universal health care system. This database will provide an excellent resource that investigators can use to study variations in the delivery of care to and real-world outcomes of this population. Methods The Ontario Rectal Cancer Cohort database will include comprehensive details about the management and outcomes of individuals with rectal cancer who have been diagnosed in Ontario, Canada (population: 14.6 million), between 2010 and 2019. Linked administrative data sets will be used to construct this comprehensive database. Individual and care provider characteristics, investigations, treatments, follow-ups, and outcomes will be derived and linked. Surgical pathology details, including the stage of disease, histopathology characteristics, and the quality of surgical excision, will be included. Ethics approval for this study was obtained through the Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board. Results Approximately 20,000 individuals who meet the inclusion criteria for this study have been identified. Data analysis is ongoing, with an expected completion date of March 2023. This study was funded through the Canadian Institute of Health Research Operating Grant. Conclusions The Ontario Rectal Cancer Cohort will include a comprehensive data set of individuals with rectal cancer who received care within a single-payer, universal health care system. This cohort will be used to determine factors associated with regional variability and adherence to recommended care, and it will allow for an assessment of a number of understudied areas within the delivery of rectal cancer treatment. International Registered Report Identifier (IRRID) RR1-10.2196/38874
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Affiliation(s)
- Sunil Patel
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Chad McClintock
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Shaila Merchant
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Carl Heneghan
- Centre for Evidence Medicine, University of Oxford, Oxford, United Kingdom
| | - Clare Bankhead
- Centre for Evidence Medicine, University of Oxford, Oxford, United Kingdom
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Woofter K, Kennedy EB, Adelson K, Bowman R, Brodie R, Dickson N, Gerber R, Fields KK, Murtaugh C, Polite B, Paschall M, Skelton M, Zoet D, Cox JV. Oncology Medical Home: ASCO and COA Standards. JCO Oncol Pract 2021; 17:475-492. [PMID: 34255551 DOI: 10.1200/op.21.00167] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide Standards on the basis of evidence and expert consensus for a pilot of the Oncology Medical Home (OMH) certification program. The OMH model is a system of care delivery that features coordinated, efficient, accessible, and evidence-based care and includes a process for measurement of outcomes to facilitate continuous quality improvement. The OMH pilot is intended to inform further refinement of Standards for OMH model implementation. METHODS An Expert Panel was formed, and a systematic review of the literature on the topics of OMH, clinical pathways, and survivorship care plans was performed using PubMed and Google Scholar. Using this evidence base and an informal consensus process, the Expert Panel developed a set of OMH Standards. Public comments were solicited and considered in preparation of the final manuscript. RESULTS Three comparative peer-reviewed studies of OMH met the inclusion criteria. In addition, the results from 16 studies of clinical pathways and one systematic review of survivorship care plans informed the evidence review. Limitations of the evidence base included the small number of studies of OMH and lack of longer-term outcomes data. More data were available to inform the specific Standards for pathways and survivorship care; however, outcomes were mixed for the latter intervention. The Expert Panel concluded that in the future, practices should be encouraged to publish the results of OMH interventions in peer-reviewed journals to improve the evidence base. STANDARDS Standards are provided for OMH in the areas of patient engagement, availability and access to care, evidence-based medicine, equitable and comprehensive team-based care, quality improvement, goals of care, palliative and end-of-life care discussions, and chemotherapy safety. Additional information, including a Standards implementation manual, is available at www.asco.org/standards.
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Affiliation(s)
- Kim Woofter
- Advanced Centers for Cancer Care, South Bend, IN
| | | | | | - Ronda Bowman
- American Society of Clinical Oncology, Alexandria, VA
| | - Rachel Brodie
- Purchaser Business Group on Health, San Francisco, CA
| | | | - Rose Gerber
- COA Patient Advocacy Network, Washington, DC
| | | | | | | | | | | | - Dennis Zoet
- Cancer and Hematology Centers of Western Michigan, Grand Rapids, MI
| | - John V Cox
- UT Southwestern Medical Center, Dallas, TX
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Liu X, Liu F, Wang L, Wu M, Yang L, Wei L. Performance evaluation of medical service for breast cancer patients based on diagnosis related groups. BMC Health Serv Res 2021; 21:496. [PMID: 34030683 PMCID: PMC8147397 DOI: 10.1186/s12913-021-06439-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/26/2021] [Indexed: 11/12/2022] Open
Abstract
Background To evaluate the performance of medical service for patients with breast cancer in Henan Province, China, using diagnosis related groups (DRGs) indicators and to provide data to inform practices and policies for the prevention and control of breast cancer. Methods The data were collected from the front pages of medical records (FPMR) of all hospitals above class II that admitted breast cancer patients in Henan Province between 2016 and 2019. Breast cancer patients were the subjects in our study. China DRGs (CN-DRGs) was used as a risk adjustment tool. Three indicators, including the case mix index (CMI), number of DRGs, and total weight, were used to evaluate the range of available services for patients with breast cancer, while indicators including the charge efficiency index (CEI), time efficiency index (TEI) and inpatient mortality of low-risk group cases (IMLRG) were used to evaluate medical service efficiency and medical safety. Results Between 2016 and 2019, there were 103,760 patients with breast cancer. The total weight increased over the study period at an average annual rate of 21.71%. The TEI decreased over the study period by 15.60%. The CEI exhibited an increasing trend, but the average annual rate of increase was small (2.94%). The IMLRP was 0.02, 0, 0 and 0.01% in 2016, 2017, 2018 and 2019, respectively. Conclusion The performance of medical service improved between 2016 and 2019 for breast cancer patients discharged from study hospitals in Henan Province. The main area of improvement was in the range of available services, but medical institutions must still make efforts to improve the efficiency of medical services and ensure medical safety. DRGs is an effective evaluation tool.
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Affiliation(s)
- Xinkui Liu
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China.
| | - Furong Liu
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China
| | - Lin Wang
- Radiotherapy Inpatient Ward II, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China
| | - MengFan Wu
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China
| | - LinPeng Yang
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China
| | - Le Wei
- Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, 1# Jian She Dong Road, Er Qi Distict, Zhenzhou, China
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Tiirola H, Poutanen VM, Vornanen R, Pylkkänen L. Development of cancer support services for patients and their close ones from the Cancer Society of Finland's perspective. Int J Qual Stud Health Well-being 2021; 16:1915737. [PMID: 33880972 PMCID: PMC8079123 DOI: 10.1080/17482631.2021.1915737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: This study examined what support cancer patients and their close ones need and how this support should be organized when developing cancer care pathways. The study focused on the opinions of professionals of the Cancer Society of Finland (CSF), who play a central role in presenting the third sector’s perspective on care pathways. Method: Six semi-structured group interviews were carried out with counselling nurses (n = 12) and managers (n = 9) of the CSF during summer 2017. The results were analysed using content analysis. Results: Both patients and their close ones need more information, psychosocial support and financial counselling after diagnosis, during rehabilitation and follow-up, at relapse and during the palliative care phase; additionally, close ones require support after the patient’s death. Participants emphasized close collaboration between public healthcare and the CSF to meet the needs of patients and their close ones. Conclusion: Psychosocial support can—and should—be provided as part of the care pathway. This support can be provided by organizations in the third sector, such as the CSF, which have resources in this area.
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Affiliation(s)
- Heli Tiirola
- Department of Social Sciences, Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland
| | - Veli-Matti Poutanen
- Department of Social Sciences, Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland
| | - Riitta Vornanen
- Department of Social Sciences, Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland
| | - Liisa Pylkkänen
- Clinical Oncology, Department of Oncology, University of Turku, Turku, Finland
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Abstract
Clinical practice guidelines in oncology provide an evidence-based roadmap for most cancer care delivery but often lack directions for specific patient factors and disease conditions. Clinical pathways serve as a real-time clinical decision support system to translate guidelines to clinical practice. Pathways allow for the creation of a standardized, multidimensional roadmap for the continuum of care that can support clinical decision-making, maintain optimal outcomes, and limit unnecessary variation in cancer care. Here we describe the process to develop and implement clinical pathways in the electronic health record. This process includes building the appropriate foundation for a clinical pathways team with supports in the institutional ecosystem, creating visual representations of care paths, formalizing the pathway approval process, and translating clinical pathways into an electronic health record-integrated clinical decision support tool.
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Dunn J, Goodwin B, Aitken JF, March S, Crawford-Williams F, Ireland M, Ralph N, Zajdlewicz L, Rowe A, Chambers SK. Are National Cancer Control Indicators for patient experiences being met in regional and remote Australia? A cross-sectional study of cancer survivors who travelled for treatment. BMJ Open 2021; 11:e042507. [PMID: 33619187 PMCID: PMC7903096 DOI: 10.1136/bmjopen-2020-042507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the health services experience of patients with cancer from regional and remote Australia using the Australian National Cancer Control Indicators (NCCI) guidelines as an assessment framework. DESIGN Cross-sectional. SETTING Queensland non-for-profit cancer accommodation lodges. PARTICIPANTS Participants were patients with cancer who travelled for treatment from rural and remote Queensland to major urban centres (n=518; age mean=64.6, SD=11.18). OUTCOME MEASURES Assessments included NCCI patient indicators, quality of life (QoL), psychological distress and unmet supportive care needs. RESULTS The frequency at which NCCI indicators were met ranged from 37.5% for receiving an assessment and care plan to 97.3% for understanding explanations about diagnosis. Geographical considerations did not impact patient experience, whereas middle school educated participants were more likely than those with senior-level education or higher to receive an assessment and care plan (OR=1.90, 95% CI 1.23 to 2.91) and to report having their views on treatment taken into account (OR=2.22, 95% CI 1.49 to 3.33). Patients with breast or prostate cancer reported better communication and patient involvement and information and services provision (r=p<0.001) compared with those with skin and head and neck cancer. When compared with information and service provision, communication and patient involvement showed stronger positive associations with QoL (z=2.03, p=0.042), psychosocial (z=2.05, p=0.040) and patient care (z=2.00, p=0.046) outcomes. CONCLUSION The patient care experience varies across the NCCI indicators by sociodemographic and clinical factors that likely reflect healthcare system biases. Perceptions about communication and involvement appear most critical for optimal outcomes and should be a priority action area for cancer control.
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Affiliation(s)
- Jeff Dunn
- Cancer Council Queensland, Queensland, Brisbane, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Queensland, Australia
- Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Belinda Goodwin
- Cancer Council Queensland, Queensland, Brisbane, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Queensland, Brisbane, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Queensland, Australia
- School of Public Health, The University of Queensland, Springfield, Queensland, Australia
| | - Sonja March
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield, Queensland, Australia
| | - Fiona Crawford-Williams
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Michael Ireland
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield, Queensland, Australia
| | - Nicholas Ralph
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Arlen Rowe
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield, Queensland, Australia
| | - Suzanne K Chambers
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Queensland, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
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Fu R, Feng S, Wu Y, He F, Lin Z, Jiang Y, Hu Z. Association between compliance with quality indicators and hospitalisation expenses in patients with heart failure: a retrospective study using quantile regression model in China. BMJ Open 2020; 10:e033926. [PMID: 32709638 PMCID: PMC7380880 DOI: 10.1136/bmjopen-2019-033926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To explore the association between compliance with quality indicators and hospitalisation expenses in patients with heart failure. DESIGN Generalised linear model and quantile regression model were used to examine the association between compliance with five quality indicators and hospitalisation expenses. SETTING Grade A hospital in Fujian Province, China. PARTICIPANTS Data on 2568 heart failure admissions between 2010 and 2015 were analysed. RESULTS The median (IQR) of hospitalisation expenses of 2568 patients was ¥10.9 (¥6.9-¥31.6) thousand. The rates of compliance with five quality indicators were 90.3% for evaluation of left ventricular function, 43.8% for diuretics, 62.0% for ACE inhibitors (ACEI) or angiotensin receptor blockers (ARB), 67.4% for beta-blockers, and 58.9% for aldosterone receptor antagonists. After adjustment for gender, age, residence, method of payment, number of diseases before admission, number of diseases at admission, number of emergency treatments during hospital stay and length of stay, patients who received evaluation for left ventricular function, diuretics, or ACEI or ARB had lower hospitalisation expenses, and patients who received beta-blockers had higher hospitalisation expenses, compared with their counterparts in generalised linear models. Differences in hospitalisation expenses between compliance and non-compliance with quality indicators became larger across quantile levels of hospitalisation expenses, and were found to be statistically significant when quantile level exceeded 0.80 (¥39.7 thousand) in quantile regression models. CONCLUSIONS The quality of care for patients with heart failure was below the target level. There was a negative relationship between compliance with quality indicators and hospitalisation expenses at the extreme quantile of expenses. More attention should be given to patients who may experience extreme expenses, and effective measures should be taken to improve the quality of care they receive.
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Affiliation(s)
- Rong Fu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Shaodan Feng
- Emergency Department, Fujian Medical University Affiliated Fuzhou First Hospital, Fuzhou, Fujian, China
| | - Yilong Wu
- Emergency Department, Fujian Medical University Affiliated Fuzhou First Hospital, Fuzhou, Fujian, China
| | - Fei He
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Yixian Jiang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
- Fujian Digital Institute for Tumor Big Data, Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
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Hanson G, Lyons KW, Fournier DA, Lollis SS, Martin ED, Rhynhart KK, Handel WJ, McGuire KJ, Abdu WA, Pearson AM. Reducing Radiation and Lowering Costs With a Standardized Care Pathway for Nonoperative Thoracolumbar Fractures. Global Spine J 2019; 9:813-819. [PMID: 31819846 PMCID: PMC6882098 DOI: 10.1177/2192568219831687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE There is marked variation in the management of nonoperative thoracolumbar (TL) compression and burst fractures. This was a quality improvement study designed to establish a standardized care pathway for TL fractures treated with bracing, and to then evaluate differences in radiographs, length of stay (LOS), and cost before and after the pathway. METHODS A standardized pathway was established for management of nonoperative TL burst and compression fractures (AOSpine classification type A1-A4 fractures). Bracing, radiographs, costs, complications, and LOS before and after pathway adoption were analyzed. Differences between the neurosurgery and orthopedic spine services were compared. RESULTS Between 2012 and 2015, 406 nonoperative burst and compression TL fractures were identified. A total of 183 (45.1%) were braced, 60.6% with a custom-made thoracolumbosacral orthosis (TLSO) and 39.4% with an off-the-shelf TLSO. The number of radiographs significantly reduced after initiation of the pathway (3.23 vs 2.63, P = .010). A total of 98.6% of braces were custom-made before the pathway; 69.6% were off-the-shelf after the pathway. The total cost for braced patients after pathway adoption decreased from $10 462.36 to $8928.58 (P = .078). Brace-associated costs were significantly less for off-the-shelf TSLO versus custom TLSO ($1352.41 vs $3719.53, respectively, P < .001). The mean LOS and complication rate did not change significantly following pathway adoption. The orthopedic spine service braced less frequently than the neurosurgery service (40.7% vs 52.2%, P = .023). CONCLUSIONS Standardized care pathways can reduce cost and radiation exposure without increasing complication rates in nonoperative management of thoracolumbar compression and burst fractures.
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Affiliation(s)
- Gregory Hanson
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Keith W. Lyons
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA,Keith W. Lyons, Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03766, USA.
| | - Debra A. Fournier
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - S. Scott Lollis
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Eric D. Martin
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kurt K. Rhynhart
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Wanda J. Handel
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kevin J. McGuire
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - William A. Abdu
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Adam M. Pearson
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Factors analysis on the use of key quality indicators for narrowing the gap of quality of care of breast cancer. BMC Cancer 2019; 19:1099. [PMID: 31718596 PMCID: PMC6852954 DOI: 10.1186/s12885-019-6334-5] [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: 03/27/2019] [Accepted: 11/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are differences in the quality of care among breast cancer patients. Narrowing the quality differences could be achieved by increasing the utilization rate of indicators. Here we explored key indicators that can improve the quality of care and factors that may affect the use of these indicators. METHODS A total of 3669 breast cancer patients were included in our retrospective study. We calculated patient quality-of-care composite score based on patient average method. Patients were divided into high- and low-quality groups according to the mean score. We obtained the indicators with large difference in utilization between the two groups. Multilevel logistic regression model was used to analyze the factors influencing quality of care and use of indicators. RESULTS The mean composite score was 0.802, and the number of patients in the high- and low-quality groups were 1898 and 1771, respectively. Four indicators showed a difference in utilization between the two groups of over 40%. Histological grade, pathological stage, tumor size and insurance type were the factors affecting the quality of care. In single indicator evaluation, besides the above factors, age, patient income and number of comorbidities may also affect the use of these four indicators. Number of comorbidities may have opposite effects on the use of different indicators, as does pathological stage. CONCLUSIONS Identifying key indicators for enhancing the quality-of-care of breast cancer patients and factors that affect the indicator adherence may provide guides for enhancing the utilization rate of these indicators in clinical practice.
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Hartjes T, Gilliam J, Thompson A, Garvan C, Cowan L. Improving Cardiac Surgery Outcomes by Using an Interdisciplinary Clinical Pathway. AORN J 2019; 108:265-273. [PMID: 30156733 DOI: 10.1002/aorn.12335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A cardiothoracic intensive care unit (CTICU) team evaluated preoperative and postoperative processes to improve outcomes for cardiac surgery patients. The primary aim of this project was to streamline and improve care in the CTICU by implementing a new clinical pathway for patients undergoing coronary artery bypass graft or valve replacement procedures. We analyzed processes, communication, ventilator days, respiratory complications, patient mobility, presence of invasive catheters and lines, CTICU length of stay, and hospital-adjusted length of stay before and after we implemented the clinical pathway. This article outlines the methods we used to plan, implement, and assess the clinical pathway. Implementation of the clinical pathway successfully streamlined care, reduced variations in care, and improved health care quality and resource use.
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Implementation of day of surgery admission for rectal cancer surgery in Ireland following a national centralisation programme. Ir J Med Sci 2018; 188:765-769. [DOI: 10.1007/s11845-018-1904-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/19/2018] [Indexed: 01/12/2023]
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Wang X, Su S, Jiang H, Wang J, Li X, Liu M. Short- and long-term effects of clinical pathway on the quality of surgical non-small cell lung cancer care in China: an interrupted time series study. Int J Qual Health Care 2018; 30:276-282. [PMID: 29401300 DOI: 10.1093/intqhc/mzy004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/08/2018] [Indexed: 12/16/2022] Open
Abstract
Objective To examine the short- and long-term effect of clinical pathway for non-small cell lung cancer surgery on the length of stay, the compliance of quality indicators and risk-adjusted post-operative complication rate. Design A retrospective quasi-experimental study from June 2011 to October 2015. Setting A tertiary cancer hospital in China. Participants Patients diagnosed as non-small cell lung cancer who underwent curative resection. Intervention(s) Clinical pathway was implemented at January 2013. Hence, the study period was divided into three periods: pre-pathway, from June 2011 to December 2012; short-term period, from January 2013 to December 2013; long-term period, from January 2014 to October 2015. Main Outcome Measure(s) Three length of hospital stay indicators, four process performance indicators and one outcome indicator. Results ITS showed there was a significant decline of 2 days (P = 0.0421) for total length of stay and 2.23 days (P = 0.0199) for post-operative length of stay right after the implementation of clinical pathway. Short-term level changes were found in the compliance rate of required number of lymph node sampling (-8.08%, P = 0.0392), and risk-adjusted complication rate (9.02%, P = 0.0001). There were no statistically significant changes in other quality of care indicators. Conclusions The clinical pathway had a positive impact on the length of stay but showed a transient negative effect on complication rate and the quality of lymph node sampling.
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Affiliation(s)
- Xinyu Wang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Shaofei Su
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Hao Jiang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Jiaying Wang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Xi Li
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Meina Liu
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
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Bultijnck R, Van de Caveye I, Rammant E, Everaert S, Lumen N, Decaestecker K, Fonteyne V, Deforche B, Ost P. Clinical pathway improves implementation of evidence-based strategies for the management of androgen deprivation therapy-induced side effects in men with prostate cancer. BJU Int 2018; 121:610-618. [DOI: 10.1111/bju.14086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Renée Bultijnck
- Department of Radiation Oncology and Experimental Cancer Research; Ghent University; Ghent Belgium
| | | | - Elke Rammant
- Department of Radiation Oncology and Experimental Cancer Research; Ghent University; Ghent Belgium
| | - Sofie Everaert
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Nicolaas Lumen
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | | | - Valérie Fonteyne
- Department of Radiation Oncology and Experimental Cancer Research; Ghent University; Ghent Belgium
| | - Benedicte Deforche
- Department of Public Health; Ghent University; Ghent Belgium
- Department of Physical Activity, Nutrition and Health; Vrije Universiteit Brussel; Brussels Belgium
| | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research; Ghent University; Ghent Belgium
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15
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Rotenstein LS, Kerman AO, Killoran J, Balboni TA, Krishnan MS, Taylor A, Martin NE. Impact of a clinical pathway tool on appropriate palliative radiation therapy for bone metastases. Pract Radiat Oncol 2017; 8:266-274. [PMID: 29429920 DOI: 10.1016/j.prro.2017.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE Clinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a pathway tool on SFRT rates in an academic radiation oncology practice. METHODS AND MATERIALS Using published literature, clinical guidelines, and expert input, we designed a clinical pathway for bone metastases radiation therapy displayed on a Web-based electronic interface. In March 2016, the pathway launched on a palliative radiation service at the Dana Farber/Brigham and Women's Cancer Center main campus and at affiliated community sites. Providers were surveyed pre- and postimplementation to assess expectations and elicit feedback. Rates of pathway utilization, compliance with SFRT recommendations, and reasons for noncompliance were assessed. RESULTS The final pathway includes 20 endpoints and several validated prognostic scoring systems. It was used in 38% of 723 bone metastases radiation prescriptions, with appropriate SFRT rates rising from 18% before implementation to 48% after launch (P < .01). Major reasons for rejecting recommendations included disagreement with life expectancy prognostication and patient convenience. The pathway increased physicians' confidence regarding compliance with treatment guidelines and made it easier to find well-supported treatment recommendations. Workflow disruptions and the inability to handle nuanced situations emerged as limitations. CONCLUSIONS Our experience demonstrates the utility of clinical pathway decision support for bone metastases radiation in complex academic settings. Next steps include increasing the pathway's ease of use, refining the pathway's prognostic abilities, and measuring cost savings related to the pathway.
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Affiliation(s)
- Lisa S Rotenstein
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alexander O Kerman
- University of Chicago Pritzker School of Medicine, Chicago, Illinois; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joseph Killoran
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tracy A Balboni
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Monica S Krishnan
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison Taylor
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neil E Martin
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
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Abstract
Introduction There has been a growing emphasis on the use of integrated care plans to deliver cancer care. However little is known about how integrated care plans for cancer patients are developed including featured core activities, facilitators for uptake and indicators for assessing impact. Methods Given limited consensus around what constitutes an integrated care plan for cancer patients, a scoping review was conducted to explore the components of integrated care plans and contextual factors that influence design and uptake. Results Five types of integrated care plans based on the stage of cancer care: surgical, systemic, survivorship, palliative and comprehensive (involving a transition between stages) are described in current literature. Breast, esophageal and colorectal cancers were common disease sites. Multi-disciplinary teams, patient needs assessment and transitional planning emerged as key features. Provider buy-in and training alongside informational technology support served as important facilitators for plan uptake. Provider-level measurement was considerably less robust compared to patient and system-level indicators. Conclusions Similarities in design features, components and facilitators across the various types of integrated care plans indicates opportunities to leverage shared features and enable a management lens that spans the trajectory of a patient's journey rather than a phase-specific silo approach to care.
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Su S, Bao H, Wang X, Wang Z, Li X, Zhang M, Wang J, Jiang H, Wang W, Qu S, Liu M. The quality of invasive breast cancer care for low reimbursement rate patients: A retrospective study. PLoS One 2017; 12:e0184866. [PMID: 28910357 PMCID: PMC5599036 DOI: 10.1371/journal.pone.0184866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/03/2017] [Indexed: 01/02/2023] Open
Abstract
Though evidence-based treatments have been recommended for breast cancer, underuse of the treatments was still observed. To certain extent, patients' access to care, which can be enhanced by increasing the coverage of health insurance, could account for the current underuse in recommended care. This study aimed to examine the association between different proportions of reimbursement and quality of recommended breast cancer care, as well as length of hospital stay. In this retrospective study, 3669 patients diagnosed with invasive breast cancer between 1 June, 2011 and 30 June, 2013 were recruited. Seven quality indicators from preoperative diagnosis procedures to adjuvant therapy and one composite indicator were selected as dependent variables. Logistic regression and generalized linear models were used to explore the association between quality of care and length of hospital stay with different reimbursement rates. Compared with UEBMI (urban employment basic medical insurance), which represented high level reimbursement rate, patients with lower rates of reimbursement were less likely to receive core biopsy, HER-2 (human epidermal growth factor receptor-2) testing, BCS (breast conserving surgery), SLNB (sentinel lymph nodes biopsy), adjuvant therapy and hormonal treatment. No significant difference in preoperative length of hospital stay was observed among the three insurance schemes, however URBMI (urban resident basic medical insurance) insured patients stayed longer for total length of hospital stay. Significant disparities in utilization of evidence-based breast cancer care among patients with different proportions of reimbursement were observed. Patients with lower rate of reimbursement were less likely to receive recommended care. Our findings could provide important support for further healthcare reform and quality improvement in breast cancer care.
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Affiliation(s)
- Shaofei Su
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Han Bao
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Xinyu Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Zhiqiang Wang
- School of Medicine, University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Xi Li
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Meiqi Zhang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Jiaying Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Hao Jiang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Wenji Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Siyang Qu
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Meina Liu
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
- * E-mail:
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Vijayakumar C, Maroju NK, Srinivasan K, Reddy KS. Clinical audit system as a quality improvement tool in the management of breast cancer. Int J Surg 2016; 35:44-50. [PMID: 27633449 DOI: 10.1016/j.ijsu.2016.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/14/2016] [Accepted: 09/11/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Quality improvement is recognized as a major factor that can transform healthcare management. This study is a clinical audit that aims at analysing treatment time as a quality indicator and explores the role of setting a target treatment time on reducing treatment delays. MATERIALS AND METHODS All newly diagnosed patients with breast cancer between September 2011 and August 2013 were included in the study. Clinical care pathway for breast cancer patients was standardized and the timeliness of care at each step of the pathway was calculated. Data collection was spread over three phases, baseline, audit cycle I, and audit cycle II. Each cycle was preceded by a quality improvement intervention, and followed by analysis. RESULTS A total of 334 patients with breast cancer were included in the audit. The overall time from first visit to initiation of treatment was 66.3 days during the baseline period. This improved to 40.4 and 28.5 days at the end of Audit cycle I and II, respectively. The idealized target time of 28 days for initiating treatment was achieved in 5, 23.5, and 65.2% of patients in the baseline period, Audit cycle I, and Audit Cycle II, respectively. There was improvement noted across all steps of the clinical care pathway. CONCLUSION This study confirms that audit is a powerful tool in quality improvement programs and helps achieve timely care. Gains achieved through an audit process may not be sustainable unless underlying patient factors and resource deficits are addressed.
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Affiliation(s)
- Chellappa Vijayakumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Nanda Kishore Maroju
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
| | - Krishnamachari Srinivasan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - K Satyanarayana Reddy
- Department of Radiotherapy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
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