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Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia. Antibiotics (Basel) 2022; 11:antibiotics11030399. [PMID: 35326862 PMCID: PMC8944506 DOI: 10.3390/antibiotics11030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023] Open
Abstract
Clinical pathways can improve the quality of health services. The effectiveness and impact of implementing clinical pathways are controversial. The preparation of clinical pathways not only enacts therapeutic guidelines but requires mutual agreement in accordance with the roles, duties, and contributions of each profession in the team. This study aimed to investigate the perception of interprofessional collaboration practices and the impact of clinical pathway implementation on collaborative and Defined Daily Dose (DDD) prophylactic antibiotics per 100 bed-days in orthopedic surgery. The Collaborative Practice Assessment Tool (CPAT) questionnaire was used as a tool to measure healthcare’ perceptions of collaborative practice. The clinical pathway (CP) in this study was adapted from existing CPs published by the Indonesian Orthopaedic Association (Perhimpunan Dokter Spesialis Orthopaedi dan Traumatologi Indonesia, PABOI) and was commended by local domestic surgeons and orthopedic bodies. We then compared post-implementation results with pre-implementation clinical pathway data using ANCOVA to explore our categorical data and its influence towards CPAT response. ANOVA was then employed for aggregated DDD per 100 bed-days to compare pre and post intervention. The results showed that the relationships among members were associated with the working length. Six to ten years of working had a significantly better relationship among members than those who have worked one to five years. Interestingly, pharmacists’ leadership score was significantly lower than other professions. The clinical pathway implementation reduced barriers in team collaboration, improved team coordination and organization, and reduced third-generation cephalosporin use for prophylaxis in surgery (pre: 59 DDD per 100 bed-days; post: 28 DDD per 100 bed-days). This shows that the clinical pathway could benefit antibiotic stewardship in improving antibiotic prescription, therefore reducing the incidence of resistant bacteria.
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Lichtner V, Baysari M. Electronic display of a patient treatment over time: a perspective on clinicians' burn-out. BMJ Health Care Inform 2021; 28:bmjhci-2020-100281. [PMID: 33853861 PMCID: PMC8054091 DOI: 10.1136/bmjhci-2020-100281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Valentina Lichtner
- UCL School of Pharmacy, University College London, London, UK
- Leeds University Business School, University of Leeds, Leeds, UK
| | - Melissa Baysari
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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Lario R, Hasley S, White SA, Eilbeck K, Soley R, Huff S, Kawamoto K. Utilization of BPM+ Health for the Representation of Clinical Knowledge: A Framework for the Expression and Assessment of Clinical Practice Guidelines (CPG) Utilizing Existing and Emerging Object Management Group (OMG) Standards. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:687-696. [PMID: 33936443 PMCID: PMC8075494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Clinical Practice Guidelines (CPG), meant to express best practices in healthcare, are commonly presented as narrative documents communicating care processes, decision making, and clinical case knowledge. However, these narratives in and of themselves lack the specificity and conciseness in their use of language to unambiguously express quality clinical recommendations. This impacts the confidence of clinicians, uptake, and implementation of the guidance. As important as the quality of the clinical knowledge articulated, is the quality of the language(s) and methods used to express the recommendations. In this paper, we propose the BPM+ family of modeling languages as a potential solution to this challenge. We present a formalized process and framework for translating CPGs into a standardized BPM+ model. Further, we discuss the features and characteristics of modeling languages that underpin the quality in expressing clinical recommendations. Using an existing CPG, we defined a systematic series of steps to deconstruct the CPG into knowledge constituents, assign CPG knowledge constituents to BPM+ elements, and re-assemble the parts into a clear, precise, and executable model. Limitations of both the CPG and the current BPM+ languages are discussed.
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Affiliation(s)
- Robert Lario
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
- Department of Veterans Affairs Knowledge Based Systems, Salt Lake City, UT
| | - Steve Hasley
- Department of OB/GYN/RS, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Karen Eilbeck
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | | | - Stan Huff
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
- Intermountain Health, Salt Lake City, UT
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
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Numico G, Viale M, Bellini R, Ippoliti R, Rossi M, Maan T, Carobene A, Pizzini A, Mistrangelo M, Bertetto O. Toward uniform and controlled clinical pathways in cancer care: a qualitative description. Int J Qual Health Care 2020; 31:781-786. [PMID: 30809643 DOI: 10.1093/intqhc/mzz015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/05/2019] [Accepted: 02/05/2019] [Indexed: 11/13/2022] Open
Abstract
QUALITY ISSUE The definition of clinical pathways (CPs) and their application are heterogeneous. Each center is used to choose whether to adopt this instrument or not and to variably conceive its features We consider CPs as the necessary description of the cancer patient journey and we emphasize their role as the user view of clinical processes rather than a local translation of guidelines. CHOICE OF SOLUTION We proposed a unique CPs model for all the centers of our regional network, with the aim of making CPs accountable and comparable. We also established a central quality evaluation. IMPLEMENTATION Through a multi-step process, the model was proposed to the 22 Regional centers. Landmark characteristics of the project were: the involvement of hospital administrations; reference to a unique set of guidelines; a peer-review and open evaluation. EVALUATION Of the 374 expected CPs, 253 (68%) were received and evaluated. A median number of 131 items were the object of evaluation in each hub center and 77 in each spoke center. About 79.5% items were considered well described, 15.5% were absent and 5.0% partially described. The median percentage of fulfilled indicators was 85.6% in hub CPs and 82.2% in spoke CPs. Although, not all diseases were equally covered through the territory a high degree of homogeneity and a good quality of compilation were achieved. LESSONS LEARNED The project was shown to be feasible and achieved its goal. We suggest this process as a functional way for building uniform cancer CPs.
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Affiliation(s)
- Gianmauro Numico
- Medical Oncology. SS Antonio e Biagio e C Arrigo Hospital; Via Venezia 16, Alessandria, Italy
| | - Monica Viale
- Rete Oncologica del Piemonte e della Valle d'Aosta, Città della Salute e della Scienza, Torino, Italy
| | - Roberta Bellini
- Quality and Management Control Unit, SS Antonio e Biagio e C Arrigo Hospital, Via Venezia 16, Alessandria, Italy
| | - Roberto Ippoliti
- Department of Business, Administration and Economics, University of Bielefeld, Bielefeld, Deutschland, Germany
| | - Maura Rossi
- Medical Oncology. SS Antonio e Biagio e C Arrigo Hospital; Via Venezia 16, Alessandria, Italy
| | - Tatiana Maan
- Quality and Management Control Unit, SS Antonio e Biagio e C Arrigo Hospital, Via Venezia 16, Alessandria, Italy
| | - Angelica Carobene
- Rete Oncologica del Piemonte e della Valle d'Aosta, Città della Salute e della Scienza, Torino, Italy
| | | | - Marinella Mistrangelo
- Rete Oncologica del Piemonte e della Valle d'Aosta, Città della Salute e della Scienza, Torino, Italy
| | - Oscar Bertetto
- Rete Oncologica del Piemonte e della Valle d'Aosta, Città della Salute e della Scienza, Torino, Italy
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Austrian JS, Volpicelli F, Jones S, Bernstein MA, Padikkala J, Bagheri A, Blecker S. The Financial and Clinical Impact of an Electronic Health Record Integrated Pathway in Elective Colon Surgery. Appl Clin Inform 2020; 11:95-103. [PMID: 32023638 DOI: 10.1055/s-0039-1701004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Enhanced Recovery after Surgery (ERAS) pathways have been shown to reduce length of stay, but there have been limited evaluations of novel electronic health record (EHR)-based pathways. Compliance with ERAS in real-world settings has been problematic. OBJECTIVE This article evaluates a novel ERAS electronic pathway (E-Pathway) activity integrated with the EHR for patients undergoing elective colorectal surgery. METHODS We performed a retrospective cohort study of surgical patients age ≥ 18 years hospitalized from March 1, 2013 to August 31, 2016. The primary cohort consisted of patients admitted for elective colon surgery. We also studied a control group of patients undergoing other elective procedures. The E-Pathway was implemented on March 2, 2015. The primary outcome was variable costs per case. Secondary outcomes were observed to expected length of stay and 30-day readmissions. RESULTS We included 823 (470 and 353 in the pre- and postintervention, respectively) colon surgery patients and 3,415 (1,819 and 1,596 in the pre- and postintervention) surgical control patients in the study. Among the colon surgery cohort, there was statistically significant (p = 0.040) decrease in costs of 1.28% (95% confidence interval [CI] 0.06-2.48%) per surgical encounter per month over the 18-month postintervention period, amounting to a total savings of $2,730 per patient at the 1-year postintervention period. The surgical control group had a nonsignificant (p = 0.231) decrease in monthly costs of 0.57% (95% CI 1.51 to - 0.37%) postintervention. For the 30-day readmission rates, there were no statistically significant changes in either cohort. CONCLUSION Our study is the first to report on the reduced costs after implementation of a novel sophisticated E-Pathway for ERAS. E-Pathways can be a powerful vehicle to support ERAS adoption.
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Affiliation(s)
- Jonathan S Austrian
- Department of Medicine, New York University School of Medicine, New York, New York, United States.,Medical Center Information Technology, NYU Langone Health, New York, New York, United States
| | - Frank Volpicelli
- Department of Medicine, New York University School of Medicine, New York, New York, United States
| | - Simon Jones
- Department of Population Health, New York University School of Medicine, New York, New York, United States
| | - Mitchell A Bernstein
- Department of Surgery, New York University School of Medicine, New York, New York, United States
| | - Jane Padikkala
- Department of Population Health, New York University School of Medicine, New York, New York, United States
| | - Ashley Bagheri
- Department of Population Health, New York University School of Medicine, New York, New York, United States
| | - Saul Blecker
- Department of Medicine, New York University School of Medicine, New York, New York, United States.,Department of Population Health, New York University School of Medicine, New York, New York, United States
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Sooter LJ, Hasley S, Lario R, Rubin KS, Hasić F. Modeling a Clinical Pathway for Contraception. Appl Clin Inform 2019; 10:935-943. [PMID: 31860113 PMCID: PMC6924335 DOI: 10.1055/s-0039-3400749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) produced a 72-page document titled "U.S. Selective Practice Recommendations for Contraceptive Use" in 2016. This document contains the medical eligibility criteria (MEC) for contraceptive initiation or continuation based on a patient's current health status. Notations such as Business Process Model and Notation (BPMN) and Decision Model and Notation (DMN) might be useful to model such recommendations. OBJECTIVE Our objective was to use BPMN and DMN to model and standardize the processes and decisions involved in initiating birth control according to the CDC's MEC for birth control initiation. This model could then be incorporated into an electronic health records system or other digital platform. METHODS Medical terminology, processes, and decisions were modeled in coordination with the CDC to ensure correctness. Challenges in terminology bindings were identified and categorized. RESULTS A model was successfully produced. Integration of clearly defined data elements proved to be the biggest challenge. CONCLUSION BPMN and DMN have strengths and weaknesses when modeling medical processes; however, they can be used to successfully create models for clinical pathways.
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Affiliation(s)
- Letha J. Sooter
- Department of Informatics and Networked Systems, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Steve Hasley
- American College of Obstetricians and Gynecologists, Washington, District of Columbia, United States
| | - Robert Lario
- Veterans Health Administration and University of Utah, Salt Lake City, Utah, United States
| | - Kenneth S. Rubin
- Veterans Health Administration and University of Utah, Salt Lake City, Utah, United States
| | - Faruk Hasić
- Research Centre for Information Systems Engineering, KU Leuven, Leuven, Belgium
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Zhang W, Wang BY, Du XY, Fang WW, Wu H, Wang L, Zhuge YZ, Zou XP. Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones. World J Gastroenterol 2019; 25:1002-1011. [PMID: 30833805 PMCID: PMC6397721 DOI: 10.3748/wjg.v25.i8.1002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A clinical pathway (CP) is a standardized approach for disease management. However, big data-based evidence is rarely involved in CP for related common bile duct (CBD) stones, let alone outcome comparisons before and after CP implementation. AIM To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017. The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care (non-pathway group, n = 467) and CP care (pathway group, n = 2196). RESULTS At baseline, the main differences observed between the two groups were the percentage of patients with multiple stones (P < 0.001) and incidence of cholangitis complication (P < 0.05). The percentage of antibiotic use and complications in the CP group were significantly less than those in the non-pathway group [adjusted odds ratio (OR) = 0.72, 95% confidence interval (CI): 0.55-0.93, P = 0.012, adjusted OR = 0.44, 95%CI: 0.33-0.59, P < 0.001, respectively]. Patients spent lower costs on hospitalization, operation, nursing, medication, and medical consumable materials (P < 0.001 for all), and even experienced shorter length of hospital stay (LOHS) (P < 0.001) after the CP implementation. No significant differences in clinical outcomes, readmission rate, or secondary surgery rate were presented between the patients in the non-pathway and CP groups. CONCLUSION Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS, hospital costs, antibiotic use, and complication rate.
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Affiliation(s)
- Wei Zhang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Bing-Yi Wang
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Xiao-Yan Du
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Wei-Wei Fang
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Han Wu
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Lei Wang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Yu-Zheng Zhuge
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Xiao-Ping Zou
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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Kwon H, Lee JH, Woo J, Lim W, Moon BI, Paik NS. Efficacy of a clinical pathway for patients with thyroid cancer. Head Neck 2018; 40:1909-1916. [PMID: 29637689 DOI: 10.1002/hed.25175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/06/2017] [Accepted: 02/15/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Clinical pathways have been proposed as a way to improve organizational efficiency and maximize patient outcomes. However, little is known as to whether a clinical pathway is effective for thyroid cancer. METHODS The study subjects included 216 patients who were managed after clinical pathway implementation and 145 control patients. Length of stay, cost per patient, and nurses' satisfaction were compared in the 2 groups. RESULTS Mean length of stay was 0.8 days shorter in the clinical pathway group than in the control group (2.9 vs 3.7 days; P = .023). Cost per patient was also lower in the clinical pathway than in the control group (USD $3953.00 vs USD $4636.00; P < .001). Nurses' overall satisfaction scores improved from 71.6% before to 82.5% after implementation of the clinical pathway and their job characteristics scores increased from 61.1% to 75.0%. CONCLUSION Implementation of a clinical pathway for thyroid cancer can improve nurses' satisfaction with reduction of hospital stay and costs.
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Affiliation(s)
- Hyungju Kwon
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Joon-Hyop Lee
- Thyroid and Endocrine Surgery Section, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Joohyun Woo
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Woosung Lim
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung-In Moon
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Nam Sun Paik
- Breast and Thyroid Cancer Center, Ewha Womans University College of Medicine, Seoul, Korea.,Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
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Huang Z, Dong W, Ji L, He C, Duan H. Incorporating comorbidities into latent treatment pattern mining for clinical pathways. J Biomed Inform 2016; 59:227-39. [DOI: 10.1016/j.jbi.2015.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/29/2015] [Accepted: 12/15/2015] [Indexed: 12/26/2022]
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