Pros and Cons of Clinical Pathway Software Management: A Qualitative Study

In this study we aimed to assess the perceived effectiveness of clinical pathway management software for healthcare professionals. A case study on the clinical pathway management software program Check-It was performed in three departments at an academic medical center. Four months after the implementation of the software, interviews were held with healthcare professionals who work with the system. The interview questions were posed in a semi-structured interview format and the participant were asked about the perceived positive or negative effects of Check-It, and whether they thought the software is effective for them. The interviews were recorded and transcribed based on grounded theory, using different coding techniques. Our results showed fewer overlooked tasks, pre-filled orders and letters, better overview, and increased protocol insight as positive aspects of using the software. Being not flexible enough was experienced as a negative aspect.

Completeness of medical records in emergency trauma care and an IT-based strategy for improvement

The medical trauma record, produced in the Accident & Emergency Departments (AEDs) receives much attention from both health-care professionals and parties interested in quality of care. While it is an important data source for health-care professionals in their everyday work, and for quality assessment by third parties, the (paper) medical record is usually negatively evaluated because of incompleteness. In this article, we show that completeness is relative to the purpose for which the record is used. We distinguish two contexts in which the trauma record is used: the primary-care process at the AED, and assessment and monitoring of trauma care. Incompleteness of the medical record is valued differently in these contexts. Especially with regard to the information demands of quality assessment, and more specifically the national trauma registry, the work processes in the AED have not evolved sufficiently as yet. Information technology has great power to improve completeness and to facilitate quality assessment, but it cannot solve the problem of incompleteness in itself. One solution we propose is to restructure the recording process by introducing a clerk. This clerk could also be a nurse or physician who is temporarily released from direct patient care.

Physical activity and its association with cardiovascular risk factors and mortality

We compared various indices for physical activity and their association with cardiovascular risk factors as well as total and cardiovascular disease mortality. We used data from three independent national representative samples in Germany, with a total of 7,689 men and 7,747 women age 25-69 years. Persons with high conditioning physical activity had more favorable risk factor levels compared with sedentary persons, after adjustment for age, body mass index, smoking, survey period, and socioeconomic status. We observed a clear association with mortality only for intense physical activity. The rate ratio (RR) for total mortality was 0.36 [95% confidence interval (CI) = 0.16-0.79] and 0.26 (95% CI = 0.08-0.83) for cardiovascular disease mortality for men spending more than 2 hours per week on sports, compared with sedentary men. Among women, the corresponding RR for total mortality was 0.28 (95% CI = 0.07-1.17). The effect of physical activity on cardiovascular disease mortality among women was not clear owing to few fatal cardiovascular events.