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Jarman H, Crouch R, Halter M, Peck G, Cole E. Provision of acute care pathways for older major trauma patients in the UK. BMC Geriatr 2022; 22:915. [PMID: 36447158 PMCID: PMC9706856 DOI: 10.1186/s12877-022-03615-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The introduction of specific pathways of care for older trauma patients has been shown to decrease hospital length of stay and the overall rate of complications. The extent and scope of pathways and services for older major trauma patients in the UK is not currently known. OBJECTIVE The primary objective of this study was to map the current care pathways and provision of services for older people following major trauma in the UK. METHODS A cross-sectional survey of UK hospitals delivering care to major trauma patients (major trauma centres and trauma units). Data were collected on respondent and site characteristics, and local definitions of older trauma patients. To explore pathways for older people with major trauma, four clinical case examples were devised and respondents asked to complete responses that best illustrated the admission pathway for each. RESULTS Responses from 56 hospitals were included in the analysis, including from 25 (84%) of all major trauma centres (MTCs) in the UK. The majority of respondents defined 'old' by chronological age, most commonly patients 65 years and over. The specialty team with overall responsibility for the patient in trauma units was most likely to be acute medicine or acute surgery. Patients in MTCs were not always admitted under the care of the major trauma service. Assessment by a geriatrician within 72 hours of admission varied in both major trauma centres and trauma units and was associated with increased age. CONCLUSIONS This survey highlights variability in the admitting specialty team and subsequent management of older major trauma patients across hospitals in the UK. Variability appears to be related to patient condition as well as provision of local resources. Whilst lack of standardisation may be a result of local service configuration this has the potential to impact negatively on quality of care, multi-disciplinary working, and outcomes.
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Affiliation(s)
- Heather Jarman
- grid.451349.eEmergency Department Clinical Research Group, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Robert Crouch
- grid.430506.40000 0004 0465 4079Emergency Department, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD UK
| | - Mary Halter
- grid.451349.eEmergency Department Clinical Research Group, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - George Peck
- grid.426467.50000 0001 2108 8951Imperial College Healthcare NHS Trust, St Mary’s Hospital, Praed Street, London, W2 1NY UK
| | - Elaine Cole
- grid.4868.20000 0001 2171 1133Queen Mary University of London, 4 Newark Street, London, E1 2EA UK
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Daniels L, Barker S, Chang YS, Chikovani T, DunnGalvin A, Gerdts JD, Gerth Van Wijk R, Gibbs T, Villarreal-Gonzalez RV, Guzman-Avilan RI, Hanna H, Hossny E, Kolotilina A, Ortega Martell JA, Pacharn P, de Lira Quezada CE, Sibanda E, Stukus D, Tham EH, Venter C, Gonzalez-Diaz SN, Levin ME, Martin B, Munblit D, Warner JO. Harmonizing allergy care-integrated care pathways and multidisciplinary approaches. World Allergy Organ J 2021; 14:100584. [PMID: 34820045 PMCID: PMC8591185 DOI: 10.1016/j.waojou.2021.100584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/08/2021] [Accepted: 08/26/2021] [Indexed: 01/14/2023] Open
Abstract
There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the "second translational gap". A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care. We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidelines provide the core knowledge, the key component of implementation involves education, training, and support of all healthcare professionals (HCPs), patients and their caregivers. The pathways should define the level of competence required for each clinical task. It may be useful to leave the setting of care delivery or the specific HCP involved undefined to account for variable patterns of health service delivery as well as local socioeconomic, ethnic, environmental, and political imperatives. In all cases, where competence is exceeded, it is necessary to refer to the next stage in the pathway. The success and sustainability of ICPs would ideally be judged by patient experience, health outcomes, and health economics. We provide examples of successful programs, most notably from Finland, but recommend that further research is required in diverse settings to optimize outcomes worldwide.
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Affiliation(s)
- Lydia Daniels
- Faculty of Medicine, Imperial College London, London, UK
| | - Sally Barker
- Faculty of Medicine, Imperial College London, London, UK
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Tinatin Chikovani
- Department of Immunology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Roy Gerth Van Wijk
- Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Trevor Gibbs
- Association for Medical Education in Europe (AMEE), Dundee, Scotland, UK
- Independant Consultant in Primary Care and Medical Education, UK
| | - Rosalaura V. Villarreal-Gonzalez
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Rosa I. Guzman-Avilan
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | | | - Elham Hossny
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Anastasia Kolotilina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Punchama Pacharn
- Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Cindy E. de Lira Quezada
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Elopy Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, Twin Palms Medical Centre, Harare, Zimbabwe
- Department of Pathology, Medical School, National University of Science and Technology, Bulawayo, Zimbabwe
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carina Venter
- Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Colorado, USA
| | - Sandra N. Gonzalez-Diaz
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Michael E. Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Bryan Martin
- Division of Allergy and Immunology, Department of Otolaryngology, The Ohio State University, Columbus, OH, USA
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - John O. Warner
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- Corresponding author. Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, SW3 6LY, UK.
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Mériade L, Rochette C. Integrated care pathway for breast cancer: A relational and geographical approach. Soc Sci Med 2020; 270:113658. [PMID: 33421916 DOI: 10.1016/j.socscimed.2020.113658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
This paper examines how to apply a spatial approach (relational and geographical) to care pathways for their better integration within their territories. Based on the case study of a senology department of a French Cancer Diagnosis, Treatment and Research Centre, we apply a mixed research methodology using qualitative data (synthesis documents, meeting minutes, in-depth interviews) and quantitative data relating to the mobility and geographical location of a cohort of 1798 patients treated in this centre. Our results show the inseparable nature of the relational dimension and the geographical approach to move towards greater integration of breast cancer care pathways. This inseparability is constructed from the proposal of a method for mapping the integrated care pathways in their territories. This method, applied to our case study, allows us to identify four main categories of pathways for the cohort of patients studied.
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Affiliation(s)
- Laurent Mériade
- CleRMa - Research Chair "Health and Territories" - IAE School of Management - Clermont Auvergne University, 11, boulevard Charles de Gaulle, 63000, Clermont-Ferrand, France.
| | - Corinne Rochette
- CleRMa - Research Chair "Health and Territories" - IAE School of Management - Clermont Auvergne University, 11, boulevard Charles de Gaulle, 63000, Clermont-Ferrand, France.
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van Hoeve JC, Vernooij RWM, Fiander M, Nieboer P, Siesling S, Rotter T. Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis. Syst Rev 2020; 9:246. [PMID: 33100227 PMCID: PMC7586678 DOI: 10.1186/s13643-020-01498-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify and synthesize existing literature on the effects of pathways in oncological care. METHODS All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy "care pathways" are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals, and system level were extracted from each study. RESULTS Out of 13,847 search results, we selected 158 articles eligible for full text assessment. One hundred fifty studies were excluded and the remaining eight studies represented 4786 patients. Most studies were conducted in secondary/tertiary care. Length of stay (LOS) was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (weighted mean difference (WMD)): - 2.75, CI: - 4.67 to - 0.83) and gynecological cancer (WMD: - 1.58, CI: - 2.10 to - 1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. CONCLUSIONS Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favor of cancer care pathways. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017057592.
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Affiliation(s)
- Jolanda C van Hoeve
- Department Health Technology & Services Research, University of Twente, Enschede, the Netherlands. .,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michelle Fiander
- College of Pharmacy, Department of Pharmacology, University of Utah, Salt Lake City, USA
| | | | - Sabine Siesling
- Department Health Technology & Services Research, University of Twente, Enschede, the Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Thomas Rotter
- School of Nursing, Queen's University, Kingston, Canada
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Seys D, Deneckere S, Lodewijckx C, Bruyneel L, Sermeus W, Boto P, Panella M, Vanhaecht K. Impact of care pathway implementation on interprofessional teamwork: An international cluster randomized controlled trial. J Interprof Care 2019:1-9. [PMID: 31390223 DOI: 10.1080/13561820.2019.1634016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/28/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
This study evaluates whether the implementation of an in-hospital care pathway (CP) improves interprofessional teamwork across countries and tests whether improved communications ("relational coordination") is the mechanism of action. A hospital-based cluster randomized controlled trial in Ireland, Belgium, Italy, and Portugal was performed. Fifty-six interprofessional teams caring for patients admitted with an exacerbation of chronic obstructive pulmonary disease or for patients with a proximal femur fracture were included and randomly assigned to an intervention group (31 teams and 567 team members), where a CP was implemented, and a control group (25 teams and 417 team members) representing usual care. Multilevel regression and mediation analysis were applied. First, although no significant effect was found on our primary outcome relational coordination, our CP significantly improved several team inputs, team processes (team climate for innovation) and team output (the level of organized care, level of competence) indicators. Second, our team process indicator of team climate for innovation partially mediated the association between CP implementation and team output indicator of better level of organized care. In conclusion, a CP sets in motion various mechanisms that improve some but not all aspects of interprofessional teamwork. Relational coordination does not appear to be the mechanism by which team outputs are enhanced.
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Affiliation(s)
- Deborah Seys
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Svin Deneckere
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Cathy Lodewijckx
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Luk Bruyneel
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
- b Department of Quality Management, University Hospitals Leuven , Leuven , Belgium
| | - Walter Sermeus
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
| | - Paulo Boto
- c Department of Health Services Policy and Management, Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL) , Lisbon , Portugal
| | - Massimiliano Panella
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
- d Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont , Vercilli , Italy
| | - Kris Vanhaecht
- a Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven , Leuven , Belgium
- b Department of Quality Management, University Hospitals Leuven , Leuven , Belgium
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Seys D, Panella M, VanZelm R, Sermeus W, Aeyels D, Bruyneel L, Coeckelberghs E, Vanhaecht K. Care pathways are complex interventions in complex systems: New European Pathway Association framework. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519839195] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Care pathway implementation is characterised by a dual complexity. A care pathway itself represents a complex intervention with multiple interacting and interdependent intervention components and outcomes. The organisations in which care pathways are being implemented represent complex systems that need to be directed at change through an in-depth understanding of their external and internal context in which they are functioning in. This study sets out a new evidence-based and pragmatic framework that unpacks how intervention mechanisms, intervention fidelity and care context are converge and represent interacting processes that determine success or failure of the care pathway. We recommend researchers looking to increase the effectiveness of care pathway implementation and accelerate improvement of desired outcomes to adopt this framework from inception to implementation of the intervention.
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Affiliation(s)
- D Seys
- KU Leuven – University of Leuven, Belgium
| | - M Panella
- KU Leuven – University of Leuven, Belgium
- University of Eastern Piedmont ‘A. Avogadro’, Italy
| | - R VanZelm
- KU Leuven – University of Leuven, Belgium
| | - W Sermeus
- KU Leuven – University of Leuven, Belgium
| | - D Aeyels
- Universitair Ziekenhuis Brussel, Belgium
| | - L Bruyneel
- KU Leuven – University of Leuven, Belgium
- University Hospitals Leuven, Belgium
| | | | - K Vanhaecht
- KU Leuven – University of Leuven, Belgium
- University Hospitals Leuven, Belgium
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Vassbotn AD, Sjøvik H, Tjerbo T, Frich J, Spehar I. General practitioners' perspectives on care coordination in primary health care: A qualitative study. INTERNATIONAL JOURNAL OF CARE COORDINATION 2018; 21:153-159. [PMID: 30595842 PMCID: PMC6297895 DOI: 10.1177/2053434518816792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction To explore Norwegian general practitioners' experiences with care coordination in primary health care. Methods Qualitative study using data from five focus groups with 32 general practitioners in Norway. We analysed the data using systematic text condensation, a descriptive and explorative method for thematic cross-case analysis of qualitative data. Results The general practitioners had different notions of care pathways. They expressed a wish and an obligation to be involved in planning and coordination of primary health-care services, but they experienced organisational and financial barriers that limited their involvement and contribution. General practitioners reported lack of information about and few opportunities for involvement in formal coordination initiatives, and they missed informal arenas for dialogue with other primary health-care professionals. They argued that the general practitioner's role as coordinator should be recognised by other parties and that they needed financial compensation for contributions and attendance in meetings with the municipality. Discussion General practitioners need informal arenas for dialogue with other primary health-care professionals and access to relevant information to promote coordinated care. There might be an untapped potential for improving patient care involving general practitioners more in planning and coordinating services at the system level. Financial compensation of general practitioners contribution may promote increased involvement by general practitioners.
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Identifying and classifying indicators affected by performing clinical pathways in hospitals: a scoping review. INT J EVID-BASED HEA 2018; 16:3-24. [PMID: 29176429 DOI: 10.1097/xeb.0000000000000126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM To analyse the evidence regarding indicators affected by clinical pathways (CPW) in hospitals and offer suggestions for conducting comprehensive systematic reviews. METHODS We conducted a systematic scoping review and searched the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, OVID, Science Direct, ProQuest, EMBASE and PubMed. We also reviewed the reference lists of included studies. The criteria for inclusion of studies included experimental and quasi-experimental studies, implementing CPW in secondary and tertiary hospitals and investigating at least one indicator. Quality of included studies was assessed by two authors independently using the Critical Appraisal Skills Program for clinical trials and cohort studies and the Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies. RESULTS Forty-seven out of 2191 studies met the eligibility and inclusion criteria. The majority of included studies had pretest-posttest quasi-experimental design and had been done in developed countries, especially the United States. The investigation of evidence resulted in identifying 62 indicators which were classified into three categories: input indicators, process and output indicators and outcome indicators. Outcome indicators were more frequent than other indicators. Complication rate, hospital costs and length of hospital stay were dominant in their own category. Indicators such as quality of life and adherence to guidelines have been considered in studies that were done in recent years. CONCLUSION Implementing CPW can affect different types of indicators such as input, process, output and outcome indicators, although outcome indicators capture more attention than other indicators. Patient-related indicators were dominant outcome indicators, whereas professional indicators and organizational factors were considered less extensively. WHAT IS KNOWN ABOUT THE TOPIC?: WHAT DOES THIS ARTICLE ADD?
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Seys D, Bruyneel L, Sermeus W, Lodewijckx C, Decramer M, Deneckere S, Panella M, Vanhaecht K. Teamwork and Adherence to Recommendations Explain the Effect of a Care Pathway on Reduced 30-day Readmission for Patients with a COPD Exacerbation. COPD 2018; 15:157-164. [PMID: 29461135 DOI: 10.1080/15412555.2018.1434137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to increase our understanding of processes that underlie the effect of care pathway implementation on reduced 30-day readmission rate. Adherence to evidence-based recommendations, teamwork and burnout have previously been identified as potential mechanisms in this association. We conducted a secondary data analysis of 257 patients admitted with chronic obstructive pulmonary disease exacerbation and 284 team members caring for these patients in 19 Belgian, Italian and Portuguese hospitals. Clinical measures included 30-day readmission and adherence to a specific set of five care activities. Teamwork measures included team climate for innovation, level of organized care and burnout (emotional exhaustion, level of competence and mental detachment). Care pathway implementation was significantly associated with better adherence and reduced 30-day readmission. Better adherence and higher level of competence were also related to reduced 30-day readmission. Only better adherence fully mediated the association between care pathway implementation and reduced 30-day readmission. Better team climate for innovation and level of organized care, although both improved after care pathway implementation, did not show any explanatory mechanisms in the association between care pathway implementation and reduced 30-day readmission. Implementation of a care pathway had an impact on clinical and team indicators. To reduce 30-day readmission rates, in the development and implementation of a care pathway, hospitals should measure adherence to evidence-based recommendations during the whole process, as this can give information regarding the success of implementation.
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Affiliation(s)
- Deborah Seys
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium
| | - Luk Bruyneel
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
| | - Walter Sermeus
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium
| | - Cathy Lodewijckx
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,c AZ Sint Maarten , Mechelen , Belgium
| | - Marc Decramer
- d Department of Clinical and Experimental Medicine , KU Leuven - University of Leuven , Leuven , Belgium.,e Chief Executive Officer , University Hospitals Leuven , Leuven , Belgium
| | - Svin Deneckere
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,f Delta hospitals Roeselare , Roeselare , Belgium
| | - Massimiliano Panella
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,g Department of Translational Medicine , University of Eastern Piedmont , Piedmont , Italy
| | - Kris Vanhaecht
- a Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy , KU Leuven - University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
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Seys D, Bruyneel L, Deneckere S, Kul S, Van der Veken L, van Zelm R, Sermeus W, Panella M, Vanhaecht K. Better organized care via care pathways: A multicenter study. PLoS One 2017; 12:e0180398. [PMID: 28672030 PMCID: PMC5495424 DOI: 10.1371/journal.pone.0180398] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 06/15/2017] [Indexed: 11/18/2022] Open
Abstract
An increased need for efficiency and effectiveness in today’s healthcare system urges professionals to improve the organization of care. Care pathways are an important tool to achieve this. The overall aim of this study was to analyze if care pathways lead to better organization of care processes. For this, the Care Process Self-Evaluation tool (CPSET) was used to evaluate how healthcare professionals perceive the organization of care processes. Based on information from 2692 health care professionals gathered between November 2007 and October 2011 we audited 261 care processes in 108 organizations. Multilevel analysis was used to compare care processes without and with care pathways and analyze if care pathways led to better organization of care processes. A significant difference between care processes with and without care pathways was found. A care pathway in use led to significant better scores on the overall CPSET scale (p<0.001) and its subscales, “coordination of care” (p<0.001) and “follow-up of care” (p<0.001). Physicians had the highest score on the overall CPSET scale and the five subscales. Care processes organized by care pathways had a 2.6 times higher probability that the care process was well-organized. In around 75% of the cases a care pathway led to better organized care processes. Care processes supported by care pathways were better organized, but not all care pathways were well-organized. Managers can use care pathways to make healthcare professionals more aware of their role in the organization of the care process.
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Affiliation(s)
- Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, UZ Leuven, Leuven, Belgium
| | - Svin Deneckere
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Medical Department, Delta Hospitals Roeselare, Roeselare, Belgium
| | - Seval Kul
- Department of Biostatistics, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Liz Van der Veken
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Q Consult, Utrecht, The Netherlands
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Clinical and Experimental Medicine, University of Eastern Piedmont 'A. Avogadro', Novara, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, UZ Leuven, Leuven, Belgium
- * E-mail:
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Seys D, Bruyneel L, Decramer M, Lodewijckx C, Panella M, Sermeus W, Boto P, Vanhaecht K. An International Study of Adherence to Guidelines for Patients Hospitalised with a COPD Exacerbation. COPD 2016; 14:156-163. [PMID: 27997254 DOI: 10.1080/15412555.2016.1257599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Guideline adherence rates for the treatment of chronic obstructive pulmonary disease (COPD) exacerbation are low. The aim of this study is to perform an importance-performance analysis as an approach for prioritisation of interventions by linking guidelines adherence rates to expert consensus rates for the in-hospital management of COPD exacerbation. We illustrate the relevance of such approach by describing variation in guideline adherence across indicators and hospitals. A secondary data analysis of patients with an acute COPD exacerbation admitted to Belgian, Italian and Portuguese hospitals was performed. Twenty-one process indicators were used to describe adherence to guidelines from patient record reviews. Expert consensus on the importance for follow-up of these 21 indicators was derived from a previous Delphi study. Three of the twenty-one indicators had high level of expert consensus and a high level of adherence. Eleven of the twenty-one indicators had high level of expert consensus but a low level of adherence. For none of the 378 patients included in this study were all process indicators adhered to, patients received 41.0% of the recommended care on average, and only 34.1% of the patients received 50% or more of the care they should receive. There was also a large variation within and between hospitals regarding the care received. This study confirms the findings of previous studies, indicating that COPD exacerbations are largely undertreated. Importance-performance analysis provides a decision-making tool for prioritising indicators. All hospitals in this study would benefit from having in place a quality framework for systematic follow-up of these indicators.
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Affiliation(s)
- Deborah Seys
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium
| | - Luk Bruyneel
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
| | - Marc Decramer
- c Department of Clinical and Experimental Medicine , KU Leuven-University of Leuven , Leuven , Belgium.,d Chief Executive Officer, University Hospitals Leuven , Leuven , Belgium
| | - Cathy Lodewijckx
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium
| | - Massimiliano Panella
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.,e Department of Translational Medicine , University of Eastern Piedmont , Vercelli , Italy
| | - Walter Sermeus
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium
| | - Paulo Boto
- f Department of Health Services Policy and Management Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL) , Lisbon , Portugal
| | - Kris Vanhaecht
- a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.,b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
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Aeyels D, Van Vugt S, Sinnaeve PR, Panella M, Van Zelm R, Sermeus W, Vanhaecht K. Lack of evidence and standardization in care pathway documents for patients with ST-elevated myocardial infarction. Eur J Cardiovasc Nurs 2015; 15:e45-51. [DOI: 10.1177/1474515115580237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/12/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Daan Aeyels
- Department of Public Health and Primary Care, University of Leuven, Belgium
- European Pathway Association, Belgium
| | - Stijn Van Vugt
- Department of Public Health and Primary Care, University of Leuven, Belgium
| | - Peter R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium
| | - Massimiliano Panella
- Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
| | - Ruben Van Zelm
- European Pathway Association, Belgium
- QConsult, The Netherlands
| | - Walter Sermeus
- Department of Public Health and Primary Care, University of Leuven, Belgium
- European Pathway Association, Belgium
| | - Kris Vanhaecht
- Department of Public Health and Primary Care, University of Leuven, Belgium
- European Pathway Association, Belgium
- Department of Quality Management, University Hospitals Leuven, Belgium
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Better Interprofessional Teamwork, Higher Level of Organized Care, and Lower Risk of Burnout in Acute Health Care Teams Using Care Pathways. Med Care 2013; 51:99-107. [DOI: 10.1097/mlr.0b013e3182763312] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Lodewijckx C, Sermeus W, Panella M, Deneckere S, Leigheb F, Troosters T, Boto PA, Mendes RV, Decramer M, Vanhaecht K. Quality indicators for in-hospital management of exacerbation of chronic obstructive pulmonary disease: results of an international Delphi study. J Adv Nurs 2012; 69:348-62. [PMID: 22716665 DOI: 10.1111/j.1365-2648.2012.06013.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To report a Delphi study that was conducted to select process and outcome indicators that are relevant to study quality of care and impact of care pathways for patients hospitalized with exacerbation of chronic obstructive pulmonary disease. BACKGROUND Management of patients hospitalized with exacerbation of chronic obstructive pulmonary disease is suboptimal and outcomes are poor. To evaluate the impact of care pathways properly, relevant indicators need to be selected. DESIGN Delphi study. METHODS The study was conducted over 4 months in 2008, with 35 experts out of 15 countries, including 19 medical doctors, 8 nurses and 8 physiotherapists. Participants were asked to rate, for 72 process and 21 outcome indicators, the relevance for follow-up in care pathways for in-hospital management of exacerbation of chronic obstructive pulmonary disease. Consensus (agreement by at least 75% of the participants) that an indicator is relevant for follow-up was sought in two rounds. RESULTS Consensus was reached for 26 of 72 process indicators (36·1%) and 10 of 21 outcome indicators (47·6%). Highest consensus levels were found for the process indicators regarding oxygen therapy (100%), pulmonary rehabilitation (100%) and patient education (94·5-88·6%) and for the outcome indicators concerning understanding of therapy (91·4-85·7%) and self-management (88·6-88·2%). CONCLUSION The selected indicators appear to be sensitive for improvement. Therefore, researchers and clinicians that want to study and improve the care for patients hospitalized with exacerbation of chronic obstructive pulmonary disease should primarily focus on these indicators.
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Vanhaecht K, Sermeus W, Peers J, Lodewijckx C, Deneckere S, Leigheb F, Boonen S, Sermon A, Boto P, Mendes RV, Panella M. The impact of care pathways for patients with proximal femur fracture: rationale and design of a cluster-randomized controlled trial. BMC Health Serv Res 2012; 12:124. [PMID: 22640531 PMCID: PMC3528433 DOI: 10.1186/1472-6963-12-124] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 05/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proximal femur fracture (PFF) is associated with considerable morbidity and mortality. The European Quality of Care Pathway (EQCP) study on PFF (NCT00962910) was designed to determine how care pathways (CP) for hospital treatment of PFF affect consistency of care, adherence to evidence-based key interventions, and clinical outcome. METHODS/DESIGN An international cluster-randomized controlled trial (cRCT) will be performed in Belgium, Ireland, Italy and Portugal. Based on power analyses, a sample of 44 hospital teams and 437 patients per arm will be included in the study. In the control arm, usual care will be provided. Experimental teams will implement a care pathway which will include three active components: a formative evaluation of quality and organization of the care setting, a set of evidence-based key interventions, and support of the development and implementation of the CP. Main outcome will be the six-month mortality rate. DISCUSSION The EQCP study constitutes the first international cRCT on care pathways. The EQCP project was designed as both a research and a quality improvement project and will provide a real-world framework for process evaluation to improve our understanding of why and when CP can really work. TRIAL REGISTRATION NUMBER NCT00962910.
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Affiliation(s)
- Kris Vanhaecht
- Health Services Research Group, School of Public Health, KU Leuven, University of Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.
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Deneckere S, Euwema M, Van Herck P, Lodewijckx C, Panella M, Sermeus W, Vanhaecht K. Care pathways lead to better teamwork: results of a systematic review. Soc Sci Med 2012; 75:264-8. [PMID: 22560883 DOI: 10.1016/j.socscimed.2012.02.060] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 09/06/2011] [Accepted: 02/23/2012] [Indexed: 11/25/2022]
Abstract
Care pathways are often said to promote interprofessional teamwork. As no systematic review on pathway effectiveness has ever focused on how care pathways promote teamwork, the objective of this review was to study this relationship. We performed an extensive search of electronic databases and identified 26 relevant studies. In our analysis of these studies we identified 20 team indicators and found that care pathways positively affected 17 of these indicators. Most frequently positive effects were found on staff knowledge, interprofessional documentation, team communication and team relations. However, the level of evidence was rather low. We found Level II evidence for improved interprofessional documentation. We also found Level II evidence for increased workload; improved actual versus planned team size; and improved continuity of care. The studies most frequently mentioned the need for a multidisciplinary approach and educational training sessions in order for pathways to be successful. The systematic review revealed that care pathways have the potential to support interprofessional teams in enhancing teamwork. Necessary conditions are a context that supports teamwork and including appropriate active pathway components that can mediate an effect on team processes. To achieve this, each care pathway requires a clearly defined team approach customized to the individual teams' needs.
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Affiliation(s)
- Svin Deneckere
- Public Health School, Faculty of Medicine, KU Leuven, Belgium.
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Impact of care pathways for in-hospital management of COPD exacerbation: A systematic review. Int J Nurs Stud 2011; 48:1445-56. [DOI: 10.1016/j.ijnurstu.2011.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 06/20/2011] [Accepted: 06/23/2011] [Indexed: 11/23/2022]
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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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Deneckere S, Robyns N, Vanhaecht K, Euwema M, Panella M, Lodewijckx C, Leigheb F, Sermeus W. Indicators for Follow-Up of Multidisciplinary Teamwork in Care Processes. Eval Health Prof 2010; 34:258-77. [DOI: 10.1177/0163278710393736] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In order to study the impact of interventions on multidisciplinary teamwork in care processes, relevant indicators need to be defined. In the present study, the authors performed a Delphi survey of a purposively selected expert panel consisting of scientific researchers and hospital managers. Thirty-six experts from 13 countries participated. Each participant rated a list of team indicators on a scale of 1–6. Consensus was sought in two consecutive rounds. The content validity index (CVI) varied from 8% to 92%. A final list of 19 indicators was generated: 5 on team context/structure, 8 on team process, and 6 on team outcomes. Most relevant team indicators were as follows: “team relations,” “quality of team leadership,” “culture/climate for teamwork,” “team perceived coordination of the care process,” and “team vision.” Scientific researchers and hospital managers that want to study and improve multidisciplinary teamwork in care processes should primarily focus on these team indicators.
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Affiliation(s)
- Svin Deneckere
- Faculty of Medicine, Catholic University Leuven, Belgium
| | | | - Kris Vanhaecht
- Faculty of Medicine, Catholic University Leuven, Belgium
- European Pathway Association, Catholic University of Leuven, Belgium
| | - Martin Euwema
- Center for Organization and Personnel Psychology, Catholic University Leuven, Belgium
| | - Massimiliano Panella
- European Pathway Association, Catholic University of Leuven, Belgium
- Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
| | | | - Fabrizio Leigheb
- Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
| | - Walter Sermeus
- Faculty of Medicine, Catholic University Leuven, Belgium
- European Pathway Association, Catholic University of Leuven, Belgium
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Vanhaecht K, Sermeus W, Peers J, Lodewijckx C, Deneckere S, Leigheb F, Decramer M, Panella M. The impact of care pathways for exacerbation of Chronic Obstructive Pulmonary Disease: rationale and design of a cluster randomized controlled trial. Trials 2010; 11:111. [PMID: 21092098 PMCID: PMC3001422 DOI: 10.1186/1745-6215-11-111] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 11/19/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hospital treatment of chronic obstructive pulmonary disease (COPD) frequently does not follow published evidences. This lack of adherence can contribute to the high morbidity, mortality and readmissions rates. The European Quality of Care Pathway (EQCP) study on acute exacerbations of COPD (NTC00962468) is undertaken to determine how care pathways (CP) as complex intervention for hospital treatment of COPD affects care variability, adherence to evidence based key interventions and clinical outcomes. METHODS An international cluster Randomized Controlled Trial (cRCT) will be performed in Belgium, Italy, Ireland and Portugal. Based on the power analysis, a sample of 40 hospital teams and 398 patients will be included in the study. In the control arm of the study, usual care will be provided. The experimental teams will implement a CP as complex intervention which will include three active components: a formative evaluation of the quality and organization of care, a set of evidence based key interventions, and support on the development and implementation of the CP. The main outcome will be six-month readmission rate. As a secondary endpoint a set of clinical outcome and performance indicators (including care process evaluation and team functioning indicators) will be measured in both groups. DISCUSSION The EQCP study is the first international cRCT on care pathways. The design of the EQCP project is both a research study and a quality improvement project and will include a realistic evaluation framework including process analysis to further understand why and when CP can really work. TRIAL REGISTRATION NUMBER NCT00962468.
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Affiliation(s)
- Kris Vanhaecht
- European Pathway Association, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Faculty of Medicine, Catholic University Leuven, Belgium
| | - Walter Sermeus
- European Pathway Association, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Faculty of Medicine, Catholic University Leuven, Belgium
| | - Jan Peers
- Faculty of Medicine, Catholic University Leuven, Belgium
| | | | - Svin Deneckere
- Faculty of Medicine, Catholic University Leuven, Belgium
| | - Fabrizio Leigheb
- Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
| | - Marc Decramer
- Faculty of Medicine, Catholic University Leuven, Belgium
| | - Massimiliano Panella
- European Pathway Association, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
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