International Journal of Care Pathways最新文献

{"title":"A bronchiolitis integrated care pathway for children","authors":"A. Soe, P. Chetcuti, G. Fox, S. Tomlin","doi":"10.1258/jicp.2012.011023","DOIUrl":"https://doi.org/10.1258/jicp.2012.011023","url":null,"abstract":"There is currently no standard in the UK for the management and prevention of bronchiolitis, leading to widespread variation in the management of infants. The authors feel that existing guidelines are not followed as a result of a lack of understanding and motivation to ensure that the necessary services and funding are available to manage patients according to recommendations. This pathway was developed to facilitate the implementation of standardized care for infants with or at risk for bronchiolitis. The integrated care pathway (ICP) for bronchiolitis was developed by a multidisciplinary steering group over the course of four facilitated workshops. During these workshops the steering group defined the ideal patient journey and then detailed each of the steps in the pathway with the information that should be assessed and collected to optimally manage patients. The results of the pathway development process and the ICP itself are the process map, ICP forms and the evidence review including commissioning outcomes. This ICP for bronchiolitis is based on expert consensus, multistakeholder input and a critique of published evidence. The steering group urges health professionals to work together across networks to improve the care for children both at risk for and with bronchiolitis.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128990305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participation in decision-making when designing care programmes and integrated care pathways","authors":"R. Kuijpers, T. Joosten, Dirk de Natris","doi":"10.1258/jicp.2012.011027","DOIUrl":"https://doi.org/10.1258/jicp.2012.011027","url":null,"abstract":"The need for improved quality in health care has forced health-care organizations worldwide to critically review and improve their current care delivery processes. While some of these projects succeed, there are also a number of projects that fail. One of the factors contributing to their success or failure is willingness to change. That is why a number of re-design methods, including care pathway development, emphasize frontline staff involvement to reduce resistance. One of the mechanisms used in care pathway development to involve staff is the sharing of influence or decision-making between superiors and their subordinates. This mechanism is also known as participatory decision-making (PDM). In this research paper, we have addressed this issue by investigating whether or not increasing PDM by developing care pathways and care programmes leads to increased organizational commitment, trust in management and willingness to change. Our research shows that PDM leads to increased trust in management and organizational commitment. Evidence indicating that PDM indirectly contributes to an increased willingness to change was also found. The outcome of our research suggests that increasing PDM when developing care programmes and care pathways can be an effective method of increasing the chances of success for care pathway development projects.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"194 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131701678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and implementation of the Rapid Discharge Pathway Version 12 to enable imminently dying patients to die in the place of their choice","authors":"M. Gambles, L. Cannell, M. Bolger, D. Murphy","doi":"10.1258/jicp.2012.012002","DOIUrl":"https://doi.org/10.1258/jicp.2012.012002","url":null,"abstract":"This study reports on the further development and implementation of a Rapid Discharge Home to Die Care Pathway (RDP Version 12). A rapid discharge pathway (RDP) was originally developed by members of the Hospital Specialist Palliative Care Team at the Royal Liverpool and Broadgreen University Hospitals NHS Trust in response to an identified clinical need to enable imminently dying patients to die in their place of choice when a clinical situation has changed rapidly and there has been an urgent request for a patient to die at home. The initial development and early evaluation, along with an example of the pathway itself, was published in 2004. The current study reports specifically on the subsequent development of the pathway that occurred alongside that of the generic Version 12 of the Liverpool Care Pathway for the Dying Patient published in December 2009. The study outlines the process of development and implementation of the RDP Version 12; patient scenario and a completed example are included to further illustrate the circumstances in which it can be used and the resultant process.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116780137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can quantification of congestive heart failure care convince medical doctors to use a care pathway? A process analysis","authors":"T. Heemskerk, M. A. Hugo, Rosalie Mesman, Lilian Jane Förster, M. Götte, Arend Jan te Hoonte","doi":"10.1258/jicp.2012.012001","DOIUrl":"https://doi.org/10.1258/jicp.2012.012001","url":null,"abstract":"The Dutch national health-care policy has two opposing objectives: firstly care has to be cost-effective and secondly the quality of care has to improve. To meet these objectives in the clinical care for congestive heart failure (CHF), the Haga Hospital Heart Centre decided to investigate whether care according to a care pathway would be the solution. The objective of this study was to gain the support of the medical doctors (MDs) for implementation of a CHF care pathway. This was accomplished by providing insight through a process analysis of care as registered in the medical records. The survey was a retrospective process description of the design of the data collection protocol and research process evaluating the current care with international guidelines. The results of the research and the process of data collection facilitated a thorough evaluation of the delivered care. This resulted in an invaluable insight by the MDs into the results and registration of the medical care to CHF patients. In order to reveal the internal urgency of the design and implementation of a care pathway quantification of the care parameters is essential to gain insight into the care processes. With this insight the MDs are more likely to support a care pathway.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134031762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor","authors":"E. Broughton","doi":"10.1258/jicp.2011.011m31","DOIUrl":"https://doi.org/10.1258/jicp.2011.011m31","url":null,"abstract":"I greatly appreciate the comments offered by Drs Krug and Crott in ‘The “How” of Cost-Effectiveness Analysis is not so straightforward’. While I agree with several points made in their response to my original article, there are others I disagree with strongly. There are several potential sources of bias in any economic analysis, including cost-effectiveness analyses (CEA) of a care pathway. However, comparing implementation of a care pathway to an existing situation where a care pathway is not always used, and therefore current practice is ‘inappropriate’, is not one of them. Clearly, care pathways should be evidence based and it should be widely accepted that they lead to the best patient results given current knowledge. What I proposed in my original article was analysis of the incremental costs and effects of increasing the use of a care pathway from its current level in a given setting, which could be as low as no use, to as high a level of use as possible with the implementation being tested. I cannot see where the issue of bias comes into play with this basic comparison. However, I agree that generalizability of the results is often an issue and that researchers should bear this in mind when designing studies and communicating their results. Krug and Crott make a valid point on the importance of considering perspectives. Researchers should be completely explicit when stating the perspective used in the analysis, explain the reasoning behind their choices, and what would happen to the results if other costs and consequences considering different perspectives were included. I also agree with the authors on the sensitivity of results to the time horizon used for the analysis. What bears closer examination is what resources are needed to keep compliance with care pathways at a maximum level for the length of time chosen for the time horizon or, alternatively, what will happen to compliance with the care pathway beyond initial implementation if no resources are dedicated to maintaining it. Quite often these data are not available. Non-medical costs are clearly difficult to measure in almost all circumstances. Whether or not the researcher includes these costs is entirely dependent on the specific research question, which in turn depends of the needs of those commissioning the study. Given the choice, and assuming research resources are available, the societal perspective including patient and family costs should be included. The issue of what to use for an effectiveness measure in many cases involves a trade-off as presented in the original paper. To label my original discussion of this a ‘flaw’ is unwarranted. Using more accurate intermediate or process measures in the absence of good epidemiological data linking that outcome to something more tangible, such as life-years saved, means that the researcher is trading off the ability to compare results with future studies of effectiveness for a defensibly accurate result. However, if future resear","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126535739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can a care pathway help streamline the care process for patients with chronic fatigue syndrome?","authors":"D. Verhelst, M. Nachtergaele, C. Hindryckx, K. Vandevyvere, S. Seghers, K. Smessaert, S. Vanderschueren","doi":"10.1258/jicp.2011.011024","DOIUrl":"https://doi.org/10.1258/jicp.2011.011024","url":null,"abstract":"In this paper, the authors show how the implementation of a care pathway can streamline the care for chronic fatigue syndrome (CFS). The methodology of seven phases is used as a guide to develop, implement and evaluate the CFS care pathway. Some patients have already completed the care pathway. With the help of these case studies, a few strengths and weaknesses of the care process can be formulated. The development and implementation of the care pathway result in a structured process. Patients are diagnosed and treated based on an evidence-based method. The care path also leads to an enhancement of the interdisciplinary cooperation. Nevertheless, the criteria for inclusion and exclusion of patients are taken into account insufficiently. Moreover, family doctors should be involved more often. In the future, it is also important to pay more attention to the role of the family members during the treatment. The entire steering group now needs to engage in a discussion about the test pathway and then subsequently put it to use in daily practice. Additional challenges for the steering group include the objective evaluation and the continuous follow-up of the care pathway.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133897275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ‘how’ of cost-effectiveness analysis for care pathways is not straightforward","authors":"B. Krug, R. Crott","doi":"10.1258/jicp.2011.011021","DOIUrl":"https://doi.org/10.1258/jicp.2011.011021","url":null,"abstract":"Introduction: As health-care payers are faced with the need to allocate finite resources to maximize the health and wellbeing of the population, interest in the economic evaluation of health-care interventions has risen over the past decades. Although we have become aware of the growing importance of economic issues in medicine, economic evaluations in care pathways have remained up to now rather limited.Even if we agree with the author that there is an urgent need for economic evaluations in health service interventions, we fear that this paper contains methodological flaws which may mislead the reader of the journal, as well as potential users of economic evaluations.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129904548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care Pathways 2011: meeting the quality and productivity challenge through care pathways","authors":"R. van Zelm, Claire L Whittle, S. Hindle","doi":"10.1258/JICP.2011.011M28","DOIUrl":"https://doi.org/10.1258/JICP.2011.011M28","url":null,"abstract":"On 21 and 22 of June, Healthcare Events and the European Pathway Association organized the two-day international conference on care pathways which was held in London. It was two days with presentations which provided good examples of care pathways, networking and inspiration. There were a number of recurrent themes during the days. The most intriguing one was perhaps the warning from the patients perspective to see pathways as a means to a higher goal, and not just as a goal in itself. A sure sign perhaps that patients view pathways as continuous quality improvement tools and not just a method for ensuring safe practice.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126688960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological support for business process redesign in health care: a literature review protocol","authors":"R. Vanwersch, Khurram Shahzad, K. Vanhaecht, P. Grefen, L. Pintelon, J. Mendling, V. Merode, H. Reijers","doi":"10.1258/jicp.2011.011025","DOIUrl":"https://doi.org/10.1258/jicp.2011.011025","url":null,"abstract":"Research efforts that aim to develop methodological support for the redesign of business processes in the health-care domain are fragmented and performed in different domains. Due to these characteristics, it can be expected to be difficult to establish the state-of-the art with respect to this body of knowledge. This paper presents a research protocol that was developed prior to a literature review in this field, which illustrates the structure and rigor that we deem necessary to overcome the noted obstacles.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"2014 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127566817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why is the International Journal of Care Pathways ready for Medline?","authors":"M. Panella, K. Vanhaecht","doi":"10.1258/JICP.2011.011M29","DOIUrl":"https://doi.org/10.1258/JICP.2011.011M29","url":null,"abstract":"The growing interest in care pathways and the organization of care processes started with the Institute of Medicine’s (IOM) Crossing the Quality Chasm report in 2001. The IOM suggested organizing care around patient needs and medical conditions, and not around professional groups or operational units. Now 10 years later, there are not only local care process improvement projects worldwide but also large cluster randomized controlled trials on the effect of pathways on patient outcomes available. A first Cochrane report on pathways was published in 2010 and although the effects are described as positive, pathways are complex interventions which make them difficult to understand and analyse. A specific journal on care pathways is not only necessary to support health-care clinicians and managers in their daily search for excellence by publishing project reports based on the SQUIRE guideline, this journal is also needed to support academic discussions on the pathway concept and methods to evaluate pathways within the field of implementation research. The development, standardization and overall change in a care process will not always lead to improvements. As the organization of care processes has a direct impact on the quality of care and patient safety, discussions on its organization, evaluation and follow-up need to be held in specific peer reviewed international journals like the International Journal of Care Pathways. Our aim is to produce a leading international peerreviewed journal, which focuses on the issues of the growing area of implementation research related to care pathways (also known as clinical pathways, critical pathways or integrated care pathways) and the organization of care processes. The journal is the official journal of the European Pathway Association (E-P-A), an international not-for-profit scientific association with members in more than 50 countries worldwide, to support research and knowledge sharing on the organization of care processes. The journal focuses on how pathways and other structured care methodologies affect quality, safety, teamwork and efficiency. It also concentrates on the role of patients, carers, health and social care professionals, managers, policy-makers and stakeholders, including the purchasers and commissioners of services, and those who monitor them for efficiency and effectiveness. This journal includes research papers and case studies on projects and programmes from all over the world. It includes issues relating to the organization of care processes themselves, and to the methodologies and outcomes related to planning, development, implementation, education, training, communication and evaluation. Debate and commentary are also included, to encourage readers to think critically and constructively about the many broad issues surrounding the application, management and evaluation of care processes. The journal highlights different areas of research but also on the general applicability and prac","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126628861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}