Journal of Integrated Care Pathways最新文献

{"title":"It's not what you do, it's the way that you do it","authors":"J. Gray","doi":"10.1258/JICP.2008.008006","DOIUrl":"https://doi.org/10.1258/JICP.2008.008006","url":null,"abstract":"As clearly demonstrated in Dr Smith’s Letter to the Editor published in this issue of Journal of Integrated Care Pathways, just having a care pathway in existence, however well-designed, is not enough to ensure improved care to the patient. Over the past 20 years, I have seen innumerable examples of care pathways that appear well-designed from the perspectives of both content and layout, having little effect either way on the care delivered. On the other hand, I have also seen as many care pathways that by anyone’s standards appear poor, but that have been embraced by the local team and that have had a significant, measurable effect on the quality and efficiency of processes and the outcomes of care. This poses the question ‘does a care pathway have any real impact on improving care, and if so, what determines its effectiveness?’ Part of the answer lies in common sense. The most perfectly designed care pathway, if little understood and poorly used, can hardly be expected to make any difference to anything. On the other hand, a care pathway thoughtfully designed with the involvement of those whowill use it, that seeks to ease, coordinate and streamline the provision of the best possible care, and that provides relevant, regular and well-targeted feedback to inform and interest those same people, has far more chance of having an impact on process and outcomes. I have recently been contacted by a Publishing Director who is interested in the better understanding of what is ‘good practice’ when it comes to reviewing pathways. To date, a surprisingly little amount of effort or research has gone into this area. Some examples of pathway audit tools that consider issues such as the content and layout of care pathway tools and the mechanisms of organizing care include: the Clinical Path Assessment developed in the late-1990s by the Centre for Case Management (USA); the ‘badge of quality’; an integrated care pathways appraisal tool developed in 2002 by De Luc et al.; the Integrated Care Pathway Appraisal Tool (ICPAT) developed in 1999 by Wittle et al.; with the support of the Partnership for Developing Quality, West Midlands Regional Levy Board; the ICP Key Elements Checklist developed in 2004 by Croucher as part of a Masters thesis; and the Care Process Self Evaluation Tool (CPSET) developed between 2004 and 2007 by Vanhaecht as part of a thesis to obtain the degree of Doctor in Social Health Sciences. Venture Training & Consulting has developed and used two Care Pathway Quality Scorecards as an exercise over the past 10 years to help teams to ‘know a good care pathway when they see one’ and to decide what they want out of the care pathway that they plan to develop locally. However, none of these tools fully address the relationship between key characteristics of the care pathway and successful implementation. It is certainly possible to teach and to recognize quality content and good design of a care pathway. This supports a growing view that nationally d","PeriodicalId":332790,"journal":{"name":"Journal of Integrated Care Pathways","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127384917","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":"Integrated care pathway for hip fractures – a help or a hindrance?","authors":"N. Smith, K. Harris, K. Salem, J. Kurian","doi":"10.1258/JICP.2008.008012","DOIUrl":"https://doi.org/10.1258/JICP.2008.008012","url":null,"abstract":"The cost of patients presenting with fragility fractures in the UK is nearly two billion pounds per year, which is mostly attributable to hip fracture care. With an ageing population, the burden of care will continue to rise, with 70,000 hip fractures in 2007 expected to rise to 101,000 by 2020. Both the Scottish Intercollegiate Guideline Network (SIGN) (2002) and the British Orthopaedic Association (BOA)(2007)havereleasedguidelinesforthemanagement of hip fractures. Integrated care pathways (ICP) for the management of hip fractures have in some cases been shown to decrease the length of hospital stay, a major contributortooverallcost.TheSIGNguidelineonthemanagement of hip fractures has highlighted the use of ICPs as an area for further research. Despite this, many centres acrosstheUKuseICPsforthemanagementofhipfractures. An ICP for the management of hip fractures was implemented at our district general hospital two years ago,withoutsubsequentevaluation.Anauditof40patients aged65years andolderwithhip fractures between January andFebruary2008showedthatonly63%ofadmissionshad an ICP filled in at all. Interestingly, only 48% of admissions using the ICP included a completed prefracture mobility assessment compared with 93% without. Secondly, only 16% of admissions with an ICP had a completed full drug and allergy history compared with 80% without. There was no significant difference between the two groups with the prescription of bone protection therapy, with 38% prescription and thromboprophylaxis and 25% evaluated for low molecular weight heparin. Following evaluation of these results, the pathway was edited to include spaces for drug, allergy and prefracture mobility history. A tick-box system was also introduced on the front page of the proforma including prescription of bone protection therapy and thromboprophylaxis evaluation. In the re-audit of 35 patients, there was a 97% use of the ICP. Drug and allergy history was included in 83% of admissions as well as a 94% documentation of prefracture mobility. Bone protection therapy increased to 80% and anticoagulation evaluation increased to 60%. This audit shows the importance of evaluating new ICPs to ensure that they improve patient care and, as in this case, do not have a detrimental effect. With some modifications in the ICP we were able to improve a number of aspects of hip fracture care above the results achieved without using an ICP. It was also beneficial to include a tick box on the front sheet to act as an aide memoir to the junior doctor admitting the patient. This small audit shows that an ICP for hip fractures may be beneficial and that the development of a national validated ICP may be important to prevent unnecessary local deviations from national guidelines.","PeriodicalId":332790,"journal":{"name":"Journal of Integrated Care Pathways","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128883416","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":"Collaboration across primary and secondary care dermatology services","authors":"S. Hargreaves","doi":"10.1258/jicp.2008.008009","DOIUrl":"https://doi.org/10.1258/jicp.2008.008009","url":null,"abstract":"Purpose: The paper demonstrates the complexities of leadership in a local health-care community across primary and secondary care interface, using the example of a general practitioner (GP) with a special interest role (GPwSI) in dermatology. It focuses on how the service will develop and how it could be achieved. Design: Various models and theories about change management were consulted focusing particularly on the goals of the local health-care economy, resources available and environment/contextual surroundings. Practical implications: Primary care trusts (PCTs), acute trusts and clinicians need to work collaboratively to achieve an integrated, flexible care pathway, so that patients and the PCTs can be assured of an efficient and good quality service. Conflicts between primary and secondary care dermatology services are not sustainable for a long period. Originality: The Government's agenda is a shift of care closer to people's homes, so PCTs do need to be aware of what they wish to commission, and consider moving traditional hospital-based facilities into community settings, such as walk-in centres, polyclinics and large health centres, associated with improved GP and patient education on skin problems.","PeriodicalId":332790,"journal":{"name":"Journal of Integrated Care Pathways","volume":"6 16","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120837080","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":"An academic medical centre's programme to develop clinical pathways to manage health care: focus on acute decompensated heart failure","authors":"D. Lombardo, T. Bridgeman, Nathalie De Michelis, M. Nunez","doi":"10.1258/jicp.2008.008007","DOIUrl":"https://doi.org/10.1258/jicp.2008.008007","url":null,"abstract":"Heart failure (HF) is a major public health issue and acute decompensated heart failure (ADHF) is a leading cause of hospitalization in the USA. The United States health care delivery system is bound by regulatory agencies requiring strict compliance to key clinical indicators, which are publicly reported. Clinical pathway development is a systematic approach to managing health care that involves a high degree of collaboration between patients, physicians, nurses and various health-care team professionals. The University of California, Irvine Medical Center (UCIMC) developed an evidence-based multidisciplinary pathway for patients with ADHF. This clinical pathway incorporates universally proven assessment and treatment measures in ADHF. Adjunctive to this process are patient and nursing guides to the ADHF pathway. Utilization of this pathway has been shown to significantly impact clinical performance by early identification of potential negative clinical outcomes. Clinical pathways, such as the ADHF pathway, promote clinical excellence in caring for acute and chronic diseases states.","PeriodicalId":332790,"journal":{"name":"Journal of Integrated Care Pathways","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121532822","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":"Poster presentations at the Integrated Care Pathways 2008 conference","authors":"J. Gray","doi":"10.1258/jicp.2008.008011","DOIUrl":"https://doi.org/10.1258/jicp.2008.008011","url":null,"abstract":"For the third year running, throughout the Care Pathways 2008 conference organized by Healthcare Events, posters were displayed, and poster presenters were available to talk about their displays and answer questions. This formed a valuable and interesting part of the annual conference, giving ample opportunity for sharing and dissemination of best practice and ideas. Eight posters that were displayed are reproduced below along with summary reviews covering the projects’ main aims and objectives, methods, results and conclusions.","PeriodicalId":332790,"journal":{"name":"Journal of Integrated Care Pathways","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115313123","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 pathway quality scorecards","authors":"J. Gray","doi":"10.1258/jicp.2008.008010","DOIUrl":"https://doi.org/10.1258/jicp.2008.008010","url":null,"abstract":"This paper describes the rationale and methodology for three exercises used to critically appraise the quality of the two main tools supporting implementation of the care pathway continuous improvement methodology. The Venture care pathway journey quality scorecard and the Venture care pathway paper-document quality scorecard builds a greater understanding of the value provided by different components of content and layout. In addition, the Venture paper care pathway document template provides a basic design guide for teams, based on 20 years of experience in developing, implementing and evaluating care pathway documents.","PeriodicalId":332790,"journal":{"name":"Journal of Integrated Care Pathways","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123947409","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":"Introducing clinical pathways as a strategy for improving care","authors":"Sander Feuth, Leonie Claes","doi":"10.1258/jicp.2008.008008","DOIUrl":"https://doi.org/10.1258/jicp.2008.008008","url":null,"abstract":"This article describes the way in which Catharina Hospital introduced clinical pathways to its workforce. The hospital, one of the largest non-academic teaching hospitals in The Netherlands, developed the first clinical pathway in 2004. Since then, clinical pathways have been presented as a strategic tool for improving care. In preparation for an organization-wide project, a team investigated and adapted the methodology as designed by the Clinical Pathway Network to the specific situation of Catharina Hospital. Staff were educated, which in return provided project teams with methodology and tools for development. Started small, the aim of the project is to achieve a snowball effect in the use of clinical pathways. Having started in 2006, six pathways are currently under construction, more of which are considered for development. An evaluation of the methodology and results in the summer of 2007, showed that the method was of great help in optimizing care processes and developing multidisciplinary agreements.","PeriodicalId":332790,"journal":{"name":"Journal of Integrated Care Pathways","volume":"145 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116479994","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":"Use of an integrated care pathway in improving secondary prevention of osteoporosis","authors":"Gavin Dabrera","doi":"10.1258/jicp.2007.007179","DOIUrl":"https://doi.org/10.1258/jicp.2007.007179","url":null,"abstract":"The authors audited how many patients admitted with hip fractures were correctly commenced with treatment for the secondary prevention of osteoporosis by the time of discharge. Such treatments were recognized as the standard of care by current guidelines. The initial audit cycle consisted of a retrospective review of 20 case notes of patients admitted with hip fractures, aged 65 years. This initial cycle identified that correct osteoporosis medications were started in only 40% of patients at discharge. Following this, an integrated care pathway (ICP) combining different elements of care for patients admitted with hip fractures was introduced. This ICP included tick-boxes for expected actions, including prescription for medications for secondary treatment of osteoporosis. A second cycle of audit was performed after the introduction of this ICP for 20 sets of case notes. This cycle found that prescription of medications for the secondary prevention of osteoporosis had increased to 80% by the time of discharge. The authors concluded that the tick-box approach had acted as ‘an aide-memoir’ to improve the quality of patient care.","PeriodicalId":332790,"journal":{"name":"Journal of Integrated Care Pathways","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131827570","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":"Solihull constipation pathway","authors":"Sarah Wells, D. Amies, Fiona Dawes, J. Millichap, Sue Reynolds","doi":"10.1258/jicp.2007.007178","DOIUrl":"https://doi.org/10.1258/jicp.2007.007178","url":null,"abstract":"ABSTRACT Constipation management is in need of improvement. This improvement is more likely to be achieved with a thorough initial assessment and ongoing daily monitoring with evaluation. A practical, user-friendly documentation system that facilitates this has been developed at Marie Curie Hospice, Solihull. It is currently being used with great success in a hospice inpatient setting and is transferable to hospitals. With some modification it could be used by district nurses and general practitioners in the community. It is an important step towards improving the management of constipation.","PeriodicalId":332790,"journal":{"name":"Journal of Integrated Care Pathways","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126137160","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":"Counselling of complications of termination of pregnancy within a single trust setting","authors":"Gavin Dabrera","doi":"10.1258/jicp.2007.007180","DOIUrl":"https://doi.org/10.1258/jicp.2007.007180","url":null,"abstract":"The authors performed an initial retrospective audit of the notes of women requesting termination of pregnancy (TOP) in both nurse-led and consultant-led clinics. The standard for the audit was documented counselling of six of the potential complications recognized by the Royal College of Obstetricians and Gynaecologists. The initial audit cycle found that consultant-led notes had recorded consent for a mean of two potential complications, while nurse-led notes had recorded consent for a mean of four potential complications. Following this initial audit cycle, the authors introduced an integrated care pathway (ICP) document. In addition to entries about personal information and medical history, a section about potential complications was included. These were included as tickboxes, as the authors intended them to act as prompts. After introduction of this ICP, the authors re-audited notes prospectively. Following this cycle, consultant-led notes now had a recorded consent for a mean of four potential complications, while nurse-led notes had recorded consent for a mean of five potential complications. Discussion","PeriodicalId":332790,"journal":{"name":"Journal of Integrated Care Pathways","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121794015","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}