Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M07
Michelle Le Braz, E. D. Clercq, C. Juillet, N. Garin, A. Perrier
Objectives: To measure the reliability of data mining for indicators related to patient treatment at hospital discharge. Methods: Design: Retrospective cohort study. Population: Patients discharged alive after an admission for heart failure in a general internal medicine department from 2009 to 2010. Data: Key treatments at patient's discharge extracted from the clinical information system compared with data extracted manually from the medical records. Endpoint: Accuracy of data mining for treatment prescription. Analysis: Sensitivity, specificity, positive and negative predictive values (PPVs and NPVs) of data mining for angiotensin-converting enzyme (ACE) inhibitors and betablockers prescription discharge. The gold standard was manual data extraction. We then investigated causes of discrepancies between the two methods. Results: A total of 724 patients were included. At discharge, 85.2% received an ACE inhibitor and 72.4% a beta-blocker. For ACE inhibitors, data mining yielded a sensitivity of 90%, a specificity of 100%, a PPV of 100% and an NPV of 64%. Corresponding values for beta-blockers were 95%, 100%, 100% and 88%, respectively. Main causes for discrepancy were: omission of some molecules in the electronic query used; non-standard writing of a prescription in the clinical information system; formats incorrectly interpreted by the query. Conclusion: Immediate reliance on data mining for drug prescription is currently unwarranted because this complex process is still prone to errors. Results should be manually checked before they can be used as quality indicators.
{"title":"Example of data mining use to follow indicators in clinical pathways","authors":"Michelle Le Braz, E. D. Clercq, C. Juillet, N. Garin, A. Perrier","doi":"10.1258/JICP.2012.012M07","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M07","url":null,"abstract":"Objectives: To measure the reliability of data mining for indicators related to patient treatment at hospital discharge. Methods: Design: Retrospective cohort study. Population: Patients discharged alive after an admission for heart failure in a general internal medicine department from 2009 to 2010. Data: Key treatments at patient's discharge extracted from the clinical information system compared with data extracted manually from the medical records. Endpoint: Accuracy of data mining for treatment prescription. Analysis: Sensitivity, specificity, positive and negative predictive values (PPVs and NPVs) of data mining for angiotensin-converting enzyme (ACE) inhibitors and betablockers prescription discharge. The gold standard was manual data extraction. We then investigated causes of discrepancies between the two methods. Results: A total of 724 patients were included. At discharge, 85.2% received an ACE inhibitor and 72.4% a beta-blocker. For ACE inhibitors, data mining yielded a sensitivity of 90%, a specificity of 100%, a PPV of 100% and an NPV of 64%. Corresponding values for beta-blockers were 95%, 100%, 100% and 88%, respectively. Main causes for discrepancy were: omission of some molecules in the electronic query used; non-standard writing of a prescription in the clinical information system; formats incorrectly interpreted by the query. Conclusion: Immediate reliance on data mining for drug prescription is currently unwarranted because this complex process is still prone to errors. Results should be manually checked before they can be used as quality indicators.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"37 15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116788216","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}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M01
K. Altman, C. Takizawa, R. Martino, R. Speyer, L. Derex, H. Chevrou-Séverac, R. Altman
{"title":"Dysphagia screening, evaluation and treatment in stroke: implementation and integration with multiple concurrent clinical pathways","authors":"K. Altman, C. Takizawa, R. Martino, R. Speyer, L. Derex, H. Chevrou-Séverac, R. Altman","doi":"10.1258/JICP.2012.012M01","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M01","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130259871","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}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M52
M. Panella, K. Vanhaecht
{"title":"State of the art of research in care pathways: do care pathways work?","authors":"M. Panella, K. Vanhaecht","doi":"10.1258/JICP.2012.012M52","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M52","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132181594","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}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M05
S. Deneckere, M. Euwema, C. Lodewijckx, M. Panella, W. Sermeus, K. Vanhaecht
{"title":"Improving interprofessional teamwork with care pathways: challenges for pathway researchers and health-care managers","authors":"S. Deneckere, M. Euwema, C. Lodewijckx, M. Panella, W. Sermeus, K. Vanhaecht","doi":"10.1258/JICP.2012.012M05","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M05","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124920913","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}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M09
C. Lodewijckx, W. Sermeus, M. Panella, S. Deneckere, F. Leigheb, M. Decramer, K. Vanhaecht
{"title":"Impact of a care pathway for exacerbation of chronic obstructive pulmonary disease: a cluster randomized controlled trial","authors":"C. Lodewijckx, W. Sermeus, M. Panella, S. Deneckere, F. Leigheb, M. Decramer, K. Vanhaecht","doi":"10.1258/JICP.2012.012M09","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M09","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"2012 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129853076","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}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M03
R. Camacho-Bejarano, M. Mariscal-Crespo, W. Sermeus, K. Vanhaecht, Dolores Merino-Navarro
{"title":"Validation of the Spanish version of the care process self-evaluation tool","authors":"R. Camacho-Bejarano, M. Mariscal-Crespo, W. Sermeus, K. Vanhaecht, Dolores Merino-Navarro","doi":"10.1258/JICP.2012.012M03","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M03","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134465817","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}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M12
A. M. Murante, S. Nuti
{"title":"The relationship between patient involvement and hospital accreditation standards","authors":"A. M. Murante, S. Nuti","doi":"10.1258/JICP.2012.012M12","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M12","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116186203","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}
Pub Date : 2012-06-01DOI: 10.1258/JICP.2012.012M15
F. V. Ewijk, M. A. Hugo
{"title":"Care pathways within orthopaedics: alike when possible, different when necessary","authors":"F. V. Ewijk, M. A. Hugo","doi":"10.1258/JICP.2012.012M15","DOIUrl":"https://doi.org/10.1258/JICP.2012.012M15","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125296544","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}
Pub Date : 2012-03-01DOI: 10.1258/jicp.2012.010031
E. Zwaan, V. Umans
Clinical pathways attempt to increase efficiency by organizing the care delivery process into individual analysable steps. We evaluate a digital clinical pathway for electrocardioversion in atrial fibrillation with a nurse coordinator in the ongoing consecutive experience in clinical practice. This paper describes the implementation and effects of introducing a clinical pathway. The pathway was launched in January 2008. Up to January 2009, 450 all-comer elective patients have been treated using this integrated digital clinical pathway without exception. Treatment and outpatient check-up appointments are made immediately for all patients. The pathway reduced walk-through times significantly. A clinical pathway for cardioversion patients is safely and efficaciously introduced in a teaching hospital.
{"title":"Step by step towards a clinical pathway","authors":"E. Zwaan, V. Umans","doi":"10.1258/jicp.2012.010031","DOIUrl":"https://doi.org/10.1258/jicp.2012.010031","url":null,"abstract":"Clinical pathways attempt to increase efficiency by organizing the care delivery process into individual analysable steps. We evaluate a digital clinical pathway for electrocardioversion in atrial fibrillation with a nurse coordinator in the ongoing consecutive experience in clinical practice. This paper describes the implementation and effects of introducing a clinical pathway. The pathway was launched in January 2008. Up to January 2009, 450 all-comer elective patients have been treated using this integrated digital clinical pathway without exception. Treatment and outpatient check-up appointments are made immediately for all patients. The pathway reduced walk-through times significantly. A clinical pathway for cardioversion patients is safely and efficaciously introduced in a teaching hospital.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"43 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":"115213952","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}
Pub Date : 2012-03-01DOI: 10.1258/jicp.2011.011m33
C. Lodewijckx, K. Vanhaecht, M. Panella
The rise of chronic diseases represents major challenges for actual health-care systems. Most developed countries are facing growing health-care costs due to an aging population in which 70% of health-care expenses are related to chronic diseases, and the current fragile economic climate may progressively limit resources available to health-care systems. Another challenge lies in the actual organization of health-care delivery systems. Current health-care delivery systems are often unable to meet the complex needs of chronically ill patients for several reasons. Firstly, health care is traditionally focused on acute care management and short-term goals. Secondly, fragmented delivery of health and social services, including disconnection of primary and secondary care, is an acknowledged problem in many health-care systems. Thirdly, too often chronic care approaches feature an uninformed, passive patient interacting with a poorly coordinated team of health professionals, resulting in frustrating and inadequate encounters. Finally, despite the availability of worldwide evidence-based practice guidelines for a wide range of chronic diseases, the use of evidencebased standards remains limited. A well-established model designed to guide the reorganization of health-care delivery systems from acute and reactive care to proactive, planned and community-based care is the Chronic Care Model (CCM) developed by Wagner et al. In this systemic model, improved functional and clinical outcomes of disease management are the results of productive interactions between informed, activated patients and a prepared, proactive practice team of healthcare professionals. These productive interactions are supported by six components: health-care organization, community resources, self-management support delivery system design, decision support, and clinical information systems. To better integrate aspects of prevention and health promotion into the CCM, an enhanced version called the Expanded Chronic Care Model was developed by Barr et al. The CCM has been used widely to guide the reorganization of health-care delivery systems; however, implementation has been shown to be fragmented and limited to one or two components, mostly including self management, multidisciplinary teamwork and information systems. This defragmented and limited implementation may explain today’s poor integration of care across organizations, unbalanced skill mix and lack of patient involvement in the current health-care delivery systems. Furthermore, practices and change strategies used to reorganize health care according to CCM delivery systems vary highly across health-care systems. Several attempts have been made to adequately measure the effectiveness of reorganizing care according to the CCM. However, because of defragmented implementation, different change strategies and different measuring methods and outcome indicators, the effectiveness of reorganizing health-care delivery systems according
慢性病的增加是实际卫生保健系统面临的重大挑战。由于人口老龄化，其中70%的卫生保健费用与慢性病有关，大多数发达国家正面临日益增长的卫生保健费用，而当前脆弱的经济气候可能会逐渐限制卫生保健系统的可用资源。另一个挑战在于卫生保健提供系统的实际组织。由于若干原因，目前的卫生保健提供系统往往无法满足慢性病患者的复杂需求。首先，卫生保健传统上侧重于急性护理管理和短期目标。第二，卫生和社会服务的提供支离破碎，包括初级和二级保健脱节，是许多卫生保健系统公认的问题。第三，慢性护理方法的特点往往是不知情、被动的患者与协调不力的卫生专业人员团队互动，导致令人沮丧和不充分的接触。最后，尽管世界范围内有针对多种慢性疾病的循证实践指南，但循证标准的使用仍然有限。Wagner等人开发的慢性护理模型(Chronic care model, CCM)是一种完善的模型，旨在指导卫生保健服务系统的重组，从急性和被动护理转向主动、有计划和基于社区的护理。在这个系统模型中，疾病管理的功能和临床结果的改善是知情、活跃的患者和有准备、积极主动的医疗保健专业人员实践团队之间富有成效的互动的结果。这些富有成效的互动由六个组成部分提供支持:卫生保健组织、社区资源、自我管理支持交付系统设计、决策支持和临床信息系统。为了更好地将预防和健康促进方面整合到CCM中，Barr等人开发了一种称为扩展慢性护理模型的增强版本。CCM已被广泛用于指导卫生保健服务系统的重组;但是，执行工作已显示是支离破碎的，只限于一两个组成部分，主要包括自我管理、多学科的团队合作和信息系统。这种非碎片化和有限的实施可能解释了当今各组织间护理整合不佳、技能组合不平衡以及当前卫生保健提供系统缺乏患者参与的原因。此外，根据CCM提供系统重组卫生保健的做法和改变策略在各个卫生保健系统中差异很大。已经进行了几次尝试，以充分衡量根据CCM重组护理的有效性。然而，由于非碎片化的实施、不同的变革策略、不同的测量方法和结果指标，根据CCM重组卫生保健提供系统的有效性及其对卫生保健成本的影响仍不清楚。此外，当有效地将CCM证据转化为临床实践时，仍不清楚应该实施哪些最佳实践。促进所有CCM组成部分整合的可能策略是实施护理途径。在信息技术的推动下，连接初级保健和医院并允许多学科团队与活跃的患者和社区互动的护理途径可能会遇到CCM的碎片化实施，并具有优化患者护理和结果(如住院率和生活质量)的巨大潜力。在急性住院环境中，已经对护理途径对护理过程依从性和结果表现的影响进行了广泛评估。然而，慢性护理的重点需要转向治疗处于慢性疾病所有阶段的患者，包括早期阶段和管理稳定和长期疾病。为了开发一条有效的包括预防性、急性和长期护理的护理途径，我们需要知道哪些组成部分，更具体地说，哪些最佳做法对这条护理途径的正常运作和有效性至关重要。然而，如前所述，分散和多样化的CCM实施策略和使用多样化的结果措施意味着人们不知道积极的基本组成部分和实践，以发展像这些综合慢性护理途径这样的结构。出于这个原因，我们认为一些研究领域应该写在护理途径下一个挑战的议程上。首先，有必要确定描述“跨组织和跨边界的护理协调”的最佳实践。
{"title":"A new model of care pathways for reorganization of chronic care","authors":"C. Lodewijckx, K. Vanhaecht, M. Panella","doi":"10.1258/jicp.2011.011m33","DOIUrl":"https://doi.org/10.1258/jicp.2011.011m33","url":null,"abstract":"The rise of chronic diseases represents major challenges for actual health-care systems. Most developed countries are facing growing health-care costs due to an aging population in which 70% of health-care expenses are related to chronic diseases, and the current fragile economic climate may progressively limit resources available to health-care systems. Another challenge lies in the actual organization of health-care delivery systems. Current health-care delivery systems are often unable to meet the complex needs of chronically ill patients for several reasons. Firstly, health care is traditionally focused on acute care management and short-term goals. Secondly, fragmented delivery of health and social services, including disconnection of primary and secondary care, is an acknowledged problem in many health-care systems. Thirdly, too often chronic care approaches feature an uninformed, passive patient interacting with a poorly coordinated team of health professionals, resulting in frustrating and inadequate encounters. Finally, despite the availability of worldwide evidence-based practice guidelines for a wide range of chronic diseases, the use of evidencebased standards remains limited. A well-established model designed to guide the reorganization of health-care delivery systems from acute and reactive care to proactive, planned and community-based care is the Chronic Care Model (CCM) developed by Wagner et al. In this systemic model, improved functional and clinical outcomes of disease management are the results of productive interactions between informed, activated patients and a prepared, proactive practice team of healthcare professionals. These productive interactions are supported by six components: health-care organization, community resources, self-management support delivery system design, decision support, and clinical information systems. To better integrate aspects of prevention and health promotion into the CCM, an enhanced version called the Expanded Chronic Care Model was developed by Barr et al. The CCM has been used widely to guide the reorganization of health-care delivery systems; however, implementation has been shown to be fragmented and limited to one or two components, mostly including self management, multidisciplinary teamwork and information systems. This defragmented and limited implementation may explain today’s poor integration of care across organizations, unbalanced skill mix and lack of patient involvement in the current health-care delivery systems. Furthermore, practices and change strategies used to reorganize health care according to CCM delivery systems vary highly across health-care systems. Several attempts have been made to adequately measure the effectiveness of reorganizing care according to the CCM. However, because of defragmented implementation, different change strategies and different measuring methods and outcome indicators, the effectiveness of reorganizing health-care delivery systems according ","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"36 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":"121926316","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}
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