Pub Date : 2011-12-01DOI: 10.1258/jicp.2011.011m30
M. Herrera, A. García, Irma Sosa Lorenzo
The aim of the paper is to describe the importance and need for the implementation of the economic evaluation of health technologies for increasing efficiency in the field of health in Cuba, as well as exposing the implementation of this activity in the National Health System (NHS) and projections of work being developed in the country. We performed a literature review to search for information on this subject at national and international level to gauge the incorporation of this discipline as an element to increase efficiency in the Cuban health system. The economic evaluation applied to the health field in Cuba is considered an aspect that contributes to the efficient use of resources. Although the costs of new technology are large, their value in terms of efficiency can identify the most effective and less costly ways to support the process of decision-making. In conclusion, the economic evaluation of health technologies has become a necessity for the NHS, since its incorporation can guide decision-making to increase the efficiency of health interventions.
{"title":"The economic evaluation of health technologies in Cuba: results achieved and challenges for the country","authors":"M. Herrera, A. García, Irma Sosa Lorenzo","doi":"10.1258/jicp.2011.011m30","DOIUrl":"https://doi.org/10.1258/jicp.2011.011m30","url":null,"abstract":"The aim of the paper is to describe the importance and need for the implementation of the economic evaluation of health technologies for increasing efficiency in the field of health in Cuba, as well as exposing the implementation of this activity in the National Health System (NHS) and projections of work being developed in the country. We performed a literature review to search for information on this subject at national and international level to gauge the incorporation of this discipline as an element to increase efficiency in the Cuban health system. The economic evaluation applied to the health field in Cuba is considered an aspect that contributes to the efficient use of resources. Although the costs of new technology are large, their value in terms of efficiency can identify the most effective and less costly ways to support the process of decision-making. In conclusion, the economic evaluation of health technologies has become a necessity for the NHS, since its incorporation can guide decision-making to increase the efficiency of health interventions.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"58 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":"116652597","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 : 2011-06-01DOI: 10.1258/jicp.2011.011M04
Kris Vanhaecht, R. V. Zelm, E. V. Gerven, Walter Sermeus, K. Bower, M. Panella, S. Deneckere
The development and implementation of a care pathway is a complex intervention. One of the goals is to standardize the interprofessional teamwork. During the development of the care pathway, the team can use the 3-blackboard method to systematically define the goals, describe the organization of the care process and develop a list of topics for further analysis. The 3-blackboard method is a consensus development exercise which can be used for pathway projects but also during other quality and patient safety improvement exercises.
{"title":"The 3-blackboard method as consensus-development exercise for building care pathways","authors":"Kris Vanhaecht, R. V. Zelm, E. V. Gerven, Walter Sermeus, K. Bower, M. Panella, S. Deneckere","doi":"10.1258/jicp.2011.011M04","DOIUrl":"https://doi.org/10.1258/jicp.2011.011M04","url":null,"abstract":"The development and implementation of a care pathway is a complex intervention. One of the goals is to standardize the interprofessional teamwork. During the development of the care pathway, the team can use the 3-blackboard method to systematically define the goals, describe the organization of the care process and develop a list of topics for further analysis. The 3-blackboard method is a consensus development exercise which can be used for pathway projects but also during other quality and patient safety improvement exercises.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127433683","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 : 2011-06-01DOI: 10.1258/jicp.2011.010030
R. Johnstone, A. Jones, A. Fowell
This paper describes the progression over 10 years of a project to implement a care pathway for the last days of life across Wales, leading to a major revision of the pathway in 2010. An initial 38 sites throughout Wales representing hospital, hospice and community settings registered. This has led to a robust end of life care network across the principality. In 2007 an annual audit cycle was established, with outcomes being fed back to the participating sites as well as informing an annual review of the integrated care pathway (ICP). In 2010, there are now over 100 sites using the ICP to deliver high-quality end of life care to patients in Wales. There has been a drop in the number of recorded variances of symptom problems. As a result of widespread adverse publicity, a fundamental re-write of the pathway was carried out. The new pathway was launched at a national conference and all teams provided with new documentation and explanation for the need to change. Within three months, most teams were using the new ICP and individual visits were carried out to those that had difficulty. In conclusion, it is possible to implement, sustain and maintain the use of an ICP for the past days of life over a large and varied geographical area. Major changes can be implemented quickly if sufficient involvement and explanation are carried out. The lessons learnt are transferable to other disciplines seeking to use an ICP.
{"title":"Welsh Collaborative Care Pathway Project; 10 years experience of implementing and maintaining a care pathway for the last days of life","authors":"R. Johnstone, A. Jones, A. Fowell","doi":"10.1258/jicp.2011.010030","DOIUrl":"https://doi.org/10.1258/jicp.2011.010030","url":null,"abstract":"This paper describes the progression over 10 years of a project to implement a care pathway for the last days of life across Wales, leading to a major revision of the pathway in 2010. An initial 38 sites throughout Wales representing hospital, hospice and community settings registered. This has led to a robust end of life care network across the principality. In 2007 an annual audit cycle was established, with outcomes being fed back to the participating sites as well as informing an annual review of the integrated care pathway (ICP). In 2010, there are now over 100 sites using the ICP to deliver high-quality end of life care to patients in Wales. There has been a drop in the number of recorded variances of symptom problems. As a result of widespread adverse publicity, a fundamental re-write of the pathway was carried out. The new pathway was launched at a national conference and all teams provided with new documentation and explanation for the need to change. Within three months, most teams were using the new ICP and individual visits were carried out to those that had difficulty. In conclusion, it is possible to implement, sustain and maintain the use of an ICP for the past days of life over a large and varied geographical area. Major changes can be implemented quickly if sufficient involvement and explanation are carried out. The lessons learnt are transferable to other disciplines seeking to use an ICP.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130335326","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 : 2011-06-01DOI: 10.1258/ijcp.2011.010034
Julie E. Hall, P. Callaghan
Integrated care pathways (ICPs) are prearranged processes of care that are being increasingly used to deliver mental health services. The literature to date reveals relatively little about service user and carer experience in relation to their use. This study was completed as part of case study research and focused on the experiences of service users and carers gathered using focus groups, as a unit of analysis. The findings revealed a number of contrasts including the perspective that people did not feel that their care was individualized to them, although among them they had different perceptions of the care process. Conclusions suggest that mental health ICPs need to reflect the relationships between stakeholders, variability of illness and individual ways of living if they are to provide a framework for managing care which is responsive to the needs of people using mental health services.
{"title":"Focus group study of service user and carer experience of an Integrated Care Pathway","authors":"Julie E. Hall, P. Callaghan","doi":"10.1258/ijcp.2011.010034","DOIUrl":"https://doi.org/10.1258/ijcp.2011.010034","url":null,"abstract":"Integrated care pathways (ICPs) are prearranged processes of care that are being increasingly used to deliver mental health services. The literature to date reveals relatively little about service user and carer experience in relation to their use. This study was completed as part of case study research and focused on the experiences of service users and carers gathered using focus groups, as a unit of analysis. The findings revealed a number of contrasts including the perspective that people did not feel that their care was individualized to them, although among them they had different perceptions of the care process. Conclusions suggest that mental health ICPs need to reflect the relationships between stakeholders, variability of illness and individual ways of living if they are to provide a framework for managing care which is responsive to the needs of people using mental health services.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117227068","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 : 2011-06-01DOI: 10.1258/JICP.2011.011M03
M. Panella, K. Vanhaecht
In 2009 when Kris Vanhaecht and I took over the editorship of the International Journal of Care Pathways – IJCP, the journal was struggling to consistently attract papers of sufficiently high quality. One of the first tasks that Kris and I tried to achieve was to broaden the journal’s scope and to try to turn the IJCP into a widely read, truly international journal that attracted papers and readers from all over the world. Our aim was (and still is) to produce a leading international peer-reviewed journal which focuses on the issues of the growing area of implementation research related to care pathways – CP (also known as clinical pathways, critical pathways or integrated care pathways) and the organization of care processes. The IJCP is now the official journal of the European Pathway Association (www.E-P-A.org), 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. A specific journal on care pathways is necessary to support health care clinicians and managers in their daily search for excellence by publishing project reports and to support academic discussions on the pathway concept and methods to evaluate pathways within the field of implementation research. 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. According to this, the IJCP focuses on how pathways and other structured care methodologies affect quality, safety, teamwork and efficiency, and 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 includes issues relating to the organization of the care process itself 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 IJCP concentrates on highlighting different areas of research but also on the general applicability and practical significance and importance to clinicians and health care managers. 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 outc
{"title":"The International Editorial Pathway of the IJCP","authors":"M. Panella, K. Vanhaecht","doi":"10.1258/JICP.2011.011M03","DOIUrl":"https://doi.org/10.1258/JICP.2011.011M03","url":null,"abstract":"In 2009 when Kris Vanhaecht and I took over the editorship of the International Journal of Care Pathways – IJCP, the journal was struggling to consistently attract papers of sufficiently high quality. One of the first tasks that Kris and I tried to achieve was to broaden the journal’s scope and to try to turn the IJCP into a widely read, truly international journal that attracted papers and readers from all over the world. Our aim was (and still is) to produce a leading international peer-reviewed journal which focuses on the issues of the growing area of implementation research related to care pathways – CP (also known as clinical pathways, critical pathways or integrated care pathways) and the organization of care processes. The IJCP is now the official journal of the European Pathway Association (www.E-P-A.org), 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. A specific journal on care pathways is necessary to support health care clinicians and managers in their daily search for excellence by publishing project reports and to support academic discussions on the pathway concept and methods to evaluate pathways within the field of implementation research. 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. According to this, the IJCP focuses on how pathways and other structured care methodologies affect quality, safety, teamwork and efficiency, and 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 includes issues relating to the organization of the care process itself 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 IJCP concentrates on highlighting different areas of research but also on the general applicability and practical significance and importance to clinicians and health care managers. 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 outc","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123378069","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 : 2011-06-01DOI: 10.1258/jicp.2011.011M01
Stephen K. Liu, F. Salvatoriello, John F. Dick, Scott C. Faucett, J. Robb
Electronic health records (EHRs) that include computerized provider order entry (CPOE) have the potential to reduce medical errors and adverse drug events, improve health outcomes and reduce health care costs. The success of CPOE is dependent upon the development of standardized evidence-based order sets and care pathways that are developed and used by clinical providers. However, development is dependent upon the engagement and clinical expertise of health care providers who are busy caring for patients and may not have the time or resources to devote to order set development. This paper describes one academic institution's experience in adopting a new EHR that includes CPOE and the efforts to stimulate the development of order set content throughout all clinical sections and departments. Based on this experience, specific recommendations and guidance to facilitate the development of evidence-based order set and care pathway content are described in the article. Through the use of the described strategies and techniques, over a three-year period the institution developed, approved and implemented 495 order sets authored by 141 different providers and well exceeded the established goals of the committee and institution.
{"title":"Facilitating the development of evidence-based order sets and care pathways: lessons learned from an academic medical centre's implementation of a new electronic health record","authors":"Stephen K. Liu, F. Salvatoriello, John F. Dick, Scott C. Faucett, J. Robb","doi":"10.1258/jicp.2011.011M01","DOIUrl":"https://doi.org/10.1258/jicp.2011.011M01","url":null,"abstract":"Electronic health records (EHRs) that include computerized provider order entry (CPOE) have the potential to reduce medical errors and adverse drug events, improve health outcomes and reduce health care costs. The success of CPOE is dependent upon the development of standardized evidence-based order sets and care pathways that are developed and used by clinical providers. However, development is dependent upon the engagement and clinical expertise of health care providers who are busy caring for patients and may not have the time or resources to devote to order set development. This paper describes one academic institution's experience in adopting a new EHR that includes CPOE and the efforts to stimulate the development of order set content throughout all clinical sections and departments. Based on this experience, specific recommendations and guidance to facilitate the development of evidence-based order set and care pathway content are described in the article. Through the use of the described strategies and techniques, over a three-year period the institution developed, approved and implemented 495 order sets authored by 141 different providers and well exceeded the established goals of the committee and institution.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129166078","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 : 2011-06-01DOI: 10.1258/JICP.2011.011M02
E. Biringer, R. van Zelm
Since 2007, the European Pathway Association (E-P-A) has successfully organized one-week courses in planning and implementation of Care pathways at Lake Orta, Italy. In 2011, E-P-A goes for another option: this time the E-P-A organizes a three-day course in Care pathways that includes the core contents of the previous ‘Summer Schools’. Now, the wonderful Italian environment is replaced with another beautiful location: the ‘Solstrand Fjord Hotel’ (Figure 1) (meaning ‘Sunny Beach Fjord Hotel’), which is situated 30 minutes south of the city of Bergen at the west coast of Norway. Bergen is Norway’s second biggest city and it is known for the Bryggen Hanseatic Wharf, the fish market, and surrounding mountains and fjords, such as the Hardangerfjord and Sognefjord, see http://www.visitnorway. com/en/Stories/Norway/Fjord-Norway/Bergen/ (Figure 2). The choice of a course location in Scandinavia is made for strategic reasons as Care pathways are only very rarely known as tools to achieve quality improvement in health care here. That is; E-P-A is now about to spread the message of Care pathways to the Nordic countries! The course is organized in close collaboration with the Research Network on Integrated Health Care in Western Norway and the Norwegian National E-P-A section.
{"title":"International course on ‘Care pathways’ and organization of care processes Solstrand Fjord Hotel, OS, Norway, 12–14 September 2011","authors":"E. Biringer, R. van Zelm","doi":"10.1258/JICP.2011.011M02","DOIUrl":"https://doi.org/10.1258/JICP.2011.011M02","url":null,"abstract":"Since 2007, the European Pathway Association (E-P-A) has successfully organized one-week courses in planning and implementation of Care pathways at Lake Orta, Italy. In 2011, E-P-A goes for another option: this time the E-P-A organizes a three-day course in Care pathways that includes the core contents of the previous ‘Summer Schools’. Now, the wonderful Italian environment is replaced with another beautiful location: the ‘Solstrand Fjord Hotel’ (Figure 1) (meaning ‘Sunny Beach Fjord Hotel’), which is situated 30 minutes south of the city of Bergen at the west coast of Norway. Bergen is Norway’s second biggest city and it is known for the Bryggen Hanseatic Wharf, the fish market, and surrounding mountains and fjords, such as the Hardangerfjord and Sognefjord, see http://www.visitnorway. com/en/Stories/Norway/Fjord-Norway/Bergen/ (Figure 2). The choice of a course location in Scandinavia is made for strategic reasons as Care pathways are only very rarely known as tools to achieve quality improvement in health care here. That is; E-P-A is now about to spread the message of Care pathways to the Nordic countries! The course is organized in close collaboration with the Research Network on Integrated Health Care in Western Norway and the Norwegian National E-P-A section.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131332828","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 : 2011-03-01DOI: 10.1258/JICP.2010.010M08
E. Biringer, M. Hartveit
We have read the paper by El-Ghorr et al. (Int J Care Pathways 2010;14:57-64) on Scotland's national approach to improving mental health services with great interest. The paper described the strategy developed by NHS Quality Improvement Scotland (NHS QIS) in which integrated care pathways were used as tools for redesign and continuous quality improvement. In our opinion, a similar national effort is also necessary in Norway. In particular, pathways would help bridge the ‘gap’ between primary and specialist services. We point to which elements of the Scottish programme it is that would be relevant to implement in Norway in future. Furthermore, we discuss factors that are already present in Norway upon which authorities, health leaders and professionals could build on in a future national-level implementation of pathways in mental health care.
我们非常感兴趣地阅读了El-Ghorr等人(Int J Care Pathways 2010;14:57-64)关于苏格兰改善精神卫生服务的国家方法的论文。本文描述了苏格兰国民保健服务质量改进(NHS QIS)制定的战略，其中综合护理途径被用作重新设计和持续质量改进的工具。我们认为，挪威也必须作出类似的全国性努力。特别是，路径将有助于弥合初级服务和专业服务之间的“差距”。我们指出，苏格兰方案的哪些内容与今后在挪威实施有关。此外，我们还讨论了挪威已经存在的因素，当局、卫生领导人和专业人员可以在今后国家一级实施精神卫生保健途径的基础上加以发展。
{"title":"A Future for Pathways in Mental Health Care in Norway: A Discussion Paper Based on El-Ghorr et al. (2010):","authors":"E. Biringer, M. Hartveit","doi":"10.1258/JICP.2010.010M08","DOIUrl":"https://doi.org/10.1258/JICP.2010.010M08","url":null,"abstract":"We have read the paper by El-Ghorr et al. (Int J Care Pathways 2010;14:57-64) on Scotland's national approach to improving mental health services with great interest. The paper described the strategy developed by NHS Quality Improvement Scotland (NHS QIS) in which integrated care pathways were used as tools for redesign and continuous quality improvement. In our opinion, a similar national effort is also necessary in Norway. In particular, pathways would help bridge the ‘gap’ between primary and specialist services. We point to which elements of the Scottish programme it is that would be relevant to implement in Norway in future. Furthermore, we discuss factors that are already present in Norway upon which authorities, health leaders and professionals could build on in a future national-level implementation of pathways in mental health care.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"38 S24","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120850832","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 : 2010-09-01DOI: 10.1258/jicp.2010.010013
J. Greenwood, S. Kavanagh, I. Mackie
The aim of the study was to reassess surgical protocols developed and introduced in 2005; to examine the changes that have been made and to understand why they have been necessary or felt to be an improvement on the original; and to introduce a new protocol to assist with burn depth assessment. A discussion of how the protocols were developed and the environment in which they are used is undertaken. Four years of experience using the protocols has been accrued. An examination of alterations is performed. The protocols have allowed a single-handed practitioner to deal successfully with a large caseload and enabled a greater understanding of time and resource management. The original development of the protocols was worthwhile but their continued evolution by frequent audit and evaluation of innovations in burn care is mandatory.
{"title":"Revisiting protocols for burn injury management","authors":"J. Greenwood, S. Kavanagh, I. Mackie","doi":"10.1258/jicp.2010.010013","DOIUrl":"https://doi.org/10.1258/jicp.2010.010013","url":null,"abstract":"The aim of the study was to reassess surgical protocols developed and introduced in 2005; to examine the changes that have been made and to understand why they have been necessary or felt to be an improvement on the original; and to introduce a new protocol to assist with burn depth assessment. A discussion of how the protocols were developed and the environment in which they are used is undertaken. Four years of experience using the protocols has been accrued. An examination of alterations is performed. The protocols have allowed a single-handed practitioner to deal successfully with a large caseload and enabled a greater understanding of time and resource management. The original development of the protocols was worthwhile but their continued evolution by frequent audit and evaluation of innovations in burn care is mandatory.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133946500","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 : 2010-09-01DOI: 10.1258/jicp.2010.010020
T. Bridgeman, H. Skinner, T. Zamansani, Michele M. Schulz
The total number of hip and knee arthroplasties has been increasing steadily in the USA every year. The University of California Irvine recognized a high volume activity that could be improved with the implementation of clinical pathways. Data collection was obtained by monitoring the clinical path on 138 patients. Baseline preoperative data and telephonic postoperative data were collected at 90 days postdischarge utilizing quality-of-life/functionality validated tools. Clinical path utilization was 100%. Ambulation day 1 was at 80% for hips and 85% for knees. Blood transfusions were at 56% for hips and 36% for knees. These percentages are well above the US national reported value for autologous blood transfusions of 30%. The short form 36 health survey questionnaire (SF-36) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) preoperative and postoperative data were available on 47 patients (35%) at 90 days. The WOMAC osteoarthritis index showed a percent mean difference improvement of 82% (pre = 35.8, post = 65.3). The SF-36 revealed statistical significance in physical functioning, role physical, social functioning, bodily pain, energy/vitality and mental health. In conclusion, clinical pathways are a reliable measure of health care. Analysis of clinical path variance and functional outcomes provide the necessary data for making sound business/health-care decisions.
{"title":"Hip and knee replacement continuum of care: combining clinical and functional outcome measurement","authors":"T. Bridgeman, H. Skinner, T. Zamansani, Michele M. Schulz","doi":"10.1258/jicp.2010.010020","DOIUrl":"https://doi.org/10.1258/jicp.2010.010020","url":null,"abstract":"The total number of hip and knee arthroplasties has been increasing steadily in the USA every year. The University of California Irvine recognized a high volume activity that could be improved with the implementation of clinical pathways. Data collection was obtained by monitoring the clinical path on 138 patients. Baseline preoperative data and telephonic postoperative data were collected at 90 days postdischarge utilizing quality-of-life/functionality validated tools. Clinical path utilization was 100%. Ambulation day 1 was at 80% for hips and 85% for knees. Blood transfusions were at 56% for hips and 36% for knees. These percentages are well above the US national reported value for autologous blood transfusions of 30%. The short form 36 health survey questionnaire (SF-36) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) preoperative and postoperative data were available on 47 patients (35%) at 90 days. The WOMAC osteoarthritis index showed a percent mean difference improvement of 82% (pre = 35.8, post = 65.3). The SF-36 revealed statistical significance in physical functioning, role physical, social functioning, bodily pain, energy/vitality and mental health. In conclusion, clinical pathways are a reliable measure of health care. Analysis of clinical path variance and functional outcomes provide the necessary data for making sound business/health-care decisions.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115590581","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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