Pub Date : 2009-11-01DOI: 10.1258/JICP.2009.009008
K. Bower
Clinical paths have demonstrated their value in support of patient care management throughout the last 25 years of use. With over 25 years of experience in using clinical paths, a number of lessons have been learned. The remainder of this article will outline 12 of those lessons. Clinical paths provide continuity of plan that needs to be augmented by continuity of provider, particularly for patients with complex issues. Clinical paths of the future will be simultaneously more simple and more complex. This dichotomy is related to increasingly complex treatment modalities; increasing numbers of care sites; and rapid infusion of evidence and research findings. Clinical paths must help simplify and focus care for providers who are engaged in providing individualized, evidence-based, focused and comprehensive care to diverse patients. And most importantly, they must make a difference to patients and their families.
{"title":"Clinical pathways: 12 lessons learned over 25 years of experience","authors":"K. Bower","doi":"10.1258/JICP.2009.009008","DOIUrl":"https://doi.org/10.1258/JICP.2009.009008","url":null,"abstract":"Clinical paths have demonstrated their value in support of patient care management throughout the last 25 years of use. With over 25 years of experience in using clinical paths, a number of lessons have been learned. The remainder of this article will outline 12 of those lessons. Clinical paths provide continuity of plan that needs to be augmented by continuity of provider, particularly for patients with complex issues. Clinical paths of the future will be simultaneously more simple and more complex. This dichotomy is related to increasingly complex treatment modalities; increasing numbers of care sites; and rapid infusion of evidence and research findings. Clinical paths must help simplify and focus care for providers who are engaged in providing individualized, evidence-based, focused and comprehensive care to diverse patients. And most importantly, they must make a difference to patients and their families.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123777396","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 : 2009-11-01DOI: 10.1258/jicp.2009.009007
M. Panella
This study was undertaken to determine how care pathways (CPs) in the hospital treatment of heart failure (HF) affected in-hospital mortality, and outcomes at discharge. A two-arm, cluster randomized trial was conducted. Fourteen community hospitals were randomized either to arm 1 (CPs) or to arm 2 (no intervention, usual care). A sample size of 424 patients (212 in each group) was used in order to have 80% of power at the 5% significance level (two-sided). The primary outcome measure was in-hospital mortality. Secondary outcomes were also evaluated. In-hospital mortality was 5.6% in the experimental arm and 15.4% in the controls (P = 0.001). In CP and usual care groups, the mean rates of unscheduled readmissions were 7.9% and 13.9%, respectively. Adjusting for age, smoking, New York Heart Association (NYHA) score, hypertension and source of referral, patients in the CP group, as compared with controls, had a significantly lower risk of in-hospital death (odds ratio [OR] = 0.18; 95% confidence interval [CI]: 0.07–0.46) and unscheduled readmissions (OR = 0.42; CI = 0.20–0.87). No differences were found between CP and control with respect to the appropriateness of the stay, costs and patient's satisfaction. This paper examines the evaluation of a complex intervention and adds evidence to previous knowledge, indicating that CP should be used to improve the quality of hospital treatment of HF.
{"title":"The impact of pathways: a significant decrease in mortality","authors":"M. Panella","doi":"10.1258/jicp.2009.009007","DOIUrl":"https://doi.org/10.1258/jicp.2009.009007","url":null,"abstract":"This study was undertaken to determine how care pathways (CPs) in the hospital treatment of heart failure (HF) affected in-hospital mortality, and outcomes at discharge. A two-arm, cluster randomized trial was conducted. Fourteen community hospitals were randomized either to arm 1 (CPs) or to arm 2 (no intervention, usual care). A sample size of 424 patients (212 in each group) was used in order to have 80% of power at the 5% significance level (two-sided). The primary outcome measure was in-hospital mortality. Secondary outcomes were also evaluated. In-hospital mortality was 5.6% in the experimental arm and 15.4% in the controls (P = 0.001). In CP and usual care groups, the mean rates of unscheduled readmissions were 7.9% and 13.9%, respectively. Adjusting for age, smoking, New York Heart Association (NYHA) score, hypertension and source of referral, patients in the CP group, as compared with controls, had a significantly lower risk of in-hospital death (odds ratio [OR] = 0.18; 95% confidence interval [CI]: 0.07–0.46) and unscheduled readmissions (OR = 0.42; CI = 0.20–0.87). No differences were found between CP and control with respect to the appropriateness of the stay, costs and patient's satisfaction. This paper examines the evaluation of a complex intervention and adds evidence to previous knowledge, indicating that CP should be used to improve the quality of hospital treatment of HF.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129030172","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 : 2009-04-01DOI: 10.1258/JICP.2008.009005
Julie E. Hall, P. Callaghan
{"title":"Part 1: The organization of mental health care. Contrasting prevailing approaches with integrated care pathways – care plans, case management and integrated care pathways","authors":"Julie E. Hall, P. Callaghan","doi":"10.1258/JICP.2008.009005","DOIUrl":"https://doi.org/10.1258/JICP.2008.009005","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127991111","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 : 2009-04-01DOI: 10.1258/JICP.2008.009004
R. Davies, C. Gray
The built environment in which health and social care is delivered can have an impact on the efficiency and outcomes of care processes. The health-care estate is large and growing and is expensive to build, adapt and maintain. The design of these buildings is a complex, difficult and political process. Better use of care pathways as an input to the design and use of the built environment has the potential to deliver significant benefits. A number of variations on the idea of care pathways are already used in designing health-care buildings but this is under-researched. This paper provides a framework for thinking about care pathways and the health-care built environment. The framework distinguishes between five different pathway ‘types’ defined for the purpose of understanding the relationship between pathways and infrastructure. The five types are: ‘care pathways’, ‘integrated care pathways’, ‘patient pathways’, ‘patient journeys’ and ‘patient flows’. The built environment implications of each type are discussed and recommendations made for those involved in either building development or care pathway projects.
{"title":"Care pathways and designing the health-care built environment: an explanatory framework","authors":"R. Davies, C. Gray","doi":"10.1258/JICP.2008.009004","DOIUrl":"https://doi.org/10.1258/JICP.2008.009004","url":null,"abstract":"The built environment in which health and social care is delivered can have an impact on the efficiency and outcomes of care processes. The health-care estate is large and growing and is expensive to build, adapt and maintain. The design of these buildings is a complex, difficult and political process. Better use of care pathways as an input to the design and use of the built environment has the potential to deliver significant benefits. A number of variations on the idea of care pathways are already used in designing health-care buildings but this is under-researched. This paper provides a framework for thinking about care pathways and the health-care built environment. The framework distinguishes between five different pathway ‘types’ defined for the purpose of understanding the relationship between pathways and infrastructure. The five types are: ‘care pathways’, ‘integrated care pathways’, ‘patient pathways’, ‘patient journeys’ and ‘patient flows’. The built environment implications of each type are discussed and recommendations made for those involved in either building development or care pathway projects.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128226592","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 : 2009-04-01DOI: 10.1258/JICP.2008.009006
Julie E. Hall, P. Callaghan
{"title":"Part 2: The organization of mental health care. Contrasting prevailing approaches with integrated care pathways – integrated care pathways, the care programme approach and clinical guidelines","authors":"Julie E. Hall, P. Callaghan","doi":"10.1258/JICP.2008.009006","DOIUrl":"https://doi.org/10.1258/JICP.2008.009006","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115094223","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 : 2009-04-01DOI: 10.1258/JICP.2008.009002
Himanchu Borase, K. Evans, K. Bidgood, R. Fox
{"title":"Termination for fetal abnormality","authors":"Himanchu Borase, K. Evans, K. Bidgood, R. Fox","doi":"10.1258/JICP.2008.009002","DOIUrl":"https://doi.org/10.1258/JICP.2008.009002","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115137145","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 : 2009-04-01DOI: 10.1258/JICP.2009.009001
J. Gray
{"title":"The future of care pathways and their journal","authors":"J. Gray","doi":"10.1258/JICP.2009.009001","DOIUrl":"https://doi.org/10.1258/JICP.2009.009001","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"329 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134159818","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":"Nimbus Conference 2006","authors":"J. Gray","doi":"10.1258/J.JICP.2006.148","DOIUrl":"https://doi.org/10.1258/J.JICP.2006.148","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116378310","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":"A personal view of the Integrated Care Pathways Conference 2006","authors":"P. Goodland","doi":"10.1258/J.JICP.2006.139","DOIUrl":"https://doi.org/10.1258/J.JICP.2006.139","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134199366","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 Pathways 2006","authors":"M. Sue","doi":"10.1258/J.JICP.2006.138","DOIUrl":"https://doi.org/10.1258/J.JICP.2006.138","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132279728","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：