Open Access
Use and evaluation of critical pathways in hospitals.
Jonathan Darer,Peter J. Pronovost,Eric B Bass +2 more
- Vol. 5, Iss: 3, pp 114-119
TLDR
The use of critical pathways varies substantially among hospitals participating in quality improvement consortia, with use highest in academic centers and lowest in community hospitals.Abstract:
Context Although hospitals have devoted substantial resources to critical pathways, it is not known whether they routinely evaluate the clinical or economic effects of these pathways. Objective To determine how use and evaluation of critical pathways differ between academic and community hospitals. Design Cross-sectional survey. Participants Hospitals participating in consortia for improving quality of care associated with the Institute of Health Care Improvement and the VHA, Inc. (formerly known as the Voluntary Hospitals of America, Inc.). Hospital administrators at 41 hospitals completed the survey (71% response rate), representing 13 academic medical centers, 13 community teaching hospitals, and 15 community hospitals. Measures Use of critical pathways and measurement of clinical and economic outcomes of pathways. Results The median number of adult critical pathways used by academic hospitals, community teaching hospitals, and community hospitals was 25, 18, and 3, respectively. The most common pathways were community-acquired pneumonia, total hip or knee replacement, and stroke or transient ischemic attack. The percentage of hospitals with pathways dedicating staff to manage them was 78% for academic hospitals, 22% for community teaching hospitals, and 14% for community hospitals (P = 0.02). Evaluation practices varied widely among hospitals with pathways. Measures assessed included monitoring length of stay (85%), total hospital costs (74%), in-hospital mortality (62%), infectious complications (53%), readmission rates (47%), functional status (18%), and adverse drug events (15%). Conclusion The use of critical pathways varies substantially among hospitals participating in quality improvement consortia. Use was highest in academic centers and lowest in community hospitals. Many hospitals with pathways do not track important clinical outcomes as part of their evaluation practices.read more
Citations
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Journal ArticleDOI
Effects of clinical pathways in the joint replacement: a meta-analysis.
A Barbieri,Kris Vanhaecht,P Van Herck,Walter Sermeus,Fabrizio Faggiano,Sara Marchisio,M Panella +6 more
TL;DR: In this paper, a meta-analysis was performed to evaluate the use of clinical pathways for hip and knee joint replacements when compared with standard medical care, evaluating the major outcomes of in-hospital joint replacement processes: postoperative complications, number of patients discharged at home, length of in hospital stay and direct costs.
Journal ArticleDOI
Prevalence and use of clinical pathways in 23 countries – an international survey by the European Pathway Association:
Kris Vanhaecht,Marcus Bollmann,Kathy Bower,Clare Gallagher,Andrea Gardini,Jen Guezo,Uwe jansen,Rashad Massoud,Karen Moody,Walter Sermeus,Walter Sermeus,Ruben van Zelm,Claire Whittle,Claire Whittle,Anne-Marie Yazbeck,Karen Zander,Massimiliano Panella,Massimiliano Panella +17 more
TL;DR: The survey showed that clinical pathways were predominantly viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care and were also used as a communication tool between professionals to manage and standardize outcome-oriented care.
Journal ArticleDOI
Clinical pathway audit tools: a systematic review.
TL;DR: Whether clinical/care pathway audit tools can identify the characteristics of well-organized care processes and the Integrated Care Pathway Appraisal Tool is the most appropriate audit tool to assess clinical pathway documents is investigated.
Journal ArticleDOI
Critical pathway effectiveness: assessing the impact of patient, hospital care, and pathway characteristics using qualitative comparative analysis.
Sydney M. Dy,Pushkal P. Garg,Dorothy Nyberg,Patricia B. Dawson,Peter J. Pronovost,Laura L. Morlock,Haya R. Rubin,Albert W. Wu +7 more
TL;DR: Critical pathway programs may have limited effectiveness, and may be effective only in certain situations, and the mechanism by which critical pathways may reduce length of stay is unclear.
Journal ArticleDOI
The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study
Helen C. Roberts,Ruth M. Pickering,Elizabeth Onslow,Mike Clancy,Jackie Powell,Alison Roberts,Kerry Hughes,Diane Coulson,J. Bray +8 more
TL;DR: This care pathway was associated with longer hospital stay and improved clinical outcomes, suggesting care pathways for hip fracture patients can be a useful tool for raising care standards but may require additional resources.
References
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Integrated care pathways
TL;DR: The degree to which integrated care pathways succeed in realising their potential for improving patient care is still uncertain, but enough evidence exists in their favour to justify more widespread evaluation of their impact.
Journal ArticleDOI
A Controlled Trial of a Critical Pathway for Treatment of Community-Acquired Pneumonia
Thomas J. Marrie,Catherine Y. Lau,Susan L. Wheeler,Cindy J. Wong,Margaret K. Vandervoort,Brian G. Feagan +5 more
TL;DR: Implementation of a critical pathway reduced the use of institutional resources without causing adverse effects on the well-being of patients in this study.
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Critical Pathways as a Strategy for Improving Care: Problems and Potential
TL;DR: In recent years, intense pressures to reduce the costs of health care have led many health care organizations to seek strategies that reduce resource utilization while maintaining the quality of care, among the most popular of the methods intended to meet this challenge are critical pathways.
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Evidence-Based Disease Management
TL;DR: This work presents a method for developing and implementing evidence-based clinical guidelines, clinical pathways, and algorithms and describes the creation of systems to measure and report processes and outcomes that could drive quality improvement in diabetes care.
Journal ArticleDOI
Rolling down the runway: the challenges ahead for quality report cards.
TL;DR: The authors need to find better ways to use quality reporting to empower purchasers and consumers and improve quality of care, and reap the advantages in different modalities of data collection and different tools for quality management.