scholarly journals Integrated care pathways on dementia in Italy: a survey testing the compliance with a national guidance

2019 ◽  
Vol 41 (4) ◽  
pp. 917-924
Author(s):  
Giuseppe Gervasi ◽  
Guido Bellomo ◽  
Flavia Mayer ◽  
Valerio Zaccaria ◽  
Ilaria Bacigalupo ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Pathway ◽  
Care Pathways ◽  
Local Health ◽  
Health Authorities ◽  
People With Dementia ◽  
Specific Objective ◽  
Item Checklist ◽  
Integrated Care Pathways ◽  
Integrated Care Pathway

AbstractDementias are chronic, degenerative neurological disorders with a complex management that require the cooperation of different healthcare professionals. The Italian Ministry of Health produced the document “Guidance on Integrated Care pathway for People with Dementia” (GICPD) with the specific objective of providing a standardized framework for the definition, development, and implementation of integrated care pathways (ICP) dedicated to people with dementia. We searched all available Italian territorial ICPs. Two raters assessed the retrieved ICPs with a 2-point scale on a 43-item checklist based on the GICPD. Only 5 out of 21 regions and 5 out of 101 local health authorities had an ICP, with most ICPs having a moderate compliance to the GICPD, in particular for the items referring to the development and implementation of the care pathways. A low to moderate inter-rater agreement was observed, mainly due to a lack of standardized models to describe ICPs for dementias. Results suggest that policy- and decision-makers should pay more attention to the GICPD when producing ICPs. The direct communication with clinicians, and the implementation of more precise and appropriate clinical outcomes, could increase the involvement of clinicians, whose participation is crucial to guarantee that ICPs meet needs of patients and their carers.

scholarly journals Quality Assessment of an Integrated Care Pathway Using Telemonitoring in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease: Protocol for a Quasi-Experimental Study (Preprint)

2020 ◽  
Author(s):  
Cyrille Herkert ◽  
Jos Johannes Kraal ◽  
Rudolph Ferdinand Spee ◽  
Anouk Serier ◽  
Lidwien Graat-Verboom ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Pathway ◽  
Single Case ◽  
Case Manager ◽  
Chronic Obstructive ◽  
Care Pathways ◽  
Obstructive Pulmonary Disease ◽  
On Demand ◽  
Quasi Experimental ◽  
Integrated Care Pathway

BACKGROUND Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually not integrated. This results in frequent outpatient consultations and suboptimal treatment during exacerbations, leading to frequent hospital admissions. Therefore, we propose an integrated care pathway for both diseases, using telemonitoring to detect deterioration at an early stage and a single case manager for both diseases. OBJECTIVE This study aims to investigate whether an integrated care pathway using telemonitoring in patients with combined CHF and COPD results in a higher general health-related QoL (HRQoL) as compared with the traditional care pathways. Secondary end points include disease-specific HRQoL, level of self-management, patient satisfaction, compliance to the program, and cost-effectiveness. METHODS This is a monocenter, prospective study using a quasi-experimental interrupted time series design. Thirty patients with combined CHF and COPD are included. The study period of 2.5 years per patient is divided into a preintervention phase (6 months) and a postintervention phase (2 years) in which end points are assessed. The intervention consists of an on-demand treatment strategy based on monitoring symptoms related to CHF/COPD and vital parameters (weight, blood pressure, heart rate, oxygen saturation, temperature), which are uploaded on a digital platform. The monitoring frequency and the limit values of the measurements to detect abnormalities are determined individually. Monitoring is performed by a case manager, who has the opportunity for a daily multidisciplinary meeting with both the cardiologist and the pulmonologist. Routine appointments at the outpatient clinic are cancelled and replaced by telemonitoring-guided treatment. RESULTS Following ethical approval of the study protocol, the first patient was included in May 2018. Inclusion is expected to be complete in May 2021. CONCLUSIONS This study is the first to evaluate the effects of a novel integrated care pathway using telemonitoring for patients with combined CHF and COPD. Unique to this study is the concept of remote on-demand disease management by a single case manager for both diseases, combined with multidisciplinary meetings. Moreover, modern telemonitoring technology is used instead of, rather than as an addition to, regular care. CLINICALTRIAL Netherlands Trial Register NL6741; https://www.trialregister.nl/trial/6741 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/20571

scholarly journals Quality Assessment of an Integrated Care Pathway Using Telemonitoring in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease: Protocol for a Quasi-Experimental Study

10.2196/20571 ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. e20571
Author(s):  
Cyrille Herkert ◽  
Jos Johannes Kraal ◽  
Rudolph Ferdinand Spee ◽  
Anouk Serier ◽  
Lidwien Graat-Verboom ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Pathway ◽  
Single Case ◽  
Case Manager ◽  
Chronic Obstructive ◽  
Care Pathways ◽  
Obstructive Pulmonary Disease ◽  
On Demand ◽  
Quasi Experimental ◽  
Integrated Care Pathway

Background Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually not integrated. This results in frequent outpatient consultations and suboptimal treatment during exacerbations, leading to frequent hospital admissions. Therefore, we propose an integrated care pathway for both diseases, using telemonitoring to detect deterioration at an early stage and a single case manager for both diseases. Objective This study aims to investigate whether an integrated care pathway using telemonitoring in patients with combined CHF and COPD results in a higher general health-related QoL (HRQoL) as compared with the traditional care pathways. Secondary end points include disease-specific HRQoL, level of self-management, patient satisfaction, compliance to the program, and cost-effectiveness. Methods This is a monocenter, prospective study using a quasi-experimental interrupted time series design. Thirty patients with combined CHF and COPD are included. The study period of 2.5 years per patient is divided into a preintervention phase (6 months) and a postintervention phase (2 years) in which end points are assessed. The intervention consists of an on-demand treatment strategy based on monitoring symptoms related to CHF/COPD and vital parameters (weight, blood pressure, heart rate, oxygen saturation, temperature), which are uploaded on a digital platform. The monitoring frequency and the limit values of the measurements to detect abnormalities are determined individually. Monitoring is performed by a case manager, who has the opportunity for a daily multidisciplinary meeting with both the cardiologist and the pulmonologist. Routine appointments at the outpatient clinic are cancelled and replaced by telemonitoring-guided treatment. Results Following ethical approval of the study protocol, the first patient was included in May 2018. Inclusion is expected to be complete in May 2021. Conclusions This study is the first to evaluate the effects of a novel integrated care pathway using telemonitoring for patients with combined CHF and COPD. Unique to this study is the concept of remote on-demand disease management by a single case manager for both diseases, combined with multidisciplinary meetings. Moreover, modern telemonitoring technology is used instead of, rather than as an addition to, regular care. Trial Registration Netherlands Trial Register NL6741; https://www.trialregister.nl/trial/6741 International Registered Report Identifier (IRRID) DERR1-10.2196/20571

scholarly journals Developing a dementia inclusive hospital environment using an Integrated Care Pathway design: research protocol

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11589
Author(s):  
Jorge Riquelme-Galindo ◽  
Manuel Lillo-Crespo
Keyword(s):  
Integrated Care ◽  
Design Research ◽  
Care Pathway ◽  
Hospital Environment ◽  
Research Protocol ◽  
Healthcare Staff ◽  
Compassionate Care ◽  
National Plan ◽  
People With Dementia ◽  
Integrated Care Pathway

People with dementia occupy 25% of the hospital beds. When they are admitted to hospitals their cognitive impairment is not considered in most of the cases. Some European and North American countries already have experience of implementing national plans about Alzheimer’s disease and dementia. However South European countries such as Spain are in the early stages. The aim of this study is to design an Integrated Care Pathway to adapt the hospital environment and processes to the needs of people with dementia and their caregivers, generating a sense of confidence, increasing their satisfaction and protecting them from potential harmful situations. This study uses King’s Fund Dementia Tool to assess the hospital environment and develop a continous improvement process. People with dementia, families, caregivers and healthcare staff will evaluate the different settings in order to provide guidance based on patient needs. Person-centred care, prudent healthcare and compassionate care are the conceptual framework of this care pathway. The implementation and evaluation of this research protocol will provide information about how to successfully design dementia interventions in a hospital environment within available resources in those contexts where dementia plans are in its infancy, as only around 15% of all states worldwide have currently designed a concise dementia national plan.

scholarly journals A novel integrated care pathway for people with dementia presenting to acute hospitals

2017 ◽  
Vol 17 (5) ◽  
pp. 417 ◽  
Author(s):  
Suzanne Timmons ◽  
Mary Mannix ◽  
Margaret McKiernan ◽  
Maria Connolly ◽  
Mary J Foley ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Pathway ◽  
People With Dementia ◽  
Acute Hospitals ◽  
Integrated Care Pathway

Integrated Care Pathways and Care Bundles for Dementia in Acute Care: Concept Versus Evidence

2017 ◽  
Vol 32 (4) ◽  
pp. 189-193 ◽  
Author(s):  
Dawn O. Sullivan ◽  
Mary Mannix ◽  
Suzanne Timmons
Keyword(s):  
Integrated Care ◽  
Acute Care ◽  
Dementia Care ◽  
Care Pathways ◽  
Medical Procedures ◽  
Limited Evidence ◽  
Care Bundles ◽  
Literature Overview ◽  
People With Dementia ◽  
Integrated Care Pathways

Caring for people with dementia in acute settings is challenging and confounded by multiple comorbidities and difficulties transitioning between community and acute care. Recently, there has been an increase in the development and use of integrated care pathways (ICPs) and care bundles for defined illnesses and medical procedures, and these are now being promoted for use in dementia care in acute settings. We present a review of the literature on ICPs and/or care bundles for dementia care in the acute sector. This includes a literature overview including “gray literature” such as relevant websites, reports, and government publications. Taken together, there is clearly a growing interest in and clinical use of ICPs and care bundles for dementia. However, there is currently insufficient evidence to support the effectiveness of ICPs for dementia care in acute settings and limited evidence for care bundles for dementia in this setting.

scholarly journals 330 Insights into Dementia- An Integrated Care Approach to Family Support

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Cathy McHale ◽  
Martina McGovern ◽  
Josephine Dewergifosse ◽  
Maria Domsa ◽  
Anna McMahon ◽  
...  
Keyword(s):  
Integrated Care ◽  
Support Group ◽  
Care Pathway ◽  
Local Area ◽  
Course Delivery ◽  
Care Needs ◽  
People With Dementia ◽  
Care Approach ◽  
Access Information ◽  
Integrated Care Pathway

Abstract Background The increase in the number of people with dementia in the coming years will be significant and could be as high as 132,000 people by 2041. There is a growing need for enhanced post diagnostic supports for patients living with dementia and their families. We identified the need for a localised educational resource for families and supportive others attending our specialist memory service Methods Staff from the Integrated Care Team, Specialist Memory Service and Primary Care were trained by the Alzheimer’s Society of Ireland to deliver a 6 week ‘Insights Into Dementia’ carers course. Tutors and dementia advisors from the Alzheimer’s Society of Ireland provided in-depth training prior to course delivery and feedback to the facilitators on a weekly basis. The course included advice and education on Dementia; Changing Relationships, Communication; Responding to changes in behaviour; Nutrition; Engaging in activities; Assisting with personal care and Safety in the home. Families gained advice regarding their self-care needs and learned how to access information and support.  All services involved worked together to identify, refer and support families with dementia in the local area. The group took place in an accessible location at a time which accommodated families to attend. Each course attendee completed a questionnaire prior to and after commencing the group. Results The group has delivered education and support to 48 families to date. Feedback from participants was very positive with self-reported increase in confidence, knowledge and awareness about dementia. Waiting time to access support has significantly decreased. Every course has led to a support group who meet up on a regular basis in their community. Conclusion This novel collaboration has become a key part of the integrated care pathway we have developed to support people living with dementia and their supportive others in our catchment area. The Integrated Care approach has served to enrich the programme and allow for timely signposting to localised supports.

Evaluation of the Current Knowledge and Awareness of the Integrated Care Pathway Tool in a Local Health Community

2005 ◽  
Vol 9 (2) ◽  
pp. 51-56
Author(s):  
Michelle Croucher
Keyword(s):  
Integrated Care ◽  
Current Knowledge ◽  
Care Pathway ◽  
Essential Element ◽  
Local Health ◽  
Continuous Assessment ◽  
Health Community ◽  
National Guidance ◽  
Health And Social Care ◽  
Integrated Care Pathway

An integrated care pathway (ICP) identifies the patient's anticipated progress and ensures that any activities delivered by health- and social-care professionals are signed off, and that any variation from the intended practice is documented. Analysis of the variances from the ICP allows continuous assessment of process and outcomes against guidelines or standards. The objectives of this study were to establish the current knowledge and awareness of the ICP tool within the local health community, and to find out how it may be improved. A semi-structured questionnaire was sent to 15 representatives at a senior manager or director level in the local health community. A response rate of 67% was achieved. The questionnaire data were examined using ‘content analysis' and ‘constant comparison’ methodology. In all, 80% of the questionnaire respondents did not identify that the variance framework was an essential element of the ICP tool. A high number of questionnaire respondents identified some, but not the majority, of the benefits that the ICP tool can offer. A total of 60% of the respondents identified resources to assist in the development of ICPs. None of the respondents identified the National Electronic Library for Health (NeLH) as a main resource where guidance was available. However, 100% of the respondents stated that it would be beneficial if standardized national guidance were made available to support ICP development. In conclusion, this study demonstrated that there is variability in the current level of knowledge and awareness of the ICP tool. It is therefore recommended that national guidance be produced, which would provide a standard framework for National Health Services staff to follow when developing ICPs. It is also recommended that improved provision and distribution of information on how ICPs can be used can lead to effective quality improvement programmes.

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