scholarly journals RarERN Path: a methodology towards the optimisation of patients’ care pathways in rare and complex diseases developed within the European Reference Networks

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Talarico Rosaria ◽  
Cannizzo Sara ◽  
Lorenzoni Valentina ◽  
Marinello Diana ◽  
Palla Ilaria ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Musculoskeletal Diseases ◽  
Care Pathway ◽  
Phase 1 ◽  
Narrative Medicine ◽  
Complex Diseases ◽  
Cost Effective ◽  
Care Pathways ◽  
European Reference Networks ◽  
Reference Networks

Abstract Background In 2017, the European Commission has launched the European Reference Networks (ERNs), virtual networks involving healthcare providers across Europe. The aim of the ERNs is to tackle complex and rare diseases and conditions that require highly specialized treatment and a concentration of knowledge and resources. The ERN on rare and complex connective tissue and musculoskeletal diseases (ERN ReCONNET) is one of the 24 ERNs approved that aims to improve the management of Rare and Complex Connective Tissue and Musculoskeletal Diseases. Objective The RarERN Path methodology aims to create a single reference organisational model for patients’ care pathways which, if applied in different contexts, helps to ensure an improved, cost-effective and patient-centred equal care to rare and complex diseases. Methods Starting from existing standard methods for the creation and elaboration of patients’ care pathways, a specific methodology was created in order to take advantage of the distinctive and peculiar characteristics of the ERNs. Specifically, the development of the RarERN Path methodology involved different stakeholders: health economists, clinicians and researchers expert in rare and complex diseases, communication experts, experts in patients’ involvement and narrative medicine and policy-makers. Results The RarERN Path methodology foresees six consecutive phases, each with different and specific aims. Specifically, the six phases are represented by: Phase 1—mapping of existing patients’ care pathways and patients’ stories; Phase 2—design of an optimised common patients’ care pathway; Phase 3—consensus on an optimised common patients’ care pathway; Phase 4—key performance indicators definition; Phase 5—refinement; Phase 6—pilot phase (optional). Conclusion The application of RarERN Path to the different disease-specific and geographical contexts would help to ensure an improved, cost-effective and patient-centred equal care to rare and complex diseases across Europe as well as a possible tangible action towards the integration of ERNs into the different European healthcare systems.

scholarly journals RarERN Path: a methodology towards the optimisation of patients’ care pathways in rare and complex diseases developed within the European Reference Networks

2020 ◽  
Author(s):  
Rosaria Talarico ◽  
Sara Cannizzo ◽  
Valentina Lorenzoni ◽  
Diana Marinello ◽  
Ilaria Palla ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Musculoskeletal Diseases ◽  
Care Pathway ◽  
Phase 1 ◽  
Narrative Medicine ◽  
Complex Diseases ◽  
Cost Effective ◽  
Care Pathways ◽  
European Reference Networks ◽  
Reference Networks

Abstract BackgroundIn 2017, the European Commission has launched the European Reference Networks (ERNs), virtual networks involving healthcare providers across Europe. The aim of the ERNs is to tackle complex and rare diseases and conditions that require highly specialized treatment and a concentration of knowledge and resources. The ERN on rare and complex connective tissue and musculoskeletal diseases (ERN ReCONNET) is one of the 24 ERNs approved that aims to improve the management of Rare and Complex Connective Tissue and Musculoskeletal Diseases.ObjectiveThe RarERN Path methodology aims to create a single reference organisational model for patients’ care pathways which, if applied in different contexts, helps to ensure an improved, cost-effective and patient-centred equal care to rare and complex diseases.MethodsStarting from existing standard methods for the creation and elaboration of patients’ care pathways, a specific methodology was created in order to take advantage of the distinctive and peculiar characteristics of the ERNs. Specifically, the development of the RarERN Path methodology involved different stakeholders: health economists, clinicians and researchers expert in rare and complex diseases, communication experts, experts in patients’ involvement and narrative medicine and policy-makers.ResultsThe RarERN Path methodology foresees six consecutive phases, each with different and specific aims. Specifically, the six phases are represented by: Phase 1 - Mapping of existing patients’ care pathways and patients’ stories; Phase 2 – Design of an optimised common patients’ care pathway; Phase 3 – Consensus on an optimised common patients’ care pathway; Phase 4 – Key Performance Indicators (KPI) definition; Phase 5 – Refinement; Phase 6 – Pilot phase (optional).ConclusionThe application of RarERN Path to the different disease-specific and geographical contexts would help to ensure an improved, cost-effective and patient-centred equal care to rare and complex diseases across Europe as well as a possible tangible action towards the integration of ERNs into the different European healthcare systems.

scholarly journals RarERN Path: a methodology towards the optimisation of patients’ care pathways in rare and complex diseases developed within the European Reference Networks

2020 ◽  
Author(s):  
Rosaria Talarico ◽  
Sara Cannizzo ◽  
Valentina Lorenzoni ◽  
Diana Marinello ◽  
Ilaria Palla ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Musculoskeletal Diseases ◽  
Care Pathway ◽  
Phase 1 ◽  
Narrative Medicine ◽  
Complex Diseases ◽  
Cost Effective ◽  
Care Pathways ◽  
European Reference Networks ◽  
Reference Networks

Abstract Background In 2017, the European Commission has launched the European Reference Networks (ERNs), virtual networks involving healthcare providers across Europe. The aim of the ERNs is to tackle complex and rare diseases and conditions that require highly specialized treatment and a concentration of knowledge and resources. The ERN on rare and complex connective tissue and musculoskeletal diseases (ERN ReCONNET) is one of the 24 ERNs approved that aims to improve the management of Rare and Complex Connective Tissue and Musculoskeletal Diseases. Objective The RarERN Path methodology aims to create a single reference organisational model for patients’ care pathways which, if applied in different contexts, helps to ensure an improved, cost-effective and patient-centred equal care to rare and complex diseases. Methods Starting from existing standard methods for the creation and elaboration of patients’ care pathways, a specific methodology was created in order to take advantage of the distinctive and peculiar characteristics of the ERNs. Specifically, the development of the RarERN Path methodology involved different stakeholders: health economists, clinicians and researchers expert in rare and complex diseases, communication experts, experts in patients’ involvement and narrative medicine and policy-makers. ResultsThe RarERN Path methodology foresees six consecutive phases, each with different and specific aims. Specifically, the six phases are represented by: Phase 1 - Mapping of existing patients’ care pathways and patients’ stories; Phase 2 – Design of an optimised common patients’ care pathway; Phase 3 – Consensus on an optimised common patients’ care pathway; Phase 4 – Key Performance Indicators (KPI) definition; Phase 5 – Refinement; Phase 6 – Pilot phase (optional).ConclusionThe application of RarERN Path to the different disease-specific and geographical contexts would help to ensure an improved, cost-effective and patient-centred equal care to rare and complex diseases across Europe as well as a possible tangible action towards the integration of ERNs into the different European healthcare systems.

scholarly journals RarERN Path: a methodology towards the optimisation of patients’ care pathways in rare and complex diseases developed within the European Reference Networks

2020 ◽  
Author(s):  
Rosaria Talarico ◽  
Sara Cannizzo ◽  
Valentina Lorenzoni ◽  
Diana Marinello ◽  
Ilaria Palla ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Complex Diseases ◽  
Cost Effective ◽  
Care Process ◽  
Care Pathways ◽  
Patient Centered ◽  
European Reference Networks ◽  
Reference Networks ◽  
Organisational Model ◽  
Disease Specific

Abstract Background In 2017, the European Commission has launched the European Reference Networks (ERNs), virtual networks involving healthcare providers across Europe. The aim of the ERNs is to tackle complex and rare diseases and conditions that require highly specialized treatment and a concentration of knowledge and resources. The ERN ReCONNET is one of the 24 ERNs approved that aims to improve the management of Rare and Complex Connective Tissue and Musculoskeletal Diseases.ResultsThe need to develop a specific methodology for the implementation of an organisational model for patients’ care pathways aligns with the mission of the ERNs to improve the care of rare and complex diseases in Europe. In this framework, ERN ReCONNET developed the RarERN Path methodology that is aimed at creating an organisational model for patients’ care pathways taking advantage of the unique setting of ERNs, represented by the large community of experts (researchers, clinicians, healthcare professionals, patients, health economists, hospital managers, etc.) involved in the Networks. The specific aim of RarERN Path is to provide a valid organisational model for patient-centered care in rare and complex diseases that enables the integration of the different stakeholders involved in the care process, and that adapts in a flexible way to different disease-specific and geographical contexts across Europe.The RarERN Path methodology foresees six consecutive phases that, if applied in different contexts, helps to ensure an improved, cost-effective and patient-centred equal care to rare and complex diseases. ConclusionThe application of RarERN Path to the different disease-specific and geographical contexts would help to ensure an improved, cost-effective and patient-centred equal care to rare and complex diseases across Europe as well as a possible tangible action towards the integration of ERNs into the different European healthcare systems.

scholarly journals Correction to: RarERN Path: a methodology towards the optimisation of patients’ care pathways in rare and complex diseases developed within the European Reference Networks

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rosaria Talarico ◽  
Sara Cannizzo ◽  
Valentina Lorenzoni ◽  
Diana Marinello ◽  
Ilaria Palla ◽  
...  
Keyword(s):  
Complex Diseases ◽  
Care Pathways ◽  
European Reference Networks ◽  
Reference Networks

An amendment to this paper has been published and can be accessed via the original article.

A Collaborative Approach to Upgrading to Limits of Technology at the York River Treatment Plant

2009 ◽  
Vol 4 (3) ◽  
Author(s):  
I. Venner ◽  
J. Husband ◽  
J. Noonan ◽  
A. Nelson ◽  
D. Waltrip
Keyword(s):  
Chesapeake Bay ◽  
Phase 1 ◽  
Treatment Plant ◽  
Cost Effective ◽  
Design Flow ◽  
Nutrient Reduction ◽  
York River ◽  
Hampton Roads ◽  
Key Issues ◽  
Virginia Department

In response to rapid population growth as well as to address the nutrient reduction goals for the Chesapeake Bay established by the Virginia Department of Environmental Quality (VDEQ), the Hampton Roads Sanitation District (HRSD) initiated the York River Treatment Plant (YRTP) Expansion Phase 1 project. The existing YRTP is a conventional step-feed activated sludge plant and is rated for an average daily design flow of 57 million liters per day (MLD). This project proposes to expand the existing treatment capacity to 114 MLD and to reduce the nutrients discharged to the York River, a tributary for the Chesapeake Bay. In order to meet the effluent limits set by the VDEQ, a treatment upgrade to limit of technology (LOT) or enhanced nutrient removal (ENR) was required. Malcolm Pirnie worked with HRSD and the VDEQ to develop and evaluate ENR process alternatives to achieve the required effluent limits with the goal of determining the most reliable and cost effective alternative to achieve the aggressive nutrient reduction goals. This paper will highlight the key issues in determining the most desirable treatment process considering both economic and non-economic factors.

Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

2021 ◽  
pp. 104973232110038
Author(s):  
Cecilie Fromholt Olsen ◽  
Astrid Bergland ◽  
Jonas Debesay ◽  
Asta Bye ◽  
Anne Gudrun Langaas
Keyword(s):  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Transitional Care ◽  
Care Pathway ◽  
Patient Flow ◽  
Care Pathways ◽  
Care Providers ◽  
Patient Centered ◽  
Care For Older People

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

scholarly journals Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
J. L. Palmer ◽  
H. J. Siddle ◽  
A. C. Redmond ◽  
B. Alcacer-Pitarch
Keyword(s):  
Musculoskeletal Diseases ◽  
Cost Effective ◽  
Time Frame ◽  
Teaching Hospitals ◽  
Potential Cost ◽  
Foot Health ◽  
Telephone Consultation ◽  
Face To Face ◽  
Initial Intervention

Abstract Background Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. Methods Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6–8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. Results Twenty-five patients (43%) were successfully contacted within the 6–8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. Conclusion Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.

scholarly journals Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016845 ◽  
Author(s):  
Kathryn Eastwood ◽  
Karen Smith ◽  
Amee Morgans ◽  
Johannes Stoelwinder
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Emergency Care ◽  
Retrospective Cohort ◽  
Care Pathway ◽  
Cohort Analysis ◽  
Care Pathways ◽  
Telephone Triage ◽  
Alternative Care ◽  
Referral Service

ObjectiveTo investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage.DesignA pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage.SettingThe secondary telephone triage service, called the Referral Service, and the hospitals were located in metropolitan Melbourne, Australia and operated 24 hours a day, servicing 4.25 million people. The Referral Service provides an in-depth secondary triage of cases classified as low acuity when calling the Australian emergency telephone number.PopulationCases triaged by the Referral Service between September 2009 and June 2012 were linked to ED and hospital admission records (N=44,523). Planned ED presentations were cases referred to the ED following the secondary triage, unplanned ED presentations were cases that presented despite being referred to alternative care pathways.Main outcome measuresAppropriateness was measured using an ED suitability definition and hospital admission rates. These were compared with mean population data which consisted of all of the ED presentations for the state (termed the ‘average Victorian ED presentation’).ResultsPlanned ED presentations were more likely to be ED suitable than unplanned ED presentations (OR 1.62; 95% CI 1.5 to 1.7; p<0.001) and the average Victorian ED presentation (OR 1.85; 95% CI 1.01 to 3.4; p=0.046). They were also more likely to be admitted to the hospital than the unplanned ED presentation (OR 1.5; 95% CI 1.4 to 1.6; p<0.001) and the average Victorian ED presentation (OR 2.3, 95% CI 2.24 to 2.33; p<0.001). Just under 15% of cases diverted away from the emergency care pathways presented in the ED (unplanned ED attendances), and 9.5% of all the alternative care pathway cases were classified as ED suitable and 6.5% were admitted to hospital.ConclusionsSecondary telephone triage was able to appropriately identify many ED suitable cases, and while most cases referred to alternative care pathways did not present in the ED. Further research is required to establish that these were not inappropriately triaged away from the emergency care pathways.

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