Key performance indicators for monitoring the integrated care pathway in breast cancer: the E.Pic.A. project

Introduction: Due to its high incidence, evaluating performance of care delivered to breast cancer patients is a crucial issue. The multidisciplinary panel E.Pic.A. (Economic Appropriateness of an Integrated Care Pathway) defined a set of key performance indexes (KPIs) to evaluate economic waste in breast cancer healthcare interventions. Methods: The E.Pic.A. panel identified the principal KPIs that are crucial within the breast cancer care pathway to evaluate the performance of care. KPIs were defined taking into account their reliability, validity, usability and feasibility of measurement through the linkage between multiple routine healthcare data sources. Results: 7 KPIs were identified: 3 on instrumental diagnostics, 2 on surgery and 2 on treatment. The 3 KPIs regarding instrumental diagnostics are aimed at assessing the inappropriateness of diagnostic tests performed before and after the index surgery. The 2 KPIs regarding surgery measure the inappropriateness of possible repeated interventions considering the time elapsed from the index surgery. The 2 KPIs regarding oncologic therapy measure the inappropriateness about the administration time of adjuvant therapy and radiotherapy considering the time elapsed from the index surgery. Conclusion: E.Pic.A methodology could help to evaluate economic waste in healthcare interventions with the objective of redirecting resources to interventions with greater value.

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Integrated care pathway for breast cancer: A relational and geographical approach

Social Science & Medicine ◽

10.1016/j.socscimed.2020.113658 ◽

2021 ◽

Vol 270 ◽

pp. 113658

Author(s):

Laurent Mériade ◽

Corinne Rochette

Keyword(s):

Breast Cancer ◽

Integrated Care ◽

Care Pathway ◽

Integrated Care Pathway

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Audit of the use of Seclusion in an Approved Centre following introduction of an Integrated Care Pathway

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v6i2.1432 ◽

2018 ◽

Vol 6 (2) ◽

pp. 204

Author(s):

Sorcha McManus ◽

Patrick McLaughlin ◽

Olwyn Cranny ◽

Peter Whitty

Keyword(s):

Integrated Care ◽

Care Pathway ◽

Retrospective Chart Review ◽

Medical Practitioner ◽

Next Of Kin ◽

Codes Of Practice ◽

Before And After ◽

Integrated Care Pathway ◽

Clinical File ◽

Full Adherence

Introduction: The Mental Health Commission (MHC) has published guidelines on the rules governing the use of seclusion. These must be followed and the use of seclusion recorded in the patient’s clinical file during each seclusion episode. We devised a Seclusion Integrated Care Pathway (ICP) for use in the Approved Centre in Tallaght Hospital, Dublin, Republic of Ireland. This document was developed in conjunction with the MHC guidelines to assist in the recording and monitoring of each seclusion episode.Methods: The MHC has listed 13 rules governing the use of seclusion. These include the responsibility of the registered medical practitioner (RMP), nursing staff and the levels of observations and frequency of reviews that must take place during each seclusion episode. Using the seclusion register we identified a total of 60 seclusion episodes; 30 prior to the introduction of the ICP and 30 following the introduction of the ICP. We conducted a retrospective chart review to assess the documentation of each seclusion episode. The purpose of this audit was to compare adherence to MHC codes of practice on the use of seclusion before and after the introduction of our ICP.Results: There was overall improvement in adherence following the introduction of the ICP. Areas of improvement included consultant notification, informing the patient of the reasons for and likely duration of seclusion, informing the next of kin, 15 minute nursing observations and 2-hourly nursing review. Medical reviews within 4 hours, documentation of whether seclusion could be discontinued and subsequent medical assessment disimproved following introduction of the ICP.Conclusion: While an ICP is a robust document and ensures that many of the rules in relation to seclusion are explicitly stated adjustments to the document and regular staff training are needed to ensure full adherence to MHC guidelines.

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