scholarly journals Home respiratory rehabilitation: a purposes literature review focusing on the clinical pathway management

2020 ◽  
Author(s):  
Civitillo Claudio ◽  
Romano Angelo ◽  
Di Lorenzo Luigi
Keyword(s):  
Clinical Pathways ◽  
Clinical Care ◽  
Care Program ◽  
Care Pathways ◽  
Critical Pathways ◽  
Management Plans ◽  
Integrated Care Pathways ◽  
Care Maps ◽  
Respiratory Rehabilitation

Clinical Care pathways, also known as critical pathways, integrated care pathways, case management plans, clinical care pathways or care maps, are used to systematically plan and follow up a patient focused care program. Clinical pathways are used all over the world and so for respiratory rehabilitation pathways (RR) and the importance of knowledge and learning Evidence Based Practice (EBP) is well known and mandatory. However, the EBP acquisitions of the home RR model and the knowledge of Clinical Care Pathways (PCA) are poorly defined.

scholarly journals Next-Generation Allergic Rhinitis Care in Singapore: 2019 ARIA Care Pathways

2020 ◽  
Vol 49 (11) ◽  
pp. 885-896
Author(s):  
Xuandao Liu ◽  
De Yun Wang ◽  
Tze Choong Charn ◽  
Leslie Timothy Koh ◽  
Neville WY Teo ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Care ◽  
Work Productivity ◽  
Suboptimal Control ◽  
Current Status ◽  
Local Context ◽  
Care Pathways ◽  
Important Health ◽  
Integrated Care Pathways ◽  
Important Health Issue

Allergic rhinitis (AR) is prevalent in Singapore, with a significant disease burden. Afflicting up to 13% of the population, AR impairs quality of life, leads to reduced work productivity and is an independent risk factor for asthma. In the last 2 decades, local studies have identified patient and physician behaviours leading to suboptimal control of the disease. Yet, there is an overall lack of attention to address this important health issue. Allergic Rhinitis and its Impact on Asthma (ARIA) is a European organisation aimed at implementing evidence-based management for AR worldwide. Recent focus in Europe has been directed towards empowering patients for self-management, exploring the complementary role of mobile health, and establishing healthcare system-based integrated care pathways. Consolidation of these ongoing efforts has led to the release of the 2019 ARIA care pathways. This review summarises the ARIA update with particular emphasis on the current status of adult AR in Singapore. In addition, we identify unmet needs and future opportunities for research and clinical care of AR in the local context. Keywords: Allergen immunotherapy, Allergic Rhinitis and its Impact on Asthma, clinical guideline

scholarly journals Early Clinical Impact of Diagnostic Breast Ultrasound Performed by General Practitioners and Nurses in Rwanda

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 38s-38s
Author(s):  
L.E. Pace ◽  
J.M.V. Dusengimana ◽  
V. Rugema ◽  
V. Hategekimana ◽  
J.B. Bigirimana ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Detection ◽  
Clinical Care ◽  
Breast Ultrasound ◽  
Clinical Role ◽  
Detection Rates ◽  
Breast Masses ◽  
Management Plans ◽  
The Impact

Background: Diagnostic breast ultrasound (US) could be an important tool for early detection of breast cancer in low-resource settings, where efficient strategies to refine the likelihood of malignancy among palpable breast masses are needed. However, the feasibility and clinical role of diagnostic ultrasound in such settings has not been described. We trained 4 general practitioner doctors (GPs) and 5 nurses in diagnostic breast US at a rural district hospital in Rwanda that serves as a cancer referral facility. Aim: Assess management plans, biopsy rates and patient diagnoses after nurse- and GP-performed breast ultrasounds to determine the impact of diagnostic US on clinical care. Methods: We reviewed outcomes from trainees' ultrasounds during 21 months of in-person and electronic training and mentorship by Boston-based radiologists. Trainees' US assessments and management plans were recorded on structured clinical forms. Patient diagnoses and follow-up were extracted from medical records using a standardized data collection form. Among patients who received breast US, we examined a) clinicians' management plans; b) biopsy rate; c) cancer detection rate; c) rate of benign diagnoses; d) cancers diagnosed among patients who were sent home after initial evaluation. Results: Between January 1, 2016 and September 30, 2017, 307 patients with breast concerns had a diagnostic breast US and a documented trainee US assessment. Of these, following their initial US, 158 (51%) were recommended to receive a biopsy, 30 (10%) were recommended to have aspiration/drainage, 49 (16%) were recommended for clinical or US surveillance, 1 (0.3%) was referred to another facility, 65 (21%) were discharged, and 4 (all with no abnormalities on US) had missing recommendations. Of those recommended for biopsy at initial presentation, 151 (96%) had a biopsy at that time. 56 (37%) were diagnosed with breast cancer, 37 (25%) with fibroadenoma, 7 (5%) with lactating adenoma, and 50 (33%) with other benign diagnoses. Among those with breast masses on US (n=255), 149 (58%) received a biopsy and 55 (22%) were diagnosed with cancer. As of November 23, 2017, all patients ultimately diagnosed with cancer had had a biopsy at their initial visit, and no patients who had been discharged or recommended for clinical or radiographic surveillance had been subsequently diagnosed with cancer. Conclusion: Diagnostic breast US by GPs and nurses has been a useful tool in the evaluation of breast lesions, including palpable masses, at a rural cancer facility in Rwanda. Early findings suggest that it has allowed avoidance of biopsy for 42% of patients with breast masses noted on US. Clinical follow-up and evaluation are ongoing to assess longer-term patient outcomes, cancer detection rates among patients who are not initially biopsied, and rates of follow-up among patients recommended to have clinical or radiographic surveillance.

Integrated care pathways in multiple sclerosis rehabilitation: completing the audit cycle

1998 ◽  
Vol 4 (2) ◽  
pp. 85-89 ◽  
Author(s):  
D A Rossiter ◽  
A Edmondson ◽  
R Al-Shahi ◽  
A J Thompson
Keyword(s):  
Multiple Sclerosis ◽  
Integrated Care ◽  
Clinical Care ◽  
Goal Achievement ◽  
Care Pathways ◽  
Rehabilitation Process ◽  
The Third ◽  
Fatigue Management ◽  
Age Variations ◽  
Integrated Care Pathways

The rehabilitation of progressive neurological disorders, such as Multiple Sclerosis (MS) requires comprehensive, expert management which is demanding of both time and resources. Mechanisms to monitor and audit both process and outcome are therefore essential. Integrated care pathways (ICPs) which detail the expected interventions during a given episode of clinical care, provide such a mechanism. In this study three cohorts of patients (totalling 125 episodes) with clinically definite progressive MS underwent a rehabilitation programme audited through ICPs. The cohorts were similar in relation to disability and age. Variations (departures from the expected pathway) were documented for both the rehabilitation process and goal achievement. Duration of stay reduced from 28 days for the first cohort to 18 days for the third and there was greater multidisciplinary input and carer involvement over time. Goal achievement increased from 79% for the first cohort to 87% for the third and there was an increased emphasis on cognitive function and fatigue management in relation to goals set. ICPs provide an excellent mechanism for closing the audit loop and have the potential to play an important role in improving service provision in MS.

scholarly journals IT-supported integrated care pathways for diabetes: A compilation and review of good practices

2017 ◽  
Vol 20 (1-2) ◽  
pp. 26-40 ◽  
Author(s):  
Hubertus JM Vrijhoef ◽  
Antonio Giulio de Belvis ◽  
Matias de la Calle ◽  
Maria Stella de Sabata ◽  
Bastian Hauck ◽  
...  
Keyword(s):  
Literature Review ◽  
Integrated Care ◽  
Systematic Literature Review ◽  
Care Pathways ◽  
Outcome Indicators ◽  
Good Practices ◽  
Eip On Aha ◽  
Integrated Care Pathways ◽  
Desk Research

Introduction Integrated Care Pathways (ICPs) are a method for the mutual decision-making and organization of care for a well-defined group of patients during a well-defined period. The aim of a care pathway is to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. To describe this concept, different names are used, e.g. care pathways and integrated care pathways. Modern information technologies (IT) can support ICPs by enabling patient empowerment, better management, and the monitoring of care provided by multidisciplinary teams. This study analyses ICPs across Europe, identifying commonalities and success factors to establish good practices for IT-supported ICPs in diabetes care. Methods A mixed-method approach was applied, combining desk research on 24 projects from the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) with follow-up interviews of project participants, and a non-systematic literature review. We applied a Delphi technique to select process and outcome indicators, derived from different literature sources which were compiled and applied for the identification of successful good practices. Results Desk research identified sixteen projects featuring IT-supported ICPs, mostly derived from the EIP on AHA, as good practices based on our criteria. Follow-up interviews were then conducted with representatives from 9 of the 16 projects to gather information not publicly available and understand how these projects were meeting the identified criteria. In parallel, the non-systematic literature review of 434 PubMed search results revealed a total of eight relevant projects. On the basis of the selected EIP on AHA project data and non-systematic literature review, no commonalities with regard to defined process or outcome indicators could be identified through our approach. Conversely, the research produced a heterogeneous picture in all aspects of the projects’ indicators. Data from desk research and follow-up interviews partly lacked information on outcome and performance, which limited the comparison between practices. Conclusion Applying a comprehensive set of indicators in a multi-method approach to assess the projects included in this research study did not reveal any obvious commonalities which might serve as a blueprint for future IT-supported ICP projects. Instead, an unexpected high degree of heterogeneity was observed, that may reflect diverse local implementation requirements e.g. specificities of the local healthcare system, local regulations, or preexisting structures used for the project setup. Improving the definition of and reporting on project outcomes could help advance research on and implementation of effective integrated care solutions for chronic disease management across Europe.

Integrated Care Pathways for Black Persons With Traumatic Brain Injury: A Critical Transdisciplinary Scoping Review of the Clinical Care Journey

2021 ◽  
pp. 152483802110622
Author(s):  
Samira Omar ◽  
Stephanie Nixon ◽  
Angela Colantonio
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Integrated Care ◽  
Scoping Review ◽  
Black People ◽  
Clinical Care ◽  
Ethnic Disparities ◽  
The United States ◽  
Care Pathways ◽  
Integrated Care Pathways

Objectives: This novel critical transdisciplinary scoping review examined the literature on integrated care pathways that consider Black people living with traumatic brain injury (TBI). The objectives were to (a) summarize the extent, nature, and range of literature on care pathways that consider Black populations, (b) summarize how Blackness, race, and racism are conceptualized in the literature, (c) determine how Black people come to access care pathways, and (d) identify how care pathways in research consider the mechanism of injury and implications for human occupation. Methods: Six databases were searched systematically identifying 178 articles after removing duplicates. In total, 43 articles on integrated care within the context of Black persons with TBI were included. Narrative synthesis was conducted to analyze the data and was presented as descriptive statistics and as a narrative to tell a story. Findings: All studies were based in the United States where 81% reported racial and ethnic disparities across the care continuum primarily using race as a biological construct. Sex, gender, and race are used as demographic variables where statistical data were stratified in only 9% of studies. Black patients are primarily denied access to care, experience lower rates of protocol treatments, poor quality of care, and lack access to rehabilitation. Racial health disparities are disconnected from racism and are displayed as symptoms of a problem that remains unnamed. Conclusion: The findings illustrate how racism becomes institutionalized in research on TBI care pathways, demonstrating the need to incorporate the voices of Black people, transcend disciplinary boundaries, and adopt an anti-racist lens to research.

From PRO screening to improved wellness: A nurse-led intervention.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 72-72
Author(s):  
Alison Morris ◽  
Erika L Tribett ◽  
Sandy Tun ◽  
Marcy Winget ◽  
Douglas W. Blayney ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Pathways ◽  
Outcome Measurement ◽  
Clinical Care ◽  
Gynecologic Oncology ◽  
Well Being ◽  
Care Pathways ◽  
Patient Portal ◽  
Patient Reported ◽  
Oncology Practice

72 Background: Emotional and physical distress in cancer patients is underreported and undertreated. In effort to address this, the Quality Oncology Practice Initiative (QOPI) requires patients to be screened for emotional well-being and pain by their second oncology visit. This project details one cancer center’s quality improvement initiative to: (1) utilize patient reported outcomes (PRO) screening to identify patient distress, (2) develop adaptive nurse-led algorithms to assess and intervene for unmet needs. Methods: In June 2015, we launched electronic collection of PROs using the Patient Reported Outcome Measurement Instrument System (PROMIS) global screen. Screening is completed via EMR patient portal prior to first return visit and 30-day intervals thereafter. A nurse-led algorithm categorizing distress was developed with evidence-based clinical pathways for care. Pathways optimize primary palliative care and referrals to specialist palliative services when appropriate. In August 2015, we will randomize four nurse navigators in gynecologic oncology to test the algorithm and make adaptations for scaling cancer center wide. We will assess the percent of patients screening positive for distress and the rate of primary palliative care interventions (e.g., symptom management and psychosocial support). We will also assess rate of referral to specialist palliative teams. Finally, we will interview a subset of patients to compare self-reported need, clinical management of needs, and whether needs were managed to the patient’s satisfaction. Results: We expect to report on adoption and adaptation of the algorithm for disease-specific groups. We will also report rates of primary palliative care interventions, referrals to specialist palliative care and PROs. Conclusions: Standard screening using PROs and clinical care pathways may foster early identification and management of patient’s psychosocial and physical needs. Support for oncology nurses to lead assessment and connect patients with resources is an opportunity to incorporate primary palliative care into oncology practice. The use of structured, adaptive, novel algorithms is a promising approach to meet patient needs and improve access to supportive resources.

The Care Process Organization Triangle: A Framework to Better Understand how Clinical Pathways Work

2007 ◽  
Vol 11 (2) ◽  
pp. 54-61 ◽  
Author(s):  
Kris Vanhaecht ◽  
Karel de Witte ◽  
Walter Sermeus
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Care Management ◽  
Clinical Pathways ◽  
Health Care Management ◽  
Care Process ◽  
Care Pathways ◽  
Patient Needs ◽  
Care Processes ◽  
Integrated Care Pathways

Clinical pathways, also known as care pathways or integrated care pathways, are used worldwide to make care processes transparent and organize care around patient needs. Although this is in international use, it is still unclear why pathways sometimes work and sometimes do not. To better understand how pathways work, there is a growing need for paradigms or organizing concepts. Different quality and health-care management gurus have developed frameworks to better understand how certain processes or methods work. This paper will provide an overview of several frameworks and integrate them into Donabedian's Structure–Process–Outcome configuration. In view of this configuration, the care process organization triangle was developed. In this paper, we will describe the three cornerstones of this triangle by integrating the literature on clinical pathways. The care process organization triangle is only one model, but as Deming described it: ‘Some models can be quite useful’.

scholarly journals Clinical Impact of Diagnostic Breast Ultrasound Performed by Generalist Doctors and Nurses in Rwanda

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 35s-35s
Author(s):  
Lydia E. Pace ◽  
J.M.V. Dusengimana ◽  
Vestine Rugema ◽  
Vedaste Hategekimana ◽  
Jean Bosco Bigirimana ◽  
...  
Keyword(s):  
Breast Cancer ◽  
General Practitioners ◽  
Cancer Detection ◽  
Clinical Care ◽  
Breast Ultrasound ◽  
Medical Services ◽  
Breast Masses ◽  
Management Plans ◽  
The Impact

Purpose Diagnostic breast ultrasound (US) can be an important tool for the early detection of breast cancer in low-resource settings where efficient strategies to refine the likelihood of malignancy among palpable breast masses are needed. However, the feasibility and clinical role of breast US in such settings has not been described. We trained four general practitioners and five nurses in diagnostic breast US at a rural Rwandan district hospital that serves as a cancer referral facility. We examined management plans, biopsy rates, and patient diagnoses after trainee breast US to determine the impact on clinical care. Methods We abstracted US assessment forms and medical records to determine outcomes from trainee US during 21 months of in-person and electronic training by Boston-based radiologists. We examined management plans, biopsy rate, cancer detection rate, rate of benign diagnoses, and cancers diagnosed among patients discharged after initial evaluation. Results Between January 2016 and September 2017, 307 patients had trainee-performed diagnostic breast US. After US, 158 (51%) were recommended to undergo biopsy, 30 (10%) were recommended to have aspiration/drainage, 49 (16%) were recommended for clinical/US surveillance, one (0.3%) was referred elsewhere, 65 (21%) were discharged, and four—all with no abnormalities on US—had missing recommendations. Of those recommended for initial biopsy, 151 patients (96%) underwent biopsy at that time. Fifty-six patients (37%) were diagnosed with breast cancer, 44 (30%) with fibroadenoma, and 50 (33%) with other benign diagnoses. Among those with breast masses on US (n = 255), 149 patients (58%) underwent biopsy and 55 (22%) were diagnosed with cancer. As of November 2017, all patients ultimately diagnosed with cancer had had a biopsy at their initial visit. No patients who had been discharged or were receiving surveillance had been subsequently diagnosed with cancer. Conclusion Diagnostic breast US by general practitioners and nurses has been a useful tool for the evaluation of breast lesions at a rural Rwandan facility and has helped avoid biopsy for 42% of patients with breast masses on US. Clinical follow-up is ongoing to assess longer-term outcomes and examine cancer detection rates and loss-to-follow-up rates among patients not initially biopsied. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Lydia E. Pace Stock or Other Ownership: Firefly Health Sughra Raza Honoraria: Fujifilm Medical Services Travel, Accommodations, Expenses: Fujifilm Medical Services

Physician participation and compliance with cancer clinical care pathways: A successful model of collaboration between payers and providers.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16552-e16552
Author(s):  
Thomas Ruane ◽  
Philip J. Stella ◽  
Jeffrey A. Scott ◽  
Bruce A. Feinberg ◽  
Joseph Cooper
Keyword(s):  
Financial Incentives ◽  
Care Pathway ◽  
Clinical Pathways ◽  
Clinical Care ◽  
Steering Committee ◽  
First Year ◽  
Care Pathways ◽  
Cancer Pathways ◽  
Physician Participation ◽  
Clinical Care Pathway

e16552 Background: Blue Cross Blue Shield of Michigan (BCBSM), Physician Resource Management (PRM), and Cardinal Health Specialty Solutions (CHSS), partnered to develop a clinical pathway program that would benefit all parties by improving the consistency and quality of patient care while reducing costs. A major obstacle to clinical pathway adoption is physician participation and compliance. Incentives were provided to physicians to join and comply with this clinical pathways program. We report the rates of physician participation and compliance after 1 year. Methods: In 2009, treatment and supportive cancer care clinical pathways moderated by PRM and CHSS chief medical officers were developed by a 12-member steering committee of BCBSM network oncologists. The non-steering committee physicians within the BCBSM network then provided input and review prior to implementation. Physician financial incentives were provided by BCBSM to encourage adoption of the cancer pathways: (1)$5,000 (2) an increased reimbursement rate for certain generic therapies associated with the pathways (3) a share of the savings realized in expenditures for chemotherapy and supportive medications directly attributable to pathways. Rates of participation and compliance by physicians were evaluated after the first year. Compliance was measured using insurance claims data from BCBSM and a proprietary CHSS claims management software tool. Results: Out of 228 Michigan private practice medical oncologists, 187 (82%) participated in the first year of BCBSM’s cancer pathways program. Average compliance rates for the cancer treatment and supportive care pathways over the year 2010 were 96% and 92.5% respectively. Conclusions: Effective clinical care pathway programs require robust physician participation and compliance. Involving physicians in the pathway development process and providing financial incentives led to high rates of physician involvement and “buy-in”, a crucial step in developing our successful clinical care pathway program.

Pathways, partners and payers: The trifecta of palliative care integration.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 129-129
Author(s):  
Diane G. Portman ◽  
Sarah Thirlwell
Keyword(s):  
Palliative Care ◽  
Strategic Alliance ◽  
Care Delivery ◽  
Clinical Pathways ◽  
Clinical Care ◽  
Symptom Control ◽  
Hematologic Malignancies ◽  
Cancer Center ◽  
Care Pathways ◽  
Disease States

129 Background: Moffitt Cancer Center has developed proprietary oncology clinical pathways. Multiple external partnership agreements which require adoption of these pathways have been completed. Our Center has enacted new cancer care delivery and payment arrangements with payers to foster cost and quality balance via use of the pathways and earlier involvement of palliative care (PC). Methods: Executive and PC leadership collaborated with the clinical pathways and strategic alliance teams to identify high priority disease states for integration of PC. Working with oncologist pathway developers, critical junctures in the pathways for inclusion of PC consultation were proposed and refined. EHR mechanisms to promote pathway adherence by clinicians were initiated. The value of pathway utilization and care coordination to involve PC was promoted to prospective oncology partners and payers. Results: PC has been mandated in oncology clinical care pathways, with a focus on thoracic, breast, gastrointestinal, prostate, gynecologic and hematologic malignancies, as directed by specific payer arrangements. Partnerships have expanded, resulting in greater utilization of PC by other centers as well. Increased referral volumes to PC, broader symptom control, and enhanced advance care planning have resulted. Conclusions: Incorporation of PC in oncologic clinical care pathways, with dissemination to internal providers, external partners and as part of novel payment models, optimizes PC integration. [Table: see text]

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