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Rosique, Ricard. "Do we need electronic support for pathways: the Spanish experience." International Journal of Care Pathways 13, no. 2 (November 2009): 67–74. http://dx.doi.org/10.1258/jicp.2009.009010.
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Care pathways are excellent tools for quality management in health care concerning the standardization of care processes, as they promote organized and efficient patient care established on evidence-based practice. The implementation of a care pathway project at any health-care setting means a change of the organizational culture. E-pathways (electronic pathways) are strategic resources in order to get the successful implementation of a care pathway project. The concept of e-pathway is recent enough and there are some different experiences worldwide. In 2000, the first electronic pathways were implemented at Hospital de Mataró, in Barcelona, Spain. The benefits of using e-pathways (Eira Healthcare Server) are very clear at Hospital de Mataró: immediate records with no transcriptions, information in the palm of your hand, no prints, and rigour and reliability. Another recent and interesting experience is the development and introduction of e-pathways at Hospital General de l'Hospitalet, in Barcelona, Spain, using an SAP integrated health-care solution. The strategy planning of hospital managers should take into account the need and priority of any pathway project linked to e-pathways. Some experiences in Spain have proven that we do really need electronic support for pathways. Electronic pathways are a basic support and should not be postponed when implementing care pathways.
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Ellis, Peter G., and Kathleen Lokay. "Pathways clinical decision support for appropriate use of key biomarker." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 172. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.172.
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172 Background: UPMC CancerCenter (UPMC) has utilized clinical pathways for almost ten years in an effort to ensure standardization to the evidence based care for its patients. UPMC oncologists participate in the various pathways disease committees that develop and maintain the pathways content and utilize the pathways through a web-based portal in their daily decision making and documentation. The pathways cover not only treatment recommendations but also guidance for work up such as recurrence risk tools (OncoType Dx) for node negative, HER2 negative, ER positive breast cancer who are candidates for chemotherapy. For patients with a low recurrence risk score, the pathways recommends hormonal therapy only, saving the patient both toxicities and costs of chemotherapy where appropriate. Methods: UPMC analyzed its use of chemotherapy in patients with a recurrence risk score of less than 19 through a retrospective review of physician-input data in its Via Pathways Portal for the twelve months ended May 31, 2014. During this time period, the Via Pathways recommended the recurrence risk test for node negative, HER2 negative, ER positive patients. For patients with a low risk score (less than 19), the Via Pathways recommended hormonal therapy only. For those low risk score patients receiving chemotherapy, the physician would document that an Off Pathway decision was being made, indicate the reason for going Off Pathway, and document the actual therapy delivered. Results: For the twelve months ended May 31, 2014, UPMC physicians documented 288 decisions for patient presentation of node negative, HER2 negative, ER positive patients with a recurrence risk score of less than 19. Of these decisions, 99% (n=284) were On Pathway for hormonal therapy. Of the remaining 1%, three (3) were for accrual to a clinical trial and one (1) was Off Pathway for chemotherapy. Conclusions: Pathways are a tool for promoting adherence to evidence based care by oncologists through the use of a point of care decision support system. Pathways have the potential to reduce costs and toxicities of treatment through the evidence based guidance developed by the pathways disease committees and the adherence to such guidance by oncologists utilizing the pathways decision support tool.
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Wells, Christine E., and Sarah J. Smith. "Diagnostic Care Pathways in Dementia." Journal of Primary Care & Community Health 8, no. 2 (November 22, 2016): 103–11. http://dx.doi.org/10.1177/2150131916678715.
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Objectives: Increasing diagnostic rates of dementia is a national health priority; to meet this priority, improvement needs to be made to diagnostic services. It has been increasingly recognized that primary can play a significant role in the diagnostic journey for people with dementia, with some diagnostic services entirely located in primary care. This article reviews the extent of the involvement of primary care in diagnostic care pathways for people presenting with memory complaints within England, and presents examples of innovative approaches, which may be of interest to practitioners. Method: A rapid review was undertaken to identify articles outlining diagnostic care pathways for dementia involving primary care in England. Results: Six articles relating to pathway evaluations and innovative approaches involving primary care were deemed suitable for inclusion in the review. Conclusions: The review found examples of diagnostic pathways and innovative practices being implemented in in primary care. These practices aligned to the strategic ambitions of the National Dementia Strategy. However, it was widely acknowledged that there is a need to improve postdiagnostic pathways; in particular, access to postdiagnostic support. This issue is being reflected in contemporary policy initiatives such as the Department of Health’s 2016 Joint Declaration on postdiagnostic dementia care and support.
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Lykins, Terri, Michael Peck, Robert Poole, and Amy Andolina Fisher. "Using Clinical Pathways in Nutrition Support Patient Care." Nutrition in Clinical Practice 13, no. 6 (December 1998): 298–309. http://dx.doi.org/10.1177/088453369801300607.
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Szcześniak, Dorota, Rose-Marie Dröes, Franka Meiland, Dawn Brooker, Elisabetta Farina, Rabih Chattat, Shirley B. Evans, et al. "Does the community-based combined Meeting Center Support Programme (MCSP) make the pathway to day-care activities easier for people living with dementia? A comparison before and after implementation of MCSP in three European countries." International Psychogeriatrics 30, no. 11 (February 13, 2018): 1717–34. http://dx.doi.org/10.1017/s1041610217002885.
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ABSTRACTBackground:The “pathway to care” concept offers a helpful framework for preparing national dementia plans and strategies and provides a structure to explore the availability and accessibility of timely and effective care for people with dementia and support for their informal carers. Within the framework of the JPND-MEETINGDEM implementation project the pathways to regular day-care activities and the Meeting Centers Support Programme (MCSP), an innovative combined support form for people with dementia and carers, was explored.Methods:An exploratory, descriptive, qualitative, cross-country design was applied to investigate the pathways to day care in several regions in four European countries (Italy, Poland, United Kingdom, and the Netherlands).Results:Before implementation of MCSP, of the four countries the United Kingdom had the most structured pathway to post-diagnostic support for people with dementia. MCSP introduction had a positive impact on the pathways to day-care activities in all countries. MCSP filled an important gap in post-diagnostic care, increasing the accessibility to support for both people with dementia and carers. Key elements such as program of activities, target group, and collaboration between healthcare and social services were recognized as success factors.Conclusions:This study shows that MCSP fills (part of) the gap between diagnosis and residential care and can therefore be seen as a pillar of post-diagnostic care and support. Further dissemination of Meeting Centers in Europe may have a multiple impact on the structure of dementia services in European countries and the pathways to day care for people with dementia and their carer(s).
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Brunton, Paul. "Developing Clinical Care Pathways." Bulletin of the Royal College of Surgeons of England 94, no. 9 (October 1, 2012): 315. http://dx.doi.org/10.1308/147363512x13448516926702.
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Clinical care pathways have existed for many years. Their origin is arguably in nursing and many will recall using a nursing care plan. Clinical care pathways are often denounced as 'tick-box' exercises as practitioners wrongly assume that they will result in a loss of clinical freedom. This is not the case; clinical care pathways do not seek to tell practitioners what to do, but to assist and support them in their decisions.
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Csik, Valerie Pracilio, Michael J. Ramirez, Adam F. Binder, and Nathan Handley. "The value of pathways on drug costs." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 327. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.327.
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327 Background: Oncology care represents a significant portion of US healthcare spending. Cost of Part B drugs has increased at a rate 5.7x that of overall Medicare spending. As a participant in the Oncology Care Model, drug costs represent a majority of our total costs. Pathways are a clinical decision-support tool that use evidence-based care maps accounting for efficacy, toxicity and cost. Our NCI-designated cancer center implemented pathways in July 2018 to reduce care variation and decrease costs. Methods: We reviewed costs related to pathway utilization over a two year period, analyzing differences in total annual drug cost for patients in three categories: On-Pathway (aligned with pathway recommendation), Off-Pathway (not aligned with recommendation), and No Pathway (not used). Per Member Per Month (PMPM) costs were calculated and a weighted average applied to account for changes in annual drug costs. Results: PMPM drug costs decreased -8% in year 1 (FY19) and -4% in year 2 (FY20) when pathways were used (On- and Off-Pathway). When pathways were followed (On-Pathway) in making treatment decisions, the drug costs were 11% lower than when pathways were not used. The annual impact on drug costs when pathways were used amounted to $2.45 million in year 1 and $1.77 million in year 2 (Table). Conclusions: Pathway use reduced drug costs, a significant variable in oncology value-based care models. This finding highlights the value of clinical decision support tools in reducing care variability, a known contributor to health care costs, in making treatment decisions. Further assessment is needed to determine if these results are similar at other cancer centers to fully realize the impact of pathways on drug costs.[Table: see text]
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Thompson, Juliana, Glenda Cook, Claire Masterman, Mark Parkinson, and Lesley Bainbridge. "Rapid evidence review to understand effective frailty care pathways and their components in primary and community care." International Journal of Health Governance 27, no. 1 (November 11, 2021): 54–75. http://dx.doi.org/10.1108/ijhg-09-2021-0090.
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PurposeDifferent pathways of frailty care to prevent or delay progression of frailty and enable people to live well with frailty are emerging in primary and community care in the UK. The purpose of the study is to understand effective frailty care pathways and their components to inform future service development and pathway evaluation in primary- and community-care services.Design/methodology/approachA rapid evidence review was conducted: 11 research publications met the inclusion criteria and were analysed using narrative thematic synthesis.FindingsThere is strong evidence that resistance-based exercise, self-management support, community geriatric services and hospital at home (HAH) improve patient health and function. In general, evaluation and comparison of frailty care pathways, components and pathway operations is challenging due to weaknesses, inconsistencies and differences in evaluation, but it is essential to include consideration of process, determinant and implementation of pathways in evaluations.Originality/valueTo achieve meaningful evaluations and facilitate comparisons of frailty pathways, a standardised evaluation toolkit that incorporates evaluation of how pathways are operated is required for evaluating the impact of frailty pathways of care.
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Marinova, Petya, and Rali Marinova. "Patient-centred stoma care support: colostomy patients." British Journal of Community Nursing 29, no. 10 (October 2, 2024): 494–502. http://dx.doi.org/10.12968/bjcn.2024.0088.
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Colostomy patients have distinct needs that require specialised pathways for optimal care. Recognising that these needs vary, based on the type and configuration of the stoma, is crucial. Specialist nurses play a vital role in providing long-term support and expertise. While many stoma nursing services in the UK offer patient pathways, these often lack specificity for different stoma types. Tailoring pathways to colostomy patients can prevent complications, reduce hospital readmissions and enhance quality of life. Community nurses and other healthcare professionals are essential in supporting colostomy patients through individualised care. Their involvement ensures that patients receive appropriate preparation for life with a stoma and are adequately educated about their specific needs. This multidisciplinary approach fosters a comprehensive care environment, addressing both the physical and emotional aspects of living with a colostomy. By focusing on personalised care and life-long support, healthcare professionals can significantly improve patient outcomes and overall well-being.
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Fitzgerald, Rachel, Marguerite De Foubert, Siobhan Cahill, Finola Cronin, Bart Daly, and Tim Dukelow. "Complex care forum for enhanced support across care settings." International Journal of Integrated Care 25 (April 9, 2025): 686. https://doi.org/10.5334/ijic.9503.
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Background: Enabling older adults to engage with and participate in their care planning requires specific geriatrician input to overcome the complex challenges facing frail patients in the community setting. Planning for future events is an integral component of the evolving collaboration between the older person, those closest to them and members of a multi-disciplinary team. Methods: I conducted a literature review using key terms on PubMed. I also reviewed the World Health Organisation’s (WHO) Integrated care for older people (ICOPE): Guidance for person-centred assessment and pathways in primary care1, as well as reviewing the guidelines and framework for the Irish National Integrated Care Programme for Older persons2. Observing and participating in complex cases in an ambulatory community setting showed the practical considerations involved in complex case management. Discussion: While standardised care pathways have always been a solution for ensuring patient safety, improving risk-adjusted patient outcomes, increasing patient satisfaction and optimising scarce resources, studies have shown that standardised care pathways are more effective in contexts with predictable care trajectories and low uncertainty and complexity3. A person-centred care plan engages older persons as stakeholders in their own care. Adopting the WHO’s ICOPE framework requires assessment of intrinsic capacity and promptly diagnosing and managing losses, both functional and cognitive. Early identification of complex cases involving multi-morbidity, polypharmacy and advancing frailty allows an integrated care team to pool expertise and facilitate patient autonomy in the decision-making process. Specific ambulatory community geriatrician hubs within Community Healthcare Organisations (CHO) enables complex cases to be individually managed in conjunction with a multi-disciplinary team. Identifying unrecognised or unvoiced needs and taking proactive steps to plan for preventative, personalised care is a key component of a multi-modal service. Conclusion: A shift towards an integrated, people-centred approach demands increased community level interventions with coordinated services, such as screening, assessment and management. On personal reflection, it appears that the majority of older persons linked in with an ambulatory hub benefit hugely from specialist MDT input. However, a subsection of older persons in the community need more in-depth specialist support, highlighting the need for increased support in an integrated care model. Establishing the concept of shared care requires transfer of information and knowledge pooling. There is undoubtedly a gap for complex case discussion in the community. A solution to this could include virtual case conferences, facilitating collaboration and coordination between services that provide community led support to older persons and other service providers. Further strengthening of pathways and systems to ensure care plan suitability requires reciprocal buy-in from tertiary centres.
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Flores, Emilia J., Nikhil K. Mull, Julia G. Lavenberg, Matthew D. Mitchell, Brian F. Leas, Austin Williams, Patrick J. Brennan, and Craig A. Umscheid. "Using a 10-step framework to support the implementation of an evidence-based clinical pathways programme." BMJ Quality & Safety 28, no. 6 (November 21, 2018): 476–85. http://dx.doi.org/10.1136/bmjqs-2018-008454.
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BackgroundIntegration of evidence into practice is suboptimal. Clinical pathways, defined as multidisciplinary care plans, are a method for translating evidence into local settings and have been shown to improve the value of patient care.ObjectiveTo describe the development of a clinical pathways programme across a large academic healthcare system.MethodsWe use a 10-step framework (grounded in the Knowledge-to-Action framework and ADAPTE Collaboration methodology for guideline adaptation) to support pathway development and dissemination, including facilitating clinical owner and stakeholder engagement, developing pathway prototypes based on rapid reviews of the existing literature, developing tools for dissemination and impact assessment. We use a cloud-based technology platform (Dorsata, Washington, DC) to assist with development and dissemination across our geographically distributed care settings and providers. Content is viewable through desktop and mobile applications. We measured programme adoption and penetration by examining number of pathways developed as well as mobile application use and pathway views.ResultsFrom 1 February 2016 to 30 April 2018, a total of 202 pathways were disseminated. The three most common clinical domains represented were oncology (46.5%, n=94), pulmonary/critical care (8.9%, n=18) and cardiovascular medicine (7.4%, n=15). Users opting to register for a personal account totalled 1257; the three largest groups were physicians (45.1%, n=567), advanced practice providers (19.5%, n=245) and nurses (19.1%, n=240). Pathway views reached an average of 2150 monthly views during the last 3 months of the period. The majority of pathways reference at least one evidence-based source (93.6%, n=180).ConclusionsA healthcare system can successfully use a framework and technology platform to support the development and dissemination of pathways across a multisite institution.
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Toy, Jennifer M., Adam Drechsler, and Richard C. Waters. "Clinical pathways for primary care: current use, interest and perceived usability." Journal of the American Medical Informatics Association 25, no. 7 (February 26, 2018): 901–6. http://dx.doi.org/10.1093/jamia/ocy010.
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Abstract Objective Translating clinical evidence to daily practice remains a challenge and may improve with clinical pathways. We assessed interest in and usability of clinical pathways by primary care professionals. Methods An online survey was created. Interest in pathways for patient care and learning was assessed at start and finish. Participants completed baseline questions then pathway-associated question sets related to management of 2 chronic diseases. Perceived pathway usability was assessed using the system usability scale. Accuracy and confidence of answers was compared for baseline and pathway-assisted questions. Results Of 115 participants, 17.4% had used clinical pathways, the lowest of decision support tool types surveyed. Accuracy and confidence in answers significantly improved for all pathways. Interest in using pathways daily or weekly was above 75% for the respondents. Conclusion There is low utilization of, but high interest in, clinical pathways by primary care clinicians. Pathways improve accuracy and confidence in answering written clinical questions.
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Marinova, Petya, and Rali Marinova. "Patient-centred stoma care support: ileostomy patients." British Journal of Community Nursing 29, no. 8 (August 2, 2024): 384–90. http://dx.doi.org/10.12968/bjcn.2024.0065.
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Stoma patients require continuous support throughout their entire journey with a stoma. Although many Stoma Care Services across the UK offer patient follow-up pathways, there is not one unified pathway. Patients may not be prepared for life with a stoma because, depending on their stoma type, they will have specific needs, and if patients and healthcare professionals are not prepared to manage these stoma-specific needs, complications and hospital readmissions may occur, worsening patients’ outcomes and quality of life. Ileostomy patients are known to be more likely to experience complications, including hospital readmissions, and therefore, special care should be taken when preparing these patients for life with a stoma. They should be informed and educated to prevent complications, and if this is not always possible, thye should at least be able to recognise and manage early signs and symptoms of complications. This will empower them to self-care and know when to seek medical attention.
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Vanhaecht, Kris, Massimiliano Panella, Ruben Van Zelm, and Walter Sermeus. "Is there a future for pathways? Five pieces of the puzzle." International Journal of Care Pathways 13, no. 2 (November 2009): 82–86. http://dx.doi.org/10.1258/jicp.2009.009013.
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In this discussion and opinion paper, the Bureau members of the European Pathway Association present five challenges for the future of care pathways. Pathways will have to be based on the latest available evidence and international databases, and tools will have to be available. If pathways have a future, the organisations should focus on disease-specific oriented care. Evidence-based pathways, which are organised in a disease-specific oriented organisation, can lead to improvement of quality and efficiency but only if we invest in real teamwork. As a fourth challenge, the need for technical support of pathways is presented. The last piece of the future pathway puzzle is the need for patient involvement. Pathways will only lead to continuous improvement if we finally see patients as real partners in care organisation.
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Kalucy, Deanna, Janice Nixon, Michael Parvizian, Peter Fernando, Simone Sherriff, Jennifer McMellon, Catherine D’Este, Sandra J. Eades, and Anna Williamson. "Exploring pathways to mental healthcare for urban Aboriginal young people: a qualitative interview study." BMJ Open 9, no. 7 (July 2019): e025670. http://dx.doi.org/10.1136/bmjopen-2018-025670.
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ObjectivesTo explore the perceptions of Aboriginal Community Controlled Health Service (ACCHS) staff involved in providing mental healthcare to Aboriginal young people of the current and ideal pathways to mental healthcare for urban Aboriginal young people attending ACCHSs, and to identify what additional supports staff may need to provide optimal mental healthcare to Aboriginal young people.DesignQualitative interview study conducted during May 2016–2017.SettingPrimary care, at two ACCHSs participating in the Study of Environment on Aboriginal Resilience and Child Health in New South Wales.ParticipantsPurposive sampling of staff involved in mental healthcare pathways of Aboriginal young people, including general practitioners (GPs), nurses and Aboriginal Health Workers (AHWs).ResultsAll individuals approached for interview (n=21) participated in the study. Four overarching themes and seven sub-themes were identified: availability and use of tools in practice (valuing training and desire for tools and established pathways), targeting the ideal care pathway (initiating care and guiding young people through care), influencing the care pathway (adversities affecting access to care and adapting the care pathway) and assessing future need (appraising service availability).ConclusionsParticipants desired screening tools, flexible guidelines and training for healthcare providers to support pathways to mental healthcare for Aboriginal young people. Both GPs and AHWs were considered key in identifying children at risk and putting young people onto a pathway to receive appropriate mental healthcare. AHWs were deemed important in keeping young people on the care pathway, and participants felt care pathways could be improved with the addition of dedicated child and adolescent AHWs. The ACCHSs were highlighted as essential to providing culturally appropriate care for Aboriginal young people experiencing mental health problems, and funding for mental health specialists to be based at the ACCHSs was considered a priority.
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McKevitt, M., J. Bacon, and R. Merritt. "P201 Integrating patient support groups into respiratory care pathways." Thorax 71, Suppl 3 (November 15, 2016): A193.2—A194. http://dx.doi.org/10.1136/thoraxjnl-2016-209333.344.
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Kotak, Dinesh, Mary Mitsuko Ichiuji, Laura Asakura, Shawn Hanifin, Nancy Aye, Tatjana Kolevska, Carol Cain, Violeta Rabrenovich, Mark Lindberg, and Yan Li. "Improving routine use of clinical pathway decision support through EMR integration." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 432. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.432.
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432 Background: There has been an explosive growth in oncology with an evolution of precision oncology based on molecular profiling. Providing evidence-based, high quality, equitable care is a foundational mission for Kaiser Permanente (KP). Thus, KP created a systematic approach toward oncology care pathways that incorporated organizational leadership, structured participation and feedback, novel integration of clinical decision support (CDS) tools, and evaluation of efficacy, safety, and value. Our goal was to make it easy and preferable for physicians to access clinical decision support for every patient, every time. Methods: KP’s inter-regional oncology chiefs, supported by relevant teams in evidence analysis, pharmacy, and other clinical specialties, convened monthly meetings in 10 oncology sub-specialties to synthesize evidence and create care pathways for priority conditions. The pathways are published to KP’s Clinical Library (CL), a trusted, curated resource of clinical knowledge guidance and tools, available via KP’s Epic Systems electronic medical record (EMR). The pathways are represented as intuitive, graphical, clickable process diagrams, with additional clinical content available as hover text. CL uses standard Epic interfaces to receive contextual information when accessed from a patient encounter. When the physician browses the CL oncology pathway and selects a treatment recommendation, CL returns to the EMR with the specific treatment plan queued up for ordering. We began initial deployment of these inter-regional pathways in Feb 2020. We combined EMR data with CL data to understand the impact of this clinical decision support. Results: We experienced dramatic uptake of oncology clinical pathways despite offering minimal training and no external incentives. KP orders over Beacon treatment plans annually in the clinical conditions supported by our pathways. In the first quarter of deployment, clinicians ordered 9% of these protocols through clicking on CDS in CL. Over the course of 2 years, we saw pathway-based ordering grow to over 75% of eligible patients. Conclusions: We find that we have made considerable progress toward our goal of having physician users consult clinical pathways decision support before ordering oncology drug treatment protocols. As with all clinical guidance, we would not expect 100% of patients to follow the recommendation, due to clinical variation and co-morbidity, but we find that by making clinical pathways easily accessible and actionable within normal clinical workflow, physicians are consulting the latest evidence in their treatment.
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Wiest, Matheus Joner, Judith Gargaro, and Mark T. Bayley. "What Is the Pathway to the Best Model of Care for Traumatic Spinal Cord Injury? Evidence-Based Guidance." Topics in Spinal Cord Injury Rehabilitation 29, suppl (November 16, 2023): 103–11. http://dx.doi.org/10.46292/sci23-00059s.
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Introduction People with traumatic spinal cord injury (tSCI) experience lifelong physical and emotional health impacts, needing specialized care that is complex to navigate. The non-standardized care pathways used by different jurisdictions to address these needs lead to care inequities and poor health outcomes. Purpose To develop an evidence-based integrated tSCI Care Pathway, from time of injury to life in the community. Methods and Analysis Eighty key partners engaged in planning, providing, and receiving tSCI care (1) identified existing guidelines, pathways, and care models; (2) created the tSCI Care Pathway with key elements or building blocks (“the what”), not specific recommendations (“the how”) for each care stage (Acute, Rehabilitation, and Community), with elements highlighting the role of primary care and equity considerations on the pathway; (3) identified regional gaps in the tSCI Pathway and prioritized them for implementation; and (4) developed quality indicators. Outcomes The tSCI Pathway was drafted in overarching and detailed formats. For Acute Care, building blocks focused on appropriate assessment, initial management, and transition planning; for Rehabilitation, building blocks focused on access to specialized rehabilitation and assessment and planning of community needs; for Community, building blocks focused on follow-up, mechanisms for re-access, and holistic support for persons and families; and for equity considerations, building blocks focused on those at-risk or requiring complex supports. Team-based primary care and navigation supports were seen as crucial to reduce inequities. Conclusion This is the first comprehensive care pathway for tSCI. The Pathway is grounded in person-centred care, integrated care and services, and up-to-date clinical practice guidelines. The tSCI Care Pathway is flexible to regional realities and individual needs to ensure equitable care for all.
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Fulceri, Francesca, Letizia Gila, Angela Caruso, Martina Micai, Giovanna Romano, and Maria Luisa Scattoni. "Building Bricks of Integrated Care Pathway for Autism Spectrum Disorder: A Systematic Review." International Journal of Molecular Sciences 24, no. 7 (March 26, 2023): 6222. http://dx.doi.org/10.3390/ijms24076222.
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An integrated plan within a defined care pathway for the diagnosis, continuative interventions, and periodic redefinition of care of autistic people is essential for better outcomes. Challenges include delivering services across all domains or life stages and effective coordination between health/social care providers and services. Further, in the ‘real world’, service provision varies greatly, and in many settings is significantly weighted towards diagnosis and children’s services rather than treatment and support or adult care. This study aims to identify existing care pathways for Autism Spectrum Disorder (ASD) from referral to care management after diagnosis. The study reviewed the international literature in PubMed and PsycInfo databases and collected information on care for autistic individuals from the Autism Spectrum Disorders in Europe (ASDEU) project partners. The study found that published data mainly focused on specific components of care pathways rather than an integrated and coordinated plan of care and legislative indications. They should be aimed at facilitating access to the services for support and the inclusiveness of autistic individuals. Given the need for care addressing the complex and heterogeneous nature of ASD, effective coordination between different health/social care providers and services is essential. It is also suggested that research priority should be given to the identification of an integrated care pathway ‘model’ centered around case management, individualization, facilitation, support, continuous training and updating, and quality management.
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Rantala, Arja, Miia M. Jansson, Otto Helve, Pekka Lahdenne, Minna Pikkarainen, and Tarja Pölkki. "Parental Experiences of the Pediatric Day Surgery Pathway and the Needs for a Digital Gaming Solution: Qualitative Study." JMIR Medical Informatics 8, no. 11 (November 13, 2020): e23626. http://dx.doi.org/10.2196/23626.
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Background The parents of hospitalized children are often dissatisfied with waiting times, fasting, discharge criteria, postoperative pain relief, and postoperative guidance. Parents’ experiences help care providers to provide effective, family-centered care that responds to parents’ needs throughout the day surgery pathway. Objective The objective of our study was to describe parental experiences of the pediatric day surgery pathway and the needs for a digital gaming solution in order to facilitate the digitalization of these pathways. Methods This was a descriptive qualitative study. The participants (N=31) were parents whose children were admitted to the hospital for the day surgical treatments or magnetic resonance imaging. The data were collected through an unstructured, open-ended questionnaire; an inductive content analysis was conducted to analyze the qualitative data. Reporting of the study findings adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results Parental experiences of the children’s day surgery pathway included 3 main categories: (1) needs for parental guidance, (2) needs for support, and (3) child involved in his or her own pathway (eg, consideration of an individual child and preparation of child for treatment). The needs for a digital gaming solution were identified as 1 main category—the digital gaming solution for children and families to support care. This main category included 3 upper categories: (1) preparing children and families for the day surgery via the solution, (2) gamification in the solution, and (3) connecting people through the solution. Conclusions Parents need guidance and support for their children’s day surgery care pathways. A digital gaming solution may be a relevant tool to support communication and to provide information on day surgeries. Families are ready for and are open to digital gaming solutions that provide support and guidance and engage children in the day surgery pathways.
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Bosserman, Linda D., Mary Cianfrocca, Bertram Yuh, Christina Yeon, Helen Chen, Stephen Sentovich, Amy Polverini, et al. "Integrating Academic and Community Cancer Care and Research through Multidisciplinary Oncology Pathways for Value-Based Care: A Review and the City of Hope Experience." Journal of Clinical Medicine 10, no. 2 (January 7, 2021): 188. http://dx.doi.org/10.3390/jcm10020188.
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As the US transitions from volume- to value-based cancer care, many cancer centers and community groups have joined to share resources to deliver measurable, high-quality cancer care and clinical research with the associated high patient satisfaction, provider satisfaction, and practice health at optimal costs that are the hallmarks of value-based care. Multidisciplinary oncology care pathways are essential components of value-based care and their payment metrics. Oncology pathways are evidence-based, standardized but personalizable care plans to guide cancer care. Pathways have been developed and studied for the major medical, surgical, radiation, and supportive oncology disciplines to support decision-making, streamline care, and optimize outcomes. Implementing multidisciplinary oncology pathways can facilitate comprehensive care plans for each cancer patient throughout their cancer journey and across large multisite delivery systems. Outcomes from the delivered pathway-based care can then be evaluated against individual and population benchmarks. The complexity of adoption, implementation, and assessment of multidisciplinary oncology pathways, however, presents many challenges. We review the development and components of value-based cancer care and detail City of Hope’s (COH) academic and community-team-based approaches for implementing multidisciplinary pathways. We also describe supportive components with available results towards enterprise-wide value-based care delivery.
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Bosserman, Linda D., Mary Cianfrocca, Bertram Yuh, Christina Yeon, Helen Chen, Stephen Sentovich, Amy Polverini, et al. "Integrating Academic and Community Cancer Care and Research through Multidisciplinary Oncology Pathways for Value-Based Care: A Review and the City of Hope Experience." Journal of Clinical Medicine 10, no. 2 (January 7, 2021): 188. http://dx.doi.org/10.3390/jcm10020188.
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As the US transitions from volume- to value-based cancer care, many cancer centers and community groups have joined to share resources to deliver measurable, high-quality cancer care and clinical research with the associated high patient satisfaction, provider satisfaction, and practice health at optimal costs that are the hallmarks of value-based care. Multidisciplinary oncology care pathways are essential components of value-based care and their payment metrics. Oncology pathways are evidence-based, standardized but personalizable care plans to guide cancer care. Pathways have been developed and studied for the major medical, surgical, radiation, and supportive oncology disciplines to support decision-making, streamline care, and optimize outcomes. Implementing multidisciplinary oncology pathways can facilitate comprehensive care plans for each cancer patient throughout their cancer journey and across large multisite delivery systems. Outcomes from the delivered pathway-based care can then be evaluated against individual and population benchmarks. The complexity of adoption, implementation, and assessment of multidisciplinary oncology pathways, however, presents many challenges. We review the development and components of value-based cancer care and detail City of Hope’s (COH) academic and community-team-based approaches for implementing multidisciplinary pathways. We also describe supportive components with available results towards enterprise-wide value-based care delivery.
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Lynch, Mary, Elizabeth Morrow, Edward Naessen, Carmel Kelly, and Clodagh Killeen. "A scoping review of the economic evidence to support the development of career pathways for home care support workers. ." International Journal of Integrated Care 25 (April 9, 2025): 47. https://doi.org/10.5334/ijic.icic24345.
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Introduction: The ever-growing demands on care systems have increased reliance on Home Care Support Worker’s (HCSW’s) which has seen a shift to provision of care away to community based and close to home care provision. Currently there is no clear outline of a career pathway nor career development for HCSW’s, and this lack of associated framework which recognises CPD for career progression is impacting on recruiting and retaining HCSW’s within the care sector. The Sláintecare implementation strategy reform and modernise of the Irish health and social care services has precipitated a government investment of up to €15 billion in commitment to health spending (Gov.ie, 2018). Aims & Objectives: The aim of this scoping review is to explore the international evidence to identify the potential costs/outcomes of the development of a career pathway for HCSW, and the economic benefits connected with continual professional development (CPD). The rational for taking this approach is that the evidence to date is limited, regarding the effectiveness of systems or models for career pathway for HCSW’s and value for money. Methods: A scoping review was conducted of peer-reviewed international literature using structured searches of electronic databases (Web of Science, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, Social Care Online, and Social Sciences Citation Index) and grey literature (Sept-Nov 2023) using key economic terms and methodologies to capture economic evidence and connected costs with HCSW career development and CPD activities. Outcomes: Article screening of titles, abstracts and full texts was conducted by three independent reviewers (EM, ML and EN) to minimise bias and ensure rigour along with applying a GRADE approach for literature quality. The search strategy identified peer reviewed literature which included economic issues associated with CPD and HCSW career development. Following, 17 papers were critically appraised and during the process of data extraction four key themes emerged: (1) Cost-benefits of employment and training (2) Organisational economic perspectives (3) Service economic perspectives and (4) Sector economic perspectives. Conclusion: The inclusion of economic evidence within this scoping review identified that there is very limited evidence associated with economic evaluation approaches to estimate the costs and benefits of CPD and development of career pathway for HCSW. The scoping review did identify the gaps in the evidence on the assessments of systems or models for HCSW’s career pathways development and CPD opportunities. Recommendations are that future research should include Cost Benefit Analysis (CBA) within the evaluations to build evidence to support CPD activity and a career pathway development for HCSW’s.
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Oliveira, Larayne Gallo Farias, Lislaine Aparecida Fracolli, Alfredo Almeida Pina-Oliveira, Anna Luiza de Fátima Pinho Lins Gryschek, Débora Rodrigues Vaz, Talitha Zileno Pereira, Jerusa Costa Dos Santos, Denise Maria Campos de Lima Castro, Fátima Madalena de Campos Lico, and Laiza Gallo Farias. "Care pathways: strategies to facilitate access and care for teenage mothers." CONTRIBUCIONES A LAS CIENCIAS SOCIALES 17, no. 2 (February 8, 2024): e4289. http://dx.doi.org/10.55905/revconv.17n.2-025.
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To explore strategies to facilitate access and care for teenage mothers, delving into solutions that aim to overcome the obstacles that permeate this crucial phase of life. This is an integrative literature review, carried out in December 2023 in the MEDLINE, Web of Science and SCOPUS databases, without limitations regarding language and date of publication. The descriptors indexed in DeCS and MeSH were used: “Adolescent Mothers”, “Effective Access to Health Services” and Primary Health Care combined using the Boolean operator “and”. The results obtained were exported to the Mendeley® software and, later, to the Rayyan® application. Six studies were eligible and the results were categorized into three categories: educational and awareness interventions, improving accessibility to health services and psychosocial support approaches. Effective strategies to promote access to and care appropriate to the needs of adolescent mothers may vary, but generally involve the implementation of comprehensive sexual and reproductive health programs, accessible education about prenatal and postnatal care, availability of specialized health services for adolescents, in addition to emotional and psychosocial support.
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Ward, M. Diane. "McKessonHBOC's Pathways Care Manager™: Decision support tool for health care delivery and management." Case Manager 12, no. 3 (May 2001): 38–39. http://dx.doi.org/10.1067/mcm.2001.115956.
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Franzoi, Maria Alice, Lena Degousée, Elise Martin, Patricia Miguel Semedo, Marion Aupomerol, Davide Soldato, Antonio Di Meglio, et al. "Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer." JCO Oncology Practice 19, no. 6 (June 2023): 353–61. http://dx.doi.org/10.1200/op.23.00016.
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PURPOSE Optimal comprehensive survivorship care is insufficiently delivered. To increase patient empowerment and maximize the uptake of multidisciplinary supportive care strategies to serve all survivorship needs, we implemented a proactive survivorship care pathway for patients with early breast cancer at the end of primary treatment phase. METHODS Pathway components included (1) a personalized survivorship care plan (SCP), (2) face-to-face survivorship education seminars and personalized consultation for supportive care referrals (Transition Day), (3) a mobile app delivering personalized education and self-management advice, and (4) decision aids for physicians focused on supportive care needs. A mixed-methods process evaluation was performed according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework including administrative data review, pathway experience survey (patient, physician, and organization), and focus group. The primary objective was patient-perceived satisfaction with the pathway (predefined progression criteria for pathway continuation ≥70%). RESULTS Over 6 months, 321 patients were eligible for the pathway and received a SCP and 98 (30%) attended the Transition Day. Among 126 patients surveyed, 77 (66.1%) responded. 70.1% received the SCP, 51.9% attended the Transition Day, and 59.7% accessed the mobile app. 96.1% of patients were very or completely satisfied with the overall pathway, whereas perceived usefulness was 64.8% for the SCP, 90% for the Transition Day, and 65.2% for the mobile app. Pathway implementation seemed to be positively experienced by physicians and the organization. CONCLUSION Patients were satisfied with a proactive survivorship care pathway, and the majority reported that its components were useful in supporting their needs. This study can inform the implementation of survivorship care pathways in other centers.
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Jackman, David M., Yichen Zhang, Carole Dalby, Tom Nguyen, Julia Nagle, Christine A. Lydon, Michael S. Rabin, Kristen K. McNiff, Belen Fraile, and Joseph O. Jacobson. "Cost and Survival Analysis Before and After Implementation of Dana-Farber Clinical Pathways for Patients With Stage IV Non–Small-Cell Lung Cancer." Journal of Oncology Practice 13, no. 4 (April 2017): e346-e352. http://dx.doi.org/10.1200/jop.2017.021741.
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Purpose: Increasing costs and medical complexity are significant challenges in modern oncology. We explored the use of clinical pathways to support clinical decision making and manage resources prospectively across our network. Materials and Methods: We created customized lung cancer pathways and partnered with a commercial vendor to provide a Web-based platform for real-time decision support and post-treatment data aggregation. Dana-Farber Cancer Institute (DFCI) Pathways for non–small cell lung cancer (NSCLC) were introduced in January 2014. We identified all DFCI patients who were diagnosed and treated for stage IV NSCLC in 2012 (before pathways) and 2014 (after pathways). Costs of care were determined for 1 year from the time of diagnosis. Results: Pre- and postpathway cohorts included 160 and 210 patients with stage IV NSCLC, respectively. The prepathway group had more women but was otherwise similarly matched for demographic and tumor characteristics. The total 12-month cost of care (adjusted for age, sex, race, distance to DFCI, clinical trial enrollment, and EGFR and ALK status) demonstrated a $15,013 savings after the implementation of pathways ($67,050 before pathways v $52,037 after pathways). Antineoplastics were the largest source of cost savings. Clinical outcomes were not compromised, with similar median overall survival times (10.7 months before v 11.2 months after pathways; P = .08). Conclusion: After introduction of a clinical pathway in metastatic NSCLC, cost of care decreased significantly, with no compromise in survival. In an era where comparative outcomes analysis and value assessment are increasingly important, the implementation of clinical pathways may provide a means to coalesce and disseminate institutional expertise and track and learn from care decisions.
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Leach, Corinne R., Catherine M. Alfano, Jessica Potts, Lisa Gallicchio, K. Robin Yabroff, Kevin C. Oeffinger, Erin E. Hahn, Lawrence N. Shulman, and Shawna V. Hudson. "Personalized Cancer Follow-Up Care Pathways: A Delphi Consensus of Research Priorities." JNCI: Journal of the National Cancer Institute 112, no. 12 (April 25, 2020): 1183–89. http://dx.doi.org/10.1093/jnci/djaa053.
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Abstract Development of personalized, stratified follow-up care pathways where care intensity and setting vary with needs could improve cancer survivor outcomes and efficiency of health-care delivery. Advancing such an approach in the United States requires identification and prioritization of the most pressing research and data needed to create and implement personalized care pathway models. Cancer survivorship research and care experts (n = 39) participated in an in-person workshop on this topic in 2018. Using a modified Delphi technique—a structured, validated system for identifying consensus—an expert panel identified critical research questions related to operationalizing personalized, stratified follow-up care pathways for individuals diagnosed with cancer. Consensus for the top priority research questions was achieved iteratively through 3 rounds: item generation, item consolidation, and selection of the final list of priority research questions. From the 28 research questions that were generated, 11 research priority questions were identified. The questions were categorized into 4 priority themes: determining outcome measures for new care pathways, developing and evaluating new care pathways, incentivizing new care pathway delivery, and providing technology and infrastructure to support self-management. Existing data sources to begin answering questions were also identified. Although existing data sources, including cancer registry, electronic medical record, and health insurance claims data, can be enhanced to begin addressing some questions, additional research resources are needed to address these priority questions.
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Marinova, Petya, and Rali Marinova. "Patient-centred stoma care support: urostomy patients." British Journal of Community Nursing 29, no. 12 (December 2, 2024): 580–87. https://doi.org/10.12968/bjcn.2024.0130.
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Urostomy patients are rare as only about 5% of ostomates have urostomies. This can prove challenging because many healthcare professionals do not have experience caring for these patients and may be unfamiliar with their specific needs. As with other ostomates, urostomy patients require specialist nurses with the expertise to provide long-term support. Care for urostomy patients may be provided by urinary diversion specialists or stoma specialist nursing. Patient-centred pathways are needed to cater for their unique needs and ensure good patient outcomes and quality of life. People with urostomy have very post-operative need needs and inadequate care may result in hospital admissions. They need specialised long-term care. It is also crucial to educate the healthcare professionals responsible for their care.
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Fields, Karen K., Hatem Hussein Soliman, Eliot Lawrence Friedman, Rachel V. Lee, Maria Czarina Acelajado, Diana Tamondong-Lachica, and John W. Peabody. "Measuring clinical pathway compliance using a simulated patient approach with clinical performance and value (CPV) vignettes." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 96. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.96.
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96 Background: Although clinical pathways have the promise to improve the quality of care, they have had limited success changing practice or standardizing care. Moffitt Cancer Center (MCC) has > 40 pathways incorporating interdisciplinary care strategies linked to evidence and decision support tools. Methods: To improve compliance with pathways we used an innovative measure to quantify quality of care, CPV vignettes. CPV vignettes are validated, simulated clinical scenarios constructed so that adherence to pathways is clear-cut. Providers care for identical cases so there is no need for case mix adjustment. After completing each case, providers are given personalized feedback. Twelve breast cancer (ca) vignettes were developed by MCC breast medical oncologists and surgeons and QURE, a healthcare measurement company. The cases were developed using MCC pathways, other evidence and core issues such as diagnostic work-up. The vignettes were randomized at the department level and given to all MCC providers who care for breast ca patients. A total of 18 providers took 34 CPVs: 7 medical oncologists, 6 advanced practitioners and 5 surgeons. QURE-trained physician abstractors blinded to the CPV-taker’s identity scored each vignette and provided confidential feedback. Results: Total scores for providers averaged 55.4%, s.d. 12.5%, a typical score for a CPV baseline study. Adherence to pathways varied by area with the highest concordance for radiation and hormonal therapy and the lowest for management of axillary lymph nodes (see Table). Conclusions: Adherence to pathways varied among providers and by clinical domain. Ongoing efforts will evaluate the impact of serial CPV measurement on pathway adherence. Simulations simplified the task of determining pathway adherence making pathway compliance at the physician level a reasonable expectation and standardization at the group level scientifically rigorous and feasible. [Table: see text]
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Dubuc, Nicole, Simon Brière, Cinthia Corbin, Afiwa N’Bouke, Lucie Bonin, and Nathalie Delli-Colli. "Computerized Care-Pathways (CCPs) System to Support Person-Centered, Integrated, and Proactive Care in Home-Care Settings." Informatics for Health and Social Care 46, no. 1 (January 6, 2021): 100–111. http://dx.doi.org/10.1080/17538157.2020.1865969.
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Black, Georgia, and Julie-Ann Moreland. "What your patient needs to know about a non-specific symptom pathway referral for suspected cancer." British Journal of General Practice 74, suppl 1 (June 2024): bjgp24X737661. http://dx.doi.org/10.3399/bjgp24x737661.
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BackgroundNon-specific symptom (NSS) pathways were implemented in the UK in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue, or GP ‘gut feeling’.AimTo explore patients’ experiences of NSS pathways, and their potential support needs in terms of understanding and navigating these pathways.MethodThis study employed ethnographic methods across four NHS trusts in England, including interviews with 28 patients and 28 professionals, patient shadowing, and clinical care observations, to examine NSS pathways for cancer diagnosis. Analysis focused on patient communication and understanding of care.ResultsPatients found it hard to understand why they were referred. Only a minority of patients appreciated that multiple organs were being investigated for cancer. Progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. Investigations often resulted in incidental findings. Patients whose persistent symptoms were not explained were often unsure what to do following discharge.ConclusionThe findings resulted in recommended messages for GPs to support patients on referral to NSS pathways, including the nature of the pathway, the team that will be responsible for their care, the multiple organ systems that will potentially be investigated, and what will happen if they don’t find a cancer. Without this support, patients’ difficulties in comprehending previous investigations and findings could result in delays, overtesting, or inadequately targeted investigations, hindering the effective use of their medical history.
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Schlencker, Aurelien, Laurent Messer, Marc Ardizzone, Gilles Blaison, Olivier Hinschberger, Etienne Dahan, Christelle Sordet, et al. "Improving patient pathways for systemic lupus erythematosus: a multistakeholder pathway optimisation study." Lupus Science & Medicine 9, no. 1 (May 2022): e000700. http://dx.doi.org/10.1136/lupus-2022-000700.
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ObjectiveAmong the most significant challenges in SLE are the excessive diagnosis delay and the lack of coordinated care. The aim of the study was to investigate patient pathways in SLE in order to improve clinical and organisational challenges in the management of those with suspected and confirmed SLE.MethodsWe conducted a cross-sectional study of patients with SLE, healthcare providers and other representative stakeholders. Focus groups were conducted, and based on the collected data the most impactful disruption points in SLE patient pathways were identified. A novel framework to improve individual patient pathways in SLE was developed, discussed and validated during a consensus meeting with representative stakeholders.ResultsSix thematic clusters regarding disruption in optimal patient pathways in SLE were identified: appropriate and timely referral strategy for SLE diagnosis; the need for a dedicated consultation during which the diagnosis of SLE would be announced, and following which clarifications and psychological support offered; individualised patient pathways with coordinated care based on organ involvement, disease severity and patient preference; improved therapeutic patient education; prevention of complications such as infections, osteoporosis and cancer; and additional patient support. During the consensus meeting, the broader panel of stakeholders achieved consensus on these attributes and a framework for optimising SLE patient pathways was developed.ConclusionsWe have identified significant disruption points and developed a novel conceptual framework to improve individual patient pathways in SLE. These data may be of valuable interest to patients with SLE, their physicians, health organisations as well as policy makers.
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Roy, Ashok, Peter Baker, and Sue Carmichael. "Care pathways for people with intellectual disabilities who present with behaviours that challenge." Tizard Learning Disability Review 25, no. 3 (November 30, 2020): 99–107. http://dx.doi.org/10.1108/tldr-07-2020-0016.
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Purpose Care pathways are being increasingly used in the national health service to outline an anticipated programme of care in relation to a particular illness, condition or set of symptoms. The purpose of this paper is to inform those using the service of what they might expect within what time frame. They are designed to reduce variation in practice and allow optimal quality of care across a variety of care settings. Care pathways map out a patient’s journey, providing coordination of services for users. They aim to have: “the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome”. Design/methodology/approach This paper outlines care pathways in relation to people with intellectual disabilities who present with behaviour that challenges. Findings It is likely that many people will have a lifelong need for support, so discharge from clinical services should only be considered if it is genuinely appropriate. Reductions in a person’s behaviours that challenge are likely to be a consequence of changes that have been made to the person’s environment and supports. Therefore, any reductions in the level or type of support that the person receives may lead to an escalation of the behaviour again. Originality/value Standards in relation to care pathways are presented.
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Chappell, Rachel, Sarah Fearn, James Raftery, and Christopher Kipps. "179 Impact inventory development in neurological pathways." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 9 (August 12, 2022): e2.139. http://dx.doi.org/10.1136/jnnp-2022-abn2.223.
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BackgroundQuantification of the economic burden within long-term neurological conditions pathways is difficult, and little evidence is available on how best to approach this. With the ambition to deliver care differently through digital mechanisms, and enhanced provision of self-management support, it is impera- tive that we develop mechanisms that can help measure the economic impact of pathway interventions in long-term neurological conditions. An impact inventory is a recognised initial step in defining the costs of an intervention from a range of perspectives including health/non-health and known/unknown cost itemsMethodsWe used thematic analysis to analyse survey data on events causing an increase in care needs, grouped these as health- or care-related, calculated reported event frequencies and then applied NHS (National Tariff workbook) and social care reference costs (PSSRU, 2020) to them.ResultsWe identified 728 events comprising 35 event types across 5 long-term neurological conditions. Six events were common across conditions, and 13 were condition-specific. Post-event care costs were significantly greater than health-related costs (mean 7.9 times), and total pathway event costs varied nearly five-fold across conditions (£5,395 vs £23,258).ConclusionCosts can be quantified in neurological pathways using an impact inventory to characterise events that change care requirements.
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Reyneke, Anel, Chrystal Jaye, and Tim Stokes. "Local clinical pathways: from ‘good ideas’ to ‘practicality’ for general practitioners." Journal of Primary Health Care 10, no. 3 (2018): 215. http://dx.doi.org/10.1071/hc18023.
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ABSTRACT INTRODUCTION There has been increased interest in the utility of clinical pathways by primary health care in New Zealand, although evaluation of their use has been limited. AIM To identify barriers and facilitators for the use of clinical pathways in one health region. METHODS Interviews with 15 general practitioners in the Western Bay of Plenty. A qualitative thematic analysis was undertaken, informed by the Diffusion of Innovation Framework. RESULTS Four themes were identified: learning to use the pathways, persuasion and decision to use, implementation and sustainability. Barriers to using the pathways included time pressure; scepticism; difficulty in portraying patients’ clinical picture within a set pathway; technical difficulties and lack of support in obtaining knowledge; and practical implementation of the pathways in daily work. Facilitators included endorsement by opinion leaders; pathways directing workup and treatment stepwise towards referral; centralised information with resources available in the consultation; and reported increased acceptance of referrals by secondary care if pathways were used. DISCUSSION The development and implementation of health care initiatives requires an understanding of the local context. Knowledge about the specific, locally appreciated barriers and facilitators can inform future health-care developments. The Diffusion of Innovation Framework offers a practical model to understand effective implementation.
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Szelągowski, Marek, Justyna Berniak-Woźny, and Cezary Lipiński. "BPM Support for Patient-Centred Clinical Pathways in Chronic Diseases." Sensors 21, no. 21 (November 6, 2021): 7383. http://dx.doi.org/10.3390/s21217383.
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Epidemiological trends over the past decade show a significant worldwide increase in the burden of chronic diseases. At the same time, the human resources of health care are becoming increasingly scarce and expensive. One of the management concepts that can help in solving this problem is business process management (BPM). The results of research conducted in the healthcare sector thus far prove that BPM is an effective tool for optimizing clinical processes, as it allows for the ongoing automatic tracking of key health parameters of an individual patient without the need to involve medical personnel. The aim of this article is to present and evaluate the redesign of diagnostic and therapeutic processes enabling the patient-centric organization of therapy thanks to the use of new telemedicine techniques and elements of hyperautomation. By using an illustrative case study of one of the most common chronic diseases, Chronic Obstructive Pulmonary Disease (COPD), we discuss the use of clinical pathways (CPs) prepared on the basis of the current version of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as a communication tool between healthcare professionals, the patient and his or her caregivers, as well as the method of identifying and verifying new knowledge generated on an ongoing basis in diagnostic and therapeutic processes. We also show how conducting comprehensive, patient-focused primary health care relieves the health care system, and at the same time, thanks to the use of patient engagement and elements of artificial intelligence (predictive analyses), reduces the significant clinical risk of therapy.
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Csik, Valerie Pracilio, Jared Minetola, Karen Walsh, Michael J. Ramirez, and Mark Hurwitz. "Pathways impact on OCM drug cost." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 109. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.109.
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109 Background: Oncology care, including drugs, represents a significant portion of US healthcare spending. Cost of Part B drugs has increased at a rate 5.7x that of overall Medicare spending (1997-2004). As a participant in the Oncology Care Model (OCM), we found drug costs represent a majority of our total costs. To reduce treatment (Tx) variability, our NCI-designated cancer center chose to implement pathways. Pathways are a clinical decision-support tool that use evidence-based care maps accounting for efficacy, toxicity and cost. At one institution, use of pathways contributed to $15k in savings for stage IV lung cancer Tx. We hypothesized pathway driven Tx standardization would favorably impact total chemotherapy (CTx) costs at the implementation site. Methods: In July 2018, we implemented pathways in Medical and Radiation Oncology for new starts or changes in Tx. Oncologists accessed the tool through our EMR, selected and placed orders for Tx. OCM quarterly data was used to compare 2 quarters immediately pre- and post-pathway implementation. The cancer-mix-adjusted Per-Member-Per-Month (PMPM) Allowed Amounts for CTx were compared between 3 groups; patients on-pathway, patients off-pathway and patients for which the pathways tool was not used (no utilization). PMPMs were evaluated pre- and post-implementation and an ANOVA test was used to evaluate significance of the difference between the two periods. Results: PMPM CTx costs decreased 4.6% between pre- and post-pathway implementation when oncologists followed pathways. By comparison, the off-pathway cohort and the no utilization groups had increases of 0.9% and 17.7% respectively. An evaluation of cost difference proved significant (p < .0001). Breast patients on-pathway had a cost decrease of 20%, compared to increases of 32% and 11% for off-pathway and no utilization groups, respectively. Conclusions: Pathway use reduced variation, a known contributor to healthcare costs, and therefore may be an effective cost control tool. Additional quarters of claims data is needed post-implementation to fully define the impact of pathways on total cost. [Table: see text]
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Evans, William K., Yee Ung, Anna Chyjek, Angelika Gollnow, and Carol Anne Sawka. "Cancer Care Ontario’s lung disease pathway initiative: Building resources for lung cancer quality care." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e17531-e17531. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e17531.
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e17531 Background: Cancer Care Ontario (CCO) is the provincial agency mandated to improve the quality of cancer care in Ontario. CCO has driven quality improvement (QI) on a programmatic basis but in 2008, introduced Disease Pathway Management (DPM) as an additional QI approach. The lung cancer (LC DPM) began in 2009 as a two-year, phased initiative. Methods: The LC DPM team, consisting of clinicians, patients and system stakeholders, was organized into five groups and focused on aspects of the patient journey from diagnosis to end-of-life care, guided by draft pathway maps of the ideal state. 17 improvement concepts were identified of which 8 were selected for detailed development at a provincial consensus conference and validated as LC DPM’s Priorities for Action. 14 regional road shows presented region-specific performance and quality data to practitioners involved in LC patient care to promote ideas for improvement. Funding was provided to support both provincial and regional initiatives that addressed identified gaps. Results: Key outputs of the LC DPM initiative were: establishment of lung diagnostic assessment programs in 14 regions; completion of diagnostic and treatment pathways for NSCLC and SCLC which were grounded in evidence; 10 improvement projects on various stages of the cancer continuum; and 6 one-year Dyspnea Management Pilot Projects. For the dyspnea projects, each funded centre used different approaches and evaluated impacts on patient symptom burden, measured by Edmonton Symptom Assessment System (ESAS), patient satisfaction and quality of life. The learnings from each project have been summarized and will be shared with all regional cancer programs to facilitate knowledge transfer. Tools to support the patient experience include a LC Patient Pathway Map (PPM) and a document, Understanding Lung Cancer. The physician and patient pathways and related materials are available on CCO's website at https://www.cancercare.on.ca Conclusions: LC DPM has proven an effective strategy to accomplish system changes across a large geography that impact the quality of LC care, processes and patient experience. Indicator development and performance management will be used to sustain the gains achieved.
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Lokay, Kathleen. "Use of radiation pathways to drive standardization of evidence-based care across a large network." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 27. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.27.
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27 Background: UPMC CancerCenter includes 37 academic and community based sites in western Pennsylvania. Consistency and quality of care are critical to such a diverse network. To meet these challenges, UPMC developed clinical pathways for medical and radiation oncology, now marketed as Via Pathways. The program has served UPMC well for over eight years and is now a key foundation for UPMC’s overall healthcare reform strategy for accountable care. Methods: Radiation treatment algorithms for 90% of cancers were developed by committees of academic and community radiation, surgical, and medical oncologists, with current representation from multiple cancer centers across the country. The committees meet semi-annually to interpret the literature and define the most efficacious and least toxic treatments for highly specific disease presentations (e.g., oropharynx, Stage III-IV, primary chemoradiation). Guidance for contouring, planning and delivery are provided along with applicable citations. Clinical trials open at UPMC sites are also imbedded into the algorithms. Converting these algorithms into measureable decision support is accomplished with a web portal that presents the individual pathways status through the physician’s daily schedule. Results: Thirty-one (31) radiation oncologists at UPMC use Via Pathways in their daily practice. For the 12 months ended May 31, 2013, UPMC physicians confirmed a pathways status for 98% of their patient visits (n=9,400) and achieved an On Pathway rate of 95% for their 5,575 treatment decisions. All off pathway treatment decisions were approved prior to treatment by a designated peer review radiation oncologist within UPMC. Reasons for going off pathway were recorded as well as what alternative approach to care was chosen. Conclusions: When appropriately developed and implemented, clinical pathways are a solution to standardizing care across multiple sites and physicians with the potential to improve the quality and cost effectiveness of cancer care. We continue to expand the scope of Via Pathways to include additional cancer types, surveillance protocols, and end of life prompts as well as surgical oncology pathways.
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Blackburn, Joanna, and Virginia Minogue. "Developing an eating disorder pathway: a case study." Journal of Mental Health Training, Education and Practice 9, no. 4 (December 2, 2014): 244–60. http://dx.doi.org/10.1108/jmhtep-06-2014-0016.
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Purpose – The purpose of this paper is to describe the development of an eating disorder care pathway for adults with eating disorders, in a northern borough town. It arose out of a need to reduce and address inconsistent access to services and treatment pathways. Design/methodology/approach – The development involved a mapping exercise of current service delivery, a review of the literature on eating disorder care pathways, consultation workshops, the engagement of service users and carers, and the development of draft pathways for patients and carers. Findings – Significant emphasis was on raising awareness, prevention, identification and assessment, treatment and recovery. Two pathways were proposed, one for service users focusing on awareness raising/prevention, identification and assessment, treatment, stabilisation and relapse prevention and one for carers/families focusing on carers being identifiable in their own right to receive support for caring for someone with an eating disorder. Research limitations/implications – A limitation of the care pathway under development was the difficulty obtaining an accurate figure of the true number of cases of eating disorders in the local area. This, together with the lack of any form of systematic review or meta-analysis of care pathways made identifying the number of people suffering from eating disorders and developing an effective model difficult. Originality/value – The proposed pathway places significant emphasis on increasing knowledge, incorporating the patient perspective, and enhancing the recognition and understanding of eating disorders in the community. A model was created that could be implemented successfully and identify patients suffering from eating disorders, when the true incidence of eating disorders remains hidden.
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Steel, Zachary, Robert Mcdonald, Derrick Silove, Adrian Bauman, Phil Sandford, Jennifer Herron, and I. Harry Minas. "Pathways to the First Contact with Specialist Mental Health Care." Australian & New Zealand Journal of Psychiatry 40, no. 4 (April 2006): 347–54. http://dx.doi.org/10.1080/j.1440-1614.2006.01801.x.
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Objective: To examine the pathways to mental health care followed by patients presenting for the first time to community- and hospital-based services and the degree to which individual characteristics, cultural background, illness type, severity and service-related variables influence the time and pathways taken to reach care. Method: One hundred and forty-six consecutive Australian-born, Asian and Arabicspeaking patients making their first lifetime contact with mental health services in two area health regions were included. Symptom severity was assessed using the Health of the Nations Outcome Scales. Illness explanatory models, social support, English-language proficiency and acculturation were also assessed. Results: An average of three professional consultations were made prior to first contact with public mental health services. Family physicians occupied a pivotal role in the helpseeking pathway with 53% of patients consulting a general practitioner. The median time taken to reach specialist mental health services was 6 months, with significantly shorter time for patients with psychotic disorders. Individual variables such as gender, social support, ethnicity and English flency were not associated with delays in receiving public mental health care. Ethnicity was associated with lower utilization of allied health professionals. Conclusions: The data suggest that social and cultural factors influence the range of professionals consulted by those with a mental illness but do not delay their presentation to public mental health services.
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Balch, Alan. "How Pathways Can Support Reimbursement for Personalized Decision Making and Care Planning." Journal of Clinical Pathways 5, no. 2 (March 14, 2019): 20–22. http://dx.doi.org/10.25270/jcp.2019.03.00065.
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Hunter, R., I. Clegg, and N. Palaniappan. "OC14.05: Planned anticipatory care pathways to support parents with lethal fetal abnormalities." Ultrasound in Obstetrics & Gynecology 56, S1 (October 2020): 41. http://dx.doi.org/10.1002/uog.22306.
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Ellis, Peter G., Kathleen Lokay, and Amanda Barry. "Using clinical pathways to understand biomarker testing patterns." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18189-e18189. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18189.
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e18189 Background: Via Pathways’ Disease Committees incorporate biomarker testing recommendations into the pathway decision support when the literature supports improved outcome. For several years, the non-small cell lung pathway (NSCLP) has recommended testing for ALK, EGFR, and, more recently ROS1 targeted therapies. The decision support software (VP) requires the practitioner to register testing and results, including the decision not to test. Methods: For the twenty months ending 10/31/16, we analyzed all NSCLP patients treated at UPMC CancerCenter locations for first line, metastatic, non-squamous lung cancer per the VP. Results were analyzed in total and by type of provider (83 community providers vs. 3 academic providers who specialize in lung cancer). Provider’s answers to the biomarker testing question included “positive” results, “negative” results, “test pending”, and “not tested”. Results: Of the 684 treatment starts in the 1stline non-squamous NSCLP, 100 were patients of academic providers (AP) and 584 were patients of community providers (CP). AP indicated testing for ALK and EGFR in 100% of patients (n=100). CP indicated testing for ALK in 91% (n=532) and for EGFR in 92% (n=538). AP indicated testing for ROS1 in 96% (n=93) and CP indicated testing for ROS1 in 81% (n=473). Results are summarized in the table. Conclusions: Data from clinical pathways software can be utilized to understand biomarker testing rates among providers. In this example, the three AP tested for actionable mutations more frequently than the 83 CP, although both rates of testing appeared to be high. This data can be used to generate hypothesis about patterns of care that may include patient parameters, size of network or other factors that can then further analyzed and tested. Pathways serves as an important tool in promoting and monitoring quality care. [Table: see text]
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Sharma, Sowmya, Michael J. Stewart, Holly Mathias, Kerri Novak, Sander Veldhuyzen Van Zanten, Courtney Heisler, Sharon Richard, et al. "Primary healthcare provider-perceived barriers to implementing an evidence-based pathway for undifferentiated lower gastrointestinal tract symptoms: A qualitative inquiry." PLOS ONE 19, no. 12 (December 31, 2024): e0313201. https://doi.org/10.1371/journal.pone.0313201.
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Background Primary healthcare providers play a critical role in diagnosing and managing digestive disorders. Standardized clinical care guidelines have been developed, but with limited and inconsistent implementation. An evidence-based gastroenterology clinical care pathway (GUTLINK) has been proposed in one region of Canada; however, little is known in the medical literature about potential barriers to pathway implementation within primary care. We aimed to identify behavioral and environmental barriers and facilitators to implementation of evidence-based care pathways for undifferentiated lower gastrointestinal tract symptoms in primary care. Methods One-on-one semi-structured interviews were conducted with primary healthcare providers between September 2021 and May 2022. Interview script development was guided by the COM-B framework. Interviews were transcribed and data were analyzed using an inductive thematic analysis approach. Results A total of 15 primary healthcare provider interviews were conducted. Several key barriers to GUTLINK implementation were identified in all three domains of the COM-B framework. Key barriers included Capability (e.g., Physician Knowledge and Access to Allied Health), Opportunity (e.g., Access to diagnostic tools), and Motivation (e.g., Comfort with managing cases and optimism). Some of these barriers have not previously been identified in medical literature. Conclusions Evidence-based clinical care pathways have the potential to support access to quality gastroenterology care, yet primary healthcare providers in this study identified several barriers to implementation. Potential solutions exist at the individual and clinic levels (e.g., greater education, improved provider-specialist communication), but must be supported with systems-level changes (e.g., increased funding for gastrointestinal care and e-Health platforms) to support pathway implementation and improve quality of care.
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Lee, Minyoung, Yeji Choi, Eun Young Lee, Dong-A. Kim, and Seung Hee Ho. "Life Experiences with Using Community Care among People with Severe Physical Disabilities: A Comparative Analysis between South Korea and Japan." International Journal of Environmental Research and Public Health 17, no. 24 (December 9, 2020): 9195. http://dx.doi.org/10.3390/ijerph17249195.
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This study identified the pathways chosen by people with severe physical disabilities (PWSPD) in South Korea and Japan in using community care throughout their life and compared their experiences while navigating these pathways from their perspective. A concurrent nested mixed-method design was adopted. Quantitative data analysis included pathway mapping of facilities and services used throughout their lives. For qualitative data, interpretative phenomenological analysis (IPA) was applied. Eleven South Korean (congenital 7, acquired 4) and nine Japanese (congenital 6, acquired 3) participants were surveyed and interviewed. Pathway mapping was conducted by classifying the participants into focus groups. South Korean participants took nine years more than the Japanese participants to reach independence and showed different pathway characteristics. Superordinate themes from the IPA provided insight into the differences in experiences between PWSPD of the two countries: (1) accessibility and continuity of medical services; (2) experience of vocational training; (3) way and degree of social support for independent living; (4) care planning for receiving comprehensive services. In developing a community care model for the PWSPD to accelerate their time to independence, the government should strive for accessibility and connectivity of medical services, strengthen vocational training, social support for independent living, and information provision for the PWSPD.
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Sullivan, Dawn O., Mary Mannix, and Suzanne Timmons. "Integrated Care Pathways and Care Bundles for Dementia in Acute Care: Concept Versus Evidence." American Journal of Alzheimer's Disease & Other Dementiasr 32, no. 4 (April 12, 2017): 189–93. http://dx.doi.org/10.1177/1533317517698791.
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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.
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David, Rodreck, Ruth Evans, and Hamish SF Fraser. "Modelling Prenatal Care Pathways at a Central Hospital in Zimbabwe." Health Services Insights 14 (January 2021): 117863292110627. http://dx.doi.org/10.1177/11786329211062742.
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Background: Maternal mortality remains a problem in low-income countries (LICs). In Zimbabwe, there has been an unprecedented increase in maternal mortality in the last 2.5 decades. Effective prenatal care delivery, particularly early visits, appropriate number of visits, and receiving recommended care is viewed as key to reducing fatal care outcomes. Aims: This study sought to model and identify gaps requiring service and care delivery improvement in prenatal care pathways for pregnant women visiting Mpilo Central Hospital in Bulawayo, Zimbabwe. Methods: This was a case study of the services offered by an antenatal care department at Mpilo Central Hospital in Bulawayo, Zimbabwe. Evidence from literature in low-income countries was used to develop prenatal care pathway guidelines as a tool to guide care delivery and identify gaps in care and service delivery. One hundred cases of prenatal care records were reviewed to determine the prenatal care pathway and care delivered to pregnant women. This data was complemented by interviews with 20 maternity care clinicians. Results: In 100 maternity case records studied, 53% booked for prenatal care. Of the 53% (n = 53) pregnant women who booked, their first visit on their pregnancy was late at an average gestational age of 27.1 weeks with extremes of 30 to 40 weeks in 38% (n = 20) cases. Missing scheduled prenatal care appointments was prevalent, with only 11% (n = 6) having attended all the expected 5 visits, whilst 60% (n = 32) missed 3 or more. There were inadequacies in the care delivered to women in each visit compared to that expected in such areas as obstetrics, physical examinations and haematological tests. Maternity care clinicians attributed the cost of prenatal booking fees in the background of poverty and poor family support systems as key factors hindering women’s access to prenatal services. Conclusions: The current prenatal care pathway at MCH requires improvement in the areas of referral, adherence to appointment by pregnant women and visiting prenatal care early. Clinicians also need to adhere to standard clinical tests recommended for each specific pregnant woman’s visit. In the Zimbabwean setting with limited resources, where the number of visits is already low, pathways with reduced visits may not be appropriate. An investment into prenatal care by the government is recommended to enable the utilisation of interventions such as e-health technologies that may improve care delivery as well as adherence to best practices. E-health and mobile health technologies involving e-referrals, e-booking, decision support, and reminder systems are recommended for clinicians to manage and deliver appropriate care to patients as well as pregnant women to adhere to scheduled visits.
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Akehurst, Joy, Zeibeda Sattar, Isabel Gordon, and Jonathan Ling. "Implementing online evidence-based care pathways: A mixed-methods study across primary and secondary care." BMJ Open 8, no. 12 (December 2018): e022991. http://dx.doi.org/10.1136/bmjopen-2018-022991.
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AimTo understand what contextual influences, mechanisms and outcomes affect the implementation and use of localised, online care pathways (HealthPathways) in primary and secondary care.Design and procedureMixed-measures design.Quantitative data included number of page views and conditions viewed. Qualitative data from semistructured interviews and focus groups were gathered over a 6-month period, and analysed using NVivo software.SettingThe first HealthPathways UK site, South Tyneside, England.ParticipantsGeneral practitioners, nurses, practice managers, hospital consultants and system leaders (managers, commissioners) (n=76).ResultsUse of the pathways significantly increased over time. Themes were developed showing how online care pathways were used—leadership, pre-existing networks and relationships; development of systems and processes for care pathways, the use of online care pathways to support decision-making and referral, and perceived availability of resources. Inter-related themes were arranged into configurations consisting of contextual influences, mechanisms and outcomes. Recommendations were made for future implementations, such as improved data collection processes to understand how and why there was variance in the use of pathways.ConclusionsThis study was early in the implementation process; however, emerging themes will facilitate the future implementation and use of online care pathways. Recommendations are made for further research to include other health and social care users and patients to inform future developments.