Littérature scientifique sur le sujet « Patient Pathways »
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Articles de revues sur le sujet "Patient Pathways"
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Dahlin, Sara, et Hendry Raharjo. « Relationship between patient costs and patient pathways ». International Journal of Health Care Quality Assurance 32, no 1 (11 février 2019) : 246–61. http://dx.doi.org/10.1108/ijhcqa-10-2017-0199.
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Purpose The purpose of this paper is to identify actual (as-is) patient pathway variation among breast cancer patients and to investigate the relationship between pathways and the cost incurred by patients. Design/methodology/approach Both quantitative and qualitative methods were employed to analyze data from four Swedish hospital groups. Quantitative methods include event-log data mining and statistical analyses on the related patient cost from the Swedish breast cancer quality registry and case-costing system. Qualitative methods included collaboration with and interviewing domain experts. Findings Unique pathways, followed by only one patient, were generally costlier than the most and less frequent pathways. Earlier study findings are confirmed for mastectomy patients, with more frequent pathways having a lower cost, whereas contradicting and inconclusive results emerged for the partial mastectomy patient groups. Highest variation in pathways was identified for patients receiving chemotherapy. Practical implications The common belief – if one follows a standardized patient pathway, then the cost will be lower – should be re-examined based on the actual pathways that occur in reality. Originality/value The relationships between patient pathways and patient cost allow more complex insights, beyond the general causal relationship between successfully implementing a “to-be” care pathway and lower cost. This highlights data-driven research’s importance, where actual pathways (as-is) provide more useful information than to-be care pathways.
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Hansen, Jens B., Jens F. L. Sørensen, Eva N. Glassou, Morten Homilius et Torben B. Hansen. « Reducing patient–staff contact in fast-track total hip arthroplasty has no effect on patient-reported outcomes, but decreases satisfaction amongst patients with self-perceived complications : analysis of 211 patients ». Acta Orthopaedica 93 (24 janvier 2022) : 264–70. http://dx.doi.org/10.2340/17453674.2022.1617.
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Background and purpose: Several studies have compared fast-track with conventional pathways for total hip arthroplasty (THA) patients, but none have compared different fast-track pathways. Due to COVID-19 restrictions, our department had to minimize patient–staff contact in the THA pathway. First, telephone consultations were implemented instead of an outpatient clinic visit and subsequently preoperative patient education was discontinued. This enabled us to compare patient-reported outcomes and satisfaction among 3 fast-track pathways. Patients and methods: We collected data from patients treated for hip osteoarthritis with THA at Gødstrup Hospital between 2018 and 2021. The patients had experienced 1 of 3 pathways and were interviewed via telephone between 2 and 6 months after discharge. We analyzed the influence of patient pathway on patient-reported pain and mobility level, self-perceived complications, and compliance using logistic regression. We then compared the pathway’s effect on patient satisfaction both for the total sample and for the patients who experienced complications. Results: The amount of patient–staff contact in the patient pathway did not have any influence on patientreported outcomes or the probability of self-perceived complications. For the full sample, patient–staff contact had no statistically significant influence on patient satisfaction either, but for the subgroup of patients experiencing complications, the pathways with less patient–staff contact reducedsatisfaction. Patient satisfaction was primarily related to pain and mobility outcomes. Interpretation: Our results indicate that reducing patient–staff contact in fast-track THA can be done without influencing mobility and pain outcomes, but the overall satisfaction among patients with self-perceived complications will be negatively affected.
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Hu, Chenyu W., Amina A. Qutub, Yihua Qiu, Suk Young Yoo, Nianxiang Zhang, Naveen Pammaraju, Courtney D. DiNardo, Kevin R. Coombes et Steven M. Kornblau. « A Global Proteomic Pathway Map In Acute Myeloid Leukemia (AML) ». Blood 122, no 21 (15 novembre 2013) : 1302. http://dx.doi.org/10.1182/blood.v122.21.1302.1302.
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Abstract Background AML has been extensively studied in a gene-to-gene and pathway-to-pathway fashion over the years, unraveling insightful local patterns that capture heterogeneity in patients and identify potential drug targets. However, our understanding of AML from a global and systems perspective is still lacking. A global proteomic pathway map is yet to be drawn to integrate local activity patterns and to translate patient classifications across pathways. This will not only improve our scientific understanding of how different functional pathways are inter-related, but will also enable us to develop more robust and effective therapeutic regimens based on pathway cross-talks. Methods A proteomic profile, containing the expression pattern of 231 proteins in each of the 415 newly diagnosed AML patients at UT MD Anderson Cancer Center, was generated using the Reverse Phase Protein Array (RPPA) technology. We grouped these proteins into 23 functional pathways based on protein association known in literature and correlation shown in the proteomic profile. Principal component analysis and scree plot were used to refine the pathway construction. The AML patients were clustered by their protein expression patterns within each individual pathway, and were then compared across pathways. The association of patient clusters between different pathways was measured by Goodman-Kruskal's (GK) tau method, indicating the predictability of patient clustering in one pathway given that in the other. This association between pathways and interchangeability of patient groupings were visualized in a circos plot (Figure 1), depicting a global proteomic pathway map. Results The global proteomic pathway map illustrates how strongly protein expression patterns of different pathways are associated, and how patient classifications under different pathways could be translated from one to another. Here, we highlight some of the key insights surfaced from this analysis. First, we identified ‘social' pathways that have intensive cross-talks with multiple other pathways, including some of the cell signal transduction pathways (MEK, PI3K, mTOR), genetic information processing pathways (transcription, histone methylation), and cell survival/death pathways (apoptosis, autophagy). We also identified ‘orphan' pathways that are more independent and are poorly associated with others. These include a subset of signal transduction pathways (pkc, tp53, S6rp, Src, Creb, Wnt), cytoskeleton and differentiation. As the association is directional, each pathway could be further characterized as either a ‘sender' or a ‘receiver' pathway based on whether it is acting more as the origin or the target of the link. The patient clusters from the ‘sender' pathways (e.g. Apoptosis, mTOR, Fli), could be easily translated to other pathways, while the patient clusters in ‘receiver' pathways (e.g. Hippo and Transcription), are highly predictable by patient clusters from multiple other pathways. We further constructed and compared the global pathway maps for patients in different cytogenetic groups. Comparison of pathway maps from patients with favorable, intermediate and unfavorable cytogenetics shows the power of this methodology to discern differences in the degree of correlation between protein functional groups. Favorable cytogenetics (T8;21) and inversion 16, because they are more similar have less patient to patient variation and thus have a more consistent and highly correlated pathway map with a higher number of connections. Conclusions Based on the RPPA data in AML patients, we built a global proteomic pathway map that captures the association between protein expression patterns in defined protein functional groups. We identified intensive interacting pathways as well as independent pathways, which indicate potential hubs and modulators of leukemic cell behavior. We further compared maps of different cytogenetic groups and revealed different correlation mappings. We are further refining the algorithms in order to study more focused changes within lower population subsets. Ultimately we believe that this will enable the matching of targeted agents to specific settings where the target is expressed and highly interactive based on proteomic data. Disclosures: No relevant conflicts of interest to declare.
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Ku, Chu-Chang, Chien-Chou Chen, Simon Dixon, Hsien Ho Lin et Peter J. Dodd. « Patient pathways of tuberculosis care-seeking and treatment : an individual-level analysis of National Health Insurance data in Taiwan ». BMJ Global Health 5, no 6 (juin 2020) : e002187. http://dx.doi.org/10.1136/bmjgh-2019-002187.
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IntroductionPatients with tuberculosis (TB) often experience difficulties in accessing diagnosis and treatment. Patient pathway analysis identifies mismatches between TB patient care-seeking patterns and service coverage, but to date, studies have only employed cross-sectional aggregate data.MethodsWe developed an algorithmic approach to analyse and interpret patient-level routine data on healthcare use and to construct patients’ pathways from initial care-seeking to treatment outcome. We applied this to patients with TB in a simple random sample of one million patients’ records in the Taiwan National Health Insurance database. We analysed heterogeneity in pathway patterns, delays, service coverage and patient flows between different health system levels.ResultsWe constructed 7255 pathways for 6258 patients. Patients most commonly initially sought care at the primary clinic level, where the capacity for diagnosing TB patients was 12%, before eventually initiating treatment at higher levels. Patient pathways are extremely heterogeneous prior to diagnosis, with the 10% most complex pathways accounting for 48% of all clinical encounters, and 55% of those pathways yet to initiate treatment after a year. Extended consideration of alternative diagnoses was more common for patients aged 65 years or older and for patients with chronic lung disease.ConclusionOur study demonstrates that longitudinal analysis of routine individual-level healthcare data can be used to generate a detailed picture of TB care-seeking pathways. This allows an understanding of several temporal aspects of care pathways, including lead times to care and the variability in patient pathways.
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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 (mai 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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Russell, Kevin, et Francis Maietta. « Simulated Patient Pathways. » Simulation in Healthcare : The Journal of the Society for Simulation in Healthcare 1, no 3 (2006) : 189. http://dx.doi.org/10.1097/01266021-200600130-00044.
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Pang, Herbert, et Hongyu Zhao. « Stratified Pathway Analysis to Identify Gene Sets Associated with Oral Contraceptive Use and Breast Cancer ». Cancer Informatics 13s4 (janvier 2014) : CIN.S13973. http://dx.doi.org/10.4137/cin.s13973.
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Cancer biomarker discovery can facilitate drug development, improve staging of patients, and predict patient prognosis. Because cancer is the result of many interacting genes, analysis based on a set of genes with related biological functions or pathways may be more informative than single gene-based analysis for cancer biomarker discovery. The relevant pathways thus identified may help characterize different aspects of molecular phenotypes related to the tumor. Although it is well known that cancer patients may respond to the same treatment differently because of clinical variables and variation of molecular phenotypes, this patient heterogeneity has not been explicitly considered in pathway analysis in the literature. We hypothesize that combining pathway and patient clinical information can more effectively identify relevant pathways pertinent to specific patient subgroups, leading to better diagnosis and treatment. In this article, we propose to perform stratified pathway analysis based on clinical information from patients. In contrast to analysis using all the patients, this more focused analysis has the potential to reveal subgroup-specific pathways that may lead to more biological insights into disease etiology and treatment response. As an illustration, the power of our approach is demonstrated through its application to a breast cancer dataset in which the patients are stratified according to their oral contraceptive use.
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Swaminathan, Padmapriya, Casey B. Williams et Tobias Meissner. « Abstract 2271 : Patient-specific visualization of cancer pathways ». Cancer Research 82, no 12_Supplement (15 juin 2022) : 2271. http://dx.doi.org/10.1158/1538-7445.am2022-2271.
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Abstract Introduction: Analysis of whole transcriptomics datasets to quantify gene expression and determine differentially expressed genes has provided valuable information for precision medicine. Evaluating enrichment of specific gene groups and pathways, and visualizing these results is an important step to obtain inferences about patient treatment outcomes, overall survival, drug resistance and therapeutic targets. However, pathway analysis of cancer patient samples in a N-of-1 setting without their respective control (normal) samples remains to be challenging. There is a crucial need for methods and tools to conduct and visualize pathway analysis results in this setting. Methods and Results: Our method focuses on a visualization technique showing patient-specific pathway activation relative to reference populations from The Cancer Genome Atlas (TCGA) and The Genotype-Tissue Expression (GTEX). Patient-specific pathway activity scores are displayed within the respective percentiles and averages of the TCGA and GTEX cohorts to visualize a patient's individual pathway activation profile within the TCGA tumor and GTEX normal reference population. Patient-specific pathway scores are derived from an individual patient's transcriptomic profile and transformed into activity scores for each of 14 cancer pathways. This allows for the comparison of an individual patient’s pathway activation profile with reference samples from TCGA and GTEX. We used PROGENy (Pathway RespOnsive GENes for activity inference) to calculate activity scores for the 14 cancer related pathways. The pathway activity scores of each new tumor sample are scaled using the parameters of scaled pathway activity scores obtained from TCGA and GTEX gene expression data of all cancer tissue types. Finally we visualized the pathway activity scores of each patient sample. Conclusion: Our visualization method is expected to unravel the activation patterns of each of the 14 cancer pathways in our patient samples. Specific pathway genes can then be evaluated in the patient samples to identify causal mutations and their associations with the pathway activity scores hence aid in treatment selection and in the further development of precision medicine therapeutic solutions. Citation Format: Padmapriya Swaminathan, Casey B. Williams, Tobias Meissner. Patient-specific visualization of cancer pathways [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2271.
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Hermansen, Sabina Bay, Jens Holmskov, Søren Paaske Johnsen, Jan Mainz et Søren Valgreen Knudsen. « Quality in practice : applying the patient inventory method at a Danish psychiatric hospital ». International Journal for Quality in Health Care 32, no 7 (21 juillet 2020) : 477–79. http://dx.doi.org/10.1093/intqhc/mzaa076.
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Abstract Quality problem Patient care pathways should be organized according to the needs of the patients. This requires methods to assess whether the specific pathways ensure the right care for the right person at the right time and in the right setting. Initial assessment Previous investigations indicate that ~25% of the patients in Danish hospitals experience inappropriate elements in their care pathways. Choice of solution This study applied the Patient Inventory method to identify inappropriate elements in care pathways in 15 psychiatric in-patient wards in Denmark. Implementation The pathway for 201 patients was systematically evaluated by the clinical staff to identify whether the admission of the patient was avoidable, the hospitalization was unnecessarily prolonged or if the patient could receive more relevant treatment elsewhere. A subsequent meeting between the clinical staff and management qualified the assessment and identified possible solutions to problems. Evaluation A total of 54 (26.9%) of the included patients were assessed to have inappropriate elements in their care pathways, some with more than one type, resulting in a total of 65 episodes. Eight of these episodes (13.1%) were admissions considered to be avoidable, 26 (42.2%) were unnecessary prolongation of admissions, and 31 (58.1%) were patients assessed to be able to receive more relevant care elsewhere. Lessons learned One out of four assessed patients admitted to a psychiatric ward was exposed to an inappropriate element in their care pathway. The Patient Inventory tool can assist in a structured dialogue between clinical staff and management to identify focus areas for improvement efforts.
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Glass, Katherine, Chad W. Cummings, Marc A. Shapiro, Dennis Urbanek et Brian James Bolwell. « Data collection for care pathways in the Cleveland Clinic Health System. » Journal of Clinical Oncology 34, no 7_suppl (1 mars 2016) : 115. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.115.
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115 Background: Care pathways are established methods of reducing healthcare costs and disparities in oncology care. To demonstrate their impact, health systems must measure and report data on care pathway adherence and outcomes in near real-time. Automating data abstraction across a health system for oncology is difficult due to the amount and detail of data required. Manual abstraction of data is considered slow and costly. Many consider Electronic Medical Record (EMR) integration of care pathways essential in order to successfully implement and assess. Methods: 7 medical oncology care pathways and 45 medical oncologists across the health system were selected for a pilot study to assess the feasibility of implementing care pathways throughout the enterprise. The pilot study also allowed for testing of data collection capabilities. Patients eligible for the care pathways were prospectively identified by manual review of physician calendars. A small number of data points were manually abstracted from the patient EMR at the time of identification. Endpoints of interest, such as hospitalization rates, chemotherapy administered, time to treatment, and costs of care were reconciled through pre-existing databases within pharmacy, research, and finance. Tumor registry data identified a retrospective cohort. Results: Over 1,000 patients were prospectively identified for the care pathway pilot between 1/1/2014 and 12/31/2014. The tumor registry identified 700 additional retrospective patients. The rapid analyses possible as a result of these efforts demonstrated physician adherence, improved patient outcomes, and significant cost savings. In one example, a care pathway for metastatic non-small cell lung cancer reduced charges by more than $98,000/patient by recommending patients receive one standardized chemotherapeutic regimen. Conclusions: Timely data collection for oncology care pathways is feasible and cost effective without EMR integration. Manual identification of patients combined with pre-existing data sources allowed for near-real time analysis of care pathways and provided valuable information about care pathway impact. Institutions can implement and assess care pathways with resources already available to them.
Thèses sur le sujet "Patient Pathways"
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Debbage, Samantha D. « Do integrated care pathways improve patient outcomes ? » Thesis, University of Sheffield, 2009. http://etheses.whiterose.ac.uk/14949/.
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The purpose of the study was to determine if the use of an Integrated Care Pathway (ICP) was associated with more positive outcomes than traditional methods of care. The effectiveness of the ICP had not previously been tested (in relation to traditional methods of care) to determine if it made any difference, at a patient, staff or system (healthcare organisation) level. In February 2001 (as part of the NHS modernisation agenda) the gynaecology services within one UK city were re-organised and two separate units were merged into one new larger unit. Prior to the reorganisation, the two units offered similar treatments and were managed collectively; however, one site had developed and implemented ICPs and the other site had continued to use traditional methods of care delivery. ICPs are multidisciplinary plans for organising and delivering patient care. The plan of care is outlined in a sequential manner including all interventions with expected patient outcomes. The literature suggests that ICPs result in improved patient outcomes and lower hospital costs by decreasing length of stay and improving observations i.e. detecting signs of infection in a timelier manner. ICPs are recognised to facilitate the multidisciplinary partnerships in planning of patient care. However the literature was primarily anecdotal or non generalisable, and therefore additional local research was deemed essential. To ensure the research problem could be answered, three specific research questions were developed for testing: (1) What effect does an /~ / ICP have on the outcomes of gynaecological patients attending for major abdominal surgery? (2) What factors, including the use of an ICP contribute to the variance in length of stay for gynaecological patients? (3) What are the opinions of the staff who have used the ICP, of the ICP itself? Relevant directional hypothesis were derived from each research question. A quasi-experimental design was used to answer the first research question. Subjects were attached to one of two groups, a treatment group, which used the ICP, and a comparison group, which continued to deliver care based on traditional methods. Descriptive correlation was used to answer research question two and for the third research question descriptive exploration was used. Variables of interest from a patient, staff and system (health care organisational) level were collected to determine the effectiveness of the ICP compared with traditional methods. One of the difficulties faced with ICP research is the number of variables that can potentially influence patient care. Holzemer's model (1994, based on the work of Donabedian, 1966) was used to conceptualise the variables (and therefore the data collection instruments) into the category of structure, process or outcome at either a patient, provider or systems (health care organisation) level. This in turn helped to theorise the linkage between the variables within this study, identifying conceptual and functional relationships. The abdominal surgery ICP supported improvements in cost and efficiency through a reduction in length of stay (treatment site = 5.29 days, comparison site = 6.16 days) and a positive return to patients' perception of health. However, there was a reduction in patient satisfaction with nursing care with the introduction of the ICP and this needs further study. Involving patients in future developments and evaluations could promote long-term patient satisfaction.
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Zulkepli, Jafri. « A theoretical framework for hybrid simulation in modelling complex patient pathways ». Thesis, Brunel University, 2012. http://bura.brunel.ac.uk/handle/2438/6448.
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Providing care services across several departments and care givers creates the complexity of the patient pathways, as it deals with different departments, policies, professionals, regulations and many more. One example of complex patient pathways (CPP) is one that exists in integrated care, which most literature relates to health and social care integration. The world population and demand for care services have increased. Therefore, necessary actions need to be taken in order to improve the services given to patients in maintaining their quality of life. As the complexity arises due to different needs of stakeholders, it creates many problems especially when it involves complex patient pathways (CPP). To reduce the problems, many researchers tried using several decision tools such as Discrete Event Simulation (DES), System Dynamic (SD), Markov Model and Tree Diagram. This also includes Direct Experimentation, one of techniques in Lean Thinking/Techniques, in their efforts to help simplify the system complexity and provide decision support tools. However, the CPP models were developed using a single tools which makes the models have some limitations and not capable in covering the entire needs and features of the CPP system. For example, lack of individual analysis, feedback loop as well as lack of experimentation prior to the real implementation. As a result, ineffective and inefficient decision making was made. The researcher also argues that by combining the DES and SD techniques, named the hybrid simulation, the CPP model would be enhanced and in turn will help to provide decision support tools and consequently, will reduce the problems in CPP to the minimum level. As there is no standard framework, a framework of a hybrid simulation for modelling the CPP system is proposed in this research. The researcher is much concerned with the framework development rather than the CPP model itself, as there is no standard model that can represent any type of CPP since it is different in term of its regulations, policies, governance and many more. The framework is developed based on several literatures, selected among developed framework/models that have used combinations of DES and SD techniques simultaneously, applied in a large system or in healthcare sectors. This is due to the condition of the CPP system which is a large healthcare system. The proposed framework is divided into three phases, which are Conceptual, Modelling and Models Communication Phase, and each phase is decomposed into several steps. To validate the suitability of the proposed framework that provides guidance in developing CPP models using hybrid simulation, the inductive research methodology will be used with the help of case studies as a research strategy. Two approaches are used to test the suitability of the framework – practical and theoretical. The practical approach involves developing a CPP model (within health and social care settings) assisted by the SD and DES simulation software which was based on several case studies in health and social care systems that used single modelling techniques. The theoretical approach involves applying several case studies within different care settings without developing the model. Four case studies with different areas and care settings have been selected and applied towards the framework. Based on suitability tests, the framework will be modified accordingly. As this framework provides guidance on how to develop CPP models using hybrid simulation, it is argued that it will be a benchmark to researchers and academicians, as well as decision and policy makers to develop a CPP model using hybrid simulation.
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Gaddari, Abdelhamid. « Analysis and Prediction of Patient Pathways in the Context of Supplemental Health Insurance ». Electronic Thesis or Diss., Lyon 1, 2024. http://www.theses.fr/2024LYO10299.
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Ce travail de thèse s'inscrit dans la catégorie de la recherche en informatique de santé, en particulier l'analyse et la prédiction des parcours patients, qui sont les séquences des actes médicaux consommés par les patients au fil du temps. Notre objectif est de proposer une approche innovante pour l'exploitation des données de parcours de soins afin de réaliser non seulement une classification binaire, mais aussi multi-label. Nous concevons également une nouvelle approche de vectorisation et représentation sémantique exclusivement pour le domaine médical français, qui permettra d'exploiter un autre aspect des parcours patients afin d'améliorer la performance prédictive de notre approche proposée. Notre recherche s'inscrit dans le cadre des travaux de CEGEDIM ASSURANCES, une business unit du groupe CEGEDIM qui fournit des logiciels et des services pour les secteurs de l'assurance maladie complémentaire et de la gestion des risques en France. En analysant le parcours de soins et en utilisant l'approche que nous proposons, nous pouvons extraire des informations précieuses et identifier des patterns dans les parcours médicaux des patients afin de prédire des événements médicaux potentiels ou la consommation médicale à venir. Cela permettra aux assureurs de prévoir les futures demandes de soins de santé et donc de négocier de meilleurs tarifs avec les prestataires de soins de santé, ce qui permettra une planification financière précise, des modèles de tarification équitables et une réduction des coûts. En outre, ça permettra aux assureurs privés de concevoir des plans de santé personnalisés qui répondent aux besoins spécifiques des patients, en veillant à ce qu'ils reçoivent les soins adéquats au bon moment afin de prévenir la progression de la maladie. Enfin, l'offre de programmes de soins préventifs et de produits et services de santé personnalisés renforce les relations avec les clients, améliore leur satisfaction et réduit l'attrition. Dans ce travail, nous visons à développer une approche permettant d'analyser les parcours patients et de prédire les événements médicaux ou les traitements à venir, sur la base d'un large portefeuille de remboursements. Pour atteindre cet objectif, nous proposons tout d'abord un nouveau modèle basé sur les LSTM qui tient compte de la notion temporelle et qui permet de réaliser de la classification binaire et multi-label. Le modèle proposé est ensuite étendu par un autre aspect des parcours de soins, à savoir des informations supplémentaires provenant d'un clustering flou du même portefeuille. Nous démontrons que l'approche proposée est plus performante que les méthodes traditionnelles et d'apprentissage profond dans la prédiction médicale binaire et multi-label. Par la suite, nous améliorons la performance prédictive de l'approche proposée en exploitant un aspect supplémentaire des parcours patients, qui consiste en une description textuelle détaillée des traitements médicaux consommés. Ceci est réalisé grâce à la conception de F-BERTMed, une nouvelle approche de vectorisation et de représentation sémantique de phrases pour le domaine médical français. Celle-ci présente des avantages significatifs par rapport aux méthodes de l'état de l'art du traitement automatique du langage naturel (TAL). F-BERTMed est basé sur FlauBERT, dont le pré-entraînement utilisant la tâche MLM (Modélisation Masqué du Langage) a été étendu sur des textes médicaux français avant d'être fine-tuné sur les tâches NLI (Inférence du Langage Naturel) et STS (Similarité Sémantique Textuelle). Nous démontrons enfin que l'utilisation de F-BERTMed pour générer une nouvelle représentation des parcours patients améliore les performances prédictives de notre modèle proposé pour les tâches de classification binaire et multi-labelThis thesis work falls into the category of healthcare informatics research, specifically the analysis and prediction of patients’ care pathways, which are the sequences of medical services consumed by patients over time. Our aim is to propose an innovative approach for the exploitation of patient care trajectory data in order to achieve not only binary, but also multi-label classification. We also design a new sentence embedding framework exclusively for the french medical domain, which will harness another view of the patients’ care pathways in order to enhance the predictive performance of our proposed approach. Our research is part of the work of CEGEDIM ASSURANCES, a business unit of the CEGEDIM Group that provides software and services for the french supplementary healthcare insurance and risk management sectors. By analyzing the patient care pathway and leveraging our proposed approach, we can extract valuable insights and identify patterns within the patients’ medical journeys in order to predict potential medical events or upcoming medical consumption. This will allow insurers to forecast future healthcare claims and therefore negotiate better rates with healthcare providers, allowing for accurate financial planning, fair pricing models and cost reductions. Furthermore, it enables private healthcare insurers to design personalized health plans that meet the specific needs of the patients, ensuring they receive the right care at the right time to prevent disease progression. Ultimately, offering preventive care programs and customized health products and services enhances client relationship, improving their satisfaction and reducing churn. In this work, we aim to develop an approach to analyze patient care pathways and predict medical events or upcoming treatments, based on a large portfolio of reimbursed medical records. To achieve this goal, we first propose a new time-aware long-short term memory based framework that can achieve both binary and multi-label classification. The proposed framework is then extended with another aspect of the patient healthcare trajectories, namely additional information from a fuzzy clustering of the same portfolio. We show that our proposed approach outperforms traditional and deep learning methods in medical binary and multi-label prediction. Subsequently, we enhance the predictive performance of our proposed approach by exploiting a supplementary view of the patient care pathways that consists of a detailed textual description of the consumed medical treatments. This is achieved through the design of F-BERTMed, a new sentence embedding framework for the french medical domain that presents significant advantages over the natural language processing (NLP) state-of-the-art methods. F-BERTMed is based on FlauBERT, whose pre-training using MLM (Masked Language Modeling) was extended on french medical texts before being fine-tuned on NLI (Natural Language Inference) and STS (Semantic Textual Similarity) tasks. We finally show that using F-BERTMed to generate a new representation of the patient care pathways enhances the performance of our proposed medical predictive framework on both binary and multi-label classification tasks
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NEVES, MARIANA GUERRA BARSTAD CASTRO. « THE DOCTOR-PATIENT RELATIONSHIP FROM THE ATTACHMENT THEORY S PERSPECTIVE : THINKING PATHWAYS ». PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2018. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=34746@1.
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PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROCOORDENAÇÃO DE APERFEIÇOAMENTO DO PESSOAL DE ENSINO SUPERIOR
PROGRAMA DE SUPORTE À PÓS-GRADUAÇÃO DE INSTS. DE ENSINO
PROGRAMA DE SUPORTE À PÓS-GRADUAÇÃO DE INSTITUIÇÕES COMUNITÁRIAS DE ENSINO PARTICULARES
A relação médico-paciente consiste numa díade que é hierarquicamente assimétrica. Uma parte cuida e a outra recebe cuidado, análogo ao que ocorre nas relações de apego. O médico teria o papel de figura de apego, possibilitando ativar o seu sistema de cuidado. O objetivo deste estudo é analisar como o sistema de cuidado está inserido na relação médico-paciente, analisando o estilo de apego do médico, além de relacioná-lo à capacidade de cuidado que o médico tem com seu paciente. Foram entrevistados onze hematologistas do Rio de Janeiro e São Paulo com experiência no SUS utilizando um roteiro de entrevista semiestruturado e foi aplicado o instrumento de autorrelato EVA (Escala de Vinculação do Adulto). Após análise de conteúdo das entrevistas e análise por clusters do EVA, os médicos entrevistados apresentaram apego seguro, com aspectos defensivos evitativos e amedrontados. Quatro categorias também foram estabelecidas: experiências pessoais com medicina e/ou hematologia; especificidade da hematologia; como lidar com as questões sobre perdas; e cuidado com o outro. Conclui-se que o presente trabalho prioriza o lado do médico nesta relação, e a importância do atendimento às suas necessidades psicológicas e relacionais. Com isso, intervenções podem ser propostas à equipe de saúde, de forma a cuidar de maneira consistente destes profissionais e aprimorar sua relação com o paciente e seus familiares.
The doctor-patient relationship consists of a hierarchically asymmetrical dyad. One side cares and the other receives care, analogous to the attachment relationship. The doctor would have the attachment figure s role, being able to activate his or her caregiving system. The purpose of this study is to analyze how the care system is inserted in the doctor-patient relationship, analyzing the attachment style of the physician in addition to relating it to the care ability that the doctor has with his/her patient. Eleven hematologists from Rio de Janeiro and São Paulo with experience in SUS were interviewed using a semi-structured interview script and the self-report instrument AAS-R (Adult Attachment Scale-Revised) was applied. After content analysis of the interview and a cluster analysis of the AAS-R, all the doctors presented secure attachment, with avoidant-dismissing and avoidant-fearful defensive aspects. Four categories were also analyzed: personal experiences with medicine and/or hematology; hematology s specificity; how to deal with loss; and caring towards other. We concluded that the present it is important to prioritize the doctor s stance in the relationship, and to attend their psychological and relational needs. In that manner, interventions in the healthcare team can be proposed, providing the proper care to the healthcare professional, and, hence, improve their relationship with patients and their family members.
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Smeds, Magdalena. « Managing care pathways for patients with complex care needs ». Licentiate thesis, Linköpings universitet, Logistik- och kvalitetsutveckling, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-156836.
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One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient. Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs. The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care. The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions. Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways. This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway. Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation. This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.
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Bhattacharya, Abhik. « Development of a framework to identify patient pathways through a segment of the health care cycle ». [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0002866.
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Pelletier, Lori Rebecca. « Information-Enabled Decision-Making in Health Care : EHR-Enabled Standardization, Physician Profiling and Medical Home ». Digital WPI, 2010. https://digitalcommons.wpi.edu/etd-dissertations/166.
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Health care today harms too frequently and routinely fails to deliver its potential benefits. Significant evidence suggests that high quality primary care can positively affect health outcomes. I explored three related topics mentioned frequently in current United States health reform €“ Electronic Health Records (EHR), physician profiling and Medical Home. An investment in these areas is expected to significantly improve quality of care and efficiency; however, there is only a patchwork of evidence supporting such claims. To achieve EHR promises, my research employed a standardization lens to study the dynamics between EHR embedded structures and primary care processes. Using grounded theory, a standardization dynamics model was created describing the influencers, conditions and consequences of the process state. A matrix of two conditions, information exchange and patient complexity, identified four distinct pathways that require a different balance between standardization and flexibility. The value of such pathways is that they frame choices about how to use embedded IT structures to support effective delivery processes. Physician profiling is an emerging methodology used in health care quality improvement programs. Efforts to measure performance at the individual physician level face a number of challenges, including the need for sufficient sample size to support reliable measurement. A process for creating a physician profiling model was developed, and a model designed for a case study site. Results indicate that reliable physician profiling is possible across care domains using a hierarchical composite model. Patient-Centered Medical Home (PCMH) is a new care delivery approach for providing comprehensive primary care that seeks to strengthen the physician-patient relationship. This exploratory study utilizes Pearson correlation coefficients to test four hypotheses about relationships between two sources of data: (1) PPC-PCMH Survey results that measure adoption of PCMH structures and (2) patient experience data from Massachusetts Health Quality Partners (MHQP). The results showed that the PPC-PCMH structures of access and communication were negatively correlated with the related patient experience measure. This study contributes to the literature by addressing deficiencies in how EHR-enabled processes, physician profiling models and Medical Home constructs are measured, to support improved outcomes.
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Namaki, Araghi Sina. « A methodology for business process discovery and diagnosis based on indoor location data : Application to patient pathways improvement ». Thesis, Ecole nationale des Mines d'Albi-Carmaux, 2019. http://www.theses.fr/2019EMAC0014.
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Dans chaque organisation, les processus métier sont aujourd’hui incontournables. Cette thèse vise à développer une méthode pour les améliorer. Dans le domaine de la santé, les organisations hospitalières déploient beaucoup d’efforts pour mettre leurs processus sous contrôle, notamment à cause de la très faible marge d’erreur admise. Les parcours des patients au sein des structures de santé constituent l’application qui a été choisie pour démontrer les apports de cette méthode. Elle a pour originalité d’exploiter les données de géolocalisation des patients à l’intérieur de ces structures. Baptisée DIAG, elle améliore les parcours de soins grâce à plusieurs sous-fonctions : (i) interpréter les données de géolocalisation pour la modélisation de processus, (ii) découvrir automatiquement les processus métier, (iii) évaluer la qualité et la performance des parcours et (iv) diagnostiquer automatiquement les problèmes de performance des processus. Cette thèse propose donc les contributions suivantes : la méthode DIAG elle-même qui, grâce à quatre différents états, extrait les informations des données de géolocalisation ; le méta-modèle DIAG qui a deux utilités : d’une part, interpréter les données de géolocalisation et donc passer des données brutes aux informations utilisables, et, d’autre part contribuer à vérifier l’alignement des données avec le domaine grâce à deux méthodes de diagnostic décrites plus bas ; deux algorithmes de découverte de processus qui utilisent la stabilité statistique des logs d’évènements ; une nouvelle approche de process mining utilisant SPC (Statistical Process Control) pour l’amélioration ; l’algorithme proDIST qui mesure les distances entre les modèles de processus ; deux méthodes de diagnostic automatique de processus pour détecter les causes des déviations structurelles dans des cas individuels et pour des processus communs. Le contexte de cette thèse confirme la nécessité de proposer de telles solutions. Une étude de cas dans le cadre de ce travail de recherche illustre l’applicabilité de la méthodologie DIAG et des fonctions et méthodes mentionnéesBusiness processes are everywhere and, as such, we must acknowledge them. Among all of them, hospital processes are of vital importance. Healthcare organizations invest huge amount of efforts into keeping these processes under control, as the allowed margin of error is so slight. This research work seeks to develop a methodology to endorse improvement of patient pathways inside healthcare organizations. It does so by using the indoor location data of patients. This methodology is called DIAG (Data state, Information state, Awareness, Governance). It is constructed of several different functions. The most important ones are as follows: (i) location data interpreting, (ii) automatic discovery of business process models, (iii) business process analyzing for evaluating the performance and quality of processes, and finally, (iv) automatic diagnosing of business processes. Along the former functions, the contribution of this thesis are: The DIAG methodology which, through four different states, extracts knowledge from location data; the DIAG meta-model which supports both the interpretation of location data (from raw data to usable information) and the alignment of the domain knowledge (which are used for the diagnosing methods); two process discovery algorithms which explore statistical stability in event logs, application of Statistical Process Control (SPC) for the “enhancement notation” of Process Mining; the ProDIST algorithm for measuring the distance between process models; two automatic process diagnosing methods to detect causes of structural deviations in individual cases and common processes. The state of the art in this dissertation endorses the necessity for proposing such solutions. A case study within this research work illustrates the applicability of the DIAG methodology and its mentioned functions and methods
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Lea, Troy William. « Spiritual Pathways to Healing and Recovery : An Intensive Single-N Study of a Patient with an Eating Disorder ». BYU ScholarsArchive, 2016. https://scholarsarchive.byu.edu/etd/6022.
Texte intégralRésumé :
This study presents an in-depth case study of eight sessions of spiritually integrated psychotherapy with a 20-year-old woman recovering from an Eating Disorder. The inclusion and utility of session-to-session outcome data as well as systematic follow up data in conjunction with in-depth qualitative interviews are shown. The therapist and client's perspectives are highlighted over the course of treatment. Three clinical areas of focus (renewing identity, reducing self-contempt, and fostering hope) are extracted from the qualitative interviews and the therapeutic process of weaving them together is highlighted. The Tau-U and SMA single case study statistical analyses are used to highlight clinical gains and maintenance.
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Hajdarevic, Senada. « Patient and health care delays in malignant melanoma ». Doctoral thesis, Umeå universitet, Dermatologi och venereologi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-54392.
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Background: Unlike other cancers, malignant melanoma (MM) is generally visible and can be easily and effectively cured if treated in time. Optimal cure of MM requires early detection, diagnosis, and treatment, which improves prognosis. However, patients as well as the health care organization and its professionals contribute to delayed treatment in various ways. Aims and objectives: The general aim of this PhD thesis was to explore reasons for delay in care seeking, diagnosis, and treatment of malignant melanoma. The specific objectives to be addressed were To explore patients’ decision making about seeking care for malignant melanoma To identify specific patterns in the decision-making process to seek care for suspect melanoma, as narrated by women and men To compare self-reported decision making coping styles between men and women in various ages, who live with or without a partner and are diagnosed with various stages of malignant melanoma in northern Sweden. To describe and compare patients diagnosed with MM, depending on their initial contact with care, and with regard to age, sex, and MM type and thickness, and to explore pathways and time intervals between clinics from the initial contact to diagnosis and treatment. Methods: In studies I and II, 21 and 30 patients, respectively, were interviewed about their decision making to seek care for MM. Study II focused on gender patterns in this decision making. The interviews were analysed using Grounded Theory (I) and qualitative content analysis (II). Study III included 270 people with MM who completed a translated questionnaire (Melbourne Decision Making Questionnaire) about coping styles in decision making. In study IV the pathways and time delay in health care for 71 people with MM were explored. Studies I and II were qualitative, whereas studies III and IV were quantitative. Results: In study I, the insights into severity and feelings of fear and existential threat were identified as key motivators for patients to decide to seek care for a suspected melanoma. Results in study II showed that gender constructions influenced the care-seeking behaviour. Women acknowledged the skin changes and attempted self-care first. They delayed care seeking due to family responsibilities. Men seldom acknowledged the suspicious skin change, but sought care immediately after prompting, and most often complied with relatives’ advice to seek care. Study III showed that men generally scored higher in buck-passing, while women and those living without a partner scored higher in hypervigilance. Participants with nodular melanoma (NM), a rapid-growing form of MM, scored higher in vigilance than those diagnosed as in situ melanoma. No correlation was found between tumour thickness and coping styles. Some differences concerning treatment of MM were found in study IV between people who initially had sought care at primary health care centres (PHC) and those who had sought care at dermatological and specialist clinics (Derm). Thicker tumours as well as NM were more common in the PHC group. A larger proportion of patients from PHCs were primarily excided within the primary health care; however, almost all of them were later referred to surgical clinics for wide excision. Patients within the PHC group also had to wait longer for the registered results of histopathological assessments. In general, women waited a shorter time for primary excision, and older people waited longer for wide excision. Conclusions: Time delay of diagnosis and treatment of MM is still common, and crucial to decrease. Future interventions should include gender aspects to influence people to seek care earlier. In health care, time delay could be decreased by facilitating access for patients with suspected skin melanomas, but also by reducing unnecessary referrals. Moreover, organizational changes whereby general practitioners and primary health care nurses are supported in using new technology for faster diagnoses and management of MM in collaboration with specialist clinics should be considered. Easy access and frequently used guidelines for MM could further decrease delay. Lastly, more efficient transfer and registration of laboratory results and referrals could decrease delay and improve patient safety.Bakgrund: Malignt melanom (MM) är till skillnad från andra cancerformer ofta synlig och kan enkelt och kostnadseffektivt botas om det behandlas i tid. En optimal prognos av MM förutsätter tidig upptäckt, diagnos och behandling. Patienter, samt hälso- och sjukvården, dess organisation och dess personal kan på olika sätt bidra till fördröjning av behandlingen av MM. Syfte: Det övergripande syftet med denna avhandling var att undersöka orsaker till fördröjning att söka vård, diagnosticera och behandla malignt melanom. Specifika delsyften var: Att utforska patienternas beslutsfattande process att söka vård för MM Att identifiera specifika mönster i beslutsfattande-processen att söka vård för misstänkt MM utifrån kvinnors och mäns egna berättelser Att jämföra självrapporterade coping-stilar i den beslutsfattande processen mellan män och kvinnor i olika åldrar, boende med eller utan partner, och diagnosticerade med MM i olika stadier från norra Sverige Att beskriva och jämföra patienter med MM utifrån deras primära vårdkontakt samt utifrån ålder, kön, MM-typ och tjocklek. Ytterligare att utforska vård- och remissvägar samt tidsintervaller mellan olika kliniker från första kontakt till diagnos och behandling. Metod: I studie I och II, intervjuades 21 respektive 30 patienter om den beslutsfattande processen att söka vård för MM. Genuskonstruktioner i relation till den beslutsfattande processen var i fokus i studie II. Intervjuerna analyserades med hjälp av Grounded Theory (I) och kvalitativ innehållsanalys (II). I studie III inkluderades 270 patienter med MM som besvarade ett instrument (MDMQ) avseende coping-stilar i beslutsfattande processen. I studie IV undersöktes övergångar mellan olika kliniker och remissvägar för 71 patienter med MM samt eventuell tidsfördröjning inom hälso- och sjukvården. Resultat: I studie I, identifierades insikt i allvarlighetsgrad samt rädsla och existentiellt hot till följd av tillståndet vara nyckel-motivatorer för att bestämma sig för att söka vård för misstänkt hudmelanom. Resultat från studie II påvisade att genuskonstruktioner påverkar hur personer söker vård för MM. Kvinnor upptäckte själv sina melanom och försökte tillämpa egenvård i början. De kunde dröja att söka vård pga. ansvar för familjen. Män upptäckte sällan suspekta melanom själva men följde oftast anhörigas råd att söka vård och sökte vård omedelbart efter påstötning. Resultaten från studie III visade att män i högre grad använde en avvaktande startegi (buck-passing) medan kvinnor och de som bodde utan partner var överdrivet vaksamma (hypervigilance). Deltagare med nodulärt melanom (NM), en snabbt växande form av MM, var mer vaksamma (vigilance) jämfört med de med melanom in situ, en mycket tidig form av melanom. Några korrelationer mellan tumörtjocklek och coping-stilar hittades ej. Vissa skillnader avseende typer av MM samt vårdens handläggning beroende på var patienter initialt sökt vård identifierades i studie IV. Bland patienter som initialt sökt vård på hälsocentralerna var tjockare tumörer vanligare jämfört med dem som hade sökt vård på hud- och andra specialistklinker. Dessa patienter hade också som regel genomgått den primära excisionen på hälsocentralerna och en majoritet blev senare remitterade till kirurgisk klinik för utvidgad excision. Hälsocentralernas patienter fick vänta längre på att det histopatologiska svaret registrerades i journalen än sjukhusklinikernas patienter. Kvinnor fick generellt vänta kortare tid på primär excision och äldre patienter fick vänta längre för utvidgad excision. Slutsatser: Tidsfördröjning av diagnos och behandling av MM är fortfarande vanlig och därför viktig att minska. Framtida interventioner för att påverka människor att söka vård tidigare bör inkludera genusaspekter. Inom hälso- och sjukvården kan tidsfördröjning minskas genom förbättrad tillgänglighet för patienter med misstänkta hudmelanom, men också genom minskning av onödig remittering. En förändrad organisation där sjuksköterskor och primärvårdsläkare i samarbete med specialistkliniker stöttas att använda ny teknologi för snabbare diagnosticering och omhändertagande av MM bör övervägas. Ökad kännedom bland hälso- och sjukvårdspersonal om riktlinjer for MM-vård kan vidare minska fördröjning. Till sist, mer effektiva och förbättrade arbetssätt kring registrering och överföring av laboratoriska svar och remisser skulle kunna minska fördröjning och därmed öka patientsäkerheten.
Livres sur le sujet "Patient Pathways"
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E, Benner Patricia, Malloch Kathy et Sheets Vickie, dir. Nursing pathways for patient safety. St. Louis, Mo : Mosby Elsevier, 2010.
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National Council of State Boards of Nursing (U.S.). Expert Panel on Practice Breakdown. Nursing pathways for patient safety. Sous la direction de Benner Patricia E, Malloch Kathy et Sheets Vickie. St. Louis, Mo : Mosby Elsevier, 2010.
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National Council of State Boards of Nursing (U.S.). Expert Panel on Practice Breakdown. Nursing pathways for patient safety. Sous la direction de Benner Patricia E et Farrell Marie. St. Louis, Mo : Mosby Elsevier, 2010.
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National Council of State Boards of Nursing (U.S.). Expert Panel on Practice Breakdown. Nursing pathways for patient safety. Sous la direction de Benner Patricia E, Malloch Kathy et Sheets Vickie. St. Louis, Mo : Mosby Elsevier, 2010.
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Beyea, Suzanne C. Critical pathways for collaborative nursing care. Menlo Park, Calif : Addison-Wesley Nursing, 1996.
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Consortium, Midwest Bioethics Center Ethics Committee. Pathways to patient-centered palliative care : A community initiative. Kansas City, MO : Midwest Bioethics Center, 1997.
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), Canadian Institute (1985, dir. How to overcome your most difficult evaluation and implementation challenges in clinical pathways. Toronto : Canadian Institute Publications, 1997.
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A, Thorson Nancy, dir. Clinical pathways for medical rehabilitation. 2e éd. Gaithersburg, Md : Aspen Publishers, 2002.
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Judy, Marcus, et Aspen Reference Group (Aspen Publishers), dir. Clinical pathways for medical rehabilitation. Gaithersburg, Md : Aspen Publishers, 1998.
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1943-, Tucker Susan Martin, dir. Patient care standards : Collaborative practice planning guides. 6e éd. St. Louis, Mo : Mosby Year Book, 1996.
Trouver le texte intégralChapitres de livres sur le sujet "Patient Pathways"
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Larsen, Anna Grøndahl, Ragnhild Halvorsrud, Rolf Eigil Berg et Märt Vesinurm. « Dual-Perspective Modeling of Patient Pathways : A Case Study on Kidney Cancer ». Dans Communications in Computer and Information Science, 51–68. Cham : Springer Nature Switzerland, 2024. http://dx.doi.org/10.1007/978-3-031-59091-7_4.
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AbstractPatient pathway has become a key concept in the organization of healthcare. However, the materialization and operationalization of pathways often focus on work processes of health personnel, clinical decision-making, and deadlines, contradicting the strong patient-oriented perspective that is inherent in their definition. In this paper, we introduce a patient-centered perspective of kidney cancer pathways, reporting on a dual-perspective strategy to map and model patient pathways. Utilizing a multi-method approach, we map and model pathways from the perspectives of both healthcare personnel and patients and investigate the feasibility of the Customer Journey Modeling Language (CJML) for modeling patient pathways. To prevent confusion, the planned pathway as seen from the hospital perspective and the actual pathway experienced by the patient are referred to as ‘pathway’ and ‘journey’, respectively. In the paper, we describe methods to engage with healthcare professionals and patients to collect the necessary information to create precise models, and we show how precise modeling of patient pathways requires the integration of several information sources. Moreover, the study underlines the value of examining pathways from a dual perspective, as the two perspectives corroborate and supplement each other, illustrating the complexity of patient journeys. Finally, the findings provide insights into the feasibility of CJML, firstly underlining that the usefulness of visual models is context-dependent, and secondly, suggesting that the methods and subsequent visualizations may be useful as organizational, instructional, and communicative tools.
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Hillier, Bradley, Christopher Lambourne et Pamela Taylor. « Mapping Offender-Patient Pathways ». Dans Forensic Psychiatry and Psychology in Europe, 91–112. Cham : Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-74664-7_6.
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Keating, Michael R., et Benjamin E. Schneider. « Clinical Care Pathways ». Dans The SAGES Manual of Quality, Outcomes and Patient Safety, 79–90. Cham : Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-94610-4_5.
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Keating, Michael R., et Benjamin E. Schneider. « Clinical Care Pathways ». Dans The SAGES Manual of Quality, Outcomes and Patient Safety, 79–90. Cham : Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-94610-4_5.
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Schneider, Benjamin E. « Clinical Care Pathways ». Dans The SAGES Manual of Quality, Outcomes and Patient Safety, 105–9. Boston, MA : Springer US, 2011. http://dx.doi.org/10.1007/978-1-4419-7901-8_11.
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Arriaga, Alexander F. « Patient Safety ». Dans Physicians’ Pathways to Non-Traditional Careers and Leadership Opportunities, 285–92. New York, NY : Springer New York, 2011. http://dx.doi.org/10.1007/978-1-4614-0551-1_28.
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Zuiderent-Jerak, Teun, Roland Bal et Marc Berg. « Patients and their Problems : Situated Alliances of Patient-Centred Care and Pathway Development ». Dans Cancer Patients, Cancer Pathways, 204–29. London : Palgrave Macmillan UK, 2012. http://dx.doi.org/10.1057/9781137272089_10.
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Doran, Robert, et Deidre Donnelly. « Orbit, optic nerve and visual pathways ». Dans Care of the Ophthalmic Patient, 323–70. Boston, MA : Springer US, 1990. http://dx.doi.org/10.1007/978-1-4899-3378-2_17.
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Kutcher, Gerald. « A Case Study in Human Experimentation : The Patient as Subject, Object and Victim ». Dans Cancer Patients, Cancer Pathways, 57–77. London : Palgrave Macmillan UK, 2012. http://dx.doi.org/10.1057/9781137272089_4.
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Dua, Monica, Eric P. Ahnfeldt et Derrick Cetin. « 7 Patient Selection : Pathways to Surgery ». Dans Minimally Invasive Bariatric Surgery, 75–81. New York, NY : Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1637-5_7.
Texte intégralActes de conférences sur le sujet "Patient Pathways"
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Raza, Haider, Dheeraj Rathee, Renato Amorim et Maria Fasli. « Optimizing Patient Care Pathways : Impact Analysis of an AI-Assisted Smart Referral System for Musculoskeletal Services ». Dans 2024 IEEE International Conference on Digital Health (ICDH), 68–72. IEEE, 2024. http://dx.doi.org/10.1109/icdh62654.2024.00021.
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Zulkepli, Jafri, et Tillal Eldabi. « Developing integrated patient pathways using hybrid simulation ». Dans THE 4TH INTERNATIONAL CONFERENCE ON QUANTITATIVE SCIENCES AND ITS APPLICATIONS (ICOQSIA 2016). Author(s), 2016. http://dx.doi.org/10.1063/1.4966089.
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Arnaud, Laurent. « 08 Disruption points in lupus patient pathways ». Dans 12th Annual Meeting of the Lupus Academy ; Virtual Pre-meeting : September 1, 2023 ; Hybrid Annual Meeting (Barcelona) : September 8–10, 2023. Lupus Foundation of America, 2023. http://dx.doi.org/10.1136/lupus-2023-la.8.
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McClean, Sally, Lalit Garg, Brian Meenan et Peter Millard. « Using Markov Models to Find Interesting Patient Pathways ». Dans Twentieth IEEE International Symposium on Computer-Based Medical Systems. IEEE, 2007. http://dx.doi.org/10.1109/cbms.2007.121.
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Brock Jakobsen, Lene, et Birgit Refsgaard Iversen. « AmbuFlex – a telemedicine tool for improving patient pathways for patients with COPD ? » Dans ERS International Congress 2023 abstracts. European Respiratory Society, 2023. http://dx.doi.org/10.1183/13993003.congress-2023.pa2789.
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Jalote-Parmar, Ashis, Dag Takuro Hara, Ida Guldbrandsøy, Astrid Woodhouse et Karen Walseth Hara. « Multistakeholder Service Design Framework for Design of Patient Care Pathways - A case of joint management of pain patients in the health, labour and welfare services in Norway ». Dans ServDes.2023 Entanglements & Flows Conference : Service Encounters and Meanings Proceedings, 11-14th July 2023, Rio de Janeiro, Brazil. Linköping University Electronic Press, 2023. http://dx.doi.org/10.3384/ecp203026.
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Offering pain management services is a cohesive effort involving several stakeholders such as health, labour and welfare services. Globally, efforts are being made to develop streamlined patient care pathways, but there remains a specific need to improve and build the health care delivery services, for pain prevention, assessment, treatment, management, and follow-up. This raises the need for customised service design frameworks that provide guidance to both designers and healthcare providers in systematically involving multiple stakeholders to design patient-centered health care pathways. This paper presents a human-centered design case of service design for joint management of pain patients in the health, labour, and welfare services in Norway. This paper contributes directly to both the service design literature and health practice by proposing a multistakeholder service design framework. Paper also highlights strategic challenges and proposed solutions in the ongoing efforts in planning new national patient care pathways
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Adeyemi, Shola, et Thierry J. Chaussalet. « A Random Effects Sensitivity Analysis for Patient Pathways Model ». Dans 2008 21st International Symposium on Computer-Based Medical Systems (CBMS). IEEE, 2008. http://dx.doi.org/10.1109/cbms.2008.49.
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McClean, Sally, Lalit Garg, Maria Barton et Ken Fullerton. « Using mixed phase-type distributions to model patient pathways ». Dans 2010 IEEE 23rd International Symposium on Computer-Based Medical Systems (CBMS). IEEE, 2010. http://dx.doi.org/10.1109/cbms.2010.6042636.
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Boudko, Svetlana, et Wolfgang Leister. « Treatment pathways as petri nets in patient workflow management ». Dans iiWAS2017 : The 19th International Conference on Information Integration and Web-based Applications & Services. New York, NY, USA : ACM, 2017. http://dx.doi.org/10.1145/3151759.3151778.
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von, K. Bargen, M. Wolny, T. Flieder, A. Hohbein, M. Dittrich, G. Kappert, S. Halimeh, C. Knabbe et I. Birschmann. « Impaired signaling pathways in Glanzmann thrombasthenia platelets ». Dans GTH Congress 2023 – 67th Annual Meeting of the Society of Thrombosis and Haemostasis Research – The patient as a benchmark. Georg Thieme Verlag, 2023. http://dx.doi.org/10.1055/s-0042-1760609.
Texte intégralRapports d'organisations sur le sujet "Patient Pathways"
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Rada, Gabriel. How do clinical pathways affect patient outcomes, professional practice and hospital costs ? SUPPORT, 2016. http://dx.doi.org/10.30846/1608105.
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Clinical pathways are structured multidisciplinary care plans used by healthcare providers to detail essential steps in the care of patients with a specific clinical problem. The use of clinal pathways is intended to link evidence to practice and to optimise clinical outcomes whilst maximising clinical efficiency.
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Ryland, Howard, et Sarah Bunn. Reforming the Mental Health Act - Approaches to Improve Patient Choice. Parliamentary Office of Science and Technology, UK Parliament, mai 2023. http://dx.doi.org/10.58248/pn695.
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The Mental Health Act 1983 has been criticised as being overly restrictive, with inadequate scope for patient choice and autonomy. The Government’s Draft Mental Health Bill proposes reforms to improve patient choice. A joint parliamentary committee report on the draft Bill recommended further changes to enhance choice, including a statutory duty to offer patients advance choice documents. Reports to date suggest that advance care planning could offer some benefits, but uptake can be low. Proposals to replace the Nearest Relative who has certain powers under the Act, with a Nominated Person of the patient’s choosing, have been widely welcomed. There are questions about operationalisation and safeguarding. Alongside the reforms, the Government is piloting ‘culturally appropriate advocacy’, which preliminary findings suggest could help advocates better support patients from ethnic minority backgrounds. The draft Bill removes learning disabilities and autism as grounds for detention under Section 3 of the Act. Stakeholders have raised concerns about unintended diversion to more restrictive pathways, such as the criminal justice system. A range of stakeholders share the view that careful implementation is needed to maximise the benefits of proposed reforms. The Government has not announced when the Bill will be introduced.
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Krahn, Thomas, Sara Campos, Robert P. Loewe, Ronny Schmidt, Robert Rothmann, Christian Rausch, Cristian Nogales Calvo, Alexandra Petraina et Harald H. H. W. Schmidt. D5.3 - Initial whitepaper on rational for a wet-lab technology platform for patient recruitment. REPO4EU, 2023. https://doi.org/10.58647/repo4eu.202300d5.3.
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Precision medicine takes patient characteristics and differences on the phenotypic, endotypic and molecular level into account. With the aim to find the right drug for the right patient at the right time, precise diagnosis becomes essential to determine the best treatment for an individual. Diagnostic tests play a crucial role in recruiting the right patients for innovative clinical trials by identifying patients who are most likely to benefit from a specific treatment and who have specific disease characteristics like a molecular mechanism that is being targeted in the trial. Our wet-lab technology platform for patient recruitment will support the identification of the right patients for innovative clinical trials and guide clinical decisions towards personalised treatments using mechanism-based diagnostics. Mechanism-based diagnostics are diagnostic tests that use the understanding of a disease's underlying biology or pathophysiology to identify the right patient for a targeted treatment. These mechanism-based biomarker tests are used to determine the presence or absence of specific disease-causing mechanisms, such as mutations, biochemical pathways, or cellular processes, which can guide treatment decisions
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Tipton, Kelley, Brian F. Leas, Nikhil K. Mull, Shazia M. Siddique, S. Ryan Greysen, Meghan B. Lane-Fall et Amy Y. Tsou. Interventions To Decrease Hospital Length of Stay. Agency for Healthcare Research and Quality (AHRQ), septembre 2021. http://dx.doi.org/10.23970/ahrqepctb40.
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Background. Timely discharge of hospitalized patients can prevent patient harm, improve patient satisfaction and quality of life, and reduce costs. Numerous strategies have been tested to improve the efficiency and safety of patient recovery and discharge, but hospitals continue to face challenges. Purpose. This Technical Brief aimed to identify and synthesize current knowledge and emerging concepts regarding systematic strategies that hospitals and health systems can implement to reduce length of stay (LOS), with emphasis on medically complex or vulnerable patients at high risk for prolonged LOS due to clinical, social, or economic barriers to timely discharge. Methods. We conducted a structured search for published and unpublished studies and conducted interviews with Key Informants representing vulnerable patients, hospitals, health systems, and clinicians. The interviews provided guidance on our research protocol, search strategy, and analysis. Due to the large and diverse evidence base, we limited our evaluation to systematic reviews of interventions to decrease hospital LOS for patients at potentially higher risk for delayed discharge; primary research studies were not included, and searches were restricted to reviews published since 2010. We cataloged the characteristics of relevant interventions and assessed evidence of their effectiveness. Findings. Our searches yielded 4,364 potential studies. After screening, we included 19 systematic reviews reported in 20 articles. The reviews described eight strategies for reducing LOS: discharge planning; geriatric assessment or consultation; medication management; clinical pathways; inter- or multidisciplinary care; case management; hospitalist services; and telehealth. All reviews included adult patients, and two reviews also included children. Interventions were frequently designed for older (often frail) patients or patients with chronic illness. One review included pregnant women at high risk for premature delivery. No reviews focused on factors linking patient vulnerability with social determinants of health. The reviews reported few details about hospital setting, context, or resources associated with the interventions studied. Evidence for effectiveness of interventions was generally not robust and often inconsistent—for example, we identified six reviews of discharge planning; three found no effect on LOS, two found LOS decreased, and one reported an increase. Many reviews also reported patient readmission rates and mortality but with similarly inconsistent results. Conclusions. A broad range of strategies have been employed to reduce LOS, but rigorous systematic reviews have not consistently demonstrated effectiveness within medically complex, high-risk, and vulnerable populations. Health system leaders, researchers, and policymakers must collaborate to address these needs.
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Wang, Ying yuan, Zechang Chen, Luxin Zhang, Shuangyi Chen, Zhuomiao Ye, Tingting Xu et Yingying Zhang c. A systematic review and network meta-analysis : Role of SNPs in predicting breast carcinoma risk. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, février 2022. http://dx.doi.org/10.37766/inplasy2022.2.0092.
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Review question / Objective: P: Breast cancer patient; I: Single nucleotide polymorphisms associated with breast cancer risk; C: Healthy person; O: By comparing the proportion of SNP mutations in the tumor group and the control group, the effect of BREAST cancer risk-related SNP was investigated; S: Case-control study. Condition being studied: Breast cancer (BC) is one of the most common cancers among women, and its morbidity and mortality have continued to increase worldwide in recent years, reflecting the strong invasiveness and metastasis characteristics of this cancer. BC is a complex disease that involves a sequence of genetic, epigenetic, and phenotypic changes. Polymorphisms of genes involved in multiple biological pathways have been identified as potential risks of BC. These genetic polymorphisms further lead to differences in disease susceptibility and severity among individuals. The development of accurate molecular diagnoses and biological indicators of prognosis are crucial for individualized and precise treatment of BC patients.
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Hollick, Rosemary J., Michelle Stevenson, Michael Parker, Mike Seabourne, Kevin Stelfox, Rebecca Pedrick-Case, Rich Fry et al. Mapping for Better Care : Supporting service planning for people with rheumatic and musculoskeletal conditions. RHEUMAPS study / University of Aberdeen, février 2025. https://doi.org/10.57064/2164/25119.
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Rheumatic and musculoskeletal disorders (RMDs) affect approximately one-third of the UK population, yet access to timely and equitable care remains inconsistent. National audits have highlighted significant variations in service provision and health outcomes, shaped by individual socio-demographic characteristics and place-based factors. Rural populations, comprising around 20% of the UK, face unique challenges due to geographic remoteness, centralised specialist services, and an ageing demographic. Workforce constraints and service accessibility further exacerbate these disparities, limiting the ability of local health systems to meet the needs of their populations effectively. The RHEUMAPS study was designed to address key evidence gaps by exploring patient priorities for care, measuring the geographical prevalence of RMDs, and assessing health outcomes across Scotland and Wales using national healthcare data. Specifically, the study examined differences in outcomes between rural and urban populations and the extent to which these disparities could be attributed to socio-economic factors. Additionally, it assessed how historical rural healthcare policies in Scotland and Wales have shaped service delivery and identified opportunities for future policy direction. Findings from the study revealed that people living with RMDs share common care priorities, including pain and fatigue management, maintaining physical activity, sustaining social connections, and participating in work and daily activities. Access to multidisciplinary, integrated, and locally available care was highly valued, yet many participants expressed dissatisfaction with existing services due to long travel distances, fragmented care pathways, and a lack of accessible information. Structural barriers, such as limited local healthcare provision and travel challenges, disproportionately affected rural communities, further widening health inequalities. To support data-driven and place-sensitive healthcare planning, the study developed interactive geospatial maps, integrating information on RMD prevalence, socio-demographic factors, and service accessibility. These tools provide timely, actionable insights to inform local, regional, and national decision-making, helping policymakers and healthcare providers design services that better align with patient needs. Additionally, the study highlighted the need for a more integrated approach to rural healthcare policy, moving beyond historically siloed strategies that have addressed health, transport, housing, and workforce issues in isolation. This report offers critical evidence and resources to support a transition toward sustainable, equitable, and person-centred healthcare for people living with RMDs. By leveraging real-world data and patient insights, the findings underscore the importance of developing adaptable, learning healthcare systems that respond to the evolving needs of diverse populations across urban and rural settings.
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Nair, Abhijit, et Hamed Humayid Mohammed Al Aamri. Enhanced recovery after surgery pathways for patients undergoing laparoscopic appendectomy- a systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, août 2022. http://dx.doi.org/10.37766/inplasy2022.8.0005.
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Review question / Objective: Does implementing enhanced recovery after surgery pathways improve outcomes in adult patients undergoing laparoscopic appendectomy when compared to conventional pathways? Condition being studied: Adult patients (more than 18 years) with acute appendicitis undergoing laparoscopic appendicectomy. Information sources: We will search all electronic databases. In published articles were outcome details appear incomplete, the corresponding author will be contacted the details will be sought. If not available, that outcome will be excluded from analysis.
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Corkum, Eleanor, Tiffanie Perrault et Erin C. Strumpf. Improving Breast Cancer Diagnosis Pathways in Quebec. CIRANO, octobre 2023. http://dx.doi.org/10.54932/qsho2261.
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Delays in breast cancer diagnosis can worsen the severity of illness and reinforce inequalities. This report analyzes Quebec’s capabilities and performance along the diagnosis pathway, gathering information from the scientific literature on cancer care, government reports, and expert interviews. The first section outlines which types of breast cancer data Quebec collects, and how data availability impacts the measurement of performance indicators. The second section discusses how socio-economic factors and unclear guidelines for patients outside Quebec’s organized screening program create barriers to diagnosis. We also explore how Quebec’s lack of standardized and integrated care and its outdated cancer registry can create further delays and inefficiencies. The final section of the report compares innovations in breast cancer diagnosis in Quebec to those in Alberta and Ontario, where diagnostic delays are shorter. This comparison suggests that Quebec should include high-risk individuals in its screening program, create personalized screening recommendations, update available imaging and genetic testing technologies, and modernize communication methods. Relevant research and initiatives seeking to increase screening adherence among groups with low screening rates are also discussed. Overall, this paper highlights tangible strategies to shorten and streamline the breast cancer diagnosis interval, and points the reader to key resources for further investigation.
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Chen, Xiaole, Peng Wang, Yunquan Luo, Yi-Yu Lu, Wenjun Zhou, Mengdie Yang, Jian Chen, Zhi-Qiang Meng et Shi-Bing Su. Therapeutic Efficacy Evaluation and Underlying Mechanisms Prediction of Jianpi Liqi Decoction for Hepatocellular Carcinoma. Science Repository, septembre 2021. http://dx.doi.org/10.31487/j.jso.2021.02.04.sup.
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Objective: The aim of this study was to assess the therapeutic effects of Jianpi Liqi decoction (JPLQD) in hepatocellular carcinoma (HCC) and explore its underlying mechanisms. Methods: The characteristics and outcomes of HCC patients with intermediate stage B who underwent sequential conventional transcatheter arterial chemoembolization (cTACE) and radiofrequency ablation (RFA) only or in conjunction with JPLQD were analysed retrospectively. The plasma proteins were screened using label-free quantitative proteomics analysis. The effective mechanisms of JPLQD were predicted through network pharmacology approach and partially verified by ELISA. Results: Clinical research demonstrated that the Karnofsky Performance Status (KPS), traditional Chinese medicine (TCM) syndrome scores, neutropenia and bilirubin, median progression-free survival (PFS), and median overall survival (OS) in HCC patients treated with JPLQD were superior to those in patients not treated with JPLQD (all P<0.05). The analysis of network pharmacology, combined with proteomics, suggested that 52 compounds targeted 80 potential targets, which were involved in the regulation of multiple signaling pathways, especially affecting the apoptosis-related pathways including TNF, p53, PI3K-AKT, and MAPK. Plasma IGFBP3 and CA2 were significantly up-regulated in HCC patients with sequential cTACE and RFA therapy treated with JPLQD than those in patients not treated with JPLQD (P<0.001). The AUC of the IGFBP3 and CA2 panel, estimated using ROC analysis for JPLQD efficacy evaluation, was 0.867. Conclusion: These data suggested that JPLQD improves the quality of life, prolongs the overall survival, protects liver function in HCC patients, and exhibits an anticancer activity against HCC. IGFBP3 and CA2 panels may be potential therapeutic targets and indicators in the efficacy evaluation for JPLQD treatment, and the effective mechanisms involved in the regulation of multiple signaling pathways, possibly affected the regulation of apoptosis.
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Untaaveesup, Suvijak, Pornteera Srichana, Gynna Techataweewan, Chanamon Pongphaew, Wichapol Dendumrongsup, Ben Ponvilawan, Nichanant Nampipat et Chanin Limwongse. Prevalence of Genetic Alterations in Advanced Basal Cell Carcinoma Patients with Resistant to Hedgehog Pathway Inhibitors : A Systematic Review. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, décembre 2023. http://dx.doi.org/10.37766/inplasy2023.12.0106.
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