Implementation Of Clinical Pathway Research Articles

Discovering congestion dynamics models in clinical pathways using background knowledge

Clinical Pathways (CPs) consist of structured multidisciplinary guidelines and protocols used to model steps of clinical treatments. The main objective of applying CPs is that of optimizing both outcomes and efficiency – however, the actual implementation of CPs can be complex and result in important deviations and unexpected inefficiencies. In this paper, we develop an approach to identifying and understanding such problems by leveraging process mining techniques and background knowledge. We design specific data structures aimed at properly capturing the data produced during the implementation of CPs, including the treatment of more than one disease for a single patient. We then provide a methodology to discover and characterize congestion dynamics in CPs. Since the resulting process discovery problem is theoretically intractable, we develop heuristic algorithms that, based on an extensive experimental assessment, prove capable of discovering meaningful knowledge with a reasonable computational effort.

Impact of clinical pathway implementation satisfaction, work engagement, and hospital-patientrelationship on quality of care in Chinese nurses.

This study aimed to investigate how clinical pathway implementation satisfaction, work engagement, and hospital-patient relationship impact the quality of care that is provided by nurses in public hospitals. Clinical pathways are recommended as a form of quality improvement by broader healthcare systems and are widely used in the world. Nurses are the most involved group of healthcare professionals in the implementation of clinical pathways in public hospitals. So, it is important to investigate how their satisfaction with the process affects the quality of care they provide and influencing factors. This descriptive cross-sectional study surveyed nurses practicing across seven tertiary public hospitals in Sichuan Province, China, online. The survey consisted of a questionnaire for the general characteristics of the participants and four Chinese maturity scales validated by previous studies: clinical pathway implementation satisfaction scale, work engagement scale, hospital-patientrelationship perception scale, and quality of care scale. The bootstrap method was used to test a moderated mediation model using Hayes' PROCESS macro models 4 and 8. We followed STROBE guidelines to prepare the study report. A total of 880 nurses filled out the questionnaires, 821 of which were regarded as valid. Clinical pathway implementation satisfaction had a positive effect on quality of care (B=0.873, P<0.001). Work engagement played a mediation role between nurses' clinical pathway implementation satisfaction and the quality of care (effect=0.080, Boot 95% CI=[0.023, 0.142]). This mediation model was moderated by the hospital-patientrelationship (P < 0.01). Clinical pathway implementation satisfaction may enhance the quality of care by work engagement of nurses. Moreover, a good hospital-patientrelationship can enhance the positive impact of nurses' satisfaction on work engagement and health service quality. Public hospital managers need to pay attention to nurses' evaluation of and perceptions toward clinical pathway implementation and then take corresponding measures to improve their satisfaction to enhance the quality of care. At the same time, the government, society, and hospitals also need to foster good hospital-patient relationships to ensure that nurses have a high level of work engagement that aids in providing high-quality care services.

Implementation of a Suicide Risk Screening Clinical Pathway in a Children's Hospital: A Feasibility Study.

Youth suicide is a pressing global concern. Prior research has developed evidence-driven clinical pathways to screen and identify suicide risk among pediatric patients in outpatient clinics, emergency departments (ED) and inpatient hospital units. However, the feasibility of implementing these pathways remains to be established. Here, we share the results of a hospital-wide "youth suicide risk screening pathway" implementation trial at an urban academic pediatric hospital to address this gap. A 3-tier "youth suicide risk screening pathway" using The Ask Suicide-Screening Questions (ASQ) was implemented for patients aged 10 to 26 years who received care at an urban academic pediatric hospital's emergency department or inpatient units. We retrospectively reviewed implementation outcomes of this pathway from January 1 to August 31, 2019. The feasibility of this implementation was measured by assessing the pathway's degree of execution, fidelity, resource utilization, and acceptability. Of 4108 eligible patient encounters, 3424 (83%) completed the screen. Forty-eight (1%) screened acute positive, 263 (8%) screened nonacute positive and 3113 (91%) screened negative. Patients reporting positive suicide risk were more likely to be older and female, although more males required specialty mental health evaluations. Pathway fidelity was 83% among all positive screens and 94% among acute positive screens. The clinical pathway implementation required 16 hours of provider training time and was associated with slightly longer length of stay for inpatients that screened positive (4 vs 3 days). Sixty-five percent of nurses and 78% of social work providers surveyed supported participation in this effort. It is feasible to implement a youth suicide risk screening pathway without overburdening the system at an urban academic pediatric hospital.

Satisfaction with clinical pathway implementation versus job performance of clinicians: empirical evidence on the mediating role of work engagement from public hospitals in Sichuan, China

BackgroundThe job performance of clinicians is a clear indicator of both hospital capacity and the level of hospital service. It plays a crucial role in maintaining the effectiveness and quality of medical care. Clinical pathways are a systematic method of quality improvement successfully recommended by broader healthcare systems. Since clinicians play a key role in implementing clinical pathways in public hospitals, this study aims to investigate the effect of the satisfaction of clinicians in public hospitals with clinical pathway implementation on their job performance.MethodsA cross-sectional study design was used. Questionnaires were administered online. A total of 794 clinicians completed the questionnaires in seven tertiary public hospitals in Sichuan Province, China, of which 723 were valid for analysis. Questionnaires contained questions on social demographic characteristics, satisfaction with clinical pathway implementation, work engagement, and job performance. Structural Equation Model (SEM) was used to test the hypotheses.ResultsThe satisfaction of clinicians in public hospitals with clinical pathway implementation was significantly positively correlated with work engagement (r = 0.570, P < 0.01) and job performance (r = 0.522, P < 0.01). A strong indirect effect of clinicians’ satisfaction with clinical pathway implementation on job performance mediated by work engagement was observed, and the value of this effect was 0.383 (boot 95%CI [0.323, 0.448]).ConclusionThe satisfaction of clinicians in public hospitals with clinical pathway implementation not only directly influences their job performance, but also indirectly affects it through the mediating variable of work engagement. Therefore, managers of public hospitals need to pay close attention to clinicians’ evaluation and perception of the clinical pathway implementation. This entails taking adequate measures, such as providing strong organizational support and creating a favorable environment for the clinical pathway implementation. Additionally, focusing on teamwork to increase clinicians’ satisfaction can further enhance job performance. Furthermore, managers should give higher priority to increasing employees’ work engagement to improve clinicians’ job performance.

Unveiling quality, clinical, and financial Impacts of Pulmonary Tuberculosis Clinical Pathway Implementation in Magelang Public Hospital, Indonesia

Tuberculosis (TB) is a popular endemic disease in Indonesia with increased risk outcomes. The clinical pathway (CP) is crucial to enhancing healthcare services and resource efficiency despite discrepancies in service variability reduction, clinical outcomes improvement, and cost saving. Therefore, this study aimed to assess pulmonary TB CP and evaluate its impacts on clinical and financial results, as well as barriers to implementation at Tidar Hospital in Magelang, Indonesia. A sequential explanatory mixed-method design was used from July 2022 to January 2023. The study began with a retrospective analysis of medical records of TB patients (total sampling, n=92). In-depth interviews (IDIs) were conducted with healthcare workers including the quality and medical committee, case manager, CP team, inpatient and non-inpatient nursing sub-coordinators, and pulmonary specialists. In addition, eight multidiscipline healthcare professionals attended the focus group discussions (FGDs). The audio recordings were transcripted verbatim and subjected to thematic analysis. The results showed that the quality and content of CP based on TB evaluation using the Integrated Clinical Pathway Assessment Tool (ICPAT) was 62.6%. Four themes were obtained: 1) CP implementation techniques, 2) supportive factors in the success of CP, 3) organization support in CP implementation, and 4) TB patient outcomes. Furthermore, procedure compliance after CP implementation was 33%. There were no significant differences in the length of stay (p=0.77), diagnosis investigation and therapy appropriateness (100%), mortality (4 vs 3 patients; p=0.589), and cost efficiency with an average cost of care (Rp 6.994.508,- vs Rp 5.521.091,-; p=0.083) before and after CP implementation. Readmission rates were low before and after deployment (1 vs. 2 patients). This study found no significant clinical or financial benefits in TB CP implementation. These results imply the need for hospital leadership and a multidisciplinary team to overcome CP implementation hurdles.

Effects of clinical nursing pathway on the surgical site wound infection in patients undergoing knee or hip replacement surgery: A meta-analysis.

To explore the effect of clinical nursing pathway on wound infection in patients undergoing knee or hip replacement surgery. Computerised searches of PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database, China National Knowledge Infrastructure databases were conducted, from database inception to September 2023, on the randomised controlled trials (RCTs) of application of clinical nursing pathway to patients undergoing knee and hip arthroplasty. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. RevMan 5.4 software was employed for data analysis. Overall, 48 RCTs involving 4139 surgical patients were included, including 2072 and 2067 in the clinical nursing pathway and routine nursing groups, respectively. The results revealed, compared with routine nursing, the use of clinical nursing pathways was effective in reducing the rate of complications (OR = 0.17, 95%CI: 0.14-0.21, p < 0.001) and wound infections (OR = 0.29, 95%CI: 0.16-0.51, p < 0.001), shortens the hospital length of stay (MD = -4.11, 95%CI: -5.40 to -2.83, p < 0.001) and improves wound pain (MD = -1.34, 95%CI: -1.98 to -0.70, p < 0.001); it also improve patient satisfaction (OR = 7.13, 95%CI: 4.69-10.85, p < 0.001). The implementation of clinical nursing pathways in clinical care after knee or hip arthroplasty can effectively reduce the incidence of complications and wound infections, and also improve the wound pain, while also improving treatment satisfaction so that patients can be discharged from the hospital as soon as possible.

ANALYSIS OF IMPLEMENTATION OF ACUTE APPENDICITIS CLINICAL PATHWAY WITH ICPAT (INTEGRATED CLINICAL PATHWAY APPRAISAL TOOL) AT FAISAL ISLAMIC HOSPITAL MAKASSAR YEAR 2022

Background: Clinical Pathways are crucial for implementing Good Clinical Governance in hospitals to reduce variations, ultimately decreasing the risk of medical errors. A Clinical Pathway must create a diagnosis with high volume, risk, cost, and problem-proneness standards. Appendicitis is an essential public health problem; the prevalence and incidence have increased globally. The clinical pathway implementation at our institution has yet to be evaluated. Objective: This study aims to analyze the implementation of the Acute Appendicitis Clinical Pathway using ICPAT. Methods: This study is a mixed methods study with a case study approach. Quantitative samples were collected from medical records of patients with acute appendicitis through proportional random sampling based on the inclusion and exclusion criteria. Qualitative participants were chosen according to appropriateness and adequacy principles. The validation method used was data triangulation. Result: The outcomes demonstrated a 0% compliance rate in implementing the clinical pathway for acute appendicitis. ICPAT results (content and quality); D1 (90%, 100%), D2 (39.13%, 25%), D3 (30.77%, 35.29%), D4 (60%, 100%), D5 (50%, 30.77%), D6 (66.67%, 75%). Conclusion: There was never a comprehensive review, especially using standard tools. This study helps Faisal Islamic Hospital conclude points to improve, especially the bad categories, namely the documentation, development, and maintenance dimensions.

The Implementation of a Clinical Pathway to Improve Child Abuse Screening in Young Children With Fractures: A Quality Improvement Analysis

The American Academy of Pediatrics recommends screening children under 2 years of age with a concerning fracture for physical abuse with a skeletal survey (SS). Nationally, 30% to 77% of children are not screened appropriately in emergency department settings. After implementation of an electronic clinical pathway for pediatric emergency department providers, guideline adherence improved from 61% to 81%. Among infants, SS performance increased from 79% to 81%. More non-White children received an SS, indicating potential implicit bias in screening practices. The results support clinical pathways to improve guideline adherence while promoting further examination of providers’ determination of screening needs.

Design organization and clinical processes around patient characteristics: Evidence from a multiple case study of Hemophilia.

Background: There is growing evidence of the relevance of designing organization of care around patient characteristics; this is especially true in the case of complex chronic diseases.Purpose: The goal of the paper - that focuses on the analysis of the clinical condition hemophilia in three different centers - is to address two different research questions:1. How can we define, within the same clinical condition, different patient profiles homogeneous in terms of intensity of service required (e.g. number of visits or diagnostics)? 2. What are the conditions to re-organize care around these patient profiles in a multidisciplinary and coordinated manner?Research design: The authors have used a multiple case study approach combining both qualitative and quantitative methodologies; in particularly the semi-structured interviews and the direct observation were aimed to map the process in order to come up with an estimate of the cost of the full cycle of care.Study sample: The research methodology has been applied consistently in three different centers. The selection of the structures has been based on two main different criteria: (i) high standards regarding both organizational and clinical aspects and (ii) willingness from management, nurses and physicians to provide data.Results: The study clearly shows that different patient profiles - within the same clinical condition - trigger a different set of diagnostic and therapeutic activities. It is, thus, important considering patient characteristics in the development and implementation of clinical pathways and this will imply relevant differences in terms of organizational and economic impact.Conclusions: These process-based analyses are very much critical especially if we want to move to a bundled and integrated payment system but, as shown by this study itself, require a lot of time and efforts since our healthcare information systems are still fragmented and vertically designed.

‘Look up from the waiting list and see the bigger picture’: a qualitative analysis of clinical specialist physiotherapist perspectives on low back pain care in Ireland

IntroductionHealthcare systems are struggling to deliver high-quality low back pain (LBP) care. In 2012 specialist physiotherapist-led musculoskeletal (MSK) triage services were introduced in Irish hospitals to expedite patient care and alleviate pressure on elective orthopaedic/ rheumatology consultant clinics. Specialist physiotherapists have expertise to inform health service improvement and reform, but their perspectives of LBP healthcare delivery have received scant attention. ObjectivesTo explore specialist physiotherapists’ perspectives on LBP care in Ireland, the barriers and facilitators to quality LBP care and the development of MSK interface services in primary care settings. DesignCross-sectional observational study using an anonymous electronic survey with thematic framework analysis of response data from open-ended questions. ParticipantsThirty-four clinical specialist physiotherapists in Irish MSK triage services. ResultsThematic analysis resulted in six overarching themes, grouped into two categories. One category pertained to LBP healthcare in Ireland with the following three themes: 1) Inadequate health services for patients with LBP; 2) Need for defined LBP clinical pathways; 3) Need for a multisectoral approach to spine health. Themes in the second category, pertaining to the development of community-based MSK interface services, were: 4) Concern regarding isolation from secondary care services; 5) Unrealistic expectations of MSK triage; 6) Improved communication and collaboration with primary care services. ConclusionSpecialist physiotherapists have concerns regarding LBP health services and persistence of a biomedical, secondary care-led approach. They advocate for investment in primary care multi-disciplinary teams, enhanced integration across primary and secondary care, development of a national clinical pathway and a multisectoral approach. Contribution of paper•This study captures, for the first time, the perspectives of specialist physiotherapists on LBP healthcare delivery enabling a better understanding of the ‘on-the-ground’ issues in delivering quality LBP healthcare.•Opportunities for LBP healthcare service improvement are identified at micro, meso and macro health system levels.•The findings can be used to inform the development and implementation of a new national LBP clinical pathway and community-based MSK triage clinics.

Practical Utility of a Clinical Pathway for Older Patients with Aspiration Pneumonia: A Single-Center Retrospective Observational Study.

Introduction: Clinical pathways (CPWs) are patient management tools based on a standardized treatment plan aimed at improving quality of care. This study aimed to investigate whether CPW-guided treatment has a favorable impact on the outcomes of hospitalized older patients with aspiration pneumonia. Method: This retrospective study included patients with aspiration pneumonia, aged ≥ 65 years, and hospitalized at a community hospital in Japan. CPW implementation was arbitrarily determined by the attending physician upon admission. Outcomes were compared according to with or without the CPW (CPW-group and non-CPW groups). Propensity score (PS)-based analyses were used to control for confounding factors. Logistic regression analyses were conducted to evaluate the impact of CPW on the clinical course and outcomes. Results: Of 596 included patients, 167 (28%) received the CPW-guided treatment. The mortality rate was 16.4%. In multivariable model, CPW implementation did not increase the risk for total and 30-day mortality, and resulted in shorter antibiotic therapy duration (≤9 days) (PS matching (PSM): odds ratio (OR) 0.50, p = 0.001; inverse provability of treatment weighting (IPTW): OR 0.48, p < 0.001) and length of hospital stay (≤21 days) (PSM: OR 0.67, p = 0.05; IPTW: OR 0.66, p = 0.03). Conclusions: This study support CPW utility in this population.

Modern management of ruptured abdominal aortic aneurysm.

Ruptured abdominal aortic aneurysms (rAAA) remain one of the most clinically challenging and technically complex emergencies in contemporary vascular surgery practice. Over the past 30 years, a variety of changes surrounding the treatment of rAAA have evolved including improvements in diagnosis, development of coordinated referral networks to transfer patients more efficiently to higher volume centers, deliberate de-escalation of pre-hospital resuscitation, modification of patient and procedure selection, implementation of clinical pathways, as well as enhanced awareness of certain high-impact postoperative complications. Despite these advances, current postoperative outcomes remain sobering since morbidity and mortality rates ranging from 25%-50% persist among modern published series. Some of the most impactful variation in rAAA management has been fostered by the rapid proliferation of endovascular repair (EVAR) along with service alignment at selected centers to improve timely revascularization. Indeed, clinical care pathways and emergency response networks are now increasingly utilized which has led to improved outcomes contemporaneously. Moreover, evolution in pre- and post-operative physiologic resuscitation has also contributed to observed improvements in rAAA outcomes. Due to different developments in care provision over time, the purpose of this review is to describe the modern management of rAAA, while providing historical perspectives on patient, procedure and systems-based practice elements that have evolved care delivery paradigms in this complex group of patients.

Compliance with Clinical Pathways and Pilot Implementation Impact on Financial Outcome in Hospitals Using National Health Insurance: An Action Research

Payment for health services with national health insurance applies a prospective method. Hospitals must make efforts so that health services can run efficiently and not cause losses. The problem in this research is the negative difference between the Indonesian Case Based Group (INA-CBG) rates and service costs based on actual patient rates with national health insurance. This study aimed to develop a clinical pathway on 10 top CBG codes with the largest negative differences between INA-CBG and hospital rate. It also evaluated its pilot implementation impact on financial outcomes. Action research was conducted on a sample of the top 10 Case Based Group (CBG) codes with the largest negative difference between INA-CBG rates. One thousand ninety-nine (1099) medical records were analyzed and taken randomly using simple random sampling. Most of the variants found were the provision of consumable medical materials that exceeded standards and the administration of patent medicines outside the national formulary without written medical indications. The value of compliance with the clinical pathway was still below the expected standard (&lt; 80%), especially in medical consumables. Researchers carried out a three-month intervention of a new clinical pathway implementation. The results showed increased compliance with clinical pathways and reduced negative differences between INA-CBG and hospital rates. Clinical pathway audits could reduce the negative difference between INA-CBG and hospital rates.

Analysis Of The Influence Of Clinical Pathway In Hospitals On Length Of Stay: A Scoping Review

Clinical pathway is a management tool used in healthcare to coordinate patient care efficiently, thereby reducing the length of stay required by patients in hospitals. The purpose of this study was to determine the effect of Clinical Pathway in hospitals on Length of Stay. This study was a scoping review using the PRISMA diagram. Article search was conducted based on the eligibility criteria of the PICO Model: P: Hospital Patients, I: Clinical Pathway, C: -, O: Length of Stay. The articles used were from 4 databases, namely: Google Scholar, Research Gate, PubMed, and Elsevier. With keywords including "Clinical pathway" AND "Length of Stay" AND "hospital". The implementation of clinical pathway is one of the strategies that can be used to reduce patient length of stay. Clinical pathway can help improve efficiency, quality, and compliance with healthcare standards. Based on the results of the study, the researchers recommend that effective socialization and training be conducted to improve the understanding and compliance of healthcare professionals with clinical pathway, develop clinical pathway based on strong scientific evidence, and conduct periodic monitoring and evaluation to ensure the effectiveness and suitability of the clinical pathway implemented.

Implementation of Clinical Pathways for CAR-T Cell Therapy in a Brazilian Private Healthcare Organization

Introduction: the treatment with CAR-T cells in Brazil is challenging because it requires a highly qualified multidisciplinary team trained in new clinical pathways to take care of these patients. Objective: to describe the implementation of the clinical pathways for CAR-T cell therapy, ensuring safety and quality. Method: this is an experience report study, performed in four private general hospitals of the Americas from São Paulo, Rio de Janeiro and Ceará states, during the year of 2022. The process of implementing the CAR-T Cell clinical pathway included: creation of a medical committee with the main medical references and specialist nurses from each center, for the elaboration of the main clinical protocols and operational procedures, in addition to the discussion of eligibility cases for therapy with CAR-T Cells. Identification of the multidisciplinary reference team in all phases of treatment, training the team involved in the clinical care of the patient, and finally, establishment of patient clinical pathway before, during and after the CAR-T cell therapy. The implementation process lasted seven months between the qualification of centers by the Therapy provider, internal qualification each center and the first cell infusion with CAR-T Cell performed. Results: In all hospitals, professionals from the multidisciplinary team (pharmacy, nursing, physicians - hematologists, pediatric hematology-oncologists involved in hematopoietic stem cell transplantation, neurologists, pediatric and adult intensive care physicians) were trained. The Multidisciplinary Care Protocol was elaborated including indications, early and late complications. The Standard Operating Procedures addressed the pre and post infusion care, daily screening, criteria to transfer the patients to the intensive care unit, recognition and management of cytokine release syndrome and neurological toxicities. The main challenges of this process were to create the routines for evaluation and systematic monitoring and to identify and involve the multidisciplinary professionals directly involved in patient care. Conclusions: the implementation of the program brought improvements to the clinical pathway, positively impacting professional satisfaction, the quality and safety of the patients. The CAR-T cell therapy was performed in a safe and integrated environment, uneventful and successful.

Persepsi Dan Hambatan Tenaga Medis Dalam Penerapan Clinical Pathway: Literatur Review

Clinical pathways involve the health team and part of the patient's records. Hence, team dynamics become a principal factor that needs to be appraised during implementation. Clinical pathways were considered as an additional workload for medical personnel. This research aims to review articles that discuss the perceptions and barriers among medical personnel in implementing clinical pathways. The articles were searched through the PubMed, Willey, ProQuest, and Google Scholar databases, which were published no less than ten years period from 2010 to 2020. The keywords used perception OR response AND barriers OR obstacles AND clinical pathway OR care. The pathway corresponds to the title and purpose of the review and is in full-text form. In total, eight articles meet the review criteria and objectives. The results showed that clinical pathways are perceived as a process that is directed at realizing benefits, creating habits, and requiring enthusiasm, support, and time. Obstacles for medical personnel that often arise in implementing clinical pathways include not having enough time, lack of direction and guidance, lack of staff awareness, lack of compliance in documentation, and lack of staff commitment. Conducting a direct study on evaluating the implementation of clinical pathways in hospitals is recommended.

Implementation of EMR-integrated ovarian cancer clinical pathways.

577 Background: Adhering to National Comprehensive Cancer Network (NCCN) Guidelines correlates with higher survival in ovarian cancer and serves as a measure of care quality. Adherence to guidelines however is relatively low, routinely reported to be less than 50%. Integration of clinical pathways into the Electronic Medical Record (EMR) is a practical approach to incorporate decision-making tools in a user-friendly interface, ensuring appropriate diagnostic testing and treatment is offered to all ovarian cancer patients. Kaiser Permanente (KP) is an integrated national healthcare delivery organization caring for 12.7 million patients across the United States. Embedded clinical pathways created by KP optimize clinical decision-making and provide treatment recommendations according to established evidence-based guidelines. This report presents data on the adherence to ovarian cancer clinical pathways within KP. Methods: Beginning in January 2021 a multidisciplinary national team at KP (gynecologic and medical oncologists, pharmacists, geneticists, pathologists, and radiation oncologists) established evidence-based clinical pathways for ovarian cancer treatment which were subsequently integrated into the Epic Systems EMR. Oncologists can use the pathways to place diagnostic and treatment orders for patient care. EMR data analytics were utilized to track adherence to the consensus-defined clinical pathways among treatment orders placed for ovarian cancer within KP nationally between January 2021 and February 2023. Treatments were considered adherent for which the order was placed through the pathway; treatments for ovarian cancer indications ordered outside of the pathway interface were non-adherent. Results: Between January 2021 and February 2023, 3721 treatment plans were initiated within KP nationally for ovarian cancer, for a median 144 plans monthly. Adherence nationally to the ovarian cancer treatment pathway varied from 16% monthly at inception to 64% in early 2023 with a high of 71% in late 2022. The median pathway adherence rates per quartile were 20%, 37%, 59%, 55% in 2021, and 62%, 66%, 70%, 67% in 2022, and 64% in January through February 2023. The increases in adherence were consistent between geographic regions and indications of treatment. Conclusions: Integration of clinical pathways into the EMR is a promising means of encouraging appropriate testing and therapy for ovarian cancer. As clinicians retained the option to initiate treatment orders outside of the embedded KP pathways, our data is limited to measuring KP pathway use, not evaluating whether treatments given were concordant with NCCN Guidelines. Treatments initiated outside the pathway may still be concordant with national guidelines. Measurement of pathway adherence is useful however to describe effective diagnostic and treatment pathway implementation across a large healthcare organization to facilitate the delivery of optimal care.

(051) An Interprofessional Approach to the Development and Implementation of a Decision-making Capacity Clinical Pathway

(051) An Interprofessional Approach to the Development and Implementation of a Decision-making Capacity Clinical Pathway

EFEKTIVITAS DAN EFISIENSI PENGGUNAAN CLINICAL PATHWAY TERHADAP AVERAGE LENGTH OF STAY (AVLOS) PASIEN SECTIO CAESAREA (SC) DI RSI NU DEMAK

Clinical Pathway (CP) was implemented at the RSI NU Demak Hospital as quality and cost control in health services. One of the quality of services can be seen from the Average Length of Stay (AvLOS), so the implementation of CP is very important to measure its effectiveness and efficiency in reducing AvLOS as well as its efficiency in financing. This study aims to determine the effectiveness and efficiency of using CP for AvLOS as well as its efficiency in financing SC patients at the RSI NU Demak Hospital for the period October 2022-May 2023. The type of this research is qualitative with used case study method. Sample data was done by documentation study in 296 SC patient medical resume document and patient transaction data as well as in-depth interviews with purposive sampling samples. The AvLOS before CP implementation was 5.2 days, after CP implementation (for seven months from November 2022 to May 2023) the AvLOS decreased to 4 days. The average efficiency of SC financing is IDR 874,670.00 (Real Hospital Tariff with LOS of 5.2 days is IDR 7,025,130.00 and with LOS of 4 days is IDR 6,150,460.00) AvLOS before and after the implementation of CP in SC patients at RSI NU Demak Hospital shows its effectiveness as seen from the reduction in AvLOS, as well as having an impact on the efficiency of treatment costs. To further increase the efficiency of financing for SC patients, including the efficiency of drug and disposable material (BHP) packages for SC operations as well as monitoring and evaluating the compliance of medical staff in using CP.

Proposal for the implementation and adaptation of 1DM and T2DM mellitus Clinical Pathway of the Piedmont Region Diabetes Endocrine Network to the indications of the National Decree 77/2022

Nel 2016 la Regione Piemonte ha pubblicato un documento sul nuovo approccio diagnostico-terapeutico del paziente affetto da diabete mellito (in seguito aggiornato a PSDTA, Percorso di Salute e Diagnostico-Terapeutico-Assistenziale Diabete Mellito), basato su un modello organizzativo ospedalo-centrico, di tipo Hub and Spoke. In seguito alla pandemia da COVID-19, le istituzioni europee hanno dato vita a un nuovo programma di ripresa economica e sociale denominato PNRR (Piano Nazionale di Ripresa e Resilienza), puntando, in Sanità, all’implementazione della medicina territoriale, favorendo una rete di interconnessione tra ospedali/case di cura/ territorio. Il Decreto Ministeriale 77/2022 ha rappresentato lo strumento legislativo operativo che rendesse concreta l’attuazione di questi principi in una nuova visione della medicina territoriale. Il presente lavoro è basato su un’approfondita analisi dell’attuale modello per l’identificazione degli attori coinvolti, siano essi sanitari, socio-sanitari, amministrativi, etc. Inoltre, si sono integrate alcune nuove strutture funzionali come le Centrali Operative Territoriali (COT), vero e proprio “ganglio” strategico all’interno della gestione dei processi. Infine, è stato proposto un nuovo percorso del paziente metabolico cronico, mediante l’implementazione della telemedicina (TLM), attraverso un approccio multidisciplinare, in una visione di “presa in carico” qualitativa e non quantitativa-prestazionale del paziente cronico. PAROLE CHIAVE Percorso Diagnostico Terapeutico Assistenziale (PDTA); Percorso di Salute e Diagnostico Terapeutico-Assistenziale (PSDTA); Centrale Operativa Territoriale (COT); telemedicina (TLM).