Effect Of Clinical Pathway Research Articles

Effect of Clinical Pathway on Nurses' Performance and Neonates Outcomes regarding Noninvasive Continous Positive Airway Pressure

Noninvasive continuous positive airway pressure is a means of providingrespiratory support to neonates vulnerable to respiratory problem and complications. Clinicalpathway provide detailed guidance for each stage in the management of neonates with a specificcondition over a given time period and include progress and outcomes details

Effectiveness of clinical pathway in subjects with heart failure: A real-world study from Italian health claims


 Background: Several process-of-care indicators have been developed and implemented to improve the quality of heart failure (HF) patients care. The aim of this study is to assess the relationship between a set of recommendations for HF care with measurable clinical outcomes, also in terms of outcomes that could be avoided.
 Methods: A retrospective cohort study was carried out on subjects with at least one hospitalization with a primary diagnosis of HF in 2007. Data were retrieved from healthcare utilization databases of Lombardy region (Italy). Exposure to selected recommendations (periodic control of echocardiogram and use of blockers of the renin-angiotensin system and beta-blockers) was recorded. All cause mortality and hospitalization with primary diagnosis of HF were considered as outcomes. Multivariable Cox models and Poisson model were fitted to estimate the exposure-outcome association.
 Results: Among 8207 cases of HF, those who adhered to none, one or all recommendations during the first year after diagnosis were 11%, 60% and 30%, respectively. Compared to patients who adhered to no recommendation, a significant mortality risk reduction of 24% (95% CI 17-31%) and 44% (36 52%) were observed for those who adhered to one and all recommendations, respectively. A significant reduction in the rate of re-hospitalizations in subjects adhered to at least one recommendation was also observed. A decreased trend in Population Attributable Fraction for death cases according to follow-up time was observed.
 Conclusion: A strict control of patients with HF through regular clinical examinations must be considered as fundamental for the reduction of mortality and re-hospitalizations.

Exploration of the Effect of Clinical Pathway Nursing in the Surgical Treatment of Cerebral Aneurysm

Exploration of the Effect of Clinical Pathway Nursing in the Surgical Treatment of Cerebral Aneurysm

Overall survival following implementation of clinical pathways for cancer care.

328 Background: Clinical pathways are decision support tools designed to enhance accessibility and ease of use of treatment recommendations. Prior studies that evaluated cancer clinical pathways largely focused on process measures such as concordance with treatment guidelines, but little evidence is available about the effect of clinical pathways on survival. We thus aimed to evaluate the effect of cancer clinical pathways on overall survival. Methods: We used institutional registry data from the JPS Oncology and Infusion Center, which is a Comprehensive Community Cancer Program. Eligible patients were aged ≥18 years, diagnosed with first primary breast, colorectal, or lung cancer between December 2013 and December 2017 with follow-up through June 2020. We used a natural experiment framework, where intervention was implementation of clinical pathways (December 2015). The pre-intervention period was December 2013 – November 2015 and post-intervention period was January 2016 – December 2017. We used marginal structural models with stabilized inverse probability weights for each cancer type to estimate restricted mean survival time (RMST) differences and 95% confidence limits (CL) comparing overall survival between pre- and post-clinical pathways within a 36-month horizon, where weights were based on a minimal sufficient set of covariates (sociodemographics, tumor characteristics, and comorbidities) to reduce confounding bias. Results: Our study population comprised 327 breast, 254 colorectal, and 431 lung cancer patients. Median age ranged between 55 years (breast) and 60 years (lung). The frequency of racial/ethnic minorities ranged between 45% (lung) and 68% (colorectal). The frequency of uninsured patients ranged between 47% (lung) and 58% (colorectal). Adherence to pathways was consistently over 80%. RMST was largely similar between pre- and post-clinical pathways for breast (RMST difference = -0.10 months, 95% CL: -1.9, 1.7), colorectal (RMST difference = -0.48 months, 95% CL: -3.4, 2.5) and lung cancer (RMST difference = 1.1 month, 95% CL: -1.5, 3.7). Conclusions: Our results suggest that implementation of clinical pathways has minimal effect on overall survival within 36 months despite high adherence in a safety-net population, but the estimates are compatible with up to 3.4 month decrease or 3.7 month increase depending on cancer type. Longer follow-up, particularly for breast and colorectal cancer, may provide further insight. Our findings may be useful for informing deliberations about implementing clinical pathways and setting expectations about the effect of clinical pathways on overall survival.

Effect of Clinical Pathway Combined with High-Quality Nursing on Postoperative Recovery, Psychological Emotion and Quality of Life of Endometrial Cancer Patients Undergoing Radical Resection

This study aimed to explore the influence of clinical pathway combined with high-quality nursing on endometrial cancer (EC) patients undergoing radical resection. Methods: A total of 116 EC patients who underwent surgery in our hospital from July 2017 to December 2019 were randomized into control group (CG) and observation group (OG). The CG (n=58) took routine nursing mode, while the OG (n=58) received clinical pathway combined with high-quality nursing. The postoperative recovery, psychological emotion and quality of life of the two groups were observed. Results: The postoperative recovery, psychological emotion and quality of life of the OG were better than those of the CG. Conclusion: Clinical pathway combined with high-quality nursing can effectively improve the quality of life and postoperative recovery of EC patients after radical resection.

Effects of Clinical Pathways on Cesarean Sections in China: Length of Stay and Direct Hospitalization Cost Based on Meta-Analysis of Randomized Controlled Trials and Controlled Clinical Trials.

The cesarean section (CS) on maternal request increased sharply in China, bringing pressure to medical resources and national insurance. We assessed the use of clinical pathways (CPWs) for CS compared with conventional medical care by outcomes of length of stay (LOS) in hospital and direct hospitalization cost (DHC). Four Chinese electronic databases, including China National Knowledge Infrastructure (CNKI), Wanfang, CQVIP, and SinoMed, were explored to December 2020 for the full-text papers published in Chinese. Literature that quantitatively assessed the effects of CPW on LOS or DHC were eligible for inclusion. The weighted mean differences (WMDs) were pooled. Twenty-five articles were included in our analysis, with a total sample of 7761 women. These studies were performed from 2004 to 2017 and reported from 2005 to 2018. The synthesized results showed a shorter LOS (in days) (WMD = −1.37, 95% CI: −1.48 to −1.26) and a less DHC (CNY¥) (WMD = −520.46, 95% CI: −554.06 to −503.63) in the CPW group, comparing with that of conventional care. With the need for CS on the rise, the introduction of CPW could effectively reduce LOS and DHC, thereby releasing the medical resources and insurance pressure.

Clinical pathways and patient-related outcomes in hospital-based settings: a systematic review and meta-analysis of randomized controlled trials.

Clinical pathways represent a multi-disciplinary approach to translate clinical practice guidelines into practical interventions. The literature from 2010 onward regarding the efficacy of adopting a clinical pathway on patient-related outcomes within the in-hospital setting has not been synthesized yet. For this reason, this systematic review and meta-analysis of randomized controlled trials aimed to critically synthesize the literature from 2010 onward about the efficacy of clinical pathways, compared with standard of care, on patient-related outcomes in different populations and to determine the effects of clinical pathways on patient outcomes. We searched PubMed, Scopus, CINAHL, and reference lists of the included studies. Two independent reviewers screened the 360 identified articles and selected fifteen eligible articles, which were evaluated for content and risk of bias. Eleven studies were finally included. Given the commonalities of the measured outcomes, a meta-analysis including eight studies was performed to evaluate the effect size of the associations between clinical pathways and quality of life (OR=1.472 [0.483–4.486]; p=0.496), and two meta-analyses, including four studies, were performed to evaluate the effect sizes of the associations between clinical pathways with satisfaction (OR=2.226 [0.868–5.708]; p=0.096) and length of stay (OR=0,585 [0.349–0.982]; p=0.042). Reduced length of stay appeared to be associated with clinical pathways, while it remains unclear whether adopting clinical pathways could improve levels of quality of life and satisfaction. More primary research is required to determine in specific populations the efficacy of clinical pathways on patient-related outcomes. (www.actabiomedica.it)

Application and efficacy evaluation of clinical pathway in clinical practice teaching in the department of liver surgery

Objective To investigate the application and effect of clinical pathway in practice teaching of hepatic surgery. Methods The 64 clinical interns who had an internship in our department between February 2018 and May 2019 were divided randomly into two groups: the experimental group (n=32) and the control group (n=32). The clinical pathway teaching method was used in the experimental group and the traditional teaching method was used in the control group. At the end of their internship, the examination and the satisfaction survey were requested to finish in the both groups. The statistical software SPSS 17.0 was used. Continuous variables were analyzed through the t-test. Categorical data were compared through Pearson chi-square. Results The examination results included theoretical knowledge (P=0.033), operating skill (P=0.021), case analysis (P=0.006) and medical record writing (P=0.017), which were significantly better in the experimental group than in the control group, and the satisfaction of interns was also significantly better in the experimental than in the control group (P<0.05). Conclusion The clinical pathway teaching method is effective in practice teaching of hepatic surgery, and can improve the results of practice teaching quality obviously. Key words: Clinical pathway; Hepatic surgery; Practice teaching

Effects of clinical pathway in cancer pain management among cancer patients

Objective To explore the effects of clinical pathway in cancer pain management among cancer patients. Methods We selected 114 cancer patients with pain and opioids pain management in Radiotherapy and Chemotherapy Center at Ningbo First Hospital of Zhejiang Province. A total of 56 cancer patients with pain from March to December 2018 were in observation group with nursing based on self-design clinical pathway; a total of 58 cancer patients with pain from May 2017 to February 2018 were in control group with routine nursing. The Numerical Rating Scale (NRS) was used to compare the effects of pain management of patients between two groups. We also investigated the medication compliance and pain management satisfaction of patients between two groups. Results As time progressed, the NRS scores of cancer pain patients in the two groups decreased, and the interaction, time and intervention differences between the two groups were statistically significant (P<0.01) . One day before discharge, the score of NRS in breakout pain attack of patients of observation group was (4.78±0.59) lower than that (5.56±0.74) of control group; times of breakout pain of patients of observation group was (2.70±0.71) times per day less than (3.21±0.84) times per day of control group; the differences were statistical (P<0.01) . The medication compliance of patients of observation group was (6.69±0.97) , higher than (6.02±1.10) of control group; patients' satisfaction with pain management of observation group was (87.84±7.21) , higher than (75.93±6.95) of control group; the differences were also statistically significant (P<0.01) . Conclusions Application of clinical pathway in pain management and nursing for cancer patients with pain can effectively management patients pain and improves patients' medication compliance and satisfaction with nursing. Key words: Neoplasms; Pain; Critical pathways; Cancer pain management; Compliance; Satisfaction

Effect of Clinical Pathway on Satisfaction of Patients Undergoing Thyroid surgery

Effect of Clinical Pathway on Satisfaction of Patients Undergoing Thyroid surgery

Effect of Clinical Pathway on Satisfaction of Patients Undergoing Thyroid surgery

The patient satisfaction is a health care outcome indicator. The clinical pathway (CP) has evolved as an important tool for enhancing efficient healthcare. The aim of the study was to measure the effect of CP implementation on satisfaction of hospitalized patients undergoing thyroid surgery. The study was conducted at the Al-Thawra Modern General Hospital which is located in Sana'a capital of Yemen. The consecutive patients admitted between June 2014 and October 2014, were enrolled to the conventional care group (n=30) and the consecutive patients admitted between November 2014 and March 2015, were recruited to the CP group (n=30). Pre-operative assessment and Patient's satisfaction questionnaire tools were used for data collection. The results revealed that the patients in the CP group had higher level of satisfaction than the conventional care group (Mean±SD: 109.9±15.4 versus 83.6±14.6). The results also revealed that there were strong negative correlation between CP outcomes (length of hospital stay and complications) and patient satisfaction (respectively, r =-0.514, r = -0.76) Conclusion: The implementation of CP in the management of patients undergoing thyroid surgery had increased significantly the level of patients' satisfaction regarding admission, patient care, education, length of stay and complications.

To study the clinical pathway of enhanced recovery after surgery in patients undergoing laparoscopic hysterectomy

Objective To investigate the effect of clinical pathway of enhanced recovery after surgery in patients undergoing laparoscopic hysterectomy. Methods All patients with uterine fibroids, uterine adenomyosis, cervical lesions and endometrial lesions were selected in Qinghai Provincial Traffic Hospital during the period of January 2015 to December 2016. Among them, 108 cases undergoing laparoscopic hysterectomy were analyzed and enrolled in the study. They were randomly divided into two groups. The observation group was treated with clinical pathway of enhanced recovery, while the control group received routine clinical pathway. The general situation, clinical pathway related indicators were recorded and compared between the two groups. Results The average age, BMI, abdominal surgery history and disease composition of the two groups were not statistically significant (P>0.05). The exhaust time [(19.5±5.6)h vs (24.2±7.5)h], activity time [(17.2±7.5)h vs (26.4±5.3)h], indwelling catheter time [(18.1±3.9)h vs (30.5±4.7)h], average hospitalization days [(5.2±1.1)days vs (6.3±1.7)days] and hospitalization expenses [(13 688.2±709.6)yuan vs (15 793.4±1 021.3)yuan] of the observation group were less than those of the control group, with statistically significance difference (P<0.05). Conclusions Clinical pathway of enhanced recovery after surgery can speed up the rehabilitation of laparoscopic hysterectomy, improve the patient′s medical experience and shorten the average length of stay. Key words: Hysterectomy; Laparoscopy; Rehabilitation; Critical pathways

Effect of clinical pathway regarding promoting quality nursing care of patients with myocardial infarction exposed to invasive procedures

Myocardial infarction is the death of myocardial tissue because of extended lack of blood and oxygen. Clinical pathway has emerged as one of the most famous new initiatives alleged to lower costs whilst maintaining or even improving the satisfactory level of patient care.Aim: to assess the effect of clinical pathway regarding promoting quality Nursing care of patients with MI exposed to invasive procedures through designing, Implementing, and evaluating the effect of clinical pathway intervention.Design: A quasi-experimental research design (pre posttest) changed into applied in this study.Setting: The study has been carried out in Beni-suef university Hospital, Zagazig University Hospitals.Sample: thirty nurses from the previously mentioned setting and thirty patients with myocardial infarction who are hospitalized and exposed to invasive procedures.Tools: Assessment questionnaire (pre/post test) sheet, An Observational Checklist, and Hamilton Anxiety Rating Scale (HAM-A).Results: more than fifty percent of a studied sample of nurses their ages ranged from 20-30yrs, the mean age was (29.1±3.4), females (66.9%), and have been trained in nursing college, their work experience ranged from half to one decade. There has been a statistically significant distinction concerning knowledge and practical abilities of studied nurses among pre and post application of clinical pathway. Recommendations: Extra new studies should be done for better assessment of the nurse's abilities and distribute educational booklets, pamphlets, and posters to all nurses with a purpose to enhance their degree of knowledge and skills.   Keywords: Clinical Pathway, Quality Nursing Care, patients, and Myocardial Infarction.

The development, implementation and evaluation of clinical pathways for chronic obstructive pulmonary disease (COPD) in Saskatchewan: protocol for an interrupted times series evaluation

BackgroundChronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worldwide by 2030. To minimize these costs high quality guidelines have been developed. However, guidelines alone rarely result in meaningful change. One method of integrating guidelines into practice is the use of clinical pathways (CPWs). CPWs bring available evidence to a range of healthcare professionals by detailing the essential steps in care and adapting guidelines to the local context.Methods/designWe are working with local stakeholders to develop CPWs for COPD with the aims of improving care while reducing utilization. The CPWs will employ several steps including: standardizing diagnostic training, unifying components of chronic disease care, coordinating education and reconditioning programs, and ensuring care uses best practices. Further, we have worked to identify evidence-informed implementation strategies which will be tailored to the local context.We will conduct a three-year research project using an interrupted time series (ITS) design in the form of a multiple baseline approach with control groups. The CPW will be implemented in two health regions (experimental groups) and two health regions will act as controls (control groups). The experimental and control groups will each contain an urban and rural health region. Primary outcomes for the study will be quality of care operationalized using hospital readmission rates and emergency department (ED) presentation rates. Secondary outcomes will be healthcare utilization and guideline adherence, operationalized using hospital admission rates, hospital length of stay and general practitioner (GP) visits. Results will be analyzed using segmented regression analysis.DiscussionFunding has been procured from multiple stakeholders. The project has been deemed exempt from ethics review as it is a quality improvement project. Intervention implementation is expected to begin in summer of 2017.This project is expected to improve quality of care and reduce healthcare utilization. In addition it will provide evidence on the effects of CPWs in both urban and rural settings. If the CPWs are found effective we will work with all stakeholders to implement similar CPWs in surrounding health regions.Trial registrationClinicaltrials.gov (NCT03075709). Registered 8 March 2017.

Clinical Pathway Effectiveness: Febrile Young Infant Clinical Pathway in a Pediatric Emergency Department.

Young infants are often treated in emergency departments (EDs) for febrile illnesses. Any delay in care or ineffective management could lead to increased patient morbidity and mortality. A standardized ED clinical pathway may improve care for these patients. The objective of this study is to evaluate the impact of a febrile young infant clinical pathway implemented in a large, urban children's hospital ED on the timeliness and consistency of care. This study used a before-and-after retrospective observational study design comparing 2 separate periods: prepathway from September 2007 through August 2008 and postpathway from September 2009 through August 2010. Subjects were infants aged 56 days or younger presenting with a rectal temperature of 38.0°C or higher. Patients were excluded if they were transferred from another hospital or if they developed a fever after initial presentation. Five hundred twenty infants were enrolled. The mean time to urine collection and time to the first antibiotic administration were reduced after pathway implementation (23-minute reduction to urine collection vs 36-minute reduction to the first antibiotic administration). There was improvement in the proportion of infants who received the pathway-specific antibiotics based on age (odds ratio, 7.2; 95% confidence interval, 4.4, 11.9) and the proportion of infants who were administered acyclovir based on pathway guidelines (odds ratio, 8.8; 95% confidence interval, 2.9-30.0). An ED-based febrile young infant clinical pathway improved the timeliness of initiation of work-up as measured by urine collection and of therapy by an earlier administration of the first antibiotic, as well as decreased variability of care.

Effect of Using Clinical Pathway on Nursing Care of Neonates with Respiratory Distress Syndrome

Respiratory distress syndrome (RDS) considered one of the most serious disorders which leading to high morbidities and mortalities among neonates. It occurs when a neonate's lungs aren't fully developed and unable to gain enough oxygen. The aim of this study was to determine the effect of clinical pathway on nursing care of neonates with respiratory distress syndrome. A quasi-experimental design was used. This study was carried out at neonatal intensive care units affiliated to Benha University Hospital and Benha specialized hospital of children and Benha Teaching Hospital at Benha city. A convenient sample of (150) nurses and all the available neonates with respiratory distress syndrome (150 neonates). Three tools were used;ToolI- A structured interviewing schedule, which consists of four parts: Nurses' characteristics, neonates' characteristics, Nurses' knowledge regarding neonatal respiratory distress syndrome, and Nurses' Knowledge about nursing care of neonates with Respiratory distress syndrome. Tool II- Clinical pathway of care checklist. Tool III-Neonatal clinical outcome assessment sheet. Results of this study revealed that, there was statistically significant differences regarding the effect of clinical pathway on the clinical outcomes of studied neonates pre and post clinical pathway implementation. This study concluded that: Implementation of the clinical pathway improved nurses' knowledge and practice that reflecting obvious improvement in clinical outcomes of neonates with respiratory distress syndrome. The study recommended that Clinical pathway on nursing care of neonates with respiratory distress should be applied for neonates with respiratory distress at different settings.

A pragmatic randomized controlled trial comparing pathway-based versus usual care in community-acquired acute kidney injury.

Clinical pathways have shown conflicting evidence in improvement of several patient-centered outcomes across different clinical settings. However, the effectiveness of clinical pathway in management of acute kidney injury (AKI) has not been reported. Therefore, we aimed to assess the length of hospital stay (LOS) and patient-centered outcomes in community acquired AKI and compared pathway care (PC) versus usual care (UC). The CHAMP-Path AKI Trial is a pragmatic, parallel, single-blind randomized controlled trial. Physicians were randomized to provide either UC or PC. Patients were randomized through a computer-generated sequence. Allocation was concealed. Patients presenting to the emergency department with AKI and hemodynamic stability, who were over 14 years with a serum creatinine greater than 1.5 times the baseline were eligible. Patients with chronic kidney disease stages 4 or 5, kidney transplantation recipients, those admitted with obstructive uropathy, suspected glomerular or interstitial disease, and pregnant women were excluded. Thirty-eight patients were enrolled from March 2012 to December 2013. The primary outcome was LOS. Secondary outcomes included: 30-day readmission, in-hospital mortality, determinants of LOS, and patient-centered outcomes. Eighteen patients were randomized to PC, and 20 to UC. Baseline characteristics were comparable in both groups. Using an intention-to-treat analysis, the median LOS was 4.96 [interquartile range (IQR) 6.57] and 4.80 days (IQR 6.84) for PC and UC, respectively (P = 0.770). Of the five readmissions, none were for AKI. No in-hospital mortality was reported. The CHAMP-Path AKI pragmatic trial demonstrated that PC was not different than UC in reducing LOS. There was no difference in 30-day re- admission, in-hospital mortality, and patient-centered outcomes.

Effect of Clinical Pathways on Antibiotic Prescriptions in an Emergency Department: Italian Pediatric Antimicrobial Stewardship Starts Here

Effect of Clinical Pathways on Antibiotic Prescriptions in an Emergency Department: Italian Pediatric Antimicrobial Stewardship Starts Here

Evidence for the Contemporary Clinical Pathway Quality Measures: Literature Review

Objectives: Clinical pathway effect on improving the healthcare quality still underestimated. An overview on clinical pathway current practice overview will be presented in the context of this paper. Methods/Statistical Analysis: A search for the medical literature was conducted to screen the contemporary evidence. We focused on finding the gold standard for clinical pathway quality measures and the current status of clinical pathway in Malaysia. Various databases (MEDLINE, EMBASE, Pub Med, COHRANCE library and CINAHEL) have been screened for 2000 to 2015 studies. Checklist of the preferred reporting items for systematic reviews and meta-analyses has been used as a guide for reporting. Findings: The search has identified 720 documents, of which 315 (44%) met the inclusion criteria of this study. Twenty meta-analysis studies have been found, while only nine have completely fulfilled the search inclusion criteria. Mostly they discussed the length of stay, patient outcome and cost from RCT (Randomized Clinical Trial) or EXP (experimental design) evidence as a quality indicator for the clinical pathway which may under represent the complexity nature of clinical pathway and ignored many aspects of care. The majority of publications in Malaysia found from (UKM) with similar heterogeneous focus on the outcome measures to what have been found in the overall literature. Interestingly, we found that no meta-analysis study has been conducted in Malaysia for clinical pathway. Application/Improvements: Current research on clinical pathway still limited. More Studies on the effect of clinical pathway on quality of care still needed with emphasize on the cofounding factors.

The Effect of Clinical Pathway in Patients with Acute Complicated Appendicitis

Clinical pathway (CP) is a medical management tool made by a group of medical specialists and specialized for certain diseases. It has been proved that CP was an efficient way to optimize the hospitalization management and control medical cost. In this paper, we focused on the effect of CP in the patients with acute complicated appendicitis via total duration of hospitalization, hospitalization time before operation, total cost of hospitalization and drug expenditure. From March 2014 to March 2015, the patients with conditions of appendicitis in Three Gorges Central Hospital of Wanzhou, Chongqing, were divided into CP group and non path control group to analyze the effect of the application of CP. Our data showed that there were no significant differences between two groups of patients in total duration of hospitalization, hospitalization time before operation, total cost of hospitalization and drug expenditure. The implementation of CP neither decreased the time of patients in hospital nor the total hospitalization cost. Besides, application of CP for acute appendicitis patients should distinguish between simple appendicitis and complicated appendicitis, simple appendectomy patients implement CP is beneficial, and patients with complicated appendicitis did not come from the benefit.