Biomedical subjects

Joan Vlayen

Publications and source records attributed to Joan Vlayen.

3 recordsLinked to original sources

PubMed2006

Defining pathways.

AIMS AND BACKGROUND: The term 'clinical pathway' is internationally accepted in all settings of healthcare management. The way in which clinical pathways have been developed in the United Kingdom differs from that in the USA. Besides the international differences in the purpose, many alternative names also can be found. These have led to confusion. There is no single, widely accepted definition of a clinical pathway. The aim of the study was to survey the definitions used in describing the concept and to derive key characteristics of clinical pathways. METHOD: Using the PubMed, we conducted a review of literature published between January 2000 and December 2003 using the following terms: critical pathway, clinical pathway, integrated care pathway, care pathway and care map. All reports reviewed had to use the concept, as defined by the Medical Subject Headings term, to be considered. To assess all definitions, the concept analysis method was used. RESULTS: In 82 of the 263 eligible articles, the definition of pathway was given. Totally, we found 84 different definitions. Each definition was rephrased by taking into consideration the following three features inherent to pathways: nouns, characteristics and aims and outcomes. Every feature was further divided into categories. CONCLUSIONS: A clinical pathway is a method for the patient-care management of a well-defined group of patients during a well-defined period of time. A clinical pathway explicitly states the goals and key elements of care based on Evidence Based Medicine (EBM) guidelines, best practice and patient expectations by facilitating the communication, coordinating roles and sequencing the activities of the multidisciplinary care team, patients and their relatives; by documenting, monitoring and evaluating variances; and by providing the necessary resources and outcomes. The aim of a clinical pathway is to improve the quality of care, reduce risks, increase patient satisfaction and increase the efficiency in the use of resources.

Critical Pathways↗

PubMed2005

A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit.

OBJECTIVE: To identify a critical appraisal tool for clinical practice guidelines that could serve as a basis for the development of an appraisal tool for clinical pathways. DESIGN: Systematic review of the literature and personal contacts. Databases searched were: Medline, Embase, and Cinahl. Search terms were: practice guidelines, appraisal, and evaluation. The items of the identified appraisal tools were examined and thematically grouped into 10 guideline dimensions. Content analysis and scoring of these domains by the appraisal tools was evaluated. RESULTS: Twenty-four different appraisal tools of practice guidelines were identified. None scored the evidence base of the clinical content of guidelines. Four tools scored all the guideline dimensions. The Cluzeau instrument is the only one of these four that has been validated. Of the three instruments based on the Cluzeau instrument, the AGREE instrument is the only validated instrument that uses a numerical scale. CONCLUSIONS: Being a simplified version of the Cluzeau instrument, the AGREE instrument has the most potential to serve as a basis for the development of an appraisal tool for clinical pathways. However, important limitations will have to be dealt with when developing such a tool.

Critical Pathways↗

PubMed2004

Classifying clinical pathways.

BACKGROUND: Clinical pathways are commonly developed for homogenous patient groups. We were wondering if the traditional patient classification systems could be used for classifying clinical pathways. METHODOLOGY: To examine the utility of patient classification systems for clinical pathways, a sample of 13 clinical pathways was analyzed, involving a total of 412 patients. Three classification systems were tested: International Classification of Diseases, Ninth Revision (ICD9-CM), Clinical Coding System (CCS) data and All-Patient Redefined Diagnosis Related Groups (APR-DRG). RESULTS: Categorization with ICD9-CM and CCS shows rather wide variation. However, when restricting for the principal codes, CCS classification shows an almost homogeneous relationship with clinical pathways. APR-DRG's are already corrected for secondary procedures and are difficult to assess. Categorization with the Risk Of Mortality (ROM) is more homogeneous than with the Severity Of Illness (SOI). CONCLUSION: Patient groups in clinical pathways are rather heterogeneous. When restricting for the principal procedures, the strongest relationship seems to exist between clinical pathways and CCS. Further research is needed to refine this relationship.

Belgium↗