Biomedical subjects

Kris Vanhaecht

Publications and source records attributed to Kris Vanhaecht.

5 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↗

PubMed2006

Clinical pathway audit tools: a systematic review.

AIM: To determine whether clinical/care pathway audit tools can identify the characteristics of well-organized care processes. BACKGROUND: Although pathways are used worldwide, confusion exists about the concept and impact. Evaluation Search of OVID-Medline, Cinahl, British Nursing Index; manual search of the Journal of Integrated Care Pathways; contact with Smartgroup on Clinical Pathways and board members of the European Pathway Association and Google search. KEY ISSUES: We selected seven of 15 clinical pathway audit tools for this review. Through content analysis, we identified 17 characteristics and grouped them using the realistic evaluation paradigm. The Integrated Care Pathway Appraisal Tool is the most appropriate audit tool to assess clinical pathway documents. CONCLUSIONS: It is astonishing that so little research on clinical pathway audit tools has been underwent, given the prevalent use of clinical pathways. Because the concept of clinical pathways remains unclear, a variety of audit tools are needed to help clarify the concept. Further research on the construct and criterion validity of pathway audit tools is necessary to fully understand why and under which circumstances pathways lead to improved care.

Critical Pathways↗

PubMed2005

Development of a clinical pathway for total knee arthroplasty and the effect on length of stay and in-hospital functional outcome.

The goal of reducing the length of a patient's hospital stay after orthopaedic surgery has recently gained much interest from surgeons and hospital administrators. The influence of hospital stay reduction on qualitative outcome is not always documented. The purpose of this study was to investigate this relationship in more detail. We report our experience with patients undergoing total knee arthroplasty. In 2000, an in-hospital clinical pathway for patients undergoing total knee arthroplasty was instituted at the University Hospitals Pellenberg, Belgium. We evaluated this pathway in 103 patients by using a pre-experimental, interrupted, time-series design. This pathway significantly decreased length of stay by 33% without negatively affecting functional outcomes during hospitalisation. In further research also the long-term effects have to be studied.

Aged↗

PubMed2004

Prevention pathways: application of the critical path methodology in occupational health services.

Occupational health services face important changes as a result of changes in work environment, changing health and safety concepts, and legislation. To ensure good quality at a good price, it is important to control the processes in occupational health services. The concept of "prevention pathways" is presented for the management of occupational health services. The model is based on the critical pathway concept. The approach is illustrated by means of a case study performed in a Belgian occupational health service. A prevention pathway for the evaluation of chemical risks at the workplace was constructed. The prevention pathway methodology revealed inefficiencies and quality problems in the current practice of chemical risk assessment and biomonitoring. The case shows how prevention pathways can be used to pilot the members of a multidisciplinary team by focusing on a specific occupational risk.

Accidents, Occupational↗

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↗