Day 2 : Oral Presentations (Theme: Patient Safety)

Event Title

Can resident-driven clinical pathways improve patient-centered outcomes? The CHAMP-Path methodology and preliminary experience

Location

Lecture Hall 2

Start Date

27-1-2013 9:10 AM

Abstract

Background: A clinical pathway is an evidence-based integrated plan of care. There is conflicting evidence on its utility in real life. Therefore, the aim of this study is to determine if ‘Pathway Care’ versus ‘Usual Care’ leads to improved ‘patient-centeredness’ in real-life settings.

Methods: CHAMP-Path is a pragmatic randomized controlled trial. Clinical pathways were developed and integrated into a Computerized Prescriber Order Entry System (CPOE). Physicians were randomized into two teams. Patient randomization was through permuted blocks and allocation was concealed. The exclusion and inclusion criteria are pathway-specific. Patients are blinded to the allocated arm. The primary outcome is a reduction in length of stay (LOS). The secondary outcomes are patient-centered outcomes, determinants of LOS, and 30-day readmission. The study is powered at 80% with an alpha of 5%. Patient-centeredness was assessed at baseline for 20 patients during validation of an Arabic survey instrument. The survey included questions about key health care professionals and was rated on a modified Likert scale.

Results: Mean LOS ± SD, 95% CI and p-values using intention-to-treat analysis will be reported with regression analysis to identify determinants of LOS. From 124 patients screened, 57 patients have been recruited to-date. The baseline survey assessment showed that the highest rated items were physician and hospital staff professionalism, nursing care, and hospitality. The lowest rated items were the questions regarding clarity of information received about the side effects of treatment and expected LOS, pharmacy counseling, and health education.

Conclusions: CHAMP- Path is a pragmatic study aiming to decrease LOS and improve patient-centeredness. Further data, we believe, shall provide insightful tools aimed at improving quality of care. The baseline survey provides opportunities for improving patient-centeredness. NB: The CHAMP-Path Methodology has been presented in-part as an oral presentation at the KAIMRC (King Abdullah International Medical Research Center) 3rd Annual Scientific Forum in Riyadh, Saudi Arabia, reporting on the first 33 patients. Results of the patient-centered survey were reported in-part as a poster at the same forum.

Key words: Clinical Pathways Length of Stay Patient-Centeredness

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Jan 27th, 9:10 AM Jan 27th, 9:25 AM

Can resident-driven clinical pathways improve patient-centered outcomes? The CHAMP-Path methodology and preliminary experience

Lecture Hall 2

Background: A clinical pathway is an evidence-based integrated plan of care. There is conflicting evidence on its utility in real life. Therefore, the aim of this study is to determine if ‘Pathway Care’ versus ‘Usual Care’ leads to improved ‘patient-centeredness’ in real-life settings.

Methods: CHAMP-Path is a pragmatic randomized controlled trial. Clinical pathways were developed and integrated into a Computerized Prescriber Order Entry System (CPOE). Physicians were randomized into two teams. Patient randomization was through permuted blocks and allocation was concealed. The exclusion and inclusion criteria are pathway-specific. Patients are blinded to the allocated arm. The primary outcome is a reduction in length of stay (LOS). The secondary outcomes are patient-centered outcomes, determinants of LOS, and 30-day readmission. The study is powered at 80% with an alpha of 5%. Patient-centeredness was assessed at baseline for 20 patients during validation of an Arabic survey instrument. The survey included questions about key health care professionals and was rated on a modified Likert scale.

Results: Mean LOS ± SD, 95% CI and p-values using intention-to-treat analysis will be reported with regression analysis to identify determinants of LOS. From 124 patients screened, 57 patients have been recruited to-date. The baseline survey assessment showed that the highest rated items were physician and hospital staff professionalism, nursing care, and hospitality. The lowest rated items were the questions regarding clarity of information received about the side effects of treatment and expected LOS, pharmacy counseling, and health education.

Conclusions: CHAMP- Path is a pragmatic study aiming to decrease LOS and improve patient-centeredness. Further data, we believe, shall provide insightful tools aimed at improving quality of care. The baseline survey provides opportunities for improving patient-centeredness. NB: The CHAMP-Path Methodology has been presented in-part as an oral presentation at the KAIMRC (King Abdullah International Medical Research Center) 3rd Annual Scientific Forum in Riyadh, Saudi Arabia, reporting on the first 33 patients. Results of the patient-centered survey were reported in-part as a poster at the same forum.

Key words: Clinical Pathways Length of Stay Patient-Centeredness