Effects of Clinical Pathways for COPD on Patient, Professional, and Systems Outcomes: A Systematic Review.
COPD
CPW
care map
care pathway
clinical pathway
critical pathway
integrated care pathway
systematic review
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
11
10
2018
revised:
18
04
2019
accepted:
29
04
2019
pubmed:
1
6
2019
medline:
23
6
2020
entrez:
1
6
2019
Statut:
ppublish
Résumé
COPD has a substantial burden seen in both patient quality of life and health-care costs. One method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs bring the best available evidence to a range of health-care professionals by adapting guidelines to a local context and detailing essential steps in care. A systematic review was conducted to address the following question: What are the effects of CPWs for COPD on patient-, professional-, and systems-level outcomes? The review used methods outlined by the Cochrane Collaboration. We included all studies that met our operational definition for CPWs and focused on COPD. All studies were evaluated for risk of bias, and all data regarding patient, professional, and systems outcomes were extracted. The search strategy identified 497 potentially relevant titles. Of these, 13 studies were included in the review. These studies reported a total of 398 outcomes, with sufficient data for meta-analysis of five outcomes: complications, length of stay, mortality, readmissions, and quality of life. Results showed statistically significant reductions in complications, readmissions, and length of stay but did not show changes in mortality or quality of life. This systematic review reveals evidence to suggest that CPWs for COPD have the potential to reduce complications, readmissions, and length of stay without negatively influencing mortality or quality of life. However, quality of evidence was generally low. The authors therefore acknowledge that results should be interpreted with caution and note the need for additional research in this area.
Sections du résumé
BACKGROUND
COPD has a substantial burden seen in both patient quality of life and health-care costs. One method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs bring the best available evidence to a range of health-care professionals by adapting guidelines to a local context and detailing essential steps in care.
METHODS
A systematic review was conducted to address the following question: What are the effects of CPWs for COPD on patient-, professional-, and systems-level outcomes? The review used methods outlined by the Cochrane Collaboration. We included all studies that met our operational definition for CPWs and focused on COPD. All studies were evaluated for risk of bias, and all data regarding patient, professional, and systems outcomes were extracted.
RESULTS
The search strategy identified 497 potentially relevant titles. Of these, 13 studies were included in the review. These studies reported a total of 398 outcomes, with sufficient data for meta-analysis of five outcomes: complications, length of stay, mortality, readmissions, and quality of life. Results showed statistically significant reductions in complications, readmissions, and length of stay but did not show changes in mortality or quality of life.
CONCLUSIONS
This systematic review reveals evidence to suggest that CPWs for COPD have the potential to reduce complications, readmissions, and length of stay without negatively influencing mortality or quality of life. However, quality of evidence was generally low. The authors therefore acknowledge that results should be interpreted with caution and note the need for additional research in this area.
Identifiants
pubmed: 31150639
pii: S0012-3692(19)31120-1
doi: 10.1016/j.chest.2019.04.131
pii:
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
864-877Investigateurs
Sheila Anderson
(S)
Margaret Baker
(M)
Zenon Belak
(Z)
Nishen Bhagaloo
(N)
Terry Blackmore
(T)
Bree Calland
(B)
Hilda Chan
(H)
Patricia Comfort
(P)
Tania Diener
(T)
Ron Epp
(R)
Milo Fink
(M)
Carmen Johnson
(C)
Barb Konstantynowicz
(B)
Jayne Leibel
(J)
Winston Lok
(W)
Mohammed Moolla
(M)
Dodi Novak
(D)
Frank Offiah
(F)
Prakash Patel
(P)
Terry Ross
(T)
Ron Taylor
(R)
Fouche Williams
(F)
Informations de copyright
Copyright © 2019 American College of Chest Physicians. All rights reserved.