Critical pathway effectiveness: Assessing the impact of patient, hospital care, and pathway characteristics using qualitative comparative analysis
Critical pathway effectiveness: Assessing the impact of patient, hospital care, and pathway characteristics using qualitative comparative analysis
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DOI：
10.1111/j.1475-6773.2005.0r370.x
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发表时间：
2005-04-01
影响因子：
3.4
通讯作者：
Wu, AW
中科院分区：
文献类型：
--
作者：
Dy, SM;Garg, P;Wu, AW
为了定性描述可能与减少住院时间的途径有效性相关的患者、医院护理和关键途径特征。1988-1998 年三级护理中心外科部门 26 个外科关键途径中每一个的管理数据和途径文件审查以及医疗记录样本。回顾性定性研究。利用文献综述和专家咨询中的信息，我们制定了可能影响关键途径有效性的特征列表。我们使用假设驱动的定性比较分析来描述可能区分有效和无效关键路径的关键主要和次要特征。与缩短住院时间相关的 26 条路径中的所有 7 条都至少具有以下特征之一：(1) 不存在预先存在缩短手术住院时间的趋势 (71%)，和/或 (2) 这是在其外科服务中实施的第一个路径 (71%)。此外，有效缩短住院时间的途径往往是患者疾病严重程度较低的手术，如重症监护天数较少和死亡率较低所示。有效途径往往比无效途径更频繁地使用（77% 的病历中存在途径文件，59% 的病历中存在途径文件），但高记录途径使用率对于途径有效性而言并不是必需的。关键途径计划的有效性可能有限，并且可能仅在某些情况下有效。由于途径利用率并不是途径有效性的有力预测因素，因此关键途径可能减少住院时间的机制尚不清楚。
To qualitatively describe patient, hospital care, and critical pathway characteristics that may be associated with pathway effectiveness in reducing length of stay.Administrative data and review of pathway documentation and a sample of medical records for each of 26 surgical critical pathways in a tertiary care center's department of surgery, 1988-1998.Retrospective qualitative study.Using information from a literature review and consultation with experts, we developed a list of characteristics that might impact critical pathway effectiveness. We used hypothesis-driven qualitative comparative analysis to describe key primary and secondary characteristics that might differentiate effective from ineffective critical pathways.All 7 of the 26 pathways associated with a reduced length of stay had at least one of the following characteristics: (1) no preexisting trend toward lower length of stay for the procedure (71 percent), and/or (2) it was the first pathway implemented in its surgical service (71 percent). In addition, pathways effective in reducing length of stay tended to be for procedures with lower patient severity of illness, as indicated by fewer intensive care days and lower mortality. Effective pathways tended to be used more frequently than ineffective pathways (77 versus 59 percent of medical records with pathway documents present), but high rates of documented pathway use were not necessary for pathway effectiveness.Critical pathway programs may have limited effectiveness, and may be effective only in certain situations. Because pathway utilization was not a strong predictor of pathway effectiveness, the mechanism by which critical pathways may reduce length of stay is unclear.