BACKGROUND: A proven efficacious and evidence-based critical pathway for community-acquired pneumonia (CAP) was implemented in six hospitals across a health service region (Edmonton, Canada). After one year (November 2000-November 2001), the pathway had reduced average length of stay by 1 day (from 10.8 to 9.8 days, p < .001). However, great variation was observed in physician adherence to the pathway. METHODS: Physician-perceived barriers to adoption of the CAP pathway were identified through in-depth interviews. Data saturation was reached after 10 physicians, representing a convenience sample of those willing to participate, were interviewed. RESULTS: Self-reported adherence to the CAP pathway was 75% (range 50%-100%). Qualitative analysis of the interview data indicated that comments could be grouped into five themes: (1) limited applicability, (2) lack of flexibility to accommodate atypical clinical presentations, (3) perception of insufficient evidence to support recommendations, (4) local organizational barriers, and (5) need for local adaptation. For example, one physician remarked that his community hospital had insufficient staff to support collection of lab samples for all patients. DISCUSSION: Interventions to increase pathway adoption and further improve quality of CAP care should address the identified barriers. For example, local audit and feedback of outcomes data to persuade physicians of the benefits of CAP pathways will need to be instituted.
BACKGROUND: A proven efficacious and evidence-based critical pathway for community-acquired pneumonia (CAP) was implemented in six hospitals across a health service region (Edmonton, Canada). After one year (November 2000-November 2001), the pathway had reduced average length of stay by 1 day (from 10.8 to 9.8 days, p < .001). However, great variation was observed in physician adherence to the pathway. METHODS: Physician-perceived barriers to adoption of the CAP pathway were identified through in-depth interviews. Data saturation was reached after 10 physicians, representing a convenience sample of those willing to participate, were interviewed. RESULTS: Self-reported adherence to the CAP pathway was 75% (range 50%-100%). Qualitative analysis of the interview data indicated that comments could be grouped into five themes: (1) limited applicability, (2) lack of flexibility to accommodate atypical clinical presentations, (3) perception of insufficient evidence to support recommendations, (4) local organizational barriers, and (5) need for local adaptation. For example, one physician remarked that his community hospital had insufficient staff to support collection of lab samples for all patients. DISCUSSION: Interventions to increase pathway adoption and further improve quality of CAP care should address the identified barriers. For example, local audit and feedback of outcomes data to persuade physicians of the benefits of CAP pathways will need to be instituted.
Authors: Bruce A Feinberg; James Lang; James Grzegorczyk; Donna Stark; Thomas Rybarczyk; Thomas Leyden; Joseph Cooper; Thomas Ruane; Scott Milligan; Philip Stella; Jeffrey A Scott Journal: J Oncol Pract Date: 2012-05 Impact factor: 3.840
Authors: Jeroen A Schouten; Marlies E J L Hulscher; Stephanie Natsch; Bart-Jan Kullberg; Jos W M van der Meer; Richard P T M Grol Journal: Qual Saf Health Care Date: 2007-04
Authors: Veroniek Spoorenberg; Marlies E J L Hulscher; Ronald B Geskus; Theo M de Reijke; Brent C Opmeer; Jan M Prins; Suzanne E Geerlings Journal: PLoS One Date: 2015-12-04 Impact factor: 3.240
Authors: John W Peabody; David R Paculdo; Diana Tamondong-Lachica; Jhiedon Florentino; Othman Ouenes; Riti Shimkhada; Lisa DeMaria; Trever B Burgon Journal: J Clin Med Res Date: 2016-07-30