BACKGROUND: Surgeons realize that safe and efficient care processes for total joint replacement requires more than just well-performed operations. Orthopaedic teams are reorganizing care process to improve efficacy and shorten length of stay. Little is known on the impact of organizational changes on patient outcome. This paper studies the relation between the organization of care processes and patient outcomes in hip and knee. Clinical pathways are used as one of the methods to structure the care process. Although evidence is available on the effect of pathways in total joint replacement, their impact with the organization of the care process has not been studied previously. METHODS: A cross-sectional multicentre study was performed on 39 care processes and 737 consecutive patients. Regression models were used to analyse the relation between the organization of the care process and risk-adjusted patient outcomes. The use of pathways and the organization of the care process, measured by the Care Process Self Evaluation Tool (CPSET), were measured at organizational level. Length of stay, pain, mobility and elapsed time to discharge were measured at patient level. RESULTS: The use of pathways had a positive effect on four out of five subscales and the overall CPSET score. Using pathways decreased length of stay (P = 0.014), pain (P = 0.052) and elapsed time to discharge (P = 0.003). The CPSET subscale communication was related with three risk adjusted outcomes. Multivariate analysis demonstrated a significant effect by three different variables on the length of stay; (1) use of pathways; (2) coordination of care processes; and (3) communication with patients and family. Both the use of pathways and coordination of the care process were determinants for the elapsed time to discharge. A significant interaction effect was found between use of pathways and coordination of the care process. CONCLUSION: This large multicentre study revealed the relation between the use of pathways, organization of the care process and patient outcomes. This information is important for both clinicians and managers to understand and further improve the organization of orthopaedic care. LEVEL OF EVIDENCE: Level I prognostic study.
BACKGROUND: Surgeons realize that safe and efficient care processes for total joint replacement requires more than just well-performed operations. Orthopaedic teams are reorganizing care process to improve efficacy and shorten length of stay. Little is known on the impact of organizational changes on patient outcome. This paper studies the relation between the organization of care processes and patient outcomes in hip and knee. Clinical pathways are used as one of the methods to structure the care process. Although evidence is available on the effect of pathways in total joint replacement, their impact with the organization of the care process has not been studied previously. METHODS: A cross-sectional multicentre study was performed on 39 care processes and 737 consecutive patients. Regression models were used to analyse the relation between the organization of the care process and risk-adjusted patient outcomes. The use of pathways and the organization of the care process, measured by the Care Process Self Evaluation Tool (CPSET), were measured at organizational level. Length of stay, pain, mobility and elapsed time to discharge were measured at patient level. RESULTS: The use of pathways had a positive effect on four out of five subscales and the overall CPSET score. Using pathways decreased length of stay (P = 0.014), pain (P = 0.052) and elapsed time to discharge (P = 0.003). The CPSET subscale communication was related with three risk adjusted outcomes. Multivariate analysis demonstrated a significant effect by three different variables on the length of stay; (1) use of pathways; (2) coordination of care processes; and (3) communication with patients and family. Both the use of pathways and coordination of the care process were determinants for the elapsed time to discharge. A significant interaction effect was found between use of pathways and coordination of the care process. CONCLUSION: This large multicentre study revealed the relation between the use of pathways, organization of the care process and patient outcomes. This information is important for both clinicians and managers to understand and further improve the organization of orthopaedic care. LEVEL OF EVIDENCE: Level I prognostic study.
Authors: Aricca D Van Citters; Cheryl Fahlman; Donald A Goldmann; Jay R Lieberman; Karl M Koenig; Anthony M DiGioia; Beth O'Donnell; John Martin; Frank A Federico; Richard A Bankowitz; Eugene C Nelson; Kevin J Bozic Journal: Clin Orthop Relat Res Date: 2013-12-03 Impact factor: 4.176
Authors: Kris Vanhaecht; Walter Sermeus; Jan Peers; Cathy Lodewijckx; Svin Deneckere; Fabrizio Leigheb; Steven Boonen; An Sermon; Paulo Boto; Rita Veloso Mendes; Massimiliano Panella Journal: BMC Health Serv Res Date: 2012-05-24 Impact factor: 2.655
Authors: Marie-Pascale Pomey; Nathalie Clavel; Claudia Amar; Juan Carlos Sabogale-Olarte; Claudia Sanmartin; Carolyn De Coster; Tom Noseworthy Journal: BMC Health Serv Res Date: 2017-09-07 Impact factor: 2.655