Christopher T Plishka1, Thomas Rotter2, Erika D Penz3, Mohammed R Hansia4, Shana-Kay A Fraser5, Darcy D Marciniuk3. 1. College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada. Electronic address: chris.plishka@usask.ca. 2. Health Quality Programs, School of Nursing, Queen's University, Kingston, ON, Canada. 3. Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada. 4. Saskatchewan Health Authority, Saskatoon, SK, Canada. 5. British Virgin Islands Health Services Authority, Road Town, Tortola, British Virgin Islands.
Abstract
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.
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.
Authors: Melissa Heightman; Jai Prashar; Toby E Hillman; Michael Marks; Rebecca Livingston; Heidi A Ridsdale; Robert Bell; Michael Zandi; Patricia McNamara; Alisha Chauhan; Emma Denneny; Ronan Astin; Helen Purcell; Emily Attree; Lyth Hishmeh; Gordon Prescott; Rebecca Evans; Puja Mehta; Ewen Brennan; Jeremy S Brown; Joanna Porter; Sarah Logan; Emma Wall; Hakim-Moulay Dehbi; Stephen Cone; Amitava Banerjee Journal: BMJ Open Respir Res Date: 2021-11
Authors: Thu-Anh Nguyen; Yen Ngoc Pham; Nhung Phuong Doan; Thao Huong Nguyen; Toan Thanh Do; Giap Van Vu; Guy B Marks; Shannon McKinn; Joel Negin; Sarah Bernays; Greg J Fox Journal: BMC Public Health Date: 2021-06-15 Impact factor: 3.295