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Dahlin, Sara, and Hendry Raharjo. "Relationship between patient costs and patient pathways." International Journal of Health Care Quality Assurance 32, no. 1 (February 11, 2019): 246–61. http://dx.doi.org/10.1108/ijhcqa-10-2017-0199.
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Purpose The purpose of this paper is to identify actual (as-is) patient pathway variation among breast cancer patients and to investigate the relationship between pathways and the cost incurred by patients. Design/methodology/approach Both quantitative and qualitative methods were employed to analyze data from four Swedish hospital groups. Quantitative methods include event-log data mining and statistical analyses on the related patient cost from the Swedish breast cancer quality registry and case-costing system. Qualitative methods included collaboration with and interviewing domain experts. Findings Unique pathways, followed by only one patient, were generally costlier than the most and less frequent pathways. Earlier study findings are confirmed for mastectomy patients, with more frequent pathways having a lower cost, whereas contradicting and inconclusive results emerged for the partial mastectomy patient groups. Highest variation in pathways was identified for patients receiving chemotherapy. Practical implications The common belief – if one follows a standardized patient pathway, then the cost will be lower – should be re-examined based on the actual pathways that occur in reality. Originality/value The relationships between patient pathways and patient cost allow more complex insights, beyond the general causal relationship between successfully implementing a “to-be” care pathway and lower cost. This highlights data-driven research’s importance, where actual pathways (as-is) provide more useful information than to-be care pathways.
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Hansen, Jens B., Jens F. L. Sørensen, Eva N. Glassou, Morten Homilius, and Torben B. Hansen. "Reducing patient–staff contact in fast-track total hip arthroplasty has no effect on patient-reported outcomes, but decreases satisfaction amongst patients with self-perceived complications: analysis of 211 patients." Acta Orthopaedica 93 (January 24, 2022): 264–70. http://dx.doi.org/10.2340/17453674.2022.1617.
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Background and purpose: Several studies have compared fast-track with conventional pathways for total hip arthroplasty (THA) patients, but none have compared different fast-track pathways. Due to COVID-19 restrictions, our department had to minimize patient–staff contact in the THA pathway. First, telephone consultations were implemented instead of an outpatient clinic visit and subsequently preoperative patient education was discontinued. This enabled us to compare patient-reported outcomes and satisfaction among 3 fast-track pathways. Patients and methods: We collected data from patients treated for hip osteoarthritis with THA at Gødstrup Hospital between 2018 and 2021. The patients had experienced 1 of 3 pathways and were interviewed via telephone between 2 and 6 months after discharge. We analyzed the influence of patient pathway on patient-reported pain and mobility level, self-perceived complications, and compliance using logistic regression. We then compared the pathway’s effect on patient satisfaction both for the total sample and for the patients who experienced complications. Results: The amount of patient–staff contact in the patient pathway did not have any influence on patientreported outcomes or the probability of self-perceived complications. For the full sample, patient–staff contact had no statistically significant influence on patient satisfaction either, but for the subgroup of patients experiencing complications, the pathways with less patient–staff contact reducedsatisfaction. Patient satisfaction was primarily related to pain and mobility outcomes. Interpretation: Our results indicate that reducing patient–staff contact in fast-track THA can be done without influencing mobility and pain outcomes, but the overall satisfaction among patients with self-perceived complications will be negatively affected.
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Hu, Chenyu W., Amina A. Qutub, Yihua Qiu, Suk Young Yoo, Nianxiang Zhang, Naveen Pammaraju, Courtney D. DiNardo, Kevin R. Coombes, and Steven M. Kornblau. "A Global Proteomic Pathway Map In Acute Myeloid Leukemia (AML)." Blood 122, no. 21 (November 15, 2013): 1302. http://dx.doi.org/10.1182/blood.v122.21.1302.1302.
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Abstract Background AML has been extensively studied in a gene-to-gene and pathway-to-pathway fashion over the years, unraveling insightful local patterns that capture heterogeneity in patients and identify potential drug targets. However, our understanding of AML from a global and systems perspective is still lacking. A global proteomic pathway map is yet to be drawn to integrate local activity patterns and to translate patient classifications across pathways. This will not only improve our scientific understanding of how different functional pathways are inter-related, but will also enable us to develop more robust and effective therapeutic regimens based on pathway cross-talks. Methods A proteomic profile, containing the expression pattern of 231 proteins in each of the 415 newly diagnosed AML patients at UT MD Anderson Cancer Center, was generated using the Reverse Phase Protein Array (RPPA) technology. We grouped these proteins into 23 functional pathways based on protein association known in literature and correlation shown in the proteomic profile. Principal component analysis and scree plot were used to refine the pathway construction. The AML patients were clustered by their protein expression patterns within each individual pathway, and were then compared across pathways. The association of patient clusters between different pathways was measured by Goodman-Kruskal's (GK) tau method, indicating the predictability of patient clustering in one pathway given that in the other. This association between pathways and interchangeability of patient groupings were visualized in a circos plot (Figure 1), depicting a global proteomic pathway map. Results The global proteomic pathway map illustrates how strongly protein expression patterns of different pathways are associated, and how patient classifications under different pathways could be translated from one to another. Here, we highlight some of the key insights surfaced from this analysis. First, we identified ‘social' pathways that have intensive cross-talks with multiple other pathways, including some of the cell signal transduction pathways (MEK, PI3K, mTOR), genetic information processing pathways (transcription, histone methylation), and cell survival/death pathways (apoptosis, autophagy). We also identified ‘orphan' pathways that are more independent and are poorly associated with others. These include a subset of signal transduction pathways (pkc, tp53, S6rp, Src, Creb, Wnt), cytoskeleton and differentiation. As the association is directional, each pathway could be further characterized as either a ‘sender' or a ‘receiver' pathway based on whether it is acting more as the origin or the target of the link. The patient clusters from the ‘sender' pathways (e.g. Apoptosis, mTOR, Fli), could be easily translated to other pathways, while the patient clusters in ‘receiver' pathways (e.g. Hippo and Transcription), are highly predictable by patient clusters from multiple other pathways. We further constructed and compared the global pathway maps for patients in different cytogenetic groups. Comparison of pathway maps from patients with favorable, intermediate and unfavorable cytogenetics shows the power of this methodology to discern differences in the degree of correlation between protein functional groups. Favorable cytogenetics (T8;21) and inversion 16, because they are more similar have less patient to patient variation and thus have a more consistent and highly correlated pathway map with a higher number of connections. Conclusions Based on the RPPA data in AML patients, we built a global proteomic pathway map that captures the association between protein expression patterns in defined protein functional groups. We identified intensive interacting pathways as well as independent pathways, which indicate potential hubs and modulators of leukemic cell behavior. We further compared maps of different cytogenetic groups and revealed different correlation mappings. We are further refining the algorithms in order to study more focused changes within lower population subsets. Ultimately we believe that this will enable the matching of targeted agents to specific settings where the target is expressed and highly interactive based on proteomic data. Disclosures: No relevant conflicts of interest to declare.
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Ku, Chu-Chang, Chien-Chou Chen, Simon Dixon, Hsien Ho Lin, and Peter J. Dodd. "Patient pathways of tuberculosis care-seeking and treatment: an individual-level analysis of National Health Insurance data in Taiwan." BMJ Global Health 5, no. 6 (June 2020): e002187. http://dx.doi.org/10.1136/bmjgh-2019-002187.
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IntroductionPatients with tuberculosis (TB) often experience difficulties in accessing diagnosis and treatment. Patient pathway analysis identifies mismatches between TB patient care-seeking patterns and service coverage, but to date, studies have only employed cross-sectional aggregate data.MethodsWe developed an algorithmic approach to analyse and interpret patient-level routine data on healthcare use and to construct patients’ pathways from initial care-seeking to treatment outcome. We applied this to patients with TB in a simple random sample of one million patients’ records in the Taiwan National Health Insurance database. We analysed heterogeneity in pathway patterns, delays, service coverage and patient flows between different health system levels.ResultsWe constructed 7255 pathways for 6258 patients. Patients most commonly initially sought care at the primary clinic level, where the capacity for diagnosing TB patients was 12%, before eventually initiating treatment at higher levels. Patient pathways are extremely heterogeneous prior to diagnosis, with the 10% most complex pathways accounting for 48% of all clinical encounters, and 55% of those pathways yet to initiate treatment after a year. Extended consideration of alternative diagnoses was more common for patients aged 65 years or older and for patients with chronic lung disease.ConclusionOur study demonstrates that longitudinal analysis of routine individual-level healthcare data can be used to generate a detailed picture of TB care-seeking pathways. This allows an understanding of several temporal aspects of care pathways, including lead times to care and the variability in patient pathways.
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Schlencker, Aurelien, Laurent Messer, Marc Ardizzone, Gilles Blaison, Olivier Hinschberger, Etienne Dahan, Christelle Sordet, et al. "Improving patient pathways for systemic lupus erythematosus: a multistakeholder pathway optimisation study." Lupus Science & Medicine 9, no. 1 (May 2022): e000700. http://dx.doi.org/10.1136/lupus-2022-000700.
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ObjectiveAmong the most significant challenges in SLE are the excessive diagnosis delay and the lack of coordinated care. The aim of the study was to investigate patient pathways in SLE in order to improve clinical and organisational challenges in the management of those with suspected and confirmed SLE.MethodsWe conducted a cross-sectional study of patients with SLE, healthcare providers and other representative stakeholders. Focus groups were conducted, and based on the collected data the most impactful disruption points in SLE patient pathways were identified. A novel framework to improve individual patient pathways in SLE was developed, discussed and validated during a consensus meeting with representative stakeholders.ResultsSix thematic clusters regarding disruption in optimal patient pathways in SLE were identified: appropriate and timely referral strategy for SLE diagnosis; the need for a dedicated consultation during which the diagnosis of SLE would be announced, and following which clarifications and psychological support offered; individualised patient pathways with coordinated care based on organ involvement, disease severity and patient preference; improved therapeutic patient education; prevention of complications such as infections, osteoporosis and cancer; and additional patient support. During the consensus meeting, the broader panel of stakeholders achieved consensus on these attributes and a framework for optimising SLE patient pathways was developed.ConclusionsWe have identified significant disruption points and developed a novel conceptual framework to improve individual patient pathways in SLE. These data may be of valuable interest to patients with SLE, their physicians, health organisations as well as policy makers.
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Russell, Kevin, and Francis Maietta. "Simulated Patient Pathways." Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 1, no. 3 (2006): 189. http://dx.doi.org/10.1097/01266021-200600130-00044.
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Pang, Herbert, and Hongyu Zhao. "Stratified Pathway Analysis to Identify Gene Sets Associated with Oral Contraceptive Use and Breast Cancer." Cancer Informatics 13s4 (January 2014): CIN.S13973. http://dx.doi.org/10.4137/cin.s13973.
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Cancer biomarker discovery can facilitate drug development, improve staging of patients, and predict patient prognosis. Because cancer is the result of many interacting genes, analysis based on a set of genes with related biological functions or pathways may be more informative than single gene-based analysis for cancer biomarker discovery. The relevant pathways thus identified may help characterize different aspects of molecular phenotypes related to the tumor. Although it is well known that cancer patients may respond to the same treatment differently because of clinical variables and variation of molecular phenotypes, this patient heterogeneity has not been explicitly considered in pathway analysis in the literature. We hypothesize that combining pathway and patient clinical information can more effectively identify relevant pathways pertinent to specific patient subgroups, leading to better diagnosis and treatment. In this article, we propose to perform stratified pathway analysis based on clinical information from patients. In contrast to analysis using all the patients, this more focused analysis has the potential to reveal subgroup-specific pathways that may lead to more biological insights into disease etiology and treatment response. As an illustration, the power of our approach is demonstrated through its application to a breast cancer dataset in which the patients are stratified according to their oral contraceptive use.
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Swaminathan, Padmapriya, Casey B. Williams, and Tobias Meissner. "Abstract 2271: Patient-specific visualization of cancer pathways." Cancer Research 82, no. 12_Supplement (June 15, 2022): 2271. http://dx.doi.org/10.1158/1538-7445.am2022-2271.
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Abstract Introduction: Analysis of whole transcriptomics datasets to quantify gene expression and determine differentially expressed genes has provided valuable information for precision medicine. Evaluating enrichment of specific gene groups and pathways, and visualizing these results is an important step to obtain inferences about patient treatment outcomes, overall survival, drug resistance and therapeutic targets. However, pathway analysis of cancer patient samples in a N-of-1 setting without their respective control (normal) samples remains to be challenging. There is a crucial need for methods and tools to conduct and visualize pathway analysis results in this setting. Methods and Results: Our method focuses on a visualization technique showing patient-specific pathway activation relative to reference populations from The Cancer Genome Atlas (TCGA) and The Genotype-Tissue Expression (GTEX). Patient-specific pathway activity scores are displayed within the respective percentiles and averages of the TCGA and GTEX cohorts to visualize a patient's individual pathway activation profile within the TCGA tumor and GTEX normal reference population. Patient-specific pathway scores are derived from an individual patient's transcriptomic profile and transformed into activity scores for each of 14 cancer pathways. This allows for the comparison of an individual patient’s pathway activation profile with reference samples from TCGA and GTEX. We used PROGENy (Pathway RespOnsive GENes for activity inference) to calculate activity scores for the 14 cancer related pathways. The pathway activity scores of each new tumor sample are scaled using the parameters of scaled pathway activity scores obtained from TCGA and GTEX gene expression data of all cancer tissue types. Finally we visualized the pathway activity scores of each patient sample. Conclusion: Our visualization method is expected to unravel the activation patterns of each of the 14 cancer pathways in our patient samples. Specific pathway genes can then be evaluated in the patient samples to identify causal mutations and their associations with the pathway activity scores hence aid in treatment selection and in the further development of precision medicine therapeutic solutions. Citation Format: Padmapriya Swaminathan, Casey B. Williams, Tobias Meissner. Patient-specific visualization of cancer pathways [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2271.
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Hermansen, Sabina Bay, Jens Holmskov, Søren Paaske Johnsen, Jan Mainz, and Søren Valgreen Knudsen. "Quality in practice: applying the patient inventory method at a Danish psychiatric hospital." International Journal for Quality in Health Care 32, no. 7 (July 21, 2020): 477–79. http://dx.doi.org/10.1093/intqhc/mzaa076.
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Abstract Quality problem Patient care pathways should be organized according to the needs of the patients. This requires methods to assess whether the specific pathways ensure the right care for the right person at the right time and in the right setting. Initial assessment Previous investigations indicate that ~25% of the patients in Danish hospitals experience inappropriate elements in their care pathways. Choice of solution This study applied the Patient Inventory method to identify inappropriate elements in care pathways in 15 psychiatric in-patient wards in Denmark. Implementation The pathway for 201 patients was systematically evaluated by the clinical staff to identify whether the admission of the patient was avoidable, the hospitalization was unnecessarily prolonged or if the patient could receive more relevant treatment elsewhere. A subsequent meeting between the clinical staff and management qualified the assessment and identified possible solutions to problems. Evaluation A total of 54 (26.9%) of the included patients were assessed to have inappropriate elements in their care pathways, some with more than one type, resulting in a total of 65 episodes. Eight of these episodes (13.1%) were admissions considered to be avoidable, 26 (42.2%) were unnecessary prolongation of admissions, and 31 (58.1%) were patients assessed to be able to receive more relevant care elsewhere. Lessons learned One out of four assessed patients admitted to a psychiatric ward was exposed to an inappropriate element in their care pathway. The Patient Inventory tool can assist in a structured dialogue between clinical staff and management to identify focus areas for improvement efforts.
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Glass, Katherine, Chad W. Cummings, Marc A. Shapiro, Dennis Urbanek, and Brian James Bolwell. "Data collection for care pathways in the Cleveland Clinic Health System." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 115. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.115.
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115 Background: Care pathways are established methods of reducing healthcare costs and disparities in oncology care. To demonstrate their impact, health systems must measure and report data on care pathway adherence and outcomes in near real-time. Automating data abstraction across a health system for oncology is difficult due to the amount and detail of data required. Manual abstraction of data is considered slow and costly. Many consider Electronic Medical Record (EMR) integration of care pathways essential in order to successfully implement and assess. Methods: 7 medical oncology care pathways and 45 medical oncologists across the health system were selected for a pilot study to assess the feasibility of implementing care pathways throughout the enterprise. The pilot study also allowed for testing of data collection capabilities. Patients eligible for the care pathways were prospectively identified by manual review of physician calendars. A small number of data points were manually abstracted from the patient EMR at the time of identification. Endpoints of interest, such as hospitalization rates, chemotherapy administered, time to treatment, and costs of care were reconciled through pre-existing databases within pharmacy, research, and finance. Tumor registry data identified a retrospective cohort. Results: Over 1,000 patients were prospectively identified for the care pathway pilot between 1/1/2014 and 12/31/2014. The tumor registry identified 700 additional retrospective patients. The rapid analyses possible as a result of these efforts demonstrated physician adherence, improved patient outcomes, and significant cost savings. In one example, a care pathway for metastatic non-small cell lung cancer reduced charges by more than $98,000/patient by recommending patients receive one standardized chemotherapeutic regimen. Conclusions: Timely data collection for oncology care pathways is feasible and cost effective without EMR integration. Manual identification of patients combined with pre-existing data sources allowed for near-real time analysis of care pathways and provided valuable information about care pathway impact. Institutions can implement and assess care pathways with resources already available to them.
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Markey, Donna W., Jim Mcgowan, and John B. Hanks. "The Effect of Clinical Pathway Implementation on Total Hospital Costs for Thyroidectomy and Parathyroidectomy Patients." American Surgeon 66, no. 6 (June 2000): 533–39. http://dx.doi.org/10.1177/000313480006600603.
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Clinical pathways have long been used to guide the delivery of patient care in varied practice settings. There is little information in the literature to document the effectiveness of pathway implementation in general surgical populations. This study reports the effect of clinical pathway implementation in two general surgical patient groups, thyroidectomy and parathyroidectomy. Clinical pathways were implemented to serve patients undergoing thyroidectomy and parathyroidectomy surgery. The effects of both clinical pathways on total hospital costs, length of hospitalization, variances, and outcomes were collected and evaluated from July 1998 through July 1999. These data were compared to data from the previous year. The average length of stay for parathyroidectomy patients decreased from 2.4 to 1.5 days ( P = 0.26) for pathway patients as compared to prepathway patients. The average cost per case decreased from $5071 to $4291 ( P = 0.50) for parathyroidectomy pathway versus prepathway patients. The average length of stay decrease for thyroidectomy patients was 1.4 to 1.2 ( P = 0.16) for the pathway to prepathway comparison. The average cost per case decrease was minor at $4117 to $4111. Pharmacy costs and laboratory utilization were effectively reduced. Perioperative costs rose dramatically during this period, operating room/central sterile supply cost per case rose 12 per cent, anesthesia supply cost per case rose 15 per cent, and surgical pathology costs increased 110 per cent overall for both patient groups. Clinical pathway implementation has allowed us to reduce or maintain total hospital costs in the face of rising perioperative costs. We conclude that implementation of these clinical pathways has allowed us to improve consistency with which we deliver care while maintaining the quality of patient outcomes and reducing the costs of care and length of hospital stay.
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Ellis, Peter G., and Kathleen Lokay. "Pathways clinical decision support for appropriate use of key biomarker." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 172. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.172.
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172 Background: UPMC CancerCenter (UPMC) has utilized clinical pathways for almost ten years in an effort to ensure standardization to the evidence based care for its patients. UPMC oncologists participate in the various pathways disease committees that develop and maintain the pathways content and utilize the pathways through a web-based portal in their daily decision making and documentation. The pathways cover not only treatment recommendations but also guidance for work up such as recurrence risk tools (OncoType Dx) for node negative, HER2 negative, ER positive breast cancer who are candidates for chemotherapy. For patients with a low recurrence risk score, the pathways recommends hormonal therapy only, saving the patient both toxicities and costs of chemotherapy where appropriate. Methods: UPMC analyzed its use of chemotherapy in patients with a recurrence risk score of less than 19 through a retrospective review of physician-input data in its Via Pathways Portal for the twelve months ended May 31, 2014. During this time period, the Via Pathways recommended the recurrence risk test for node negative, HER2 negative, ER positive patients. For patients with a low risk score (less than 19), the Via Pathways recommended hormonal therapy only. For those low risk score patients receiving chemotherapy, the physician would document that an Off Pathway decision was being made, indicate the reason for going Off Pathway, and document the actual therapy delivered. Results: For the twelve months ended May 31, 2014, UPMC physicians documented 288 decisions for patient presentation of node negative, HER2 negative, ER positive patients with a recurrence risk score of less than 19. Of these decisions, 99% (n=284) were On Pathway for hormonal therapy. Of the remaining 1%, three (3) were for accrual to a clinical trial and one (1) was Off Pathway for chemotherapy. Conclusions: Pathways are a tool for promoting adherence to evidence based care by oncologists through the use of a point of care decision support system. Pathways have the potential to reduce costs and toxicities of treatment through the evidence based guidance developed by the pathways disease committees and the adherence to such guidance by oncologists utilizing the pathways decision support tool.
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Smith, O., T. MacLeod, P. Lim, P. Chitsabesan, and S. Chintapatla. "A structured pathway for developing your complex abdominal hernia service: our York pathway." Hernia 25, no. 2 (February 18, 2021): 267–75. http://dx.doi.org/10.1007/s10029-020-02354-9.
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Abstract Purpose Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors’ knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. Methods A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. Results We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. Conclusion A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.
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Anand, Royana. "Enhancing Patient Care Pathways through AI-Driven Data Science and Program Management Strategies." International Journal of Media and Networks 2, no. 8 (August 30, 2024): 01–06. http://dx.doi.org/10.33140/ijmn.02.08.04.
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The integration of Artificial Intelligence (AI) and data science into healthcare program management offers transformative potential for enhancing patient care pathways. By leveraging advanced algorithms and data analytics, healthcare organizations can streamline processes, personalize treatment, and improve outcomes. This research paper explores the application of AIdriven data science in optimizing patient care pathways, examines current strategies in program management, and provides recommendations for implementing these technologies to achieve more effective and efficient patient care.
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Das, Biswajit, Yvonne A. Evrard, Li Chen, Rajesh Patidar, Tomas Vilimas, Justine N. McCutcheon, Amanda Peach, et al. "Integrative analyses of signaling and DNA damage repair pathways in patient-derived xenograft (PDX) models from NCI’s patient-derived models repository (PDMR)." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 3111. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.3111.
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3111 Background: Patient-derived xenografts (PDXs) are increasingly being used in translational cancer research for preclinical drug efficacy studies. The National Cancer Institute (NCI) has developed a Patient-Derived Models Repository (NCI PDMR; pdmr.cancer.gov ) of PDXs with clinical annotation, proteomics, and comprehensive genomic datasets to facilitate these studies. Here, we present an integrative genomic, transcriptomic, and proteomic analysis of critical signaling and DNA damage repair pathways in these PDX models, which represent 9 common and multiple rare tumor histologies. Methods: 304 PDX models from 294 patients were established from various solid tumor histologies from patients with primary or metastatic cancer. Whole Exome Sequencing, RNA-Seq and Reverse Phase Protein Array (RPPA) were performed on 2-9 PDXs per model across multiple passages. An integrative workflow was applied on multiple data sets to detect pathway activation. Results: We profiled 10 signaling and 5 DNA repair pathways in the PDMR dataset. We observed that: (i) a large fraction (40%) of PDX models have at least 1 targetable mutation in the RTK/RAS and/or PIK3CA pathways; (ii) 131 models (45%) have putative driver and oncogenic mutations and copy number variants (CNVs) in the WNT, TGFRb , NRF2 and NOTCH pathways. In addition, 17% of PDX models have targetable mutations in DNA damage repair pathways and 20 PDMR models have a DNA mismatch repair defect (MSI-H). We confirmed activation of the signaling pathways in a subset of PDX models by pathway enrichment analysis on gene expression data from RNASeq and phosphoprotein-specific antibody binding data from RPPA. Activation of DNA repair processes was confirmed by enrichment of relevant mutational signatures and loss of heterozygosity in these PDX models. Conclusions: Genomic analysis of NCI PDMR models revealed that a large fraction have clinically relevant somatic alterations in key signaling and DNA damage repair pathways. Further integrative analyses with matched transcriptomic and proteomic profiles confirmed pathway activation in a subset of these models, which may prioritize them for preclinical drug studies.
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Coughlan, Jane, Julie Eatock, and Tillal Eldabi. "Evaluating telemedicine: A focus on patient pathways." International Journal of Technology Assessment in Health Care 22, no. 1 (January 2006): 136–42. http://dx.doi.org/10.1017/s0266462306050938.
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Evaluations of telemedicine have sought to assess various measures of effectiveness (e.g., diagnostic accuracy), efficiency (e.g., cost), and engagement (e.g., patient satisfaction) to determine its success. Few studies, however, have looked at evaluating the organizational impact of telemedicine, which involves technology and process changes that affect the way that it is used and accepted by patients and clinicians alike. This study reviews and discusses the conceptual issues in telemedicine research and proposes a fresh approach for evaluating telemedicine. First, we advance a patient pathway perspective, as most of the existing studies view telemedicine as a support to a singular rather than multiple aspects of a health care process. Second, to conceptualize patient pathways and understand how telemedicine impacts upon them, we propose simulation as a tool to enhance understanding of the traditional and telemedicine patient pathway.
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Simon, Shayna, Sadaf Charania, Judy Devlin, Edie Brucker, Christine Hong, Angela F. Bazzell, Kavitha Nair, and John W. Sweetenham. "Development of evidence-based clinical pathways for an outpatient oncology acute care clinic." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18676-e18676. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18676.
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e18676 Background: Oncology patients frequently experience acute physical symptoms related to cancer and its treatment. Management of symptoms is best accomplished using evidence-based clinical care. When implementing an advanced practice provider (APP)-led oncology acute care clinic, evidence-based clinical pathways were developed to ensure standardization among treating providers. Methods: The top ten emergency department admitting diagnoses for oncology patients identified by the Centers for Medicare and Medicaid Services provided the foundation for development of the clinical pathways. Relevant primary literature, National Comprehensive Cancer Center Network guidelines, and American Society of Clinical Oncology guidelines were reviewed for development of outpatient oncology acute care clinical pathways. The information was cross-referenced with institutional data to confirm applicability to the patient population. A multidisciplinary team including nursing, pharmacy, laboratory services, radiology, information technology, and administrative staff reviewed the workflow to ensure best processes. The pathways were reviewed by oncologists, APPs and pharmacists before finalization. Results: Nine evidence-based clinical pathways were developed by August 1, 2020. From August to December 2020, 165 patient visits took place in the outpatient oncology acute care clinic. Gastrointestinal manifestations (25%), hypovolemia/weakness (25%), and infections (17%) were the most frequently encountered symptoms. Evidence-based clinical pathways were followed for patients with a chief complaint with an associated algorithm (N=124). Conclusions: Implementation of clinical pathways facilitate best practice standardization when ordering labs, tests, and medications while enhancing the acceptance of the new service. The pathways will be reviewed and updated by a multidisciplinary team every 3 months to ensure current evidence-based practices. Semi-annual pathway audits have been implemented to evaluate utilization and optimize patient outcomes, as well as determine areas of improvement and growth. Areas of opportunity identified during the first pathway audit included creating pathways for cardiac disorders, mouth disorders, and infections unrelated to neutropenia. Additionally, order set integration to automate the clinical pathway process in the electronic medical record is in progress.[Table: see text]
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Zhang, Lunzhong, Shu Han, Manli Zhao, Runshun Zhang, Xuebin Zhang, Jing Zhang, Xiaoqing Liu, et al. "Using the Symptom Patient Similarity Network to Explore the Difference between the Chinese and Western Medicine Pathways of Ischemic Stroke and its Comorbidities." Evidence-Based Complementary and Alternative Medicine 2021 (December 1, 2021): 1–12. http://dx.doi.org/10.1155/2021/4961738.
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Background and Objectives. The development of network medicine provides new opportunities for disease research. Ischemic stroke has a high incidence, disability, and recurrence rate, and one of the reasons is that it is often accompanied by other complex diseases, including risk factors, complications, and comorbidities. Network medicine was used to try to analyze the characteristics of IS-related diseases and find out the differences in genetic pathways between Chinese herbs and Western drugs. Methods. Individualized treatment of traditional Chinese medicine (TCM) provides a theoretical basis for the study of the personalized classification of complex diseases. Utilizing the TCM clinical electronic medical records (EMRs) of 7170 in patients with IS, a patient similarity network (PSN) with shared symptoms was constructed. Next, patient subgroups were identified using community detection methods and enrichment analyses were performed. Finally, genetic data of symptoms, herbs, and drugs were used for pathway and GO analysis to explore the characteristics of pathways of subgroups and to compare the similarities and differences in genetic pathways of herbs and drugs from the perspective of molecular pathways of symptoms. Results. We identified 34 patient modules from the PSN, of which 7 modules include 98.48% of the whole cases. The 7 patient subgroups have their own characteristics of risk factors, complications, and comorbidities and the underlying genetic pathways of symptoms, drugs, and herbs. Each subgroup has the largest number of herb pathways. For specific symptom pathways, the number of herb pathways is more than that of drugs. Conclusion. The research of disease classification based on community detection of symptom-shared patient networks is practical; the common molecular pathway of symptoms and herbs reflects the rationality of TCM herbs on symptoms and the wide range of therapeutic targets.
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Breckons, M., S. M. Bissett, C. Exley, V. Araujo-Soares, and J. Durham. "Care Pathways in Persistent Orofacial Pain." JDR Clinical & Translational Research 2, no. 1 (November 17, 2016): 48–57. http://dx.doi.org/10.1177/2380084416679648.
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Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the “fluidity of the care pathway,” in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a “failure to progress,” where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the “effects of unmanaged pain,” where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.
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Zon, Robin T., James N. Frame, Michael N. Neuss, Ray D. Page, Dana S. Wollins, Steven Stranne, and Linda D. Bosserman. "American Society of Clinical Oncology Policy Statement on Clinical Pathways in Oncology." Journal of Oncology Practice 12, no. 3 (March 2016): 261–66. http://dx.doi.org/10.1200/jop.2015.009134.
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The use of clinical pathways in oncology care is increasingly important to patients and oncology providers as a tool for enhancing both quality and value. However, with increasing adoption of pathways into oncology practice, concerns have been raised by ASCO members and other stakeholders. These include the process being used for pathway development, the administrative burdens on oncology practices of reporting on pathway adherence, and understanding the true impact of pathway use on patient health outcomes. To address these concerns, ASCO’s Board of Directors established a Task Force on Clinical Pathways, charged with articulating a set of recommendations to improve the development of oncology pathways and processes, allowing the demonstration of pathway concordance in a manner that promotes evidence-based, high-value care respecting input from patients, payers, and providers. These recommendations have been approved and adopted by ASCO’s Board of Directors on August 12, 2015, and are presented herein.
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Mavor, Meaghan E., Patti A. Groome, Yuka Asai, Hugh Langley, Nicole J. Look Hong, Frances C. Wright, and Timothy P. Hanna. "Characterising melanoma diagnostic pathways for patients in routine practice using administrative health data in Ontario, Canada: a population-based study." BMJ Open 15, no. 1 (January 2025): e086140. https://doi.org/10.1136/bmjopen-2024-086140.
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ObjectiveTo characterise diagnostic pathways for patients with melanoma in routine practice and compare patient, disease and diagnostic interval (DI) characteristics across pathways.DesignDescriptive cross-sectional study using administrative health data.SettingPopulation-based study in Ontario, Canada.ParticipantsPatients with melanoma diagnosed from 2007 to 2019.Main outcome measuresWe used latent class cluster analysis to create clusters of patients with similar diagnostic experiences to characterise diagnostic pathways in routine practice. Indicator variables characterised the patient’s keratinocyte carcinoma and dermatologist history, presentation pattern, procedure types, number of visits and procedures, and the activity on the diagnosis date. χ2tests and Pearson residuals were used. We characterised clusters by the lengths of their DI, primary care subinterval and specialist care subinterval.ResultsThere were 33 371 patients diagnosed with melanoma from 2007 to 2019. We identified four diagnostic pathways: ‘primary care only’ (n=6107), ‘referred to specialist with immediate action’ (n=8987), ‘multiple visits and procedures in specialist care’ (n=11 893) and ‘specialist care only’ (n=6384). Patient, disease and DI characteristics varied across pathways. Pathway types varied regionally. A higher proportion in the ‘primary care only’ pathway lived in rural areas whereas a higher proportion in the ‘referred to specialist for immediate action’ and the ‘specialist care only’ pathways lived in major urban centres. Across pathways, the median DI varied from 1 to 67 days, the median primary care subinterval varied from 1 to 30 days and the median specialist care subinterval varied from 1 to 25 days. Patients in the ‘primary care only’ pathway experienced the shortest DIs, and patients in the ‘multiple visits and procedures in specialist care’ pathway experienced the longest DIs.Conclusions and relevanceWe identified four melanoma diagnostic pathways. The shortest DI, the ‘primary care only’ pathway, highlights the important role of primary care and the need to reduce the wait for specialists. Diagnostic processes varied across geographical locations. Future research should address reasons for these differences, including whether they are associated with inefficient or inappropriate care.
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Vanhaecht, Kris, Massimiliano Panella, Ruben Van Zelm, and Walter Sermeus. "Is there a future for pathways? Five pieces of the puzzle." International Journal of Care Pathways 13, no. 2 (November 2009): 82–86. http://dx.doi.org/10.1258/jicp.2009.009013.
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In this discussion and opinion paper, the Bureau members of the European Pathway Association present five challenges for the future of care pathways. Pathways will have to be based on the latest available evidence and international databases, and tools will have to be available. If pathways have a future, the organisations should focus on disease-specific oriented care. Evidence-based pathways, which are organised in a disease-specific oriented organisation, can lead to improvement of quality and efficiency but only if we invest in real teamwork. As a fourth challenge, the need for technical support of pathways is presented. The last piece of the future pathway puzzle is the need for patient involvement. Pathways will only lead to continuous improvement if we finally see patients as real partners in care organisation.
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Findlay, Callum, Wei Chern Gavin Fong, Simon Goldie, and Huw Jones. "Implementing criteria-led discharge for acute admissions to facilitate the elective recovery from COVID-19: an example in acute tonsillitis." BMJ Open Quality 12, no. 1 (March 2023): e002123. http://dx.doi.org/10.1136/bmjoq-2022-002123.
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BackgroundHealthcare systems face unprecedented numbers of patients waiting for elective treatments in the wake of the COVID-19 pandemic. Hospitals must urgently optimise patient pathways and build capacity to meet the populations health needs. Criteria-led discharge (CLD) is frequently used to optimise elective care pathways but may hold potential in discharging patients at the end of an acute hospital admission.MethodsWe conducted a quality improvement project to design and introduce a novel inpatient pathway using CLD for patients with severe acute tonsillitis. Our analysis compared the standardisation of treatment, length of stay, discharge time and readmission rate between those treated on the novel pathway compared with standard treatment.ResultsThe study population included 137 patients admitted to a tertiary centre with acute tonsillitis. Introduction of the tonsillitis pathway using CLD resulted in a significant reduction in median length of stay from 24 hours to 18 hours. Of those treated on the tonsillitis pathway, 52.2% were discharged prior to midday compared with 29.1% who received standard treatment. No patient discharged using CLD required readmission.ConclusionCLD is safe and effective at reducing length of stay in patients requiring acute hospital admission for acute tonsillitis. CLD should be used and evaluated in further novel patient pathways across different areas of medicine to optimise care and build capacity for provision of elective healthcare services. Further research is required to investigate safe and optimal criteria which indicate patients are fit for discharge.
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Black, Georgia, and Julie-Ann Moreland. "What your patient needs to know about a non-specific symptom pathway referral for suspected cancer." British Journal of General Practice 74, suppl 1 (June 2024): bjgp24X737661. http://dx.doi.org/10.3399/bjgp24x737661.
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BackgroundNon-specific symptom (NSS) pathways were implemented in the UK in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue, or GP ‘gut feeling’.AimTo explore patients’ experiences of NSS pathways, and their potential support needs in terms of understanding and navigating these pathways.MethodThis study employed ethnographic methods across four NHS trusts in England, including interviews with 28 patients and 28 professionals, patient shadowing, and clinical care observations, to examine NSS pathways for cancer diagnosis. Analysis focused on patient communication and understanding of care.ResultsPatients found it hard to understand why they were referred. Only a minority of patients appreciated that multiple organs were being investigated for cancer. Progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. Investigations often resulted in incidental findings. Patients whose persistent symptoms were not explained were often unsure what to do following discharge.ConclusionThe findings resulted in recommended messages for GPs to support patients on referral to NSS pathways, including the nature of the pathway, the team that will be responsible for their care, the multiple organ systems that will potentially be investigated, and what will happen if they don’t find a cancer. Without this support, patients’ difficulties in comprehending previous investigations and findings could result in delays, overtesting, or inadequately targeted investigations, hindering the effective use of their medical history.
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Chern, Joshua J., Charles G. Macias, Andrew Jea, Daniel J. Curry, Thomas G. Luerssen, and William E. Whitehead. "Effectiveness of a clinical pathway for patients with cerebrospinal fluid shunt malfunction." Journal of Neurosurgery: Pediatrics 6, no. 4 (October 2010): 318–24. http://dx.doi.org/10.3171/2010.7.peds09534.
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Object Patients with CSF shunts often present to the emergency department (ED) with suspected shunt malfunction. Timely assessment and treatment are important factors affecting patient outcomes. A protocol was implemented at a tertiary children's hospital ED to expedite the care of these patients. This study evaluated the effectiveness of this protocol. Methods The protocol assigned all patients with CSF shunts into 1 of 3 pathways. If a patient presented with altered mental status, the Cushing triad, acute focal neurological deficit, ongoing seizure activity, or severe dehydration due to emesis, an ED physician was immediately notified (emergency pathway). If a patient presented with emesis, headache, increasing frequency of seizure, or parental concern for shunt malfunction, the patient entered the expedited pathway, and imaging studies were ordered prior to physician evaluation. All other patients entered the default pathway, in which a physician would evaluate the patient before deciding on further workup. Outcomes of interest included measures of timeliness in the ED and clinical outcomes. Comparisons were made between preprotocol and protocol periods and among the 3 pathways. Results The total time to complete both ED physician evaluation and to initiate imaging studies was significantly shorter in the protocol period than in the preprotocol period (104 vs 147 minutes). Similar time saving over the 2 processes was demonstrated comparing expedited and default pathways during the protocol period (95 vs 134 minutes, a 29% difference). Clinically, more patients underwent surgery in the expedited pathway than the default pathway (36% vs 17%), and patients in the expedited pathway had a shorter hospital stay (3.4 ± 0.9 days vs 5.7 ± 4.0 days; p = 0.02). Conclusions An ED-based protocol helped identify patients at risk for shunt failure early in the triage process and shortened the assessment process prior to neurosurgical intervention. Improving the timeliness of care for patients with shunt failure is important because morbidity and mortality associated with shunt failure are time dependent.
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French, Katy E., Shannon Popovich, B. Bryce Speer, Iris Recinos, and Tayab Andrabi. "Advance electronic screening of patients with cancer leveraging a new EHR to increase efficiency of care delivery, driving clinical care pathways in a perioperative anesthesia assessment center (PAAC), at a comprehensive cancer center." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 308. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.308.
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308 Background: Most cancer institutions are using electronic health records (EHRs). With MACRA and MIPS, this number will continue to grow. EHR’s can be frustrating as some are seen as more cumbersome than useful to patient care delivery. In 2017, the MD Anderson cancer center (MDACC) PAAC assessed over 20,000 patients. We wanted to demonstrate positive utility of our EHR. We hypothesized that advanced electronic screening of our cancer patients, leveraging a questionnaire embedded in the EHR, could increase efficiency by driving patient specific perioperative care pathways leading to positive patient experience while not negatively affecting our low same day surgery cancellation rate of 2.07%. Methods: In March of 2016, MDACC launched a new EHR and the PAAC commenced an online medical and anesthesia screening questionnaire to be completed via a secure online portal by our cancer patients in advance of the surgery date. The questionnaire was developed and vetted by specialists from many areas including anesthesia, cardiology, internal medicine, and surgery. The answers to these questions were validated by a healthcare provider, and the patient was directed to one of two care pathways. Complex patients were scheduled for an in person clinic assessment prior to surgery and all other patients were scheduled for a phone call assessment. We used reports created within our EHR to track baseline and 2017 data for numbers of patients directed to the 2 different pathways and same day surgery cancellation data throughout this time frame. Results: Using the online patient entered questionnaire, we were able to improve clinic efficiency by implementing two patient care delivery pathways. Using our new EHR we saw an increase of 18.4% in our phone assessment pathway for patients. Patient experience improved as we were able to offer patients more options in the delivery of care saving them time. Conclusions: Use of our new EHR and IT analytics helped drive patient-specific care pathways, improve efficiency and the patient experience. MDACC same day surgery cancellation rate remained 2.07%.
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Petit-Steeghs, Violet, Tjerk Jan Schuitmaker-Warnaar, Ciska A. Pruijssers, Gerard van Oortmerssen, and Jacqueline EW Broerse. "A qualitative research on co-creating care pathways for Sarcoma and GIST by stimulating reflection." International Journal of Care Coordination 23, no. 1 (March 2020): 24–32. http://dx.doi.org/10.1177/2053434520907743.
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Introduction Care Pathway Management intends to enhance the quality of care by restructuring care services. As recipients of care, patients have relevant experiential knowledge on the provision of care, but they are rarely involved in Care Pathway Management due to various barriers. This study aims to acquire insights into how patients can be meaningfully involved in Care Pathway Management. Methods A case study was conducted to assess the implementation of patient involvement in the co-creation of the care pathways of Soft Tissue Sarcoma and Gastrointestinal Stromal Tumour at Erasmus MC Cancer Institute (the Netherlands), using the Interactive Learning and Action methodology. Within the pathways, seven patients and eight health professionals were involved. To overcome expected and encountered barriers to involving patients, reflection was stimulated on the care pathways and the development process. Qualitative data were collected via interviews, participatory observations and informal conversations. For analysis, a patient involvement evaluation framework and criteria for knowledge co-creation were used. Results Patients indicated specific improvements for current pathways regarding communication, the assistance of a nurse and integrated care. However, the co-creation process encountered several barriers, including limited opportunities to overcome patients’ knowledge gap on medical care services, limited time and uncertainties about responsibilities. Moreover, participatory reflection to enhance the co-creation process was constrained by power imbalances between patients and health professionals and health professionals’ restricted perceptions of their role. Discussion To enhance the meaningful involvement of patients in Care Pathway Management, constraints in joint reflection on the co-creation process must be overcome.
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Araujo de Oliveira Junior, Nilson, Olga Ferreira de Souza, Rodrigo Periquito Cosenza, Martha Valéria Tavares Pinheiro, Angelina Camiletti, and Leonardo Rezende de Siqueira. "Cryoablation of the para-Hisian region." Journal of Cardiac Arrhythmias 32, no. 1 (2019): 6–9. http://dx.doi.org/10.24207/jac.v32i1.528_in.
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Basis: the ablation of the para-Hisian region is a challenge due to the risk of inadvertent lesion of a bundle of His. Cryoablation, due to its slower progression, allows interruption of the application in case of signs of undesired lesions and catheter adhesion during the applications, which has made cryoablation the ideal method for these patients. Objectives: to demonstrate the results of an initial series of patients referred for cryoablation of para-Hisian pathways. Patients and methods: From April 2015 to August 2017, 13 patients were referred for cryoablation due to the necessity for a para-Hisian approach detected in previous ablation procedures. Of the 13 patients, seven were submitted a radiofrequency ablation attempt (RF) and presented failure or recurrence, five performed only electrophysiological studies, and no ablation was attempted, and one was indicated primarily. The mean age was 32 ± 16 years. Eleven patients had manifest anomalous pathways (APs), one hidden and one nodal reentrant tachycardia (NRT) with a transient atrioventricular block (AB) during RF. A cycle of 4 minutes followed by one more cycle in case of a positive result. Results: Of the 13 patients, 11 had an acute success in eliminating the accessory pathway. One patient had multiple accessory pathways, one right side, and one left side. In this patient, it was possible only the ablation of the left pathway. In all others, it was observed exuberant Hisian potential at the point of application with success. The patient with NRT was ablated in the M region without intercurrences. Four applications were required on average to eliminate the accessory pathway successfully. The mean local temperature was -74 ºC. In five patients, the occurrence of third-degree right branch block (RBB) was observed. In one patient, early application of RBB was interrupted and the bonus application was not applied. This wasthe only acutely successful patient who presented clinical recurrence. Transient AB was not observed in any patient. No complications were observed. Conclusion: Cryoablation of para-Hisian pathways and NRTs in regions surrounding the His was an effective method for treatment in this population of patients refractory or refused for RF treatment. The occurrence of acute RBB does not seem to be a criterion for the interruption of applications.
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Yeats, Melania, Sue Wedergren, Nicole Fox, and Jon S. Thompson. "The Use and Modification of Clinical Pathways to Achieve Specific Outcomes in Bariatric Surgery." American Surgeon 71, no. 2 (February 2005): 152–54. http://dx.doi.org/10.1177/000313480507100211.
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Clinical pathways are promoted for standardizing patient care and decreasing resource use without compromising outcome. Once established, we hypothesized that clinical pathways can then be used to modify patient care to achieve specific goals. Our aim was to evaluate a clinical pathway for the bariatric surgical patient that was initially designed to standardize care and later altered to modify the postoperative course. We retrospectively reviewed 150 consecutive patients undergoing open gastric bypass by a single surgeon. The first 50 patients were managed without a formal pathway, (group I). The next 50 were managed with a pathway that standardized care in order to reduce length of stay (LOS), (group II). For the final 50 patients, the pathway was modified to shorten nasogastric decompression time (group III). Patient information, blood loss (EBL), operative time, length of stay (LOS), nasogastric decompression, 30-day complication rates, and early readmissions were reviewed. The groups were similar with respect to gender, age, body mass index, American Society of Anesthesiologists (ASA) classification, and EBL. Operative time was significantly less in groups II and III compared to group I (82% and 68% vs. 38% <180 minutes, P < 0.05). LOS was shorter in groups II and III compared to group I (62% and 42% vs. 20% with a 4-day LOS, P < 0.05). Duration of nasogastric tube decompression was successfully decreased in group III when compared to groups I and II (76% vs. 14% and 6% 1 day or less, P < 0.05). Complication rates were significantly lower in group III as well (14% vs. 36% and 28%, P < 0.05). Standardizing patient care with a clinical pathway decreases LOS after bariatric surgery. An established clinical pathway can then be used to further modify patient care in order to achieve specific goals, such as shortened time of nasogastric decompression. This goal was accomplished without compromising patient outcome.
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Skouboe, Aske, Zaza Hansen, and Jan Kloppenborg MØller. "Process Improvement in Patient Pathways." Journal of Healthcare Management 64, no. 6 (November 2019): 415–28. http://dx.doi.org/10.1097/jhm-d-18-00224.
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Brownson, Peter, Oliver Donaldson, Michael Fox, Jonathan L. Rees, Amar Rangan, Anju Jaggi, Graham Tytherleigh-Strong, Julie McBernie, Michael Thomas, and Rohit Kulkarni. "BESS/BOA Patient Care Pathways." Shoulder & Elbow 7, no. 3 (May 26, 2015): 214–26. http://dx.doi.org/10.1177/1758573215585656.
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Gresz, Miklós. "Characteristics of patient pathways in Hungary." Orvosi Hetilap 152, no. 9 (February 2011): 338–43. http://dx.doi.org/10.1556/oh.2011.29043.
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Over the past four years, there were nearly 250 million registered visits of insured patients in outpatient services in Hungary according to the database of the National Health Insurance Fund. In the process of renewal of health care system it is extremely important to analyze the characteristics of patient pathways. With the analysis of registered visits between 2007 and 2010 the author shows that 65%-96% (average 86%) of the insured patients used the services of outpatient care in the county of their living. This figure was the lowest (65%) in Pest County, which is the service area of several providers located in Budapest. Author presents and analyses the characteristics of patient pathways in different counties of Hungary. Orv. Hetil., 2011, 152, 338–343.
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Aghdasi, Nava, Mark Whipple, Ian M. Humphreys, Kris S. Moe, Blake Hannaford, and Randall A. Bly. "Automated Surgical Approach Planning for Complex Skull Base Targets: Development and Validation of a Cost Function and Semantic At-las." Surgical Innovation 25, no. 5 (June 27, 2018): 476–84. http://dx.doi.org/10.1177/1553350618782287.
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Successful multidisciplinary treatment of skull base pathology requires precise preoperative planning. Current surgical approach (pathway) selection for these complex procedures depends on an individual surgeon’s experiences and background training. Because of anatomical variation in both normal tissue and pathology (eg, tumor), a successful surgical pathway used on one patient is not necessarily the best approach on another patient. The question is how to define and obtain optimized patient-specific surgical approach pathways? In this article, we demonstrate that the surgeon’s knowledge and decision making in preoperative planning can be modeled by a multiobjective cost function in a retrospective analysis of actual complex skull base cases. Two different approaches— weighted-sum approach and Pareto optimality—were used with a defined cost function to derive optimized surgical pathways based on preoperative computed tomography (CT) scans and manually designated pathology. With the first method, surgeon’s preferences were input as a set of weights for each objective before the search. In the second approach, the surgeon’s preferences were used to select a surgical pathway from the computed Pareto optimal set. Using preoperative CT and magnetic resonance imaging, the patient-specific surgical pathways derived by these methods were similar (85% agreement) to the actual approaches performed on patients. In one case where the actual surgical approach was different, revision surgery was required and was performed utilizing the computationally derived approach pathway.
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Skouw-Rasmussen, Naja, and Laura Savini. "Future Care Pathways – A report from the 1st workshop of the EHC Think Tank Workstream on Future Care Pathways." Journal of Haemophilia Practice 10, no. 1 (January 1, 2023): 74–81. http://dx.doi.org/10.2478/jhp-2023-0013.
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Abstract Introduction A care pathway is defined as “a complex intervention for the mutual decision-making and organisation of care processes for a well-defined group of patients during a well-defined period.” The European Haemophilia Consortium (EHC) established a Think Tank Workstream on Future Care Pathways to identify and address key challenges in shaping future pathways that meet the needs of people with rare diseases while remaining practicable and affordable to healthcare providers in countries with different budgets and resources. This workstream is particularly timely as the introduction of innovative therapies is adding to the complexity of care pathways in some rare conditions. Identifying key challenges During the first virtual workshop of the Future Care Pathways Workstream on 14 February 2023, stakeholders, including healthcare providers, patient groups, researchers, and industry representatives, agreed to focus on four workable themes/challenges: 1. Prioritisation (cost and evidence); 2. Agreeing on a baseline; 3. Digital health; 4. Fragmentation of healthcare. Summary Prioritisation relates to economic and financial challenges in justifying the optimisation of a care pathway for a rare disease within the context of other healthcare priorities. Currently, there is too much emphasis on costs to healthcare systems, and not enough on real-life patient experience and indirect costs to patients and their families. Innovation in pathways is generally considered unaffordable, and cost-effectiveness models are difficult to apply to rare diseases. Agreeing on a baseline for a minimum standard of care in a pathway should take into account variability in patient needs, agency and healthcare system resources. A baseline needs to be agreed upon for each stage of a pathway: first clinical presentation, diagnosis, treatment, and monitoring and follow-up. Lack of awareness, gender and resource inequalities and gaps in evidence are among the issues that need to be addressed. Digital health holds promise but also brings challenges for future care pathways and must be considered from the viewpoint of all major stakeholders: patients, healthcare providers, tech companies and payers. Digital health systems are often developed in silos and do not allow for effective integration and sharing of data. Collaboration from the beginning is essential to the successful integration of digital tool as in healthcare. Fragmentation of healthcare can arise because people with rare diseases may access care pathways through multiple entry points in primary and secondary care, and they may not experience holistic care that takes account of all their needs. Poor communication at multiple levels (e.g. between clinical stakeholders and between clinicians and patients) is a common problem leading to inadequate treatment and care. Fragmentation may also arise when care pathways do not allow for a patient’s evolving needs when he/she is already on a pathway.
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Lee, Grace, and Richard Hodin. "Applying Enhanced Recovery Pathways to Unique Patient Populations." Clinics in Colon and Rectal Surgery 32, no. 02 (February 28, 2019): 134–37. http://dx.doi.org/10.1055/s-0038-1676479.
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AbstractEnhanced Recovery after Surgery (ERAS) pathways have become popular in colorectal surgery due to their associated decrease in length of stay (LOS), complications, and readmission rate. However, it is unclear if these pathways are safe, feasible, or effective in unique patient populations such as elderly patients, urgent/emergent surgeries, patients with specific comorbidities, inflammatory bowel disease, or pediatric patients. Enhanced recovery pathways appear safe in elderly patients, associated with decreased complications, though with slightly lower rates of adherence and increased LOS and readmission rates. Modified ERAS pathways have been applied to urgent and emergent surgeries, resulting in decreased morbidity and LOS. There have been no studies that performed subgroup analyses of ERAS pathways in patients with specific comorbidities. Studies investigating patients with inflammatory bowel disease on enhanced recovery pathways are extremely limited, but suggest that they are safe and feasible. Data on ERAS pathways in pediatric patients are still emerging. Therefore, though data are sparse, enhanced recovery pathways appear to be safe in unique patient populations, with similar efficacy in decreasing LOS and complications. There is an urgent need for more studies investigating these specific patient groups to aid perioperative decision making by colorectal surgeons.
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Marinova, Petya, and Rali Marinova. "Patient-centred stoma care support: colostomy patients." British Journal of Community Nursing 29, no. 10 (October 2, 2024): 494–502. http://dx.doi.org/10.12968/bjcn.2024.0088.
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Colostomy patients have distinct needs that require specialised pathways for optimal care. Recognising that these needs vary, based on the type and configuration of the stoma, is crucial. Specialist nurses play a vital role in providing long-term support and expertise. While many stoma nursing services in the UK offer patient pathways, these often lack specificity for different stoma types. Tailoring pathways to colostomy patients can prevent complications, reduce hospital readmissions and enhance quality of life. Community nurses and other healthcare professionals are essential in supporting colostomy patients through individualised care. Their involvement ensures that patients receive appropriate preparation for life with a stoma and are adequately educated about their specific needs. This multidisciplinary approach fosters a comprehensive care environment, addressing both the physical and emotional aspects of living with a colostomy. By focusing on personalised care and life-long support, healthcare professionals can significantly improve patient outcomes and overall well-being.
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Mæhle, Per Magnus, Ingrid Kristine Small Hanto, Victoria Charlotte Simensen, and Sigbjørn Smeland. "Mind the Differences: How Diagnoses and Hospital Characteristics Influence Coordination in Cancer Patient Pathways." International Journal of Environmental Research and Public Health 18, no. 16 (August 21, 2021): 8818. http://dx.doi.org/10.3390/ijerph18168818.
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Integrated care pathway (ICP) is a prevailing concept in health care management including cancer care. Though substantial research has been conducted on ICPs knowledge is still deficient explaining how characteristics of diagnose, applied procedures, patient group and organizational context influence specific practicing of ICPs. We studied how coordination takes place in three cancer pathways in four Norwegian hospitals. We identified how core contextual variables of cancer pathways affect complexity and predictability of the performance of each pathway. Thus, we also point at differences in core preconditions for accomplishing coordination of the cancer pathways. In addition, the findings show that three different types of coordination dynamics are present in all three pathways to a divergent degree: programmed chains, consultative hubs and problem-solving webs. Pathway coordination also depends on hierarchical interaction. Lack of corresponding roles in the medical–professional and the administrative–institutional logics presents a challenge for coordination, both within and between hospitals. We recommend that further improvement of specific ICPs by paying attention to what should be standardized and what should be kept flexible, aligning semi-formal and formal structures to pathway processes and identify the professional cancer related background and management style required by the key-roles in pathway management.
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Melby, Line, Kristine Gjermestad, Ingrid K. L. Solem, and Ragnhild Halvorsrud. "On track on the care pathway: Care coordination, information, and communication needs among Norwegian cancer patients." International Journal of Integrated Care 23, S1 (December 28, 2023): 597. http://dx.doi.org/10.5334/ijic.icic23229.
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Background: Cancer patients may have long-lasting and complex care pathways. These typically involve a wide range of care providers who must coordinate their actions, so that treatment and follow up is experienced as seamless and integrated. Good communication with patients and providing them with the 'right amount' of information is crucial to ensure that patients feel engaged and empowered along the pathway.
The study: This paper reports from an ongoing research study ('Pathway') on the management of patient pathways in Norway, exemplified with cancer pathways. The project aims to give detailed descriptions of the unfolding of pathways, with an emphasis on patients' experiences and needs. These form the basis for the development of a theoretical pathway model and a visual multi-layered modeling language. This paper addresses the research question: What are cancer patients' information- and communication needs from care providers during their patient pathway?
Methods: We conducted three workshops with cancer patients and next of kin (n=35), supplemented with individual interviews (n=6) in June 2022. Participants had various cancer diagnoses. Data collection was conducted on a digital platform. Study participants were asked i.e., about communication with the services, their information needs, and how they keep overview of their appointments and contacts with the services, as well as how they would like to stay informed and engaged.
Results: A 'regular' cancer pathway was described to involve a wide range of providers, like regional and local public hospitals, private medical imaging centers, general practitioners, municipal care providers (i.e., physiotherapy, home care services), as well as the labour and welfare office. For the most complex cancers, and for multimorbid patients, the pathways could be even more complex. Study participants unanimously agreed that knowing as much as possible about the disease, its treatment, and follow up is critical to feel in control. Even though the participants mostly were satisfied with the cancer pathway, they all had experienced breakdowns in care coordination, missing and contradictory information, and providers lacking overview of their situation. Most participants had experience with taking on the task of collecting and aligning information and taking responsibility for coordinating their own follow up and care. Specifically, this was true when patients were discharged from hospital and from the standardized cancer patient pathway (CPP). The participants had invented various creative ways of keeping track of all the information they were given, and they frequently acted as messengers between providers.
Learning and next steps: The study underscores the challenge of ensuring integrated care for patients. Cancer is among the diseases that has evidence-based treatment protocols, and in Norway diagnostics and treatment is organized in standardized care pathways. Nevertheless, also these patients struggled with keeping track of their 'simple' pathways. Such findings remind us about the need to keep on working for improving integration across disease specific pathways, and that good communication and access to information for all the involved actors are means for achieving this. The next step in our study is to map patients' touchpoints with the services over time, in detail.
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Rahman, Azmi, Louise Strickland, Hemant Pandit, Crispin Jenkinson, and David Murray. "DIFFERENCES IN EARLY RECOVERY FOLLOWING UNICOMPARTMENTAL KNEE ARTHROPLASTY WITH DAY-CASE AND STANDARD CARE PATHWAYS, ASSESSED USING NOVEL PATIENT-REPORTED MEASURES." Orthopaedic Proceedings 105-B, SUPP_13 (August 7, 2023): 40. http://dx.doi.org/10.1302/1358-992x.2023.13.040.
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AbstractBackgroundDaycase pathways which aim to discharge patients the same day following Unicompartmental Knee Replacement have been introduced in some centres, though most continue with Standard pathways. While Daycase pathways have cost savings, recovery data comparing pathways is limited. This study aims to compare patient-reported early recovery between Daycase and Standard pathways following UKR.MethodThis study was carried out in two centres that originally used the same Standard recovery pathway for UKR. In one centre, the Standard pathway was modified into a Daycase pathway. 26 Daycase-Outpatient, 11 Daycase-Inpatient, and 18 Standard patients were recruited. Patients completed the Oxford Arthroplasty Early Recovery Score (OARS) and SF-36 (Acute) measure between Days 1–42.ResultsStandard patients had significantly better Day-1 scores than Daycase patients, but this difference rapidly diminished, and from Day-3 onwards both groups had near-identical scores (OARS Day-1, 59 vs 37, p=0.002, stemming from differences in Pain, Nausea/Feeling-Unwell, Function/Mobility subscores p=0.003,0.014,0.011. OARS Day-3 48 vs 49, p=0.790).Daycase-Outpatients had a higher overall OARS (p=0.002), recovering 1–2 weeks faster than Daycase-Inpatients. OARS subscores demonstrated that Daycase-Outpatients had better Pain, Nausea/Feeling-Unwell, Fatigue/Sleep scores (p=0.020,0.0004,0.019 respectively). SF-36 scores corroborate OARS scores.ConclusionThe Standard cohort had better Day-1 scores than the Daycase cohort, likely due to later mobilisation and stronger inpatient analgesia; these differences diminished by Day-3. Daycase-Outpatients recovered substantially faster than Daycase-Inpatients – likely due to the factors that delayed their discharge. The convergence of scores at 6 weeks demonstrates that both pathways have similar early recovery outcomes.
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Chan, Timothy C. Y., Maria Eberg, Katharina Forster, Claire Holloway, Luciano Ieraci, Yusuf Shalaby, and Nasrin Yousefi. "An Inverse Optimization Approach to Measuring Clinical Pathway Concordance." Management Science 68, no. 3 (March 2022): 1882–903. http://dx.doi.org/10.1287/mnsc.2021.4100.
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Clinical pathways outline standardized processes in the delivery of care for a specific disease. Patient journeys through the healthcare system, however, can deviate substantially from these pathways. Given the positive benefits of clinical pathways, it is important to measure the concordance of patient pathways so that variations in health system performance or bottlenecks in the delivery of care can be detected, monitored, and acted upon. This paper proposes the first data-driven inverse optimization approach to measuring pathway concordance in any problem context. Our specific application considers clinical pathway concordance for stage III colon cancer. We develop a novel concordance metric and demonstrate using real patient data from Ontario, Canada that it has a statistically significant association with survival. Our methodological approach considers a patient’s journey as a walk in a directed graph, where the costs on the arcs are derived by solving an inverse shortest path problem. The inverse optimization model uses two sources of information to find the arc costs: reference pathways developed by a provincial cancer agency (primary) and data from real-world patient-related activity from patients with both positive and negative clinical outcomes (secondary). Thus, our inverse optimization framework extends existing models by including data points of both varying “primacy” and “alignment.” Data primacy is addressed through a two-stage approach to imputing the cost vector, whereas data alignment is addressed by a hybrid objective function that aims to minimize and maximize suboptimality error for different subsets of input data. This paper was accepted by Chung Piaw Teo, Management Science Special Section on Data-Driven Prescriptive Analytics.
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G Masiutin, Maxim, and Maneesh K Yadav. "Alternative androgen pathways." WikiJournal of Medicine 10, no. 1 (2023): X. http://dx.doi.org/10.15347/wjm/2023.003.
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Steroidogenic routes to androgens have been discovered and characterized over the last two decades that fall outside the Δ4 and Δ5 "classical androgen pathways" to testosterone and 5α-dihydrotestosterone. There has been considerable investigation into these routes that has come with natural inconsistencies and overlap in naming that can make it difficult to discover information about them as might be needed in a clinical context. This expository review uses "alternative androgen pathways" to include what has been called the "backdoor" pathway to 5α-dihydrotestosterone, the 5α-dione pathway and pathways to 11-oxygenated steroids. A brief history of what led to the discovery of these pathways, basic information about the steroids and proteins involved in their biosynthesis as well as a summary of clinically significant findings is provided. PubChem CIDs for all steroids have been compiled to help authors avoid naming errors in their work. Modest suggestions for future work in these pathways are also given at the end. Patient comprehension and the clinical diagnosis of relevant conditions such as hyperandrogenism can be impaired by the lack of clear and consistent knowledge of alternative androgen pathways; the authors hope this review will accurately disseminate such knowledge to facilitate the beneficial treatment of such patients.
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Blucher, Aurora S., Shannon K. McWeeney, Lincoln Stein, and Guanming Wu. "Visualization of drug target interactions in the contexts of pathways and networks with ReactomeFIViz." F1000Research 8 (June 20, 2019): 908. http://dx.doi.org/10.12688/f1000research.19592.1.
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The precision medicine paradigm is centered on therapies targeted to particular molecular entities that will elicit an anticipated and controlled therapeutic response. However, genetic alterations in the drug targets themselves or in genes whose products interact with the targets can affect how well a drug actually works for an individual patient. To better understand the effects of targeted therapies in patients, we need software tools capable of simultaneously visualizing patient-specific variations and drug targets in their biological context. This context can be provided using pathways, which are process-oriented representations of biological reactions, or biological networks, which represent pathway-spanning interactions among genes, proteins, and other biological entities. To address this need, we have recently enhanced the Reactome Cytoscape app, ReactomeFIViz, to assist researchers in visualizing and modeling drug and target interactions. ReactomeFIViz integrates drug-target interaction information with high quality manually curated pathways and a genome-wide human functional interaction network. Both the pathways and the functional interaction network are provided by Reactome, the most comprehensive open source biological pathway knowledgebase. We describe several examples demonstrating the application of these new features to the visualization of drugs in the contexts of pathways and networks. Complementing previous features in ReactomeFIViz, these new features enable researchers to ask focused questions about targeted therapies, such as drug sensitivity for patients with different mutation profiles, using a pathway or network perspective.
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Abernathy, Bailey R., Lisa K. Schroder, Deborah C. Bohn, and Julie A. Switzer. "Low-Energy Pelvic Ring Fractures: A Care Conundrum." Geriatric Orthopaedic Surgery & Rehabilitation 12 (January 1, 2021): 215145932098540. http://dx.doi.org/10.1177/2151459320985406.
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Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care. Results: Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population. Conclusions: Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.
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Khorashad, Jamshid S., Carme Ripoll Fiol, Eva Yebra-Fernandez, Elisabet Nadal-Melsio, Mahroo Karimpoor, Simone Claudiani, Alistair Reid, et al. ""Function First" Screen of Primary AML Cells Identifies Common and Personalised Therapeutic Targets." Blood 132, Supplement 1 (November 29, 2018): 1517. http://dx.doi.org/10.1182/blood-2018-99-115417.
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Abstract Background Acute myeloid leukaemia (AML) is a tremendously heterogeneous clonal disorder of haemopoietic progenitor cells and is the most common malignant myeloid disorder in adults. Identified mutations from genomic data cannot provide information about their therapeutic significance without functional data. Hereby, we applied a pooled shRNA library screen to identify the activated signalling pathways essential for the survival of AML cells. Methods Mononuclear cells from seven karyotypically normal AML patients were separated from peripheral blood or bone marrow aspirate at diagnosis and transduced with a pooled shRNA library containing 27500 shRNAs targeting 5000 individual genes (Human Module 1, Decipher, Cellecta). The targeted genes were components of known signalling pathways. At 72h post transduction, 30% of the cells were stored for baseline measurements and the rest were co-cultured with HS-5 stromal cells for the selection period. DNA was then extracted and the shRNA barcodes were sequenced on the Illumina NextSeq platform. The frequency of barcode appearance after the selection period was compared to their prevalence at baseline to calculate the shRNA depletion. The shRNAs were filtered to identify those genes which had multiple shRNA meeting a threshold depletion. Results Our data analysis of the 7 AML samples identified various signalling pathways for each of these patients. These data support the notion of heterogeneity in AML. The top 100 depleted genes (with depletion in at least 3 shRNA per gene) in each patient were selected and compared. Our limited initial data showed there to be several activated signalling pathways for each AML sample indicating that inhibition of more than one gene or pathway might be required for efficiently suppressing these leukaemia cells. Common targets: NOX1 was the most commonly identified therapeutic target among the screened patients being significantly depleted in AML cells from 5/7 patients. This is an important finding as there are available NOX1 inhibitors for treatment of colon cancers and can be investigated as a therapeutic option for acute myeloid leukaemia. The other most common targets were CDK5R1, DISC1, FSCN3, and PSMB7 which were found to be significantly depleted among 3 of the 7 screened patients. The merged data also showed 58 essential genes for AML cell survival were common in at least 2/7 patients. Using Enrichr the activated signalling pathways based on the top selected genes were identified. Various signalling pathways were observed for each patient showcasing the heterogeneity among AML patients (Figure 1). However, some signalling pathways were indeed common among multiple patients - with different genes being responsible for the activation of those pathways among the patients. The most common pathway was the metabolic pathway which was observed among the top 20 essential pathways in 6/7 patients. The JAK-STAT5 signalling pathway, purine metabolism and cAMP signalling pathway were also among the top 20 essential pathways in 3/7 patients while the following pathways: FoxO, PI3K-AKT, HIF-1, P53, Glucagon, and proteasome were observed in 2/7 patients. Identification of several essential survival pathways provides the opportunity to develop personalised therapy through combined targeting of more than one pathway. Conclusion The signalling pathways analysis using candidate genes from a pooled shRNA library screen showed patient-specific signalling pathways and also common pathways among these screened patients. Absence of a common gene among the screened patients further highlights the significance of personalised therapy in AML and the necessity of developing diagnostic tools to identify potential targets at diagnosis. Identification of crucial genes such as NOX1 (a gene known to have a role in the survival of leukemic stem cells) and other genes with known significance in the pathogenesis of AML supports the application of this method for identifying therapeutic targets at diagnosis or relapse. Figure 1. Figure 1. Disclosures Knapper: Jazz: Other: Meeting and travel support; Daiichi Sankyo: Other: Meeting and travel support; Chroma Therapeutics: Research Funding; Celgene: Other: Meeting and travel support; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Apperley:Pfizer: Honoraria, Speakers Bureau; Incyte: Honoraria, Speakers Bureau; Novartis: Honoraria, Research Funding, Speakers Bureau; BMS: Honoraria, Speakers Bureau.
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Ricci-Cabello, Ignacio, Aina María Yañez-Juan, Maria A. Fiol-deRoque, Alfonso Leiva, Joan Llobera Canaves, Fabrice B. R. Parmentier, and Jose M. Valderas. "Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data." Journal of Clinical Medicine 10, no. 8 (April 20, 2021): 1782. http://dx.doi.org/10.3390/jcm10081782.
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We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.
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Pearson, C., J. Fraser, and J. Shelton. "Using English National Cancer Registration and Linked Health Datasets to Assess Variation in Diagnostic Pathway Length for Colorectal and Lung Cancer Patients by Stage and Route to Diagnosis." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 75s. http://dx.doi.org/10.1200/jgo.18.62700.
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Background: Understanding factors that contribute to longer diagnostic pathways is important to improve efficiency of these pathways and can provide evidence for the implementation of the forthcoming 28-day Faster Diagnostic Standard (FDS) in England. This analysis uses linked national cancer registrations and other health datasets to define diagnostic pathway length and examine variation by route to diagnosis (RtD), stage and patient characteristics for colorectal and lung cancer patients. Aim: To achieve a more in-depth understanding of the diagnostic pathway for colorectal and lung cancer patients and identify particular factors associated with longer diagnostic pathways. Methods: English cancer registrations (2014 & 2015) diagnosed with colorectal and lung cancers (C18-20, C33-34) were linked to the hospital episode statistics, diagnostic imaging dataset, cancer waiting times and RtD data. Patients with multiple diagnoses or unknown RtD were excluded. To construct the pathway length, a start date was derived by defining the earliest relevant event (referral into/appointment in secondary care or diagnostic procedure) from available datasets in the 6 months prediagnosis. The pathway length was determined for each cancer site separately, by stage, RtD and patient characteristic. Regression analysis produced odds ratios (OR) of having a longer diagnostic pathway while controlling for other factors, including age, sex, comorbidities and deprivation. The longer pathway was defined as longer than the median days per cancer site. Results: Of 64,320 colorectal and 71,526 lung patients included, 99.5% and 99.8% respectively had at least one relevant first event recorded. The median pathway length (days) was 26 (IQR 11-56) for colorectal and 35 for lung (15-83). Pathway length decreased significantly with later stage (stage 1-4 - colorectal: 35 to 20, lung: 75 to 25) with significant variation also by presentation route and comorbidity score. Regression analysis showed that, after adjustment for other factors (including stage), patients on a GP referral route had an increased odds of a long pathway compared with the two week wait route (an urgent GP referral with a suspicion of cancer) (colorectal aOR: 4.5, lung aOR: 2.5). Patients diagnosed via emergency presentation route, which are predominantly late stage, had the shortest pathway length and reduced ORs of having a longer diagnostic pathway (colorectal aOR: 0.2, lung aOR: 0.4). Certain patient characteristics are also associated with longer diagnostic pathway length. Conclusion: There is substantial variation in diagnostic pathway length by stage and route for both sites and in many cases these pathways exceeded 28-days (colorectal: 45.3%, lung: 56.4%). Vague symptoms, comorbidities and other patient characteristics may make cancer more difficult to diagnose. Factors associated with longer waits could support the creation of targeted initiatives to reduce the diagnostic pathway length.
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Jha, Rohan, Daria Anderson, and John Rolston. "1000 Propagation of Seizures Throughout the Brain can be Predicted With Patient Specific Seizure Propagation Pathways." Neurosurgery 71, Supplement_1 (April 2025): 128. https://doi.org/10.1227/neu.0000000000003360_1000.
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INTRODUCTION: The propagation of seizures throughout the brain is well-characterized at the cellular level, though the propagation at the network and whole brain level remains incompletely understood. To this end, the resting state connectivity and structural connectivity of the brain have been characterized and correlated with SEEG investigations and MRI imaging. METHODS: We collated ictal and inter-ictal data from eighteen patients undergoing SEEG investigations for seizure onset zone localization. For each investigation, the location of SEEG contacts were identified in patient space. The ictal onset at each SEEG channel was determined with the creation of a permutation entropy model. Using patient specific diffusion imaging, the probability of axonal connection and the white matter path length between each SEEG contact identified. In addition, the Euclidean path distance between each SEEG contact was identified as well. Linear correlations were identified between time of ictal onsets and the three propagation pathways metrics. RESULTS: SEEG investigation from 18 patients, with 94 distinct seizure events were analyzed. All patients and seizure events demonstrated good correlation between ictal onset time and 1) probability of connection, 2) path length, and 3) Euclidean distance between the clinically determined seizure onset zone contacts and the remaining, non-SOZ contacts. The correlations between the ictal onset times and the different propagation pathways ranged from ∼0.5 to ∼0.8 based on patient and seizure event. The dominant propagation pathway, as determined by the pathway with best correlation, differed between patients and seizure events. CONCLUSIONS: The propagation of seizures throughout the brain can be in part predicted by patient specific seizure propagation pathways. Patient and seizure specific differences may suggest variability in seizure propagation modalities.
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Marinova, Petya, and Rali Marinova. "Patient-centred stoma care support: ileostomy patients." British Journal of Community Nursing 29, no. 8 (August 2, 2024): 384–90. http://dx.doi.org/10.12968/bjcn.2024.0065.
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Stoma patients require continuous support throughout their entire journey with a stoma. Although many Stoma Care Services across the UK offer patient follow-up pathways, there is not one unified pathway. Patients may not be prepared for life with a stoma because, depending on their stoma type, they will have specific needs, and if patients and healthcare professionals are not prepared to manage these stoma-specific needs, complications and hospital readmissions may occur, worsening patients’ outcomes and quality of life. Ileostomy patients are known to be more likely to experience complications, including hospital readmissions, and therefore, special care should be taken when preparing these patients for life with a stoma. They should be informed and educated to prevent complications, and if this is not always possible, thye should at least be able to recognise and manage early signs and symptoms of complications. This will empower them to self-care and know when to seek medical attention.
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Hoegger, Blake, Cassidy Rose Davis, Calliope Constance Bodenhorn Payne, Lance Ortega, and Debra A. Patt. "Remote nurse triage and standardization of clinical pathway utilization." JCO Oncology Practice 19, no. 11_suppl (November 2023): 574. http://dx.doi.org/10.1200/op.2023.19.11_suppl.574.
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574 Background: In March of 2022, Texas Oncology (community oncology practice) initiated a state-wide rollout for Remote Nurse Triage. This program implemented and standardized the utilization of Clinical Pathways within the Navigating Care system with a goal to decrease time to patient first call back, increase first touch resolution for patient-initiated contact, and increase patient satisfaction related to patient-initiated communication resolution. Methods: To determine an appropriate plan of action, a needs assessment was conducted to evaluate current pathway utilization, call volumes and patient satisfaction. Based on the findings of this assessment, triage nurses were trained to resolve incidents using standardized care pathways and standing orders within the Navigating Care System. This implementation was monitored on a weekly basis with metrics from Navigating Care and the Relatient dashboard and compared to the 12-month baseline data for 2 beta sites. Results: In the 12-month pilot, standardized pathway utilization increased from 1% pre-pilot to 78% post-pilot for clinical symptom management calls. With standardized pathways and better first touch resolution clinical calls decreased 8% overall from 4,302/month to 3,987/month while patient volumes (billable visits) increased 25%. Patient satisfaction scores, in relation to their phone experience and needs resolution, went up to 4.5/5 from 3.9/5. Symptom management resolution times also trended down since beginning the pilot. Conclusions: Standardizing the usage of clinical pathways by virtual triage nurses reduced clinical call volumes despite a positive growth in the number of billable visits at the pilot sites. This increase in pathway utilization also led to decreased time for symptom management resolution. Additionally, these measures resulted in an increased patient satisfaction related to patient-initiated communication.
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Jiang, Dadi, Brandon Turner, Jie Song, Ruijiang Li, Maximilian Diehn, Quynh-Thu Le, Purvesh Khatri, and Albert C. Koong. "Comprehensive Analysis of the Unfolded Protein Response in Breast Cancer Subtypes." JCO Precision Oncology, no. 1 (November 2017): 1–9. http://dx.doi.org/10.1200/po.16.00073.
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Purpose Triple-negative breast cancers (TNBCs) are associated with a worse prognosis and patients with TNBC have fewer therapeutic options than patients with non-TNBC. Recently, the IRE1α-XBP1 branch of the unfolded protein response (UPR) was implicated in TNBC prognosis on the basis of a relatively small patient population, suggesting the diagnostic and therapeutic value of this pathway in TNBCs. In addition, the IRE1α-XBP1 and hypoxia-induced factor 1 α (HIF1α) pathways have been identified as interacting partners in TNBC, suggesting a novel mechanism of regulation. To comprehensively evaluate and validate these findings, we investigated the relative activities and relevance to patient survival of the UPR and HIF1α pathways in different breast cancer subtypes in large populations of patients. Materials and Methods We performed a comprehensive analysis of gene expression and survival data from large cohorts of patients with breast cancer. The patients were stratified based on the average expression of the UPR or HIF1α gene signatures. Results We identified a strong positive association between the XBP1 gene signature and estrogen receptor–positive status or the HIF1α gene signature, as well as the predictive value of the XBP1 gene signature for survival of patients who are estrogen receptor negative, or have TNBC or HER2+. In contrast, another important UPR branch, the ATF4/CHOP pathway, lacks prognostic value in breast cancer in general. Activity of the HIF1α pathway is correlated with patient survival in all the subtypes evaluated. Conclusion These findings clarify the relevance of the UPR pathways in different breast cancer subtypes and underscore the potential therapeutic importance of the IRE1α-XBP1 branch in breast cancer treatment.