Impact evaluation of a Critical Pathway for patients with Clostridium difficile infection: A pre-post analysis in a Third Level Referral Center

Abstract

Background: Clostridium Difficile Infections (CDIs) have been increasing both in incidence and in severity, representing a big public health concern. Aim: The aim of this study was to evaluate the impact of a recently implemented Critical Pathway (CP) focused on patients with CDI in an Italian Teaching Hospital. Methods: The CP implementation consisted of intervention aimed to faster diagnosis and appropriateness in admission and discharge point of care; activation of a multidisciplinary team; staff training; information to patients and caregivers. In a pre-post retrospective observational study, volume, process and outcome indicators were analyzed. Findings: A total of 228 patients (128 in 2013 and 100 in 2016) were included. A decrease in the absolute number of access to the Emergency Department (p = 0.02) and an increase in hospitalization in more appropriate ward (ie gastroenterology ward, p < 0.001) were found. The median hospital length of stay decreased from 20.5 (12.5-31) days in 2013 to 16.5 (7-31) days in 2016 (p = 0.05). With regards to outcome indicators, an increase of discharge to home and a decrease of discharge to long term facilities were showed (p = 0.01 both). Despite a reduction, no statically significant differences in mortality between 2013 and 2016 were revealed by the analysis. Conclusion:In conclusion, we found quality improvement in patient hospital management. Our experience confirms that the implementation of the CP increases the appropriateness in hospital quality of care.

Agomelatine Drug Utilisation Study in Selected European Countries: A Multinational, Observational Study to Assess Effectiveness of Risk-Minimisation Measures

“…The pre-/post-RMM approach of this study was appropriate to evaluate the immediate impact of short-term programmes (e.g. 12-18 months) such as RMMs [5,6]. Limited improvements were observed between the study periods, suggesting that the aRMMs had a low impact; however, most RMMs, including contraindications, precautions of use and liver monitoring, were already in place in November 2014.…”

Ivabradine drug utilization study in five European countries: A multinational, retrospective, observational study to assess effectiveness of risk‐minimization measures

“…This study design is aligned with the guideline on good pharmacovigilance practices (GVP) module XVI, where a medical chart abstraction is considered as a valuable option to assess clinical knowledge and prescribing behavior and is preferred to surveys or self‐reported data. The pre‐post retrospective study design, widely used among similar PASS and DUS, allows for showing the immediate impact of short‐term programs such as RMMs . A review of 29 studies in the European Union electronic Register of Post‐Authorization Studies found that only four studies used retrospective medical files review—others were surveys—and only 10 studies were conducted within a 12–18‐month timeframe after RMM implementation .…”

“…The pre-post retrospective study design, widely used among similar PASS and DUS, [9][10][11][12][13][14] allows for showing the immediate impact of short-term programs such as RMMs. 15,16 A review of 29 studies in the European Union electronic Register of Post-Authorization Studies found that only four studies used retrospective medical files review-others were surveys-and only 10 studies were conducted within a 12-18-month timeframe after RMM implementation. 17 The main strength of this PASS remains its conclusiveness on the effectiveness of RMMs on the prescribing of ivabradine since EU marketing authorization.…”

Definition of a tool to assess shared decision‐making (SDM) on women with breast cancer: A value‐based approach

“…This methodology replicated one already applied by the team to another clinical setting. 20 For Delphi's first round, experts were asked to express their degree of agreement on a Likert scale from 1 to 3 (with 1 corresponding to the lowest-"Not relevant" and 3 to the highest-"Relevant"), with the set of the statements formulated for each question, with regard to the four criteria described above.…”