Implementing online evidence-based care pathways: A mixed-methods study across primary and secondary care

Akehurst, Joy; Sattar, Zeibeda; Gordon, Isabel; Ling, Jonathan

doi:10.1136/bmjopen-2018-022991

Cited by 16 publications

(23 citation statements)

References 28 publications

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“…In primary care, a web-based clinical pathway tool called HealthPathways has been implemented in New Zealand, Australia and the UK 14 15. HealthPathways was developed in Canterbury, New Zealand, in 2008 and has grown to over 550 clinical pathways 15–17. It has been implemented at 33 sites impacting more than 25 million patients 15–17.…”

Section: Literature Reviewmentioning

confidence: 99%

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Clinical pathways on a mobile device

Barrett

Turner

Silva

et al. 2019

BMJ EBM

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Clinical pathways have been successfully implemented in the primary care setting in New Zealand, Australia and the UK. Despite wide adoption and decreased costs, these pathways have yet to translate evidence into clinical practice while also saving providers time—an important barrier for the translation of evidence at the point of care. The goal of this project was to determine if future development of a point-of-care mobile application should be undertaken with design principles using the theoretical framework of Hick’s law. Three new-to-practice providers participated in three plan-do-study-act cycles using these pathways installed on mobile devices to determine if they were a feasible, efficient and useful method to implement evidence. The project was a success with all three participants wishing to continue using the pathways after project completion. Participants felt the digital clinical pathways were the next evolution of the popular UpToDate software platform and helped them apply the latest evidence better than other available tools. While these results are promising, there were also limitations. Participants felt the lack of chart integration coupled with time constraints made full integration challenging and suggested launching the platform using a variety of delivery systems. The project’s findings suggest that future application development using the developed design principles would be worth further consideration. If this mobile application ultimately proved successful, the application framework could be implemented on a larger scale, thus improving patient outcomes and saving providers time.

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Section: Literature Reviewmentioning

confidence: 99%

“…HealthPathways was developed in Canterbury, New Zealand, in 2008 and has grown to over 550 clinical pathways 15–17. It has been implemented at 33 sites impacting more than 25 million patients 15–17. These pathways are customised for each location and agreed on by both primary care providers and specialists 16 18.…”

Section: Literature Reviewmentioning

confidence: 99%

Clinical pathways on a mobile device

Barrett

Turner

Silva

et al. 2019

BMJ EBM

View full text Add to dashboard Cite

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“…Online knowledge bases have been shown to increase the application of evidence-based medicine in clinical practice [11][12][13]. In this study, we used Lobach's definition of a knowledge base: "Electronic (computer-based) resources comprising distilled (synthesized) or curated information that allows clinicians to select content germane to a specific patient to facilitate medical decision making" [14].…”

Section: Introductionmentioning

confidence: 99%

Use of online knowledge base in primary health care and correlation to health care quality: an observational study

Gerdesköld

Toth-Pal

Wårdh

et al. 2020

BMC Med Inform Decis Mak

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Background Evidence-based information available at the point of care improves patient care outcomes. Online knowledge bases can increase the application of evidence-based medicine and influence patient outcome data which may be captured in quality registries. The aim of this study was to explore the effect of use of an online knowledge base on patient experiences and health care quality. Methods The study was conducted as a retrospective, observational study of 24 primary health care centers in Sweden exploring their use of an online knowledge base. Frequency of use was compared to patient outcomes in two national quality registries. A socio-economic Care Need Index was applied to assess whether the burden of care influenced the results from those quality registries. Non-parametric statistical methods and linear regression were used. Results Frequency of knowledge base use showed two groups: frequent and non-frequent users, with a significant use difference between the groups (p < 0.001). Outcome data showed significant higher values for all seven National Primary Care Patient Survey dimensions in the frequent compared to the non-frequent knowledge base users (p < 0.001), whereas 10 out of 11 parameters in the National Diabetes Register showed no differences between the groups (p > 0.05). Adjusting for Care Need Index had almost no effect on the outcomes for the groups. Conclusions Frequent users of a national online knowledge base received higher ratings on patient experiences, but figures on health care quality in diabetes showed near to no correlation. The findings indicate that some effects may be attributed to the use of knowledge bases and requires a controlled evaluation.

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“…Online knowledge bases have been shown to increase the application of evidence-based medicine in clinical practice (11)(12)(13). In this study, we used Lobach's de nition of a knowledge base: "Electronic (computer-based) resources comprising distilled (synthesized) or curated information that allows clinicians to select content germane to a speci c patient to facilitate medical decision making" (14).…”

Section: Introductionmentioning

confidence: 99%

Use of online knowledge base in primary health care and correlation to health care quality: An observational study

Gerdesköld

Toth-Pal

Wårdh

et al. 2020

Preprint

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BackgroundEvidence-based information available at the point of care improves patient care outcomes. Online knowledge bases can increase the application of evidence-based medicine and influence patient outcome data which may be captured in quality registries. The aim of this study was to explore the effect of use of an online knowledge base on patient experiences and health care quality.MethodsThe study was conducted as a retrospective, observational study of 24 primary health care centers in Sweden exploring their use of an online knowledge base. Frequency of use was compared to patient outcomes in two national quality registries. A socio-economic Care Need Index was applied to assess whether the burden of care influenced the results from those quality registries. Non-parametric statistical methods and linear regression were used.ResultsFrequency of knowledge base use showed two groups: frequent and non-frequent users, with a significant use difference between the groups (p<.001). Outcome data showed significant higher values for all seven National Primary Care Patient Survey dimensions in the frequent compared to the non-frequent knowledge base users (p<.001), whereas 10 out of 11 parameters in the National Diabetes Register showed no differences between the groups (p>.05). Adjusting for Care Need Index had almost no effect on the outcomes for the groups.ConclusionsFrequent users of a national online knowledge base received higher ratings on patient experiences, but figures on health care quality in diabetes showed near to no correlation. The findings indicate that some effects may be attributed to the use of knowledge bases and requires a controlled evaluation.

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Implementing online evidence-based care pathways: A mixed-methods study across primary and secondary care

Cited by 16 publications

References 28 publications

Clinical pathways on a mobile device

Clinical pathways on a mobile device

Use of online knowledge base in primary health care and correlation to health care quality: an observational study

Use of online knowledge base in primary health care and correlation to health care quality: An observational study

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