Patient, Clinician, and Healthcare Perspectives in Evaluating Care Pathways for Stable Chest Pain

Kwok, Chun Shing; Duckett, Simon; Satchithananda, Duwarakan; Potluri, Rahul; Morgan-Smith, Dot; Bellenger, Nick G.; Gunning, Mark; Mallen, Christian

doi:10.1097/hpc.0000000000000261

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…This review was developed to utilise the knowledge from experts to explore what possible events can occur to patients. It has been demonstrated in several conditions, including stable chest pain [ 18 ], atrial fibrillation [ 19 ], and COVID-19 [ 20 ]. The approach of this method, in summary, is defining an ideal pathway based on clinical expertise and evaluating each step of the ideal pathway critically to develop a real-world pathway.…”

Section: The Patient Pathway Reviewmentioning

confidence: 99%

Should Audits Consider the Care Pathway Model? A New Approach to Benchmarking Real-World Activities

et al. 2022

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Clinical audit is a method to assess the quality of healthcare services based on whether standards are met or not met. This approach is limited because it fails to recognize how decisions that take place over time and the natural progression of disease has an impact on what happens to patients and the care they receive. The aim of this paper is to introduce the concept of care pathway and explain how care pathways can be audited to better understand care. The care pathway is defined by clinically relevant events that take place within one or more healthcare institutions. The process begins with defining an ideal care pathway which is created by considering local expertise and guidelines. It is then possible to audit against the extent to which this ideal care pathway is achieved. This care pathway audit can enable identification of patterns in real-world care which can help with the of design interventions to help shift patients from the less to more desirable pathways. We conclude that through the process of the care pathway audit cycle, it is possible to learn about real-world activities, better utilize resources, promote safer care, improve quality of care, and help develop more effective interventions.

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Section: The Patient Pathway Reviewmentioning

confidence: 99%

Should Audits Consider the Care Pathway Model? A New Approach to Benchmarking Real-World Activities

et al. 2022

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“…This approach has been previously used to evaluate care pathways for stable chest pain. 4 The key perspectives in healthcare are shown in Figure 4.…”

Section: Perspectivesmentioning

confidence: 99%

The Patient Pathway Review: A New Method of Evaluating Clinical Practices to Understand the Complexities of Real-world Care

Kwok

Muntean

Mallen

2021

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Healthcare research has contributed to the good patient care that is delivered today. With the perpetual demand for higher quality, costeffective care, the current approaches in research could be improved to answer important research questions related to actual healthcare practices. In this article, we introduce the concept of the patient pathway review, which focuses on the identification of what happens to patients based on clinical expertise and systematic evaluation. This approach can help understand real-world healthcare activities and explore reasons for clinically relevant patient events. The patient pathway is defined as a series of clinically relevant events. The patient pathway review begins with selection of the area which merits exploration. This is followed by the development of an "ideal" pathway, which defines what is expected to happen to most patients in the area. Through critical reasoning and detailed consideration of different possible activities or outcomes at each stage of the "ideal" pathway, the "real-world" pathways can be determined. To understanding the significance of the "real-world" pathway, descriptions from all the stakeholders involved are necessary. Typically, in the healthcare setting, these perspectives are the patient, clinician, health service, policy makers, and society who have variable interests the important clinical events. Finally, the pathways together with the perspectives are integrated into a discussion. We conclude that the patient pathway review is a novel approach, which has value to explain real-world events for patients and can enable identification of favorable paths, which can help guide the development of interventions to improve clinical practice.

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“…10 First described in the context of stable chest pain, the clinical pathway can be considered either as both an exposure and outcome variable. 11 Utilizing this concept, the patient pathway review was subsequently developed, which uses critical reasoning and clinical knowledge to define an “ideal” pathway and this pathway is then systematically evaluated by considering different activities and outcomes at each stage to generate the “real-world”pathway. 8 The value of these “real-world” pathways is that awareness may help rationalize the complexity of actual healthcare so that the more favorable paths can be promoted through the development of interventions to improve clinical practice.…”

Section: Introductionmentioning

confidence: 99%

The Patient Pathway Review for Atrial Fibrillation

Kwok

Lip

2022

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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The care pathway for patients with atrial fibrillation (AF) is variable and this variability is explored in a patient pathway review. This review describes events that may take place for a patient with AF considering the "ideal" and the "real-world" pathway and attempts to rationalize them by considering the patient, clinician, health service, and societal perspective. In the "ideal" pathway, AF in a patient is either identify before or after stroke. The "real-world" pathway introduces the concepts that symptoms may influence patient decision-making to seek help, AF may be identified incidentally, and healthcare professionals may fail to identify AF. The management of AF includes no treatment or treatment such as stroke prevention, rate or rhythm control, and comorbidity management. The overall outcomes for patient depend on the presence of symptoms and response to therapies. The two major priorities for patients are symptomatic relief and avoidance of stroke. While most clinicians will find that initial AF management is not challenging but there may be incidental opportunities for earlier identification. From the healthcare service perspective, noncardiologists and cardiologists care for patients with AF, which results in much heterogeneity management. From the societal perspective, the burden of AF is significant resulting in substantial cost from hospitalizations and treatments. People with AF can take on different paths, which depend on factors related to the patient's decisionmaking, clinical decision-making, and patient's response to the treatment. A streamlined approach to a holistic and integrated care pathway approach to AF management is needed.

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Patient, Clinician, and Healthcare Perspectives in Evaluating Care Pathways for Stable Chest Pain

Cited by 5 publications

References 6 publications

Should Audits Consider the Care Pathway Model? A New Approach to Benchmarking Real-World Activities

Should Audits Consider the Care Pathway Model? A New Approach to Benchmarking Real-World Activities

The Patient Pathway Review: A New Method of Evaluating Clinical Practices to Understand the Complexities of Real-world Care

The Patient Pathway Review for Atrial Fibrillation

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