The Critical Path Method in Stroke Rehabilitation: Lessons from an Experiment in Cost Containment and Outcome Improvement

Falconer, Judith; Roth, Elliot J.; Sutin, Judith; Strasser, Dale C.; Chang, Rowland W.

doi:10.1016/s0097-5990(16)30582-6

Cited by 113 publications

(107 citation statements)

References 11 publications

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“…5,6 However, novel methods of healthcare delivery may have subtle effects on wider aspects of outcome relating to overall well-being or perceptions of care, which may not be identified by disease/ disability-oriented measures. Many patients, families, and professionals consider quality of life (QOL) in the longer term as central to recovery from stroke, 7 and measures to assess well-being used in conjunction with disease-specific measures provide a better assessment of long-term health outcome in disability and chronic disease.…”

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confidence: 99%

Integrated Care Pathways and Quality of Life on a Stroke Rehabilitation Unit

Sulch

Melbourn

Perez

et al. 2002

Stroke

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Background and Purpose-Integrated care pathways (ICP) may not reduce disability, institutionalization, or duration of hospitalization compared with conventional multidisciplinary team (MDT) care in organized stroke rehabilitation. Their potential to improve patient heath status or satisfaction with care is not known. Methods-A comparison of quality of life, caregiver strain, and patient/caregiver satisfaction at 6 months after stroke was undertaken in 152 stroke patients randomized to receive ICP or MDT care. Differences in processes of care were recorded with the use of a predefined schedule. Multivariate analyses were undertaken to identify the effect of age, sex, stroke severity, functional status, mood, and use of care pathway on quality of life score. Results-The 2 groups were comparable for baseline characteristics of age, sex, stroke severity, and initial disability. MDT care was characterized by greater emphasis on return of higher function and caregiver needs compared with ICP. EuroQol Visual Analogue Scale (EQ-VAS) scores were higher in the MDT group (median, 72 versus 63; PϽ0.005), who also had higher scores for EuroQol dimension of social functioning (Pϭ0.014). Higher EQ-VAS scores were independently related to MDT care (Pϭ0.04), Rankin score (Pϭ0.01), and psychological function (PϽ0.0001) but not to age, sex, or stroke severity. There were no significant differences in patient or caregiver satisfaction between the 2 settings. Conclusions-Better quality of life in patients receiving conventional MDT care may be attributable to improved social functioning and greater attention to higher function and caregiver needs during rehabilitation. (Stroke. 2002;33:1600-1604.)

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confidence: 99%

Integrated Care Pathways and Quality of Life on a Stroke Rehabilitation Unit

Sulch

Melbourn

Perez

et al. 2002

Stroke

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“…The 2 randomized studies showed a nonsignificant trend toward a longer mean length of stay in care pathway group. 14,19 By contrast, the 4 nonrandomized studies showed that mean length of stay was significantly shorter in the care pathway group. 7,8,16,17 The aggregate result showed a nonsignificant trend toward shorter mean length of hospital stay in the care pathway group.…”

Section: Resultsmentioning

confidence: 91%

“…[7][8][9][10][11] In total, we included 3 randomized controlled trials (total of 340 patients) and 12 nonrandomized studies (total of 4081 patients). 2,3,[7][8][9][10][11][12][13][14][15][16][17][18][19] Seven of the care pathways were implemented for acute stroke management, 3 were for stroke rehabilitation, and 5 were for combined acute stroke management and rehabilitation.…”

Section: Resultsmentioning

confidence: 99%

In-Hospital Care Pathways for, Stroke

Kwan

Sandercock

2005

Stroke

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“…Other practice-based IPL studies have also encountered a variety of barriers and delays. 16,17 The role of facilitators was to change educational practice, bringing the broad and ambitious TUILIP remit to, in many cases, virgin soil for IPL (with its implied criticism of established practice). 18 This makes it perhaps unsurprising that, despite the comparative luxury of paid IPL time, not all were able to fulfil the remit.…”

Section: Discussionmentioning

confidence: 99%

Establishing and facilitating practice-based interprofessional learning: experiences from the TUILIP project

2012

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The Trent Universities Interprofessional Learning in Practice (TUILIP) project aimed to establish interprofessional learning (IPL) for healthcare students in clinical practice settings. Ten IPL facilitators were employed in eight varied practice setting pilot sites for up to a year to research, develop and run locally appropriate, sustainable IPL initiatives. Following the pilot phase, a qualitative evaluation was conducted in each site by means of interviews or focus groups with all key stakeholders (facilitators, clinical managers, practitioners, students, service users, carers). Data collection was guided by Kirkpatrick's evaluation framework (1996), which focuses upon participant reactions, and their perceptions of learning, behaviour change and sustainable impact. In keeping with this framework, participants were asked to discuss their experiences of TUILIP in their placement setting (including its facilitation), and their opinions about its impact and success in terms of learning, behaviour change and sustainability. We report a subset of evaluation results relating to the roles of the facilitator, facilitation processes, experiences and challenges, personal and professional impact upon facilitators, and implications for IPL projects in practice. Facilitation tasks included preparing the ground, earning credibility, gathering ideas, researching feasibility, developing initiatives, involving service users, trialling and embedding initiatives. Facilitators were faced with challenges such as getting a focus, time limitations and dealing with logistics. They reported highs (being a fly on the wall, protected time, their educational role, and a sense of satisfaction) and lows (loneliness, frustration and fear of failure), but considered they had developed personally and professionally as a result of their experiences. Results demonstrated the complexity and demands of establishing and facilitating IPL initiatives in practice settings. Facilitation was time-consuming and effortful and did not always achieve its aims, but was a source of satisfaction and personal development. These findings suggest higher education institutions and practice settings should consider carefully the selection, preparation and support for facilitators of practice-based IPL, as well as how to engage local practitioners and service users, and embed changes in the clinical setting.

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The Critical Path Method in Stroke Rehabilitation: Lessons from an Experiment in Cost Containment and Outcome Improvement

Cited by 113 publications

References 11 publications

Integrated Care Pathways and Quality of Life on a Stroke Rehabilitation Unit

Integrated Care Pathways and Quality of Life on a Stroke Rehabilitation Unit

In-Hospital Care Pathways for, Stroke

Establishing and facilitating practice-based interprofessional learning: experiences from the TUILIP project

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