The European quality of care pathways (EQCP) study on the impact of care pathways on interprofessional teamwork in an acute hospital setting: study protocol: for a cluster randomised controlled trial and evaluation of implementation processes

Abstract

BackgroundAlthough care pathways are often said to promote teamwork, high-level evidence that supports this statement is lacking. Furthermore, knowledge on conditions and facilitators for successful pathway implementation is scarce. The objective of the European Quality of Care Pathway (EQCP) study is therefore to study the impact of care pathways on interprofessional teamwork and to build up understanding on the implementation process.Methods/designAn international post-test-only cluster Randomised Controlled Trial (cRCT), combined with process evaluations, will be performed in Belgium, Ireland, Italy, and Portugal. Teams caring for proximal femur fracture (PFF) patients and patients hospitalized with an exacerbation of chronic obstructive pulmonary disease (COPD) will be randomised into an intervention and control group. The intervention group will implement a care pathway for PFF or COPD containing three active components: a formative evaluation of the actual teams’ performance, a set of evidence-based key interventions, and a training in care pathway-development. The control group will provide usual care. A set of team input, process and output indicators will be used as effect measures. The main outcome indicator will be relational coordination. Next to these, process measures during and after pathway development will be used to evaluate the implementation processes. In total, 132 teams have agreed to participate, of which 68 were randomly assigned to the intervention group and 64 to the control group. Based on power analysis, a sample of 475 team members per arm is required. To analyze results, multilevel analysis will be performed.DiscussionResults from our study will enhance understanding on the active components of care pathways. Through this, preferred implementation strategies can be defined.Trail registrationNCT01435538

Better Interprofessional Teamwork, Higher Level of Organized Care, and Lower Risk of Burnout in Acute Health Care Teams Using Care Pathways

“…14 Sample size calculation was performed at the level of the overall EQCP project 28 and was based on expected improvement in relational coordination. For a significance level of 0.05 (2-sided), a sample size of 475 team members per arm was required to obtain a statistical power of 0.80.…”

“…Looking back at the sample size calculation, note that a sample size of 475 team members per arm was required to obtain a statistical power of 0.80. 28 …”

“…The methodology of the study has been described in detail previously. 28 In brief, because CPs are complex interventions and are developed for and will affect groups of people, a cluster randomized design is regarded as the golden standard to evaluate their effectiveness. 29 Each cluster consists of all individual members of the interprofessional team caring for COPD or PFF patients in a particular hospital.…”

“…48 For this, an evaluation of the implementation processes will be performed utilizing the Normalization Process Model. 28,49 The Normalization Process Model provides a tool to evaluate the effectiveness of implementation processes of complex interventions, by looking at its workability (capability of being put into practice) and level of integration (assimilation …”

Treatment pathways as petri nets in patient workflow management

“…Healthcare pathways are also used for diseases that the elderly often suffer from [34,37], for patients that are dismissed after having been hospitalised [20], or for patients with chronic diseases [7].…”