Clinical pathway s methodology. Concrete use of the 30 activities plan

Transcription

1 10th Symposium on Public Health Networks in Public Health: at the crossing of Practice and Research Clinical pathway s methodology Concrete use of the 30 activities plan Roxane Dierckx de Casterlé Presented by Dr. Xavier de Béthune, B RIC-UCL UCL-ANMC Réseau Itinéraires Cliniques Université catholique de Louvain December 11 th, 2009

2 Plan Introduction: Deming s cycle + CP methodology Objectives of research Methods used Main results: Quantitative analysis Qualitative analysis Advantages and disadvantages of the methodology Lacks of CP methodology Conclusions 2

3 Deming s s cycle to develop, implement and evaluate CP s Plan Identify patient population, team, first version, expected outcomes Act Evaluation Implementation Factsand figuresonactualcare and best-practice Do Interpreting data (do phase) developing second version of CP s based on findings Check Réseau Itinéraires Cliniques, CZV-KULeuven,

4 Interest and objectives of research To identify the most relevant steps To understand the real use of the 30 activities plan To evaluate the effectiveness of the activities To find quicker ways to use the methodology «In how far was the process of Clinical Pathways development really followed?» Adaptation of the methodology to standardize the practices within the various organisations of the RIC 4

5 Methods used Qualitative analysis 23 institutions 23 organisations de soins Group 1 (2004) Cohorte Group 2 2 (2005) Cohorte Group 3 3 (2007) Group 4 (2008) 7 hospitals 2 hospitals 5 hospitals 6 hospitals 1 revalidation center 1 revalidation center 1 revalidation center Target population Mother population (+ flemish organisations) Quantitative analysis 5

6 Main results: Quantitative analysis Graph n 4: n Summary of the scheduling of the 30 activities by RIDIT analysis for the two groups Ordonnancement des activités du plan en 30 activités selon le degré de pertinence - Récapitulatif - 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 6 Ridit groupe multidisciplinaire objectifs/indic/interv-clés 1er contact première version adaptation IC et version défin.. post-test formation collaborateurs planification processus complet dossier patients boucle feed-back population patients prétest / boussole time-task matrix bonnes pratiques description processus système information patients dépliants / internet analyse dossiers plan capacité/ressources gestion itinéraire enregistrement écarts enquête patients analyse im pact brochure/procédés/check list critères opérationnels Service Level Agreements intranet peer review cas-test agendas/réservations Activités

7 Principal results: Qualitative analysis General vision of CP s Contents Localised projects CP strategy (methodology, patients, organisation) Development of one CP: +/- 8 months Project initiator : care staff, medical direction, head office Adequacy of methodology Appropriation of methodology Process Project management Preliminaries: need for CP, documentation, information of the services concerned 30 activities carried out according to the CP, to the institutional context, to the coordinators and the team s s needs Budget Use of CP methodology in a context other than CP Advice Coordinator s s profile 7

8 Advantages and disadvantages of the methodology Disadvantages Advantages Heaviness BUT Necessary to adapt it School learning Less useful for non elective admissions to hospital BUT Necessary for a better understanding of the activities Main focus 8

9 Gaps in the CP methodology Knowledge of the organisational strategy Implication of the direction Identification of similar projects in the organisations Planning of the project and deadlines Risk identification (for the patients, the staff, ) Resource identification from the start 9

10 DISCUSSION

11 PRELIMINAIRES. Objectifs institutionnels. Comanditaire. Identification des projets existants. Identification des ressources disponibles NECESSITE D UN IC SEANCE INFORMATIVE DOCUMENTATION I. CONTEXTE 1 er contact Analyse d impact Groupe pluridisciplinaire + gestion de l IC IV. EVALUATION Post-tests Feedback Adaptation Communication II. PLANIFICATION Délimitation de la population + critères opérationnels Définition des objectifs + indicateurs (BP + PR) Description du processus complet III. ACTION Prétests : Analyse de dossiers + Enquête patients + Analyse de la documentation Création/Modification du dossier patient (In-)formation du personnel (In-)formation des patients + brochure 11

12 Conclusions Priority setting of the most relevant activities, scheduling the steps not a too precise diagram but rather a main focus All the activities are important even if they are not always used Any project generates an organisational change managerial support, adequacy between institutional objectives and project objectives The 30 activities plan and the training are a help for the development of one CP The network is a support Without focus or precise methodology, a CP project cannot take form f correctly 12

13 Thank You! 13