Experiences of using clinical pathways in hospitals: Perspectives of quality improvement personnel

Abstract Aim This study aimed to explore the experiences of quality improvement personnel in implementing clinical pathways (CPs) in Korean hospitals. Design A qualitative study using focus‐group interviews was conducted with healthcare professionals in charge of CP development and management in hospitals. Methods Sixteen quality improvement personnel from eight tertiary and seven general hospitals were recruited using purposive sampling. The verbatim transcribed data were analysed using qualitative content analysis. Results Three key themes emerged: (1) the primary focus of CP development on surgeries through concerted efforts between management and frontline healthcare professionals; (2) CP fidelity management using indicators and feedback to relevant staff or departments; and (3) positive outcomes, despite concerns about system safety. The factors affecting CP use included availability of clinical evidence, flexibility of CPs, top management and clinical leadership, physicians' perceptions of CPs, computerized support systems, and external policies and regulations

Risk factors for developing liver cancer in people with and without liver disease.

BACKGROUND:The National Liver Cancer Surveillance Program (NLCSP) targets patients with liver diseases that lead to liver cancer in South Korea. This study aimed to investigate the risk of liver disease leading to liver cancer using nationally representative data to establish an efficient NLCSP. METHODS:This study used data from the National Health Insurance Service National Sample Cohort (NHIS-NSC) from 2002 to 2013. A retrospective matched cohort design was applied to compare the development of liver cancer in patients with and without liver disease. Cox- proportional hazard regression for liver cancer with competing risk of death was performed for all subjects or each group stratified according to age or income level. RESULTS:A total of 66,192 patients with liver disease and matched subjects without liver disease were included in the study. The incidences of liver cancer among patients with and without liver disease within a median 8-year follow-up period were 2.68% (n = 1,772) and 0.34% (n = 210), respectively. Cox- regression analysis for liver cancer incidence indicated that cirrhosis had the highest risk (hazard ratio [HR]: 18.13, 95% confidence interval [CI]: 15.24-21.58), followed by hepatitis B (HR: 9.32, 95% CI: 8.00-10.85). Subgroup analysis showed that the presence of liver disease was an important risk factor in younger as well as elderly people, and a higher risk of liver disease was also observed in the patients with Medicaid. CONCLUSIONS:Attention should be paid to the development of liver cancer in young people under 50 years old and preventive efforts to decrease the incidence of liver cancer among Medicaid recipients is needed