Do integrated care pathways improve patient outcomes?

Abstract

The purpose of the study was to determine if the use of an Integrated Care Pathway (ICP) was associated with more positive outcomes than traditional methods of care. The effectiveness of the ICP had not previously been tested (in relation to traditional methods of care) to determine if it made any difference, at a patient, staff or system (healthcare organisation) level. In February 2001 (as part of the NHS modernisation agenda) the gynaecology services within one UK city were re-organised and two separate units were merged into one new larger unit. Prior to the reorganisation, the two units offered similar treatments and were managed collectively; however, one site had developed and implemented ICPs and the other site had continued to use traditional methods of care delivery. ICPs are multidisciplinary plans for organising and delivering patient care. The plan of care is outlined in a sequential manner including all interventions with expected patient outcomes. The literature suggests that ICPs result in improved patient outcomes and lower hospital costs by decreasing length of stay and improving observations i.e. detecting signs of infection in a timelier manner. ICPs are recognised to facilitate the multidisciplinary partnerships in planning of patient care. However the literature was primarily anecdotal or non generalisable, and therefore additional local research was deemed essential. To ensure the research problem could be answered, three specific research questions were developed for testing: (1) What effect does an /~ / ICP have on the outcomes of gynaecological patients attending for major abdominal surgery? (2) What factors, including the use of an ICP contribute to the variance in length of stay for gynaecological patients? (3) What are the opinions of the staff who have used the ICP, of the ICP itself? Relevant directional hypothesis were derived from each research question. A quasi-experimental design was used to answer the first research question. Subjects were attached to one of two groups, a treatment group, which used the ICP, and a comparison group, which continued to deliver care based on traditional methods. Descriptive correlation was used to answer research question two and for the third research question descriptive exploration was used. Variables of interest from a patient, staff and system (health care organisational) level were collected to determine the effectiveness of the ICP compared with traditional methods. One of the difficulties faced with ICP research is the number of variables that can potentially influence patient care. Holzemer's model (1994, based on the work of Donabedian, 1966) was used to conceptualise the variables (and therefore the data collection instruments) into the category of structure, process or outcome at either a patient, provider or systems (health care organisation) level. This in turn helped to theorise the linkage between the variables within this study, identifying conceptual and functional relationships. The abdominal surgery ICP supported improvements in cost and efficiency through a reduction in length of stay (treatment site = 5.29 days, comparison site = 6.16 days) and a positive return to patients' perception of health. However, there was a reduction in patient satisfaction with nursing care with the introduction of the ICP and this needs further study. Involving patients in future developments and evaluations could promote long-term patient satisfaction