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The impact of pathways: a significant decrease in mortality

The impact of pathways: a significant decrease in mortality This study was undertaken to determine how care pathways (CPs) in the hospital treatment of heart failure (HF) affected in-hospital mortality, and outcomes at discharge. A two-arm, cluster randomized trial was conducted. Fourteen community hospitals were randomized either to arm 1 (CPs) or to arm 2 (no intervention, usual care). A sample size of 424 patients (212 in each group) was used in order to have 80% of power at the 5% significance level (two-sided). The primary outcome measure was in-hospital mortality. Secondary outcomes were also evaluated. In-hospital mortality was 5.6% in the experimental arm and 15.4% in the controls (P = 0.001). In CP and usual care groups, the mean rates of unscheduled readmissions were 7.9% and 13.9%, respectively. Adjusting for age, smoking, New York Heart Association (NYHA) score, hypertension and source of referral, patients in the CP group, as compared with controls, had a significantly lower risk of in-hospital death (odds ratio [OR] = 0.18; 95% confidence interval [CI]: 0.07–0.46) and unscheduled readmissions (OR = 0.42; CI = 0.20–0.87). No differences were found between CP and control with respect to the appropriateness of the stay, costs and patient's satisfaction. This paper examines the evaluation of a complex intervention and adds evidence to previous knowledge, indicating that CP should be used to improve the quality of hospital treatment of HF. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Care Pathways SAGE

The impact of pathways: a significant decrease in mortality

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Publisher
SAGE
Copyright
© The Royal Society of Medicine Press 2009
ISSN
2040-4034
eISSN
1758-1079
DOI
10.1258/jicp.2009.009007
Publisher site
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Abstract

This study was undertaken to determine how care pathways (CPs) in the hospital treatment of heart failure (HF) affected in-hospital mortality, and outcomes at discharge. A two-arm, cluster randomized trial was conducted. Fourteen community hospitals were randomized either to arm 1 (CPs) or to arm 2 (no intervention, usual care). A sample size of 424 patients (212 in each group) was used in order to have 80% of power at the 5% significance level (two-sided). The primary outcome measure was in-hospital mortality. Secondary outcomes were also evaluated. In-hospital mortality was 5.6% in the experimental arm and 15.4% in the controls (P = 0.001). In CP and usual care groups, the mean rates of unscheduled readmissions were 7.9% and 13.9%, respectively. Adjusting for age, smoking, New York Heart Association (NYHA) score, hypertension and source of referral, patients in the CP group, as compared with controls, had a significantly lower risk of in-hospital death (odds ratio [OR] = 0.18; 95% confidence interval [CI]: 0.07–0.46) and unscheduled readmissions (OR = 0.42; CI = 0.20–0.87). No differences were found between CP and control with respect to the appropriateness of the stay, costs and patient's satisfaction. This paper examines the evaluation of a complex intervention and adds evidence to previous knowledge, indicating that CP should be used to improve the quality of hospital treatment of HF.

Journal

International Journal of Care Pathways – SAGE

Published: Nov 1, 2009

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