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Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial
BACKGROUND: The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have ma...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674906/ https://www.ncbi.nlm.nih.gov/pubmed/23692634 http://dx.doi.org/10.1186/1748-5908-8-55 |
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author | Jabbour, Mona Curran, Janet Scott, Shannon D Guttman, Astrid Rotter, Thomas Ducharme, Francine M Lougheed, M Diane McNaughton-Filion, M Louise Newton, Amanda Shafir, Mark Paprica, Alison Klassen, Terry Taljaard, Monica Grimshaw, Jeremy Johnson, David W |
author_facet | Jabbour, Mona Curran, Janet Scott, Shannon D Guttman, Astrid Rotter, Thomas Ducharme, Francine M Lougheed, M Diane McNaughton-Filion, M Louise Newton, Amanda Shafir, Mark Paprica, Alison Klassen, Terry Taljaard, Monica Grimshaw, Jeremy Johnson, David W |
author_sort | Jabbour, Mona |
collection | PubMed |
description | BACKGROUND: The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. DESIGN/METHODS: We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma—the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis—the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. DISCUSSION: This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01815710 |
format | Online Article Text |
id | pubmed-3674906 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-36749062013-06-07 Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial Jabbour, Mona Curran, Janet Scott, Shannon D Guttman, Astrid Rotter, Thomas Ducharme, Francine M Lougheed, M Diane McNaughton-Filion, M Louise Newton, Amanda Shafir, Mark Paprica, Alison Klassen, Terry Taljaard, Monica Grimshaw, Jeremy Johnson, David W Implement Sci Study Protocol BACKGROUND: The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. DESIGN/METHODS: We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma—the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis—the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. DISCUSSION: This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01815710 BioMed Central 2013-05-22 /pmc/articles/PMC3674906/ /pubmed/23692634 http://dx.doi.org/10.1186/1748-5908-8-55 Text en Copyright © 2013 Jabbour et al.; licensee BioMed Central Ltd. http://www.creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://www.creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Study Protocol Jabbour, Mona Curran, Janet Scott, Shannon D Guttman, Astrid Rotter, Thomas Ducharme, Francine M Lougheed, M Diane McNaughton-Filion, M Louise Newton, Amanda Shafir, Mark Paprica, Alison Klassen, Terry Taljaard, Monica Grimshaw, Jeremy Johnson, David W Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial |
title | Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial |
title_full | Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial |
title_fullStr | Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial |
title_full_unstemmed | Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial |
title_short | Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial |
title_sort | best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial |
topic | Study Protocol |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674906/ https://www.ncbi.nlm.nih.gov/pubmed/23692634 http://dx.doi.org/10.1186/1748-5908-8-55 |
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