Evaluation of the impact of an integrated care pathway for pulmonary embolism: a quasi-experimental pre-post study

Journal of Thoracic Disease

article

Nuria Rodríguez-Núñez¹  Alberto Ruano-Raviña²  Adriana Lama¹  Lucía Ferreiro¹  Jorge Ricoy¹  José M. Álvarez-Dobaño¹  Juan Suárez-Antelo¹  M. Elena Toubes¹  Carlos Rábade¹  Antonio Golpe¹  Vanessa Riveiro¹  Ana Casal¹  Romina Abelleira¹  Francisco Javier González-Barcala¹  José R. González-Juanatey⁶  Luis Valdés¹ 

[1] Department of Pulmonology, Complejo Hospitalario Universitario de Santiago;Department of Preventive Medicine and Public Health, Universidad de Santiago de Compostela;CIBER of Epidemiology and Public Health;Group C013, Health Research Institute of Santiago de Compostela;Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago;Service of Cardiology, Spanish Network-Center for Cardiovascular Biomedical Research, CIBERCV, Health Research Institute of Santiago de Compostela

关键词: Pulmonary embolism (PE);    integrated care pathway (ICP);    hospital stay;    mortality;    anticoagulation;   

DOI  :  10.21037/jtd-21-595

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: An integrated care pathway (ICP) is intended to improve the management of prevalent resource-consuming, life-threatening diseases. The purpose of this study was to determine whether the quality of patient care improved with the establishment of a dedicated unit for pulmonary embolism (PE). Methods: A quasi-experimental pre-post study (pre: years 2010–2013; post: 2015–2020; year 2014, “washing” period) of PE patients ≥18 years (January 2010–June 2020). The intervention involved the implementation of an ICP for PE. Results: The sample was composed of 1,142 patients (510 pre-intervention and 612 post-intervention) without significant differences between the two populations. In the post-intervention period, significant reductions were observed in the median length of hospital stay (LOS) (8 vs. 6 days); time to start of oral anticoagulation therapy (4.5 vs. 3.5 days; P<0.001); and the percentage of patients with high-risk PE in whom recanalization was not contraindicated (66.7% vs. 96%; P=0.009). In-hospital and 30-day mortality decreased, although not significantly (4.5% vs. 2.8%; P=0.188; 6.1% vs. 5.2%; P=0.531, respectively). Multivariate logistic regression analysis showed that the median LOS intervention decreased significantly according to the service where patients were referred to, and with the use of the simplified PESI. During follow-up, lifelong anticoagulation was prescribed to a higher proportion of patients in the post-intervention period (30.7% vs. 69.3%; P<0.001). Conclusions: Although an ICP for PE does not reduce mortality significantly, it improves the quality of patient care.

【 授权许可】

Unknown