Collaborative Healthcare Professionals Approach in Monitoring of Patient Centered Outcomes Through Pathways

Majed Aljeraisy341 enrolled

Overview

The aim of this study is to determine if by providing a collaborative, integrated pathway-based healthcare compared to the usual healthcare, whether or not this would be superior in reducing the length of hospital stay across five high frequency /high risk medical diagnoses: Acute Venous Thromboembolism, Acute Kidney Injury, Community Acquired Pneumonia, Adult Left Ventricular Heart Failure, and Asthma.

This study is a pragmatic randomized controlled trial. To date, there is a scarcity of randomized controlled trials looking at pathway-based, patient-centered healthcare versus usual care in several high-risk or high volume diagnoses that account for the vast majority of hospitalizations in medical settings. In this study, the pathway care intervention is a collaborative effort that involves healthcare professionals from multiple departments, including pharmacists, health educators, nurses, social workers, nutritionists, and quality management. For patients allocated to the usual care, these healthcare professionals will deliver standardized care when consulted. For pathway care patients, this collaborative healthcare will be default.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Enrollment

341

Conditions

Heart Failure Community Acquired Pneumonia

Interventions

Pathway-Based CareOTHER

Patients who are randomly allocated to Pathway Care will be treated by the Pathway Clinical Teaching Unit as well as other collaborative healthcare professionals (pharmacists, nurses, health educators, nutritionists, and social workers). The Pathway Care physicians will have access to the Clinical Care Plan on the QuadraMed, which is a detailed, organized, day-to-day treatment plan that includes pre-set orders and medications. Physicians for the patients on Usual Care will not have access to this information, and the collaborative healthcare will only be provided upon consultation.

Eligibility

Sex: ALLMin age: 14 Years

Medical Language ↔ Plain English

1. Inclusion Criteria (Overall Criteria): * One principle diagnosis * Hemodynamic Stability 2. Inclusion Criteria (Specific to each Diagnosis): Acute Venous Thromboembolism: * New onset / in-patient Acute Kidney Injury: * Patients with increased serum creatinine of more than 50% from baseline Community Acquired Pneumonia: * Age limit Adult Left Ventricular Heart Failure: * Age limit Asthma * Acute exacerbation of Asthma 3. Exclusion Criteria (Overall Criteria): * Intensive Care Unit (ICU) patients * Pregnancy 4. Exclusion Criteria (Specific to each Diagnosis): Acute Venous Thromboembolism: * Hemodynamic instability (Systolic Blood Pressure (SBP) less than 90 mmHg or massive Pulmonary Embolism (PE) * PE patients with an sPESI Score ≥ 1 Acute Kidney Injury: * Critical care patients (ICU, Coronary Care Unit, burn units) * Stage 4 and 5 chronic kidney diseases * Kidney allograft recipients * Obstructive uropathy * Glomerulonephritis * Interstitial nephritis Community Acquired Pneumonia: * Intensive Care Unit (ICU) patients * Pregnancy Adult Left Ventricular Heart Failure: * All non-cardiogenic pulmonary edema * Patients requiring Inotropic agents Asthma * Patients with Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis * Severe Asthma (Peak Expiratory Flow Rate (PEFR) less than 40 percent)

Outcomes

Primary Outcomes

Decrease in length of hospital stay by two days

Time frame: During hospitalization period of 7 to 10 days

Secondary Outcomes

30-Day Rehospitalization

To determine the effect of the pathway-based care versus usual care on 30-day rehospitalization rates for the same diagnosis

Time frame: After discharge up to 30 days

Determinants of the Length of Stay

Time frame: Upon admission until discharge

Pathway Care Specific Clinical Outcomes

For pathway care, there are specific targeted outcomes that ought to be met.