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作者 Halloran, Teresa Heise
書名 The effects of a clinical pathway on hospitalized heart failure patients
國際標準書號 0493439714
book jacket
說明 236 p
附註 Source: Dissertation Abstracts International, Volume: 62-10, Section: B, page: 4466
Adviser: Ruth Jenkins
Thesis (Ph.D.)--University of Missouri - Saint Louis, 2002
This retrospective study compared the outcomes of two methods of health care coordination, i.e., the clinical pathway or routine care, with hospitalized heart failure patients. The study hypothesized that the clinical pathway group would receive clinical interventions that corresponded with clinical practice guideline recommendations to a greater extent than the routine care group. The clinical practice guideline recommendations included: evaluation of cardiac left ventricular ejection fraction; the utilization of pharmacological therapy including angiotensin-converting enzyme (ACE) inhibitors, diuretics and digoxin; improved time to ambulation; smoking cessation counseling from a nurse; and specific discharge instructions from a nurse
The health care records of 523 hospitalized heart failure patients from a southern Illinois community were reviewed. Results showed that of the 523 hospitalized heart failure patients, 183 (35%) were in the clinical pathway group while 340 (65%) received routine care
The clinical pathway and routine care groups differed significantly in the diagnosis of heart failure on the diagnostic chest x-ray taken at admission. The clinical pathway group had a higher proportion (79.2%) for diagnosis of heart failure on the admission chest x-ray and meeting admission criteria (87.4%), while the routine care group had only 64.2% who had a diagnostic admission chest x-ray and 69.1% who met admission criteria
There were some significant differences in the extent to which the two groups received clinical interventions that corresponded with clinical practice guideline recommendations; however this was not true for all clinical practice guidelines. The clinical pathway group ambulated earlier and received specific discharge instructions from a nurse that included medication instructions, dietary instructions, weight monitoring, activity level, and what to do if symptoms worsened. However, the clinical pathway group did not receive more assessments of cardiac left ventricular ejection fraction and a higher proportion of pharmacological therapy including ACE inhibitors, diuretics and digoxin prescribed at discharge than the routine care group even though clinical practice guidelines recommended that this be done. Nor did they receive more smoking cessation nurse counseling than the routine care group
Although it was hypothesized that the clinical pathway group would have a shorter hospital stay, this was not supported. Nor was there any significant difference in one and three-month hospital readmission rates between the two groups. However, demographic variables and being in the clinical pathway group explained 18.8% of the variance in the readmission rates
Secondary findings showed that the two groups were significantly different in the admission source, time to administration of the first dose of an intravenous diuretic, the use of an oxygen weaning protocol, and an assigned activity level upon admission into the hospital. The admission source for the clinical pathway group was almost exclusively through the Emergency Department (97.8%). In comparison, 63.1% of the routine care group was admitted through the Emergency Department. The clinical pathway group had less time in hours to the administration of the first dose of an intravenous diuretic (2.67 compared to 11.43 hours), greater use of an oxygen weaning protocol (73.1% compared to 33.1%) and had the type of order to progress the patient to a more active level of activity (88% compared to 17%)
Potential methods to increase the use of clinical pathways with hospitalized heart failure patients are discussed
School code: 0481
DDC
Host Item Dissertation Abstracts International 62-10B
主題 Health Sciences, Nursing
Health Sciences, Medicine and Surgery
0569
0564
Alt Author University of Missouri - Saint Louis
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