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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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A Pragmatic Randomized Controlled Trial of Patient-Centered Integrated Clinical Pathways Based Versus Usual Care in an Academic Center: National Guard Health Affairs Western Region Experience

Conditions
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Heart Failure, Community Acquired Pneumonia, Venous Thromboembolism, Acute Kidney Injury, Asthma

Intervention / Treatment
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* Other: Pathway-Based Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria (Overall Criteria): One principle diagnosis Hemodynamic Stability 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 Exclusion Criteria (Overall Criteria): Intensive Care Unit (ICU) patients Pregnancy 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)

Ages Eligible for Study
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Minimum Age: 14 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Patients on Pathway Care<br> | Other: Pathway-Based Care<br>* 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.<br>|
| No Intervention: Patients on Usual Care<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Decrease in length of hospital stay by two days |  | During hospitalization period of 7 to 10 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 30-Day Rehospitalization | To determine the effect of the pathway-based care versus usual care on 30-day rehospitalization rates for the same diagnosis | After discharge up to 30 days | 
| Determinants of the Length of Stay |  | Upon admission until discharge | 
| Pathway Care Specific Clinical Outcomes | For pathway care, there are specific targeted outcomes that ought to be met. | Upon admission until discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Clinical Pathways, Length of Stay, Patient-Centered Care, Pragmatic Randomized Controlled Trial