Care pathways to improve care co-ordination and quality between primary and hospital care for patients with radical prostatectomy: a quality improvement project.

BACKGROUND

Care pathways are widely used in hospitals to improve quality. There is a growing interest in extending care pathways into primary care. There is little evidence on the relationship between care pathways across the primary-hospital care continuum and improvement in quality of care. Members of primary and hospital care services in the region of Bruges (Belgium) developed a care pathway for radical prostatectomy patients. An evaluation of this care pathway encountered some problems.

AIM

To assess if a revision of the care pathway would improve quality of care enhancing patient outcomes.

METHODS

An exploratory trial was performed to test the feasibility of quality measurement, the possible intervention effect and recruitment. A pre-post-intervention postal survey was used. Quality of care was translated into process and outcome indicators. These indicators were measured in two groups receiving a postal questionnaire: one group before (pre-intervention) and another group after implementation (post-intervention). A Fisher's exact test was used to compare differences for dichotomous variables, and a Mann-Whitney U-test to compare ordinal and continuous variables.

RESULTS

Observed improvements in process and outcome indicators were not statistically significant after correcting for multiple testing: 95.1% of patients received the information pack during the pre-operative consultation (versus 81.0% in the pre-intervention), 86.0% of the patients consulted a physiotherapist who specialised in pelvic floor muscle exercise treatment (versus 56.0% in the pre-intervention) and no patients experienced pain (versus 13.6% in the pre-intervention). No changes were observed for communication and co-ordination between caregivers.

CONCLUSION

Given the background of scarce evidence on the quality improvement effect of care pathways between primary and hospital care, this exploratory trial provides information about the quality measurement, the possible intervention effect and recruitment. The quality improvement process is continuing as the hospital takes further initiatives to improve well-being.