Ten Berge D M, Braem M J, Altenburg A, Dieltjens M, Van de Heyning P H, Vanhaecht K, Vanderveken O M
Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Sleep Breath. 2014 May;18(2):325-34. doi: 10.1007/s11325-013-0888-2. Epub 2013 Sep 3.
Clinical pathways are used to organize complex care processes by providing structure and standardization. The multidisciplinary approach of oral appliance (OA) therapy for sleep-disordered breathing (SDB) is a complex and dynamic process suitable for such a structured pathway approach.
A clinical pathway for patients referred for OA therapy was developed and implemented. The aim of this study was to evaluate the impact of this clinical pathway on the time to delivery of the OA and the organization of the multidisciplinary dental sleep clinic (MDSC). The latter was achieved using the care process self-evaluation tool (CPSET).
First, development and implementation of the clinical pathway gave structure and shortened the mean time to delivery by 102 days (240 ± 70 vs. 138 ± 33 days) (Mann-Whitney U: P < 0.001). Second, the CPSET scores were obtained in a cohort of 49 healthcare professionals involved in the pathway. Overall, patient-focused organization received the highest scores (80.5 ± 9.0%), whereas cooperation with primary care received the lowest score (66.7 ± 12.4%).
This is the first project on clinical pathways in OA therapy for SDB. The implementation of the pathway in our MDSC has created a significant shortening of the time to delivery. A first evaluation of the clinical pathway using the CPSET scores indicates that all disciplines involved should be thoroughly informed in an ongoing approach.
临床路径通过提供结构和标准化来组织复杂的护理流程。口腔矫治器（OA）治疗睡眠呼吸障碍（SDB）的多学科方法是一个复杂且动态的过程，适合采用这种结构化的路径方法。
制定并实施了针对接受OA治疗患者的临床路径。本研究的目的是评估该临床路径对OA交付时间以及多学科牙科睡眠诊所（MDSC）组织的影响。后者通过护理流程自我评估工具（CPSET）来实现。
首先，临床路径的制定和实施提供了结构，并将平均交付时间缩短了102天（240±70天对138±33天）（曼-惠特尼U检验：P<0.001）。其次，在参与该路径的49名医疗保健专业人员队列中获得了CPSET分数。总体而言，以患者为中心的组织得分最高（80.5±9.0%），而与初级保健的合作得分最低（66.7±12.4%）。
这是首个关于SDB的OA治疗临床路径的项目。在我们的MDSC中实施该路径显著缩短了交付时间。使用CPSET分数对临床路径进行的首次评估表明，应持续全面地告知所有相关学科。
