van Hoeve Jolanda C, Elferink Marloes A G, Klaase Joost M, Kouwenhoven Ewout A, Schiphorst Pieter Paul J B M, Siesling Sabine
Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands,
Int J Colorectal Dis. 2015 Jun;30(6):787-95. doi: 10.1007/s00384-015-2209-7. Epub 2015 Apr 14.
Introducing care pathways is seen as a method to realise patient-focussed care conform evidence-based guidelines. The goal of this study is to determine the long-term effects of a regional care pathway for patients with rectal cancer.
Data on almost 400 patients with rectal carcinoma from three hospitals were obtained from the Netherlands Cancer Registry and the Dutch Surgical Colorectal Audit. Results on seven structure and process indicators were analysed and compared before and at two time points after implementing a regional care pathway over a total period from 2007 to 2012. To determine motivation and interpret the results, relevant professionals of the participating hospitals were interviewed.
After implementing the care pathway, the performance of computed tomography (CT) scans in the diagnostic phase significantly improved (p = 0.007/0.07). The number of patients discussed in the preoperative multidisciplinary team (MDT) meeting improved significantly (p = <0.001), and after implementing the care pathway, 94% of the patients were discussed. Further, a significant reduction in time between the first tumour biopsy and the MDT meeting was realised (p = 0.01). Professionals stated that the regional care pathway has led to more clarity about the patient route and more awareness about complying with evidence-based guidelines.
The regional care pathway provided a solid basis for uniforming care, working according evidence-based guidelines and further cooperation on regional level. For mainly the waiting and throughput times, the guidelines and norms had probably a stronger effect on the results than the care pathway.
引入护理路径被视为一种实现以患者为中心的循证护理的方法。本研究的目的是确定直肠癌患者区域护理路径的长期效果。
从荷兰癌症登记处和荷兰结直肠外科审计中获取了来自三家医院近400例直肠癌患者的数据。在2007年至2012年的整个期间实施区域护理路径之前以及实施后的两个时间点，对七个结构和过程指标的结果进行了分析和比较。为了确定动机并解释结果，对参与医院的相关专业人员进行了访谈。
实施护理路径后，诊断阶段计算机断层扫描（CT）的执行情况显著改善（p = 0.007/0.07）。术前多学科团队（MDT）会议讨论的患者数量显著增加（p = <0.001），实施护理路径后，94%的患者得到了讨论。此外，首次肿瘤活检与MDT会议之间的时间显著缩短（p = 0.01）。专业人员表示，区域护理路径使患者的就医流程更加清晰，并且提高了对遵循循证指南的认识。
区域护理路径为统一护理、遵循循证指南以及在区域层面进一步合作提供了坚实的基础。对于主要的等待时间和周转时间而言，指南和规范对结果的影响可能比护理路径更大。
