Seys Deborah, Deneckere Svin, Lodewijckx Cathy, Bruyneel Luk, Sermeus Walter, Boto Paulo, Panella Massimiliano, Vanhaecht Kris
Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.
Department of Quality Management, University Hospitals Leuven, Leuven, Belgium.
J Interprof Care. 2025 Jan-Feb;39(1):48-56. doi: 10.1080/13561820.2019.1634016. Epub 2019 Aug 7.
This study evaluates whether the implementation of an in-hospital care pathway (CP) improves interprofessional teamwork across countries and tests whether improved communications ("relational coordination") is the mechanism of action. A hospital-based cluster randomized controlled trial in Ireland, Belgium, Italy, and Portugal was performed. Fifty-six interprofessional teams caring for patients admitted with an exacerbation of chronic obstructive pulmonary disease or for patients with a proximal femur fracture were included and randomly assigned to an intervention group (31 teams and 567 team members), where a CP was implemented, and a control group (25 teams and 417 team members) representing usual care. Multilevel regression and mediation analysis were applied. First, although no significant effect was found on our primary outcome relational coordination, our CP significantly improved several team inputs, team processes (team climate for innovation) and team output (the level of organized care, level of competence) indicators. Second, our team process indicator of team climate for innovation partially mediated the association between CP implementation and team output indicator of better level of organized care. In conclusion, a CP sets in motion various mechanisms that improve some but not all aspects of interprofessional teamwork. Relational coordination does not appear to be the mechanism by which team outputs are enhanced.
本研究评估医院护理路径（CP）的实施是否能改善不同国家间的跨专业团队合作，并检验沟通改善（“关系协调”）是否为作用机制。在爱尔兰、比利时、意大利和葡萄牙开展了一项基于医院的整群随机对照试验。纳入了56个照顾慢性阻塞性肺疾病急性加重患者或股骨近端骨折患者的跨专业团队，并随机分为干预组（31个团队和567名团队成员），在该组实施CP，以及代表常规护理的对照组（25个团队和417名团队成员）。应用了多水平回归和中介分析。首先，虽然未发现对我们的主要结局关系协调有显著影响，但我们的CP显著改善了几个团队投入、团队过程（创新团队氛围）和团队产出（组织化护理水平、能力水平）指标。其次，我们的创新团队氛围团队过程指标部分介导了CP实施与更好的组织化护理水平团队产出指标之间的关联。总之，CP启动了各种机制，这些机制改善了跨专业团队合作的某些而非全部方面。关系协调似乎不是增强团队产出的机制。
