Bilò Maria Beatrice, Corsi Alice, Pravettoni Valerio, Bignardi Donatella, Bonadonna Patrizia, Quercia Oliviero, Mauro Marina, Novembre Elio, Micheletti Rebecca, Papa Roberto
1Allergy Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
2Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy.
Clin Transl Allergy. 2020 Mar 4;10:8. doi: 10.1186/s13601-020-00312-3. eCollection 2020.
Hymenoptera venom allergy (HVA) is an underestimated condition representing an important cause of morbidity and mortality worldwide. Preventing future allergic reactions in patients who have already developed a systemic reaction is based on the correct management of the acute phase of the reaction followed by a correct diagnosis and, where indicated, prescription of adrenaline autoinjectors and VIT. A possible strategy to optimize care processes and to improve outcomes is the implementation of a Diagnostic and Therapeutic Care Pathways, also known as Integrated Care Pathways or Clinical Pathways (CPWs). The aim of the care pathway is to enhance the quality of care by improving risk-adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. To our knowledge, currently in Italy as well as in Europe, there is no CPWs codified for the management of HVA patients. This paper describes the development of the clinical content of a care pathway for the management of HVA.
The methodology applied is based on the eight step method to build the clinical content of an evidence-based care pathway suggested by Lodewijckx et al.
Three hundred and seventeen different clinical activities were extracted from the selected literature. The expert panel was involved in their evaluation, expressing a judgment of relevance through the Delphi study. As a result, 126 clinical activities were appraised to be valid and feasible. The final recommendations (126) were translated into 123 key interventions. Six indicators were produced by the clinical activities.
A set of 123 key interventions and of six process indicators were found to be appropriate for the development and standardization of the clinical content of the Hymenoptera venom allergy care pathway.
膜翅目昆虫毒液过敏（HVA）是一种被低估的疾病，是全球发病和死亡的重要原因。预防已发生全身反应的患者未来发生过敏反应，基于对反应急性期的正确处理，随后进行正确诊断，并在必要时开具肾上腺素自动注射器和毒液免疫疗法（VIT）的处方。优化护理流程和改善治疗效果的一种可能策略是实施诊断和治疗护理路径，也称为综合护理路径或临床路径（CPW）。护理路径的目的是通过改善风险调整后的患者治疗效果、促进患者安全、提高患者满意度和优化资源利用来提高护理质量。据我们所知，目前在意大利以及欧洲，尚无针对HVA患者管理编纂的CPW。本文描述了HVA管理护理路径临床内容的制定。
所应用的方法基于Lodewijckx等人提出的构建循证护理路径临床内容的八步法。
从选定的文献中提取了317项不同的临床活动。专家小组参与了对这些活动的评估，通过德尔菲研究表达相关性判断。结果，126项临床活动被评估为有效且可行。最终建议（126条）被转化为123项关键干预措施。临床活动产生了6项指标。
发现一组123项关键干预措施和6项过程指标适用于膜翅目昆虫毒液过敏护理路径临床内容的制定和标准化。
