Critical Pathways
Hospital Costs
Utilization Review
Efficiency, Organizational
Hospitals, University
Postoperative Care
Signal Transduction
Experience with a managed care approach to HIV infection: effectiveness of an interdisciplinary team. (1/353)
To evaluate the function and effectiveness of a multidisciplinary team for managing human immunodeficiency virus (HIV) infection, we conducted a follow-up cohort study of HIV-positive patients managed according to a clinical care path at a staff-based health maintenance organization (HMO). The study group consisted of 230 HIV-positive health plan members who received care at the Kaiser Permanente Santa Rosa medical center (KPMC-SRO). In 1994, the comparison group consisted of 4747 HIV-positive health plan members who received care at Kaiser Permanente's 18 other medical centers in northern California. The percentages of acquired immunodeficiency syndrome (AIDS) and HIV-positive patients as determined by CD4+ T-cell counts were similar (P = 0.97). Compared with patients at the other Kaiser Permanente medical centers, KPMC-SRO patients had more visits with nurse practitioners (rate ratio [RR] = 1.72) and nutritionists (RR = 12.3) and fewer visits with primary care physicians (RR = 0.82). More HIV-positive members at KPMC-SRO received social workers' services (27% at KPMC-SRO vs 6% for patients at the other Kaiser Permanente medical centers) and fewer used emergency services (RR = 0.92) and psychiatric services (RR = .89). At KPMC-SRO, the mean number of days that AIDS patients spent in the hospital decreased from 7.8 (1991) to 2.01 (1994). Hospital admissions were fewer (AIDS patients, RR = 0.67; HIV-positive patients without AIDS, RR = 0.45), and length of stay was briefer, compared with patients at the other Kaiser Permanente Medical Centers. The mean cost of HIV-related drugs for patients seen at KPMC-SRO ($2343 per infected member) was lower than that for patients seen elsewhere in the region ($3289 per infected member). These results suggest that in an HMO setting, managed care provided by a dedicated interdisciplinary team according to a clinical care path can substantially and favorably affect resource use. (+info)The development and implementation of normal vaginal delivery clinical pathways in a large multihospital health system. (2/353)
The entire country has become more concerned with healthcare costs due to managed care, capitation risk-based contracts, and the near elimination of the cost-plus reimbursement system. Clinical pathways have become one way to reduce unnecessary resource consumption by reducing provider variance, improving clinical outcomes, and reducing cost. We present here our rationale and process for developing a common clinical pathway for normal vaginal delivery in a large and varied multihospital system. We also discuss how this new pathway is expected to improve quality of care and reduce costs. (+info)Influence of a critical path management tool in the treatment of acute myocardial infarction. Clinical Quality Improvement Network Investigators. (3/353)
OBJECTIVE: The primary objective of this study was to determine the effect of implementing a critical path on use of proven efficacious therapies and outcomes in patients admitted to a hospital with acute myocardial infarction (AMI). The secondary objectives were to evaluate the use of unproven medications and to develop an understanding of the factors associated with adverse in-hospital outcomes in these patients. STUDY DESIGN: A nonrandomized before-after study design was used to evaluate the efficacy of a critical path instrument in patients admitted to hospital with AMI. PATIENTS AND METHODS: Consecutive patients admitted with AMI in nine participating hospitals were enrolled in the study. The critical path instrument consisted of a locally developed, preprinted physician order form. Practice patterns were determined before (n = 2305) and after (n = 2349) implementation of the critical path by primary chart review. Multivariate analysis of risk factors for mortality was performed on a combined database of 6088 AMI patients. RESULTS: The use of acetylsalicylic acid (ASA), nitrates, and beta blockers increased significantly by 3%, 2%, and 9%, respectively, after implementation of the critical path. Use of thrombolytics remained stable at 41%, and calcium channel blocker use decreased significantly by 8%. In-hospital mortality decreased by 1%. There was less use of ASA, nitrates, beta blockers, and thrombolytic therapy in women and the elderly. Multivariate analysis showed that advanced age was associated with increased mortality risk, whereas ASA, beta blockers, nitrates, and calcium channel blockers were associated with reduced mortality risk. CONCLUSION: Implementation of a critical path resulted in increased use of proven efficacious therapies, reduced use of noneffective therapy, and a trend toward reduced mortality. (+info)Evaluating and improving the delivery of heart care: the University of Michigan experience. (4/353)
With increasing pressure to curb escalating costs in medical care, there is particular emphasis on the delivery of cardiovascular services, which account for a substantial portion of the current healthcare dollar spent in the United States. A variety of tools were used to improve performance at the University of Michigan Health System, one of the oldest university-affiliated hospitals in the United States. The tools included initiatives to understand outcomes after coronary bypass operations and coronary angioplasty through use of proper risk-adjusted models. Critical pathways and guidelines were implemented to streamline care and improve quality in interventional cardiology, management of myocardial infarction, and preoperative assessment of patients undergoing vascular operations. Strategies to curb unnecessary costs included competitive bidding of vendors for expensive cardiac commodities, pharmacy cost reductions, and changes in nursing staff. Methods were instituted to improve guest services and partnerships with the community in disease prevention and health promotion. (+info)Infrarenal aortic surgery with a 3-day hospital stay: A report on success with a clinical pathway. (5/353)
PURPOSE: This paper reports on an experience with a clinical pathway for elective infrarenal aortic surgery (AS) that targeted hospital discharge on postoperative day (POD) 3. The pathway incorporated early feeding, early ambulation, and selective use of the intensive care unit (ICU). METHODS: A review of 50 consecutive hospital discharges after AS (aneurysm repair and aortofemoral bypass grafting) by a single surgeon performed from April 1996 through June 1998 with this clinical pathway is reported. The data collected included morbidity rate, mortality rate, length of stay (LOS), and number of hospital readmissions. RESULTS: The average LOS for all patients was 3.0 days. Only six patients (12%) were admitted to the ICU. Discharge on POD 3 was achieved in 80% of the group (40 of 50), and increasing experience improved compliance, with 92% of the most recent 25 patients (23 of 25) being discharged by POD 3. Eleven of these 25 patients (44%) were discharged on POD 2. No patient was readmitted to the hospital within a 30-day period after discharge. There was no mortality after AS during this period. CONCLUSION: Factors that limit the discharge of patients recovering from AS include the ability to ambulate independently and to tolerate a diet. Ambulation and feeding on POD 1 were well tolerated by most patients, which shortened the period of hospitalization. Admission to the ICU was infrequently required when a monitored surgical step-down unit was available. Discharge by POD 3 for AS has been proven to be routinely achievable, safe, and well accepted by patients and to reduce the cost of hospitalization. (+info)The role of clinical practice guidelines in disease management. (6/353)
This activity is designed for medical directors, pharmacy directors, quality assurance managers, and all members of disease management or quality improvement teams. GOAL: To review the guideline literature and help healthcare organizations plan guideline development and implementation strategies. OBJECTIVES: 1. Clarify the terminology used in practice policy development. 2. Explain how guideline implementation is related to disease management. 3. Discuss interventions utilized to enhance guideline adoption. 4. Provide a stepwise plan for healthcare organizations to follow. (+info)New picture archiving and communications system plus new facility equals critical path planning challenge. (7/353)
The architectural design and construction of a new imaging department is one of the most complex challenges in healthcare architecture. When a client also plans a simultaneous change in basic operating system technology from film-based to filmless imaging, the challenge for both hospital management and the facility/technology design team is even more complicated. A purposeful planning process plus a carefully composed team of internal and external experts are the two essentials for success in executing this difficult conversion of both facility and technology. (+info)A community hospital-based congestive heart failure program: impact on length of stay, admission and readmission rates, and cost. (8/353)
OBJECTIVE: To do an analysis of patients with a primary diagnosis of congestive heart failure at discharge before (n = 407) and after (n = 347) the implementation of a comprehensive inpatient and outpatient congestive heart failure program consistent with the guidelines of the Agency for Health Care Policy and Research. STUDY DESIGN: A retrospective analysis of the impact of the congestive heart failure program on length of stay, admission and readmission rates, and costs to both patient and provider. The program, which used a multidisciplinary team approach, included an intensive education program focusing on diet, compliance, and symptom recognition, as well as the use of outpatient infusions. It also incorporated aggressive pharmacologic treatment for patients with advanced congestive heart failure. RESULTS: Our analysis revealed significant decreases in length of stay, admission and readmission rates, and costs to the patient and provider (P < or = .05). The mean cost per admission decreased 17% ($1118), and a substantial 77% ($718,468) net reduction in nonreimbursed (lost) hospital revenue was noted. CONCLUSION: A multidisciplinary, comprehensive congestive heart failure program can improve patient care in a community-hospital setting while significantly reducing costs to both the patient and the institution. (+info)1. Infection: Bacterial or viral infections can develop after surgery, potentially leading to sepsis or organ failure.
2. Adhesions: Scar tissue can form during the healing process, which can cause bowel obstruction, chronic pain, or other complications.
3. Wound complications: Incisional hernias, wound dehiscence (separation of the wound edges), and wound infections can occur.
4. Respiratory problems: Pneumonia, respiratory failure, and atelectasis (collapsed lung) can develop after surgery, particularly in older adults or those with pre-existing respiratory conditions.
5. Cardiovascular complications: Myocardial infarction (heart attack), cardiac arrhythmias, and cardiac failure can occur after surgery, especially in high-risk patients.
6. Renal (kidney) problems: Acute kidney injury or chronic kidney disease can develop postoperatively, particularly in patients with pre-existing renal impairment.
7. Neurological complications: Stroke, seizures, and neuropraxia (nerve damage) can occur after surgery, especially in patients with pre-existing neurological conditions.
8. Pulmonary embolism: Blood clots can form in the legs or lungs after surgery, potentially causing pulmonary embolism.
9. Anesthesia-related complications: Respiratory and cardiac complications can occur during anesthesia, including respiratory and cardiac arrest.
10. delayed healing: Wound healing may be delayed or impaired after surgery, particularly in patients with pre-existing medical conditions.
It is important for patients to be aware of these potential complications and to discuss any concerns with their surgeon and healthcare team before undergoing surgery.
CGAS-STING cytosolic DNA sensing pathway
Lorna Breen
Peripartum cardiomyopathy
Internal medicine
Obesity paradox
Axonotmesis
Notch signaling pathway
Saturated fat
Lectin pathway
European Pathway Association
English as a second or foreign language
Cortico-basal ganglia-thalamo-cortical loop
Basal ganglia
Medium spiny neuron
Claude Raffestin
Nate Smith (musician)
Binding site
Fundic gland polyposis
Hippo signaling pathway
Orofaciodigital syndrome 1
Religion and health
MTORC2
Zaragozic acid
Ciliopathy
Marden-Walker syndrome
Vascular endothelial growth factor C
Pulvinar nuclei
Chloramination
Urotensin-II receptor
CNOT9
Digital self-determination
Health realization
United States border security concerns
Special Report on Global Warming of 1.5 °C
Resource curse
Hibernation
Death-associated protein 6
TENM3
Papillary tumors of the pineal region
Wetar Strait
Metabolism
PSMD7
Myelin-associated glycoprotein
CD278
Interferon
Sydney Secondary College Leichhardt Campus
Synthetic musk
Topical fluoride
Montessori education
Poughkeepsie Day School
Toll-like receptor 6
Pre-Bötzinger complex
Zinc deficiency
Environmental effects of shipping
Reading comprehension
Homewood High School
Jack Pettigrew
Betrayal trauma
Psychological stress and sleep
PDCD10
Central amygdala ERK signaling pathway is critical to incubation of cocaine craving
Mount Sinai Researchers Uncover a Neural Pathway that is Critical to Correcting Behavioral Errors Relevant to Many Psychiatric...
Pages that link to "Abdominal pain duration critical pathways" - wikidoc
Training course on the inpatient management of severe acute malnutrition: module 3: initial management. Web annex A: critical...
ERIC - EJ1067544 - Pathways from Polyvictimization to Youth Problem Behaviors: The Critical Role of School Engagement,...
Pathways of psychodramatic research: between critical action research and intervention research
Results of search for 'su:{Critical pathways.}'
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WHO HQ Library catalog
IMS Curated Pathways
A monocyte-leptin-angiogenesis pathway critical for repair post-infection. | Nature;609(7925): 166-173, 2022 09. | MEDLINE ...
Using Proteomics To Elucidate Critical Signaling Pathways
- KAUST FACULTY PORTAL
Postdoctoral Position to Study Critical Pathways in Cancer Metabolism - Glunde LAB
IBM, Vodafone, and GSMA Outline Critical Pathways to Protect Telcos - TelecomDrive
The way out of the pandemic: what the modelling says - ABC Radio National
The Krishnamurthy Lab
Aalto University
Strategies to Improve the Integration of Community Health Workers Into Health Care Teams: "A Little Fish in a Big Pond"
Complementary anti-cancer pathways triggered by inhibition of sideroflexin 4 in ovarian cancer | Scientific Reports
Eunice Kennedy Shriver National Institute of Child Health and Human Development - NICHD
Critical assessment of human metabolic pathway databases: a stepping stone for future integration › Research Explorer
State of COPD Research | NHLBI, NIH
NOT-CA-19-010: NCI Request for Information (RFI): Input to Advance Computational Approaches in Cancer Prevention Science
Michael O'Connell, Ph.D. | NIH: National Institute of Allergy and Infectious Diseases
NIMH » Social Disconnection and Late-Life Suicide: Mechanisms, Treatment Targets, and Interventions - Day One, Part Two
Publications - Min Li, Ph.D. - NIDDK
Clinical Pathway for Suicide Risk Screening in Adult Primary Care Settings: Special Recommendations - PubMed
A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 ...
Publication Detail
Ethylene Glycol and Propylene Glycol Toxicity: Literature Cited | Environmental Medicine | ATSDR
Regulate2
- We have identified and biologically characterized several critical pathways that regulate allergic responses. (cincinnatichildrens.org)
- Ubiquitin (yellow) can modify proteins and target them for degradation by the proteosome (right, violet) and can regulate pathways implicated in disease formation. (asbmb.org)
Clinical5
- Seeking to reduce opioid use and improve patient safety at UTMC, Dr. Vanterpool and her colleagues implemented pain management pathways to standardize and streamline acute pain management at the hospital, which were innovative healthcare delivery system strategies initiated by Jerry Epps, MD, UTMC's CMO, and the medical clinical pathways development team. (beckershospitalreview.com)
- Since implementing the pathways in 2016, UTMC has seen significant improvements in patient safety, staff communication and clinical accuracy. (beckershospitalreview.com)
- The pathways also contain safeguards the ensure the accuracy of clinical pain diagnoses, according to Dr. Vanterpool. (beckershospitalreview.com)
- Guidelines/Recommendations (revised 12/3/2015) clinical adj3 pathway).ti,ab,kw. (bvsalud.org)
- or (clinical adj3 pathways).ti,ab,kw. (bvsalud.org)
Acute2
- Our Acute and Critical Care pathway incorporates issues such as health assessment, as well as the treatment of cardiac patients or patients in other acute settings. (gradireland.com)
- During an interview with Becker's Hospital Review, Dr. Vanterpool spoke about the acute pain pathways, how they benefited the organization and key challenges associated with their implementation. (beckershospitalreview.com)
Degradation1
- The unit focuses on the characterization of molecules, degradation pathways and defines critical quality attributes in a phase appropriate context. (bcm.edu)
Metabolic1
- The Glunde lab combines multinuclear magnetic resonance spectroscopy and imaging with complementary molecular and biochemical methods to investigate metabolic pathways that are critical in cancer development and response to therapy. (glundelab.org)
Intracellular1
- Their results expand our knowledge of the light-regulated protein quality control mechanism in photosynthetic organisms, which is critical for maintaining intracellular homeostasis during day-night alternation. (asbmb.org)
Practice1
- The course is delivered through the five specialist pathways long associated with the School of Nursing & Midwifery, enabling students from differing professional backgrounds to review their own practice and share balanced and critical findings that contribute towards improving the quality and efficiency of health and social care provision on a global level. (gradireland.com)
Metabolism1
- Insulin is a critical hormone that regulates sugar metabolism. (fda.gov)
Chronic diseases1
- In recognition of the increasing burden of diabetes and other NCDs as a major socio-economic challenge, Government of Uganda is scaling up critical care pathways for managing chronic diseases including diabetes up to primary health care level," said Hon. Margaret Muhanga, the Minister of State for Primary Health Care. (who.int)
Targets2
- These signaling pathways are all potential targets for anti-fibrotic treatments. (spandidos-publications.com)
- Therefore, interrogation of potential organophosphorylation targets and aberrant phosphoprotein responses of critical signaling pathways in the STR were conducted. (cdc.gov)
Enzymes2
- Second, because enzymes critical to multiple DNA repair pathways require Fe-S clusters for their function, DNA repair enzymes and DNA repair itself are inhibited by reduction of SFXN4. (nature.com)
- Dysregulation of ubiquitylation enzymes can lead to activation or deactivation of pathways implicated in diseases, including cancer and neurodegeneration. (asbmb.org)
Care4
- In 2010, Congress, through the Biologics Price Competition and Innovation Act (BPCI Act), gave the FDA the authority to implement a pathway for approval of biosimilar and interchangeable products, to open biologics to competition, ultimately providing more treatment options, increasing access to lifesaving medications and potentially lowering health care costs. (fda.gov)
- Students following this pathway will explore the latest evidence for the care and treatment of cancer patients, including palliative care. (gradireland.com)
- or algorithms/ or care pathway.ti,ab,kw. (bvsalud.org)
- 3 The term emergency, critical and operative care (ECO-) system is used here to refer to emergency, critical and operative care services and the mechanisms that ensure they are accessible to the people who need them. (who.int)
Nursing1
- Students completing this pathway will often come from a Midwifery or Children's Nursing background. (gradireland.com)
Paths2
- These courses are specifically for Rotarians and Rotaractors and reflects projects from various paths in Pathways, already available to Toastmasters. (toastmasters.org)
- If the central UN processes at COP27 fail to deliver the necessary support for small and vulnerable states, there are alternatives paths to change that speakers at our next Critical Conversation will consider. (commonwealthfoundation.com)
Assessment2
- This structured program is based on current Pathways content, relying on self-assessment, independent study, applied projects, peer-to-peer feedback, and reflection. (toastmasters.org)
- The pathways aim to promote the accurate assessment of pain, along with safe and effective pain management practices. (beckershospitalreview.com)
Responsiveness1
- Results suggest that the incubation of cocaine craving is mediated by time-dependent increases in the responsiveness of the central amygdala ERK pathway to cocaine cues. (nih.gov)
Protein2
- This gene provides instructions for making a protein called glypican 3, which blocks (inhibits) a developmental pathway called the hedgehog signaling pathway. (medlineplus.gov)
- Target signaling pathways include the TGF-β/SMAD, TNF-α/NF-κB, leptin, IFN-γ/signal transducer and activator of transcription 3, adipoR/mitogen-activated protein kinase and peroxisome proliferator-activated receptor-α signaling pathways. (spandidos-publications.com)
Content3
- While these courses take content from Pathways, they are not as in-depth as the Pathways projects. (toastmasters.org)
- There is content included in Pathways projects that will be critical to the new Toastmaster's learning. (toastmasters.org)
- the leadership development and communication courses would be more of a sample of the Pathways content. (toastmasters.org)
Current1
- Chapters discuss current teaching and critical thought within the discipline, identify promising analytical approaches through which to research key aspects of social transformation, and investigate the relationship between sociology and its various publics. (e-elgar.com)
Engagement1
- Based on the existing empirical literature and several unifying theories, we present a conceptual model that documents pathways from polyvictimization to multiple youth problem behaviors, with school engagement as a key mediator. (ed.gov)
Health3
- It eventually leads to cirrhosis of the liver and liver failure, and it is a critical threat to the health and lives of patients with chronic liver diseases. (spandidos-publications.com)
- A robust pathway for generic competition is critical to expanding drug access and promoting public health. (fda.gov)
- Until recently, biologics lacked effective competition because there was no abbreviated pathway for bringing follow-on versions of biologics to market under the Public Health Service Act (PHS Act), similar to the generic pathway we have for small molecule drugs under created under the 1984 Hatch Waxman amendments to the Federal Food, Drug, and Cosmetic Act (FD&C Act). (fda.gov)
Topic1
- or Consensus Development Conferences as Topic/ or Consensus Development Conferences, NIH as Topic/or critical pathway/ or guidance.ti,ab. (bvsalud.org)
Formation1
- Module de formation pour la prise en charge syndromique des infections sexuellement transmissibles. (who.int)
Credit2
- Do Rotarians receive credit in Pathways if they complete the Rotary courses and then join Toastmasters? (toastmasters.org)
- No. There is no credit provided in Pathways for completing the Rotary courses. (toastmasters.org)
Projects1
- The Glunde Lab is a diverse, international, and inclusive team of faculty, postdoctoral fellows, graduate students, undergraduate researchers, and staff members who engage in open, respectful, and critical discussions of innovative scientific concepts and evolving research projects. (glundelab.org)
Important role1
- The FDA can play an important role in encouraging competition by implementing a robust pathway for biosimilar competition. (fda.gov)
Role1
- Here, we explored the role of the amygdala extracellular signal-regulated kinase (ERK) signaling pathway in this incubation. (nih.gov)
Repair2
- A monocyte-leptin-angiogenesis pathway critical for repair post-infection. (bvsalud.org)
- Unfortunately, resistance to such DNA damaging agents frequently develops, often due to increased activity of DNA repair pathways. (nature.com)
Types1
- Liver fibrosis is a continuous remodeling process involving numerous cells types, inflammatory cytokines and signaling pathways ( 5 , 6 ). (spandidos-publications.com)
Issues2
- Students completing this pathway will consider leadership and strategic issues in the global delivery of healthcare. (gradireland.com)
- To mitigate any issues that could arise from a well-trained, but inexperienced workforce, UTMC placed safeguards in the pathways, including the pain red flags, opioid sedation scale and communication scripts to prompt critical thinking, explained Dr. Vanterpool. (beckershospitalreview.com)
Perspectives1
- This incisive Research Handbook explores the critical authors, texts, and research perspectives foundational to the discipline of public sociology. (e-elgar.com)
Cancer1
- Through its participation in the Fenton reaction and other pathways, excess iron contributes to the oxidative fragility of cancer cells and heightens cancer cell susceptibility to agents that trigger oxygen radical-mediated cell death 3 . (nature.com)
Search1
- Results of search for 'su:{Critical pathways. (who.int)
Activation1
- Traditionally, inhibition of AChE and the subsequent accumulation of acetylcholine (ACh) result in the activation of the cholinergic anti-inflammatory pathway. (cdc.gov)
Access1
- But access to this critical drug can be increasingly difficult for these Americans. (fda.gov)
Level1
- A pathway is chosen based on a patient's baseline level of need, as well as the experience of the provider. (beckershospitalreview.com)
Patients1
- Évaluation de l'implantation des guichets d'accès première ligne pour les patients orphelins en Montérégie et ses impacts. (usherbrooke.ca)