A Pragmatic Randomized Controlled Trial of Patient-Centered Integrated Clinical Pathways Based Versus Usual Care in an Academic Center: National Guard Health Affairs Western Region Experience
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 341
- 试验地点
- 1
- 主要终点
- Decrease in length of hospital stay by two days
研究概览
简要总结
The aim of this study is to determine if by providing a collaborative, integrated pathway-based healthcare compared to the usual healthcare, whether or not this would be superior in reducing the length of hospital stay across five high frequency /high risk medical diagnoses: Acute Venous Thromboembolism, Acute Kidney Injury, Community Acquired Pneumonia, Adult Left Ventricular Heart Failure, and Asthma.
详细描述
This study is a pragmatic randomized controlled trial. To date, there is a scarcity of randomized controlled trials looking at pathway-based, patient-centered healthcare versus usual care in several high-risk or high volume diagnoses that account for the vast majority of hospitalizations in medical settings.
In this study, the pathway care intervention is a collaborative effort that involves healthcare professionals from multiple departments, including pharmacists, health educators, nurses, social workers, nutritionists, and quality management.
For patients allocated to the usual care, these healthcare professionals will deliver standardized care when consulted. For pathway care patients, this collaborative healthcare will be default.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 14 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Inclusion Criteria (Overall Criteria):
- •One principle diagnosis
- •Hemodynamic Stability
- •Inclusion Criteria (Specific to each Diagnosis):
- •Acute Venous Thromboembolism:
- •New onset / in-patient
- •Acute Kidney Injury:
- •Patients with increased serum creatinine of more than 50% from baseline
- •Community Acquired Pneumonia:
- •Age limit
- •Adult Left Ventricular Heart Failure:
- •Age limit
- •Acute exacerbation of Asthma
排除标准
- •(Overall Criteria):
- •Intensive Care Unit (ICU) patients
- •Pregnancy
- •Exclusion Criteria (Specific to each Diagnosis):
- •Acute Venous Thromboembolism:
- •Hemodynamic instability (Systolic Blood Pressure (SBP) less than 90 mmHg or massive Pulmonary Embolism (PE)
- •PE patients with an sPESI Score ≥ 1
- •Acute Kidney Injury:
- •Critical care patients (ICU, Coronary Care Unit, burn units)
- •Stage 4 and 5 chronic kidney diseases
- •Kidney allograft recipients
- •Obstructive uropathy
- •Glomerulonephritis
- •Interstitial nephritis
- •Community Acquired Pneumonia:
- •Intensive Care Unit (ICU) patients
- •Pregnancy
- •Adult Left Ventricular Heart Failure:
- •All non-cardiogenic pulmonary edema
- •Patients requiring Inotropic agents
- •Patients with Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis
- •Severe Asthma (Peak Expiratory Flow Rate (PEFR) less than 40 percent)
研究组 & 干预措施
Patients on Pathway Care
干预措施: Pathway-Based Care (Other)
Patients on Usual Care
结局指标
主要结局
Decrease in length of hospital stay by two days
时间窗: During hospitalization period of 7 to 10 days
次要结局
- Determinants of the Length of Stay(Upon admission until discharge)
- 30-Day Rehospitalization(After discharge up to 30 days)
- Pathway Care Specific Clinical Outcomes(Upon admission until discharge)
研究者
Majed Aljeraisy
Research Office Head
King Abdullah International Medical Research Center