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Key interventions and outcomes in joint arthroplasty clinical pathways: a systematic review |
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| Authors: | Pieter Van Herck RN MSc Kris Vanhaecht RN MSc PhD Svin Deneckere RN MSc Johan Bellemans MD PhD Massimiliano Panella MD PhD Antonietta Barbieri PharmD Walter Sermeus RN MSc PhD |
| Affiliation: | Research Fellow at the Centre for Health Services and Nursing Research, Catholic University Leuven, Belgium; Professor in Orthopedics and head of the Department of Orthopedic Surgery, University Hospitals Leuven, Belgium; Professor in Public Health, Amedeo Avogadro University of Eastern Piemont, Novara, Italy; Research Fellow, Amedeo Avogadro University of Eastern Piemont, Novara, Italy; Professor and Program Director at the Centre for Health Services and Nursing Research, Catholic University Leuven, Belgium |
| Abstract: | Rationale, aims and objectives Clinical pathways are globally used to improve quality and efficiency of care. Total joint arthroplasty patients are one of the primary target groups for clinical pathway development. Despite the worldwide use of clinical pathways, it is unclear which key interventions multidisciplinary teams select as pathway components, which outcomes they measures and what the effect of this complex intervention is. This literature study is aimed at three research questions: (1) What are the key interventions used in joint arthroplasty clinical pathways? (2) Which outcome measures are used? (3) What are the effects of a joint arthroplasty clinical pathway? Method Systematic literature review using a multiple reviewer approach. Five electronic databases were searched comprehensively. Reference lists were screened. Experts were consulted. After application of inclusion and exclusion criteria and critical appraisal, 34 of the 4055 publications were included. Results Joint arthroplasty clinical pathways address pre‐admission education, pre‐admission exercises, pre‐admission assessment and testing, admission and surgical procedure, postoperative rehabilitation, minimal manipulation, symptoms management, thrombosis prophylaxis, discharge management, primary caregiver involvement, home‐based physiotherapy and continuous follow‐up. An overview of target dimensions and corresponding indicators is provided. Clinical pathways for joint arthroplasty could improve process and financial outcomes. The effects on clinical outcome are mixed. Evidence on team and service outcome is lacking. Conclusions A set of key interventions and outcome measures is available to support joint arthroplasty clinical pathways. Team and service outcomes should be further addressed in practice and research. Meta‐analysis on the outcome indicators should be performed. Future studies should more rigorously comply with existing reporting standards. |
| Keywords: | care pathway critical pathway health care hip joint arthroplasty knee outcome and process assessment quality indicators review |