CRITICAL PATHWAYS AS A STRATEGY FOR IMPROVING CARE - PROBLEMS AND POTENTIAL

被引:376
作者
PEARSON, SD
GOULARTFISHER, D
LEE, TH
机构
[1] PARTNERS COMMUNITY HLTHCARE INC, BOSTON, MA 02199 USA
[2] HARVARD PILGRIM HLTH CARE, DEPT AMBULATORY CARE & PREVENT, BOSTON, MA 02215 USA
[3] HARVARD UNIV, BRIGHAM & WOMENS HOSP, SCH MED, BOSTON, MA 02115 USA
关键词
D O I
10.7326/0003-4819-123-12-199512150-00008
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In an era of increasing competition in medical care, critical pathway guidelines have emerged as one of the most popular new initiatives intended to reduce costs while maintaining or even improving the quality of care. Developed primarily for high-volume hospital diagnoses, critical pathways display goals for patients and provide the corresponding ideal sequence and timing of staff actions for achieving those goals with optimal efficiency. Despite the rapid dissemination of critical pathway programs in hospitals throughout the United States, many uncertainties remain about their development, implementation, and evaluation. In addition, serious concerns have been raised about their effect on patient outcomes and satisfaction with care, physician autonomy, malpractice risks, and the teaching and research missions of many hospitals. Underlying these concerns is the absence of data from controlled trials to evaluate the effects of critical pathways. Physicians should understand the potential benefits and problems associated with critical pathways because physicians are increasingly being asked to provide leadership for pathway programs. Physicians and other health service investigators should also develop methods to study pathways in evolving health care settings. Although the promise of reduced costs and improved quality is enticing, the gaps in our knowledge about critical pathways are extensive; therefore, like any new health care technology, pathway programs should be fully evaluated in order to understand the conditions under which that promise may be fulfilled.
引用
收藏
页码:941 / 948
页数:8
相关论文
共 51 条
[1]   MEDICAL-PRACTICE GUIDELINES - CURRENT ACTIVITIES AND FUTURE-DIRECTIONS [J].
AUDET, AM ;
GREENFIELD, S ;
FIELD, M .
ANNALS OF INTERNAL MEDICINE, 1990, 113 (09) :709-714
[2]   PRACTICE GUIDELINES AND PRACTICING MEDICINE - ARE THEY COMPATIBLE [J].
BROOK, RH .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1989, 262 (21) :3027-3030
[3]  
Bueno M M, 1993, Nurs Manage, V24, P51
[4]  
BUFFA ES, 1969, MODERN PRODUCTION MA
[5]   VARIATIONS IN THE USE OF MEDICAL AND SURGICAL SERVICES BY THE MEDICARE POPULATION [J].
CHASSIN, MR ;
BROOK, RH ;
PARK, RE ;
KEESEY, J ;
FINK, A ;
KOSECOFF, J ;
KAHN, K ;
MERRICK, N ;
SOLOMON, DH .
NEW ENGLAND JOURNAL OF MEDICINE, 1986, 314 (05) :285-290
[6]  
Coffey R J, 1992, Qual Manag Health Care, V1, P45
[7]  
Coffey R J, 1995, Qual Manag Health Care, V3, P14
[8]  
Crummer M B, 1993, J Cardiovasc Nurs, V7, P30
[9]  
DiJerome L, 1992, Comput Nurs, V10, P250, DOI 10.1097/00024665-199211000-00005
[10]  
Ethridge P, 1989, Nurs Manage, V20, P30