Evaluation of the Impact of an Integrated Care Pathway for Pulmonary Embolism: a Quasi-experimental Pre-post Study

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2021 Oct 18

PMID 34659804

Authors

Nuria Rodriguez-Nunez

Alberto Ruano-Ravina

Adriana Lama

Lucia Ferreiro

Jorge Ricoy

Jose M Alvarez-Dobano

Juan Suarez-Antelo

M Elena Toubes

Carlos Rabade

Antonio Golpe

Vanessa Riveiro

Ana Casal

Romina Abelleira

Francisco Javier Gonzalez-Barcala

Jose R Gonzalez-Juanatey

Luis Valdes

Affiliations

Soon will be listed here.

Abstract

Background: An integrated care pathway (ICP) is intended to improve the management of prevalent resource-consuming, life-threatening diseases. The purpose of this study was to determine whether the quality of patient care improved with the establishment of a dedicated unit for pulmonary embolism (PE).

Methods: A quasi-experimental pre-post study (pre: years 2010-2013; post: 2015-2020; year 2014, "washing" period) of PE patients ≥18 years (January 2010-June 2020). The intervention involved the implementation of an ICP for PE.

Results: The sample was composed of 1,142 patients (510 pre-intervention and 612 post-intervention) without significant differences between the two populations. In the post-intervention period, significant reductions were observed in the median length of hospital stay (LOS) (8 6 days); time to start of oral anticoagulation therapy (4.5 3.5 days; P<0.001); and the percentage of patients with high-risk PE in whom recanalization was not contraindicated (66.7% 96%; P=0.009). In-hospital and 30-day mortality decreased, although not significantly (4.5% 2.8%; P=0.188; 6.1% 5.2%; P=0.531, respectively). Multivariate logistic regression analysis showed that the median LOS intervention decreased significantly according to the service where patients were referred to, and with the use of the simplified PESI. During follow-up, lifelong anticoagulation was prescribed to a higher proportion of patients in the post-intervention period (30.7% 69.3%; P<0.001).

Conclusions: Although an ICP for PE does not reduce mortality significantly, it improves the quality of patient care.

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