Quality in Primary Care vol:21 issue:3 pages:149-155
Care pathways are widely used in hospitals to improve quality. There is a growing interest in extending care pathways into primary care. Little evidence exists on the relationship between care pathways across the primary-hospital care continuum and improving quality of care.
Members of primary and hospital care in the region of Bruges (Belgium) developed a care pathway for radical prostatectomy patients. An evaluation of this care pathway encountered some problems.
The aim of this study was to assess if a revision of the care pathway would improve quality of care enhancing patient outcomes.
An exploratory trial was performed to test the feasibility of quality measurement, the possible intervention effect and the recruitment. A pre- post intervention mail out survey was used.
Quality of care was translated into process and outcome indicators. These indicators were measured in two groups receiving a postal questionnaire: one group before (pre-intervention) and another group after implementation (post-intervention). A Fisher exact test compared differences for dichotomous variables while a Mann-Whitney U test compared ordinal and continuous variables.
Observed improvements in process and outcome indicators were not statistically significant after correcting for multiple testing: 95.12% of the patient received the information pack during the pre-operative consultation (versus 80.95% in the pre-intervention), 86% of the patients consulted a physiotherapist specialized in pelvic floor muscle exercise treatment (versus 56% in the pre-intervention) and no patients experienced pain (versus 13.64% in the pre-intervention). No changes were observed for communication and coordination between caregivers.
Given the background of little evidence about the quality improvement effect of care pathways between primary and hospital care, this exploratory trial provides information about the quality measurement, the possible intervention effect and the recruitment.
The quality improvement process is continuing as the hospital takes further initiatives to improve well-being.