PDF(Pubmed)
Abstract：
BACKGROUND: Confusion exists over the definition of the care pathway concept and existing conceptual frameworks contain various inadequacies which have led to implementation difficulties. In the current global context of rapidly changing health care systems, there is great need for a standardized definition and integrative framework that can guide implementation. This study aims to propose an accurate and up-to-date definition of care pathway and an integrative conceptual framework.
METHODS: An innovative hybrid method combining systematic review, concept analysis and bibliometric analysis was undertaken to summarize qualitative, quantitative, and mixed-method studies. Databases searched were PubMed, Embase and ABI/Inform. Methodological quality of included studies was then assessed.
RESULTS: Forty-four studies met the inclusion criteria. Using concept analysis, we developed a fine-grained understanding, an integrative conceptual framework, and an up-to-date definition of patient-centered care pathway by proposing 28 subcategories grouped into seven attributes. This conceptual framework considers both operational and social realities and supports the improvement and sustainable transformation of clinical, administrative, and organizational practices for the benefit of patients and caregivers, while considering professional experience, organizational constraints, and social dynamics. The proposed attributes of a fluid and effective pathway are (i) the centricity of patients and caregivers, (ii) the positioning of professional actors involved in the care pathway, (iii) the operation management through the care delivery process, (iv) the particularities of coordination structures, (v) the structural context of the system and organizations, (vi) the role of the information system and data management and (vii) the advent of the learning system. Antecedents are presented as key success factors of pathway implementation. By using the consequences and empirical referents, such as outcomes and evidence of care pathway interventions, we went beyond the single theoretical aim, proposing the application of the conceptual framework to healthcare management.
CONCLUSIONS: This study has developed an up-to-date definition of patient-centered care pathway and an integrative conceptual framework. Our framework encompasses 28 subcategories grouped into seven attributes that should be considered in complex care pathway intervention. The formulation of these attributes, antecedents as success factors and consequences as potential outcomes, allows the operationalization of this model for any pathway in any context.
METHODS: An innovative hybrid method combining systematic review, concept analysis and bibliometric analysis was undertaken to summarize qualitative, quantitative, and mixed-method studies. Databases searched were PubMed, Embase and ABI/Inform. Methodological quality of included studies was then assessed.
RESULTS: Forty-four studies met the inclusion criteria. Using concept analysis, we developed a fine-grained understanding, an integrative conceptual framework, and an up-to-date definition of patient-centered care pathway by proposing 28 subcategories grouped into seven attributes. This conceptual framework considers both operational and social realities and supports the improvement and sustainable transformation of clinical, administrative, and organizational practices for the benefit of patients and caregivers, while considering professional experience, organizational constraints, and social dynamics. The proposed attributes of a fluid and effective pathway are (i) the centricity of patients and caregivers, (ii) the positioning of professional actors involved in the care pathway, (iii) the operation management through the care delivery process, (iv) the particularities of coordination structures, (v) the structural context of the system and organizations, (vi) the role of the information system and data management and (vii) the advent of the learning system. Antecedents are presented as key success factors of pathway implementation. By using the consequences and empirical referents, such as outcomes and evidence of care pathway interventions, we went beyond the single theoretical aim, proposing the application of the conceptual framework to healthcare management.
CONCLUSIONS: This study has developed an up-to-date definition of patient-centered care pathway and an integrative conceptual framework. Our framework encompasses 28 subcategories grouped into seven attributes that should be considered in complex care pathway intervention. The formulation of these attributes, antecedents as success factors and consequences as potential outcomes, allows the operationalization of this model for any pathway in any context.
摘要：
背景：护理路径概念的定义存在混淆，现有的概念框架包含各种不足，导致实施困难。在当前全球医疗体系快速变化的背景下,非常需要一个可以指导实施的标准化定义和综合框架。这项研究旨在提出一个准确和最新的护理途径定义和一个综合的概念框架。
方法：一种结合系统综述的创新混合方法，概念分析和文献计量分析进行了定性总结，定量,和混合方法研究。搜索的数据库是PubMed，Embase和ABI/Inform。然后评估纳入研究的方法学质量。
结果：44项研究符合纳入标准。使用概念分析，我们形成了细粒度的理解，一个综合的概念框架，并通过提出分为七个属性的28个子类别，对以患者为中心的护理途径进行了最新定义。这个概念框架考虑了操作和社会现实，并支持临床的改进和可持续转型。行政,和组织实践，以造福患者和护理人员，在考虑专业经验的同时，组织约束，和社会动态。提出的流体和有效途径的属性是（i）患者和护理人员的中心性，（ii）参与护理途径的专业演员的定位，（iii）通过护理提供过程的运营管理，(四)协调结构的特殊性，(五)系统和组织的结构背景，（vi）信息系统和数据管理的作用，以及（vii）学习系统的出现。前提是路径实施的关键成功因素。通过使用后果和经验参考，如护理途径干预的结果和证据，我们超越了单一的理论目标，提出概念框架在医疗保健管理中的应用。
结论：本研究开发了以患者为中心的护理路径的最新定义和综合概念框架。我们的框架包括28个子类别，分为七个属性，在复杂的护理途径干预中应考虑这些属性。这些属性的表述，作为成功因素的先行因素和作为潜在结果的后果，允许此模型在任何上下文中对任何路径进行操作。
方法：一种结合系统综述的创新混合方法，概念分析和文献计量分析进行了定性总结，定量,和混合方法研究。搜索的数据库是PubMed，Embase和ABI/Inform。然后评估纳入研究的方法学质量。
结果：44项研究符合纳入标准。使用概念分析，我们形成了细粒度的理解，一个综合的概念框架，并通过提出分为七个属性的28个子类别，对以患者为中心的护理途径进行了最新定义。这个概念框架考虑了操作和社会现实，并支持临床的改进和可持续转型。行政,和组织实践，以造福患者和护理人员，在考虑专业经验的同时，组织约束，和社会动态。提出的流体和有效途径的属性是（i）患者和护理人员的中心性，（ii）参与护理途径的专业演员的定位，（iii）通过护理提供过程的运营管理，(四)协调结构的特殊性，(五)系统和组织的结构背景，（vi）信息系统和数据管理的作用，以及（vii）学习系统的出现。前提是路径实施的关键成功因素。通过使用后果和经验参考，如护理途径干预的结果和证据，我们超越了单一的理论目标，提出概念框架在医疗保健管理中的应用。
结论：本研究开发了以患者为中心的护理路径的最新定义和综合概念框架。我们的框架包括28个子类别，分为七个属性，在复杂的护理途径干预中应考虑这些属性。这些属性的表述，作为成功因素的先行因素和作为潜在结果的后果，允许此模型在任何上下文中对任何路径进行操作。
