Designing an integrated care pathway for spondyloarthritis: A Lean Thinking approach.

Autor: Lobo-Prat D; Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.; Rheumatology Department, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.; Faculty of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain., Sainz L; Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.; Faculty of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain., Laiz A; Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.; Faculty of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain., De Dios A; Faculty of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.; Digital Health Validation Center, Digital Health Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.; Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Fontcuberta L; Lean Management Institute, Barcelona, Spain., Fernández S; Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain., Masip M; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.; Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Riera P; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.; Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.; CIBER de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain., Pagès-Puigdemont N; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.; Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Ros S; Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain., Gomis-Pastor M; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.; Digital Health Validation Center, Digital Health Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Corominas H; Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.; Faculty of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.; Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.
Jazyk: angličtina
Zdroj: Journal of evaluation in clinical practice [J Eval Clin Pract] 2024 Sep 10. Date of Electronic Publication: 2024 Sep 10.
DOI: 10.1111/jep.14132
Abstrakt: Introduction: Integrated care pathways (ICPs) are crucial for delivering individualised care. However, the development of ICPs is challenging and must be well designed to provide the expected benefits. Regarding this, healthcare organisations are increasingly adopting management systems based on Lean Thinking to improve their organisational processes by eliminating non-value-added steps. This study elucidates the process and evaluates the impact of applying Lean Thinking to redesign an ICP for patients with spondyloarthritis, a chronic inflammatory disease affecting young adults.
Methods: A multidisciplinary team was assembled and trained in Lean Thinking. Patient's perspective was gathered through a focus group. Guided by an expert methodologist, the team constructed a value stream map of the entire care pathway and analysed each step. Five work streams were defined to increase value at each step, leading to targeted process improvements. Key process and outcome metrics were collected and compared in 2-month baseline and post-implementation audits.
Results: A total of 118 patients were included in the baseline audit (September-October 2022), and 116 in the post-implementation audit (January-February 2023). Process redesign resulted in statistically significant improvements (p < 0.05), including a reduction in the mean number of hospital visits per patient over a 2-month period from 2.54 (SD = 0.93) to 1.84 (SD = 0.79), an increase in complementary exams scheduled on the same day (81.4% to 94.8%) and an increase in baseline disease and treatment education (from 22.2% to 84.2% and from 18.2% to 84.6%, respectively). Regarding standardisation of clinical practice, there were significant increases in collecting data for medical records on composite activity indices (76.3% to 95.7%), reporting of pharmacological treatment adherence (68.6% to 94%) and providing nonpharmacological recommendations (31.3% to 95.7%).
Conclusions: The application of Lean Thinking to redesign the spondyloarthritis ICP led to significant improvements in outpatient appointment scheduling, reduced patient hospital visits, improved interdepartmental coordination and standardised clinical practice.
(© 2024 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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