Age and Ageing, Vol 29, 349-352, Copyright © 2000 by British Geriatrics Society
D Sulch and K Kalra
Background: an organized, goal-defined and
time-specified plan of management as envisaged by the integrated care
pathway approach can achieve quality outcomes at lower cost. Integrated
care pathways may have applications to stroke management because diagnosis
is well defined, complex interdisciplinary inputs are required and there is
good evidence on best practice.Method: we reviewed
medical, nursing, rehabilitation and health services databases to identify
studies on integrated care pathways in stroke management. Criteria for
inclusion were: use of a care pathway or similar methods in acute or
rehabilitation settings, randomized studies or non-randomized comparisons
with concurrent or historical controls and some form of outcome
assessment.Results: we identified six non-randomized
studies of acute stroke. One used concurrent controls; the rest used
historical controls. Only one study investigated stroke rehabilitation and
this used a quasi-randomized controlled design. Five studies in the acute
setting demonstrated reduced hospital stay. A reduction in costs of care
was reported in all five studies that examined costs. Two studies reported
improved uptake of medical interventions. No difference in length of
hospital stay, costs or functional status was seen in the rehabilitation
study.Conclusions: integrated care pathway methodology
may facilitate quality and cost improvements in stroke care, but evidence
is weak and uncertainty exists. Further evidence is needed before
implementation in practice.Keywords: effectiveness,
integrated care pathways, rehabilitation, stroke
ARTICLES
Systematic review. Integrated care pathways in stroke management
Department of Internal Medicine, Guy's, King's and St Thomas's School of Medicine, Denmark Hill Campus, Bessemer Road, London SE5 9PJ, UK; Corresponding author; e-mail: lalit.kalra@kcl.ac.uk
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. I. Cameron, C. Tsoi, and A. Marsella Optimizing Stroke Systems of Care by Enhancing Transitions Across Care Environments Stroke, September 1, 2008; 39(9): 2637 - 2643. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.D.H. van Wijngaarden, M. Dirks, D.W.J. Dippel, M. Minkman, and L.W. Niessen Towards effective and efficient care pathways: thrombolysis in acute ischaemic stroke QJM, April 1, 2006; 99(4): 267 - 272. [Full Text] [PDF]
|
|
|
|
|
|
N.J.A. van Exel, M.A. Koopmanschap, W. Scholte op Reimer, L.W. Niessen, and R. Huijsman Cost-effectiveness of integrated stroke services QJM, June 1, 2005; 98(6): 415 - 425. [Abstract] [Full Text] [PDF]
|
|