Effects of care pathways on the in-hospital treatment of heart failure: a systematic review

Abstract

BackgroundCare pathways have become a popular tool to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. We performed a disease specific systematic review to determine how care pathways in the hospital treatment of heart failure affect in-hospital mortality, length of in-hospital stay, readmission rate and hospitalisation cost when compared with standard care.MethodsMedline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched from 1985 to 2010. Each study was assessed independently by two reviewers. Methodological quality of the included studies was assed using the Jadad methodological approach for randomised controlled trials, controlled clinical trials and the New Castle Ottawa Scale for case–control studies, cohort studies and time interrupted series.ResultsSeven studies met the study inclusion criteria and were included in the systematic review with a total sample of 3,690 patients. The combined overall results showed that care pathways have a significant positive effect on mortality and readmission rate. A shorter length of hospital stay was also observed compared with the standard care group. No significant difference was found in the hospitalisation costs. More positive results were observed in controlled trials compared to randomized controlled trials.ConclusionBy combining all possible results, it can be concluded that care pathways for treatment of heart failure decrease mortality rates and length of hospital stay, but no statistically significant difference was observed in the readmission rates and hospitalisation costs. However, one should be cautious with overall conclusions: what works for one organization may not work for another because of the subtle differences in processes and bottlenecks.

How to Read a Meta-Analysis? A Guideline for Clinicians

“…In a forest plot, the result of each included study and the total effect can be easily seen. To explain the statistical part of meta-analysis the forest plots of the publication with the title "Effects of care pathways on the in-hospital treatment of heart failure: a systematic review" were used (10).…”

“…In addition to the overall comparison, it is also possible to show results for subgroups in the same forest plot. As it is mentioned, the aforementioned two main outcomes of "Effects of care pathways on the in-hospital treatment of heart failure: a systematic review" were used to show the interpretation of the statistical part of a meta-analysis with different outcomes (10). The aim of the study was to show the impact of care pathways (CPs) on chronic heart failure patient outcomes, such as hospital mortality, readmission rate, length of hospital stay, and hospitalization cost.…”

“…RRs<1 show decrease in the risk, which is demanded for mortality. Figure 1 shows forest plot to compare the rate of hospital mortality (10). For readers to understand the forest plot for hospital mortality, which is a dichotomous outcome, five steps were defined in this article.…”

“…The forest plot of comparison for the length of hospital stay is presented in Figure 2 (10). To ensure that the readers understand a forest plot, five steps are defined in this article.…”

“…Because the outcome of interest is the length of hospital stay, mean and standard deviations and the number of the total participants are given for each included study. For example, in the first study performed by Kul et al (10) in 2009, the mean length of hospital stay for the CP group was 10.4 days, and 214 patients were included in the CP group; the mean is 11.4 day and 215 patients were included in the standard care group.…”