Collaborative Healthcare Professionals Approach in Monitoring of Patient Centered Outcomes Through Pathways

A Pragmatic Randomized Controlled Trial of Patient-Centered Integrated Clinical Pathways Based Versus Usual Care in an Academic Center: National Guard Health Affairs Western Region Experience

The aim of this study is to determine if by providing a collaborative, integrated pathway-based healthcare compared to the usual healthcare, whether or not this would be superior in reducing the length of hospital stay across five high frequency /high risk medical diagnoses: Acute Venous Thromboembolism, Acute Kidney Injury, Community Acquired Pneumonia, Adult Left Ventricular Heart Failure, and Asthma.

This study is a pragmatic randomized controlled trial. To date, there is a scarcity of randomized controlled trials looking at pathway-based, patient-centered healthcare versus usual care in several high-risk or high volume diagnoses that account for the vast majority of hospitalizations in medical settings.

In this study, the pathway care intervention is a collaborative effort that involves healthcare professionals from multiple departments, including pharmacists, health educators, nurses, social workers, nutritionists, and quality management.

For patients allocated to the usual care, these healthcare professionals will deliver standardized care when consulted. For pathway care patients, this collaborative healthcare will be default.

1. Inclusion Criteria (Overall Criteria):

   • One principle diagnosis
   • Hemodynamic Stability

2. Inclusion Criteria (Specific to each Diagnosis):

   Acute Venous Thromboembolism:

   • New onset / in-patient

   Acute Kidney Injury:

   • Patients with increased serum creatinine of more than 50% from baseline

   Community Acquired Pneumonia:

   • Age limit

   Adult Left Ventricular Heart Failure:

   • Age limit

   Asthma

   • Acute exacerbation of Asthma

3. Exclusion Criteria (Overall Criteria):

   • Intensive Care Unit (ICU) patients
   • Pregnancy

4. Exclusion Criteria (Specific to each Diagnosis):

Acute Venous Thromboembolism:

• Hemodynamic instability (Systolic Blood Pressure (SBP) less than 90 mmHg or massive Pulmonary Embolism (PE)
• PE patients with an sPESI Score ≥ 1

Acute Kidney Injury:

• Critical care patients (ICU, Coronary Care Unit, burn units)
• Stage 4 and 5 chronic kidney diseases
• Kidney allograft recipients
• Obstructive uropathy
• Glomerulonephritis
• Interstitial nephritis

Community Acquired Pneumonia:

• Intensive Care Unit (ICU) patients
• Pregnancy

Adult Left Ventricular Heart Failure:

• All non-cardiogenic pulmonary edema
• Patients requiring Inotropic agents

Asthma

• Patients with Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis
• Severe Asthma (Peak Expiratory Flow Rate (PEFR) less than 40 percent)