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Title: Impact of care pathways on the care of people with diabetes mellitus
Author: O'Brien, Sarah Victoria
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2006
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This thesis aimed to develop care pathways for the management of in-patients and outpatients with diabetes in an acute NHS Trust, to review the evidence-base for existing care pathways and to evaluate the impact of care pathways on the management of in-patients with diabetes and patients with Diabetic Nephropathy. A comprehensive literature review (using the principles of a systematic review) was completed to determine whether care pathways improved the management and or outcome of hospital in-patients with a medical or surgical condition. From this review it appears that the main potential benefits associated with the introduction of a care pathway are a reduction in length of stay, reduced costs and possible improvements in the quality of patient care. However, these findings are limited because of the poor methodology used in all of the papers reviewed and there is a need for more robust research concerning care pathways. This work has provided a systematic process for developing diabetes care pathways and examples of diabetes care pathways that could be used and adapted by other clinicians managing patients with diabetes. A randomised controlled trial examined the impact of the in-patient diabetes care pathway on HbA1c, length of stay, re-admissions within 12 months, nurse knowledge and the quality of in-patient care. In terms of the primary endpoint of HbA 1c, the null hypothesis cannot be rejected as there was no difference between the study groups. In the main, secondary endpoints improved, but limitations in the design and execution of the study preclude excessive weight being attached to these findings. Furthermore, completion of the care pathway was poor and sustaining its ongoing use outside of a research study may be difficult, further work is needed to assess the cost of wider implementation of this care pathway. A care pathway-driven Diabetic Nephropathy service was developed, implemented and evaluated to examine whether it resulted in improvements in the management of Diabetic Kidney Disease (DKD). The results demonstrated successful implementation of six key evidence-based interventions for DKD and more importantly both surrogate and hard endpoints were comparable to those achieved in recent large clinical trials, in particular, the rate of doubling of serum creatinine, progression to End Stage Renal Failure and Death. This thesis demonstrates that in some circumstances care pathways can improve implementation of evidence-based diabetes care and lead to improvements in patient outcomes. Care pathways appear to be particularly useful when used by a dedicated, appropriately trained team dealing primarily with one condition, and can be an effective tool for the implementation of evidence-based diabetes care. Further work examining the impact of care pathways in all areas of health care would be useful.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available