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Title: Integrated care pathways for acute stroke : an evaluation of their effects using multiple approaches
Author: Kwan, Joseph Shiu Kwong
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2003
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Methods and results: I sought to evaluate the effects of ICPs for acute stroke using four approaches: 1) Assessment of the evidence from previous studies of ICPs for non-stroke conditions: I performed a review of the recent literature and found that there were a large number of randomised and non-randomised studies of ICPs for non-stroke conditions. Positive, neutral and negative findings have been reported. 2) Assessment of the evidence from previous studies of ICPs for acute stroke: I performed a Cochrane systematic review and found three randomised trials and seven non-randomised studies. There were substantial heterogeneity between the studies and most of the evidence came from non-randomised studies. I found that ICP care may significantly improve the process of care and reduce in-hospital complications, but patient satisfaction and quality of life may be lower. 3) Undertaking of a non-randomised study of the ICP introduced for acute stroke at the Western General Hospital (WGH): I performed a before-and-after study (total of 351 patients) to assess the effects of introducing an ICP in a stroke unit. I found that, after its introduction, there were significant improvements in the quality of documentation and certain aspects of patient care, and the risk of urinary tract infection was reduced. However, there was no significant difference in death or discharge destination. I also assessed in the process of care and outcomes between stroke unit care after the introduction of the ICP and general medical ward care (total of 285 patients). The results were consistent with those of the before-and-after study. 4) Undertaking of a questionnaire survey to assess the experience of the stroke unit staff regarding the use of the ICP for acute stroke at the WGH: I found that, when the ICP was first introduced, the staff expected the ICP to improve the process and quality of care, communication and the general working environment. I repeated the survey at seven months after its introduction and found that, although certain aspects of care were felt to have improved, many of the staff’s expectations were not realised.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available