APPLIED NURSING RESEAACH

Applied Nursing Research

Applied Nursing Research

Introduction

Clinical pathways (treatment plans, also referred to as Care Maps or critical paths) are important tools for all participants in the health care system. This includes the patient, clinicians, nurses, other health care workers, managed care organizations, and other payers. Clinical Pathways allow an institution to achieve high-quality and cost-effective care. Clinical pathways are useful in planning, coordinating, communicating, and evaluating patient care (Kongstvedt, 2006).

Clinical pathways allow for the development of collaborative care teams that set the plan or goals for a specific case type or diagnosis (Lighter, 2007). Teams are made up of physicians, nurses, therapists, administrators, and others who are part of the team caring for a patient with a specific diagnosis. The outcomes that have been reviewed and agreed on by an entire team are more likely to be achieved. The changes or variations in outcome are more easily explored and addressed (Kongstvedt, 2006).

The use of clinical pathways also allows for a “data driven” process related to outcomes. This helps both payers and health care providers agree on resources for care provision (Lighter, 2007). The data (benchmarking) are then incorporated into future pathways for a specific diagnosis allowing for improvement of care (best practices) as well as input into the payer's guidelines for determining reasonable care (Burr, 2006).

Clinical pathways, which define a map or plan of care for a specific diagnosis, imply coordination of all clinical activities or “time limited” paths, clarifying that the goal of resource coordination is to minimize the duration of care (Lighter, 2007). It is important to recognize that we strive for an appropriate length of stay while maximizing efficiency of care and minimizing variances in quality of care. Pathways may include preprinted order sheets, daily goals of treatment, tools for documenting care, and patient/staff education materials. Evaluation of variances (variations in care) is used to help improve the quality of care (Kongstvedt, 2006).

Discussion

Diabetes is a group of chronic metabolic diseases characterized by hyperglycemia due to a defect in insulin secretion, insulin action, or both. Diabetes mellitus increases morbidity, mortality, and health care costs through acute and chronic complications, including ketoacidosis, hyperosmolarity, cardiovascular disease, kidney disease, retinopathy, neuropathy, and limb amputations (Bradley, 2008).

The prevalence of diabetes increases with age. Approximately 8.7% of American adults are affected by diabetes mellitus, and most develop type 2 diabetes mellitus (T2DM). The incidence of T2DM increased by 61% in the United States between 1990 and 2002. Population estimates from the Centers for Disease Control and Prevention (CDC) indicate that approximately 19 million persons have diabetes mellitus. In addition, estimates of the prevalence of prediabetes (impaired fasting glucose [IFG] or impaired glucose tolerance [IGT]) indicate that approximately 35 million persons 40 to 74 years of age have IFG and that 16 million have IGT, totaling 51 million adults with prediabetes using the new American Diabetes Association (ADA) diagnostic criteria. Furthermore, Third National Health and Nutrition Examination Survey (NHANES III) data show that at least 47 million individuals in the United States have metabolic ...