NDLI: Development and implementation of a treatment pathway to reduce coronary angiograms

Content Provider	Springer Nature : BioMed Central
Author	Jung-Henrich, Jutta Schlößler, Kathrin Uebel, Til Chikhradze, Nino Suslow, Anastasia Lindner, Nicole Fahrenkrog, Sandra Kraft, Judith Hummers, Eva Vollmar, Horst Christian Gágyor, Ildikó Heider, Dirk König, Hans-Helmut Donner-Banzhoff, Norbert
Abstract	Background The rates of coronary angiograms (CA) and related procedures (percutaneous intervention [PCI]) are significantly higher in Germany than in other Organisation for Economic Co-ordination and Development (OECD) countries. The current guidelines recommend non-invasive diagnosis of coronary heart disease (CHD); CA should only have a limited role in choosing the appropriate revascularisation procedure. The aim of the present study was to explore whether improvements in guideline adherence can be achieved through the implementation of regional treatment pathways. We chose four regions of Germany with high utilisation of CAs for the study. Here we report the results of the concomitant qualitative study. Methods General practitioners and specialist physicians (cardiologists, hospital-based cardiologists, emergency physicians, radiologists and nuclear medicine specialists) caring for patients with suspected CHD were invited to develop regional treatment pathways. Four academic departments provided support for moderation, provision of materials, etc. The study team observed session discussions and took notes. After the development of the treatment pathways, 45 semi-structured interviews were conducted with the participating physicians. Interviews and field notes were transcribed verbatim and underwent qualitative content analysis. Results Pathway development received little support among the participants. Although consensus documents were produced, the results were unlikely to improve practice. The participants expressed very little commitment to change. Although this attempt clearly failed in all study regions, our experience provides relevant insights into the process of evidence appraisal and implementation. A lack of organisational skills, ignorance of current evidence and guidelines, and a lack of feedback regarding one’s own clinical behaviour proved to be insurmountable. CA was still seen as the diagnostic gold standard by most interviewees. Conclusions Oversupply and overutilisation can be assumed to be present in study regions but are not immediately perceived by clinicians. The problem is unlikely to be solved by regional collaborative initiatives; optimised resource planning within the health care system combined with appropriate economic incentives might best address these issues.
Related Links	https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-024-10904-5.pdf
Ending Page	9
Page Count	9
Starting Page	1
File Format	HTM / HTML
ISSN	14726963
DOI	10.1186/s12913-024-10904-5
Journal	BMC Health Services Research
Issue Number	1
Volume Number	24
Language	English
Publisher	BioMed Central
Publisher Date	2024-04-25
Access Restriction	Open
Subject Keyword	Public Health Health Administration Health Informatics Nursing Research Small area-analysis Coronary artery disease Guideline Adherence Standard of Care [MeSH] Treatment pathway [non-MeSH]
Content Type	Text
Resource Type	Article
Subject	Health Policy

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

Impact of patient involvement on clinical practice guideline development: a parallel group study

Health care personnel’s perception of guideline implementation for musculoskeletal imaging: a process evaluation

Factors influencing adherence to clinical practice guidelines in patients with suspected chronic coronary syndrome: a qualitative interview study in the ambulatory care sector in Germany

Effectiveness of a tailored implementation strategy to improve adherence to a guideline on mental health problems in occupational health care

The implementation of national action program diabetes in the Netherlands: lessons learned

Complexity and involvement as implementation challenges: results from a process analysis

Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice

The effectiveness of clinical guideline implementation strategies in oncology—a systematic review

Reporting standards for guideline-based performance measures

Development and implementation of a treatment pathway to reduce coronary angiograms - lessons from a failure

Similar Documents

Impact of patient involvement on clinical practice guideline development: a parallel group study

Health care personnel’s perception of guideline implementation for musculoskeletal imaging: a process evaluation

Factors influencing adherence to clinical practice guidelines in patients with suspected chronic coronary syndrome: a qualitative interview study in the ambulatory care sector in Germany

Effectiveness of a tailored implementation strategy to improve adherence to a guideline on mental health problems in occupational health care

The implementation of national action program diabetes in the Netherlands: lessons learned

Complexity and involvement as implementation challenges: results from a process analysis

Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice

The effectiveness of clinical guideline implementation strategies in oncology—a systematic review

Reporting standards for guideline-based performance measures

Development and implementation of a treatment pathway to reduce coronary angiograms - lessons from a failure