Evidence map›Paper›PMID 22781160›Full record

Trial reportBMC medicine2012

A cluster randomized trial to assess the effect of clinical pathways for patients with stroke: results of the clinical pathways for effective and appropriate care study.

Massimiliano Panella, Sara Marchisio, Romeo Brambilla, Kris Vanhaecht, Francesco Di Stanislao

Registry-linked trialOpen access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00673491 (Diffusion of Clinical Pathways for the Implementation of Effective and Appropriate Care), which is not on this map. Cited by 20 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 2 pooled it
5.3field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00673491 nacompletednot on this map

Diffusion of Clinical Pathways for the Implementation of Effective and Appropriate Care

TypeinterventionalSponsorAgenzia Regionale Sanitaria delle MarcheRan2005 to 2007Enrolled448ConditionsStrokeArmsClinical Pathways
3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 60 citations in OpenAlex.

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  12. The COPDnet integrated care model.International journal of chronic obstructive pulmonary disease · 2018
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 3 countries.

Massimiliano PanellaDepartment of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy. panella@med.unipmn.it
Sara Marchisio
Romeo Brambilla
Kris Vanhaecht
Francesco Di Stanislao
Università degli Studi del Piemonte Orientale “Amedeo Avogadro” · ITBitron (Italy) · ITEuropean Pathway Association · BE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundClinical pathways (CPs) are used to improve the outcomes of acute stroke, but their use in stroke care is questionable, because the evidence on their effectiveness is still inconclusive. The objective of this study was to evaluate whether CPs improve the outcomes and the quality of care provided to patients after acute ischemic stroke.

methodsThis was a multicentre cluster-randomized trial, in which 14 hospitals were randomized to the CP arm or to the non intervention/usual care (UC) arm. Healthcare workers in the CP arm received 3 days of training in quality improvement of CPs and in use of a standardized package including information on evidence-based key interventions and indicators. Healthcare workers in the usual-care arm followed their standard procedures. The teams in the CP arm developed their CPs over a 6-month period. The primary end point was mortality. Secondary end points were: use of diagnostic and therapeutic procedures, implementation of organized care, length of stay, re-admission and institutionalization rates after discharge, dependency levels, and complication rates.

resultsCompared with the patients in the UC arm, the patients in the CP arm had a significantly lower risk of mortality at 7 days (OR = 0.10; 95% CI 0.01 to 0.95) and significantly lower rates of adverse functional outcomes, expressed as the odds of not returning to pre-stroke functioning in their daily life (OR = 0.42; 95 CI 0.18 to 0.98). There was no significant effect on 30-day mortality. Compared with the UC arm, the hospital diagnostic and therapeutic procedures were performed more appropriately in the CP arm, and the evidence-based key interventions and organized care were more applied in the CP arm.

conclusionsCPs can significantly improve the outcomes of patients with ischemic patients with stroke, indicating better application of evidence-based key interventions and of diagnostic and therapeutic procedures. This study tested a new hypothesis and provided evidence on how CPs can work.

trial registrationClinicalTrials.gov ID: [NCT00673491].

Indexed as

Critical PathwaysAgedAged, 80 and overEmergency Medical ServicesFemaleFibrinolytic AgentsFollow-Up StudiesHumansMaleMiddle AgedNeurosurgical ProceduresQuality ImprovementStrokeSurvival AnalysisTreatment OutcomeFibrinolytic Agents

Identifiers

PMID22781160
PMCPMC3403956
OpenAlexW2090877401

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.