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      Experimental application of Business Process Management technology to manage clinical pathways: a pediatric kidney transplantation follow up case

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          Abstract

          Background

          To test the application of Business Process Management technology to manage clinical pathways, using a pediatric kidney transplantation as case study, and to identify the benefits obtained from using this technology.

          Methods

          Using a Business Process Management platform, we implemented a specific application to manage the clinical pathway of pediatric patients, and monitored the activities of the coordinator in charge of the case management during a 6-month period (from June 2015 to November 2015) using two methodologies: the traditional procedure and the one under study.

          Results

          The application helped physicians and nurses to optimize the amount of time and resources devoted to management purposes. In particular, time reduction was close to 60%. In addition, the reduction of data duplication, the integrated event management and the efficient data collection improved the quality of the service.

          Conclusions

          The use of Business Process Management technology, usually related to well-defined processes with high management costs, is an established procedure in multiple environments; its use in healthcare, however, is innovative. The use of already accepted clinical pathways is known to improve outcomes. The combination of these two techniques, well established in their respective areas of application, could represent a revolution in clinical pathway management. The study has demonstrated that the use of this technology in a clinical environment, using a proper architecture and identifying a well-defined process, leads to real benefits in terms of resources optimization and quality improvement.

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          Most cited references12

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          Reducing clinical variations with clinical pathways: do pathways work?

          To test clinical pathways in a variety of Italian health care organizations in 2000-2002 to measure performance in decreasing process and outcome variations. Creation of indicators, specific for each clinical pathway, to measure variations in the care processes and outcomes. Pre- and post-analysis model to evaluate the possible effect of the clinical pathways on each indicator. We tested the clinical pathways in six sites, each with different clinical pathways. Reductions in health care macro-variation phenomena (length of stay, patient pathways, etc.) and in performance micro-variation (variations in diagnostic and therapeutic prescriptions, protocol implementation, etc.) were shown in sites where pathways were implemented successfully. A significant improvement in outcome for patients who were treated according to the clinical pathway for heart failure was also demonstrated. The overall purpose of clinical pathways is to improve outcome by providing a mechanism to coordinate care and to reduce fragmentation, and ultimately cost. Our results demonstrated that it is possible to achieve this goal. Although controversial elements still exist, we think that clinical pathways can have a positive impact on quality in health care.
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            Recommendations for the outpatient surveillance of renal transplant recipients. American Society of Transplantation.

            Many complications after renal transplantation can be prevented if they are detected early. Guidelines have been developed for the prevention of diseases in the general population, but there are no comprehensive guidelines for the prevention of diseases and complications after renal transplantation. Therefore, the Clinical Practice Guidelines Committee of the American Society of Transplantation developed these guidelines to help physicians and other health care workers provide optimal care for renal transplant recipients. The guidelines are also intended to indirectly help patients receive the access to care that they need to ensure long-term allograft survival, by attempting to systematically define what that care encompasses. The guidelines are applicable to all adult and pediatric renal transplant recipients, and they cover the outpatient screening for and prevention of diseases and complications that commonly occur after renal transplantation. They do not cover the diagnosis and treatment of diseases and complications after they become manifest, and they do not cover the pretransplant evaluation of renal transplant candidates. The guidelines are comprehensive, but they do not pretend to cover every aspect of care. As much as possible, the guidelines are evidence-based, and each recommendation has been given a subjective grade to indicate the strength of evidence that supports the recommendation. It is hoped that these guidelines will provide a framework for additional discussion and research that will improve the care of renal transplant recipients.
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              Monitoring and managing graft health in the kidney transplant recipient.

              Ongoing monitoring of kidney transplants is a widely accepted and practiced part of posttransplantation management. One reason to monitor is to evaluate whether the transplant is stable. The transplant community evaluates stability by checking kidney function. Despite problems with sensitivity and specificity, obtaining serial serum creatinine levels is the most common approach to assessing kidney function. Some programs supplement serial serum creatinine levels with surveillance kidney biopsies. Although not uniformly accepted as beneficial, surveillance biopsies are useful in select subsets of patients such as highly sensitized recipients. Recent biopsy studies shed light on which histopathology findings portend poor prognoses. The Long-Term Deterioration of Kidney Allograft Function Study (DeKAF) and similar studies that will prospectively evaluate therapeutic interventions should help the transplant community better define how to monitor and manage the kidney transplant optimally. In the meantime, Kidney Diseases: Improving Global Outcomes (KDIGO) provides an evidence-based approach toward monitoring and managing the kidney transplant.
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                Author and article information

                Contributors
                +39 06 6859 4760 , martina.andellini@opbg.net
                sandra.fernandezriesgo@opbg.net
                federica.morolli@opbg.net
                matteo.ritrovato@opbg.net
                piero.cosoli@openworkbpm.com
                silverio.petruzzellis@openworkbpm.com
                nicola.rosso@opbg.net
                Journal
                BMC Med Inform Decis Mak
                BMC Med Inform Decis Mak
                BMC Medical Informatics and Decision Making
                BioMed Central (London )
                1472-6947
                3 November 2017
                3 November 2017
                2017
                : 17
                : 151
                Affiliations
                [1 ]ISNI 0000 0001 0727 6809, GRID grid.414125.7, Health Technology Assessment Unit, Bambino Gesù Children’s Hospital, ; Viale Ferdinando Baldelli, 41, 00146 Rome, Italy
                [2 ]ISNI 0000 0001 0727 6809, GRID grid.414125.7, IT Department, Bambino Gesù Children’s Hospital, ; Rome, Italy
                [3 ]ISNI 0000 0001 0727 6809, GRID grid.414125.7, Surgery Department, Bambino Gesù Children’s Hospital, ; Rome, Italy
                [4 ]Operations Director, Openwork srl, Bari, Italy
                [5 ]Product Manager, Openwork srl, Bari, Italy
                [6 ]ISNI 0000 0001 0727 6809, GRID grid.414125.7, IT Department, Bambino Gesù Children’s Hospital, ; Rome, Italy
                Author information
                http://orcid.org/0000-0002-2931-0753
                Article
                546
                10.1186/s12911-017-0546-x
                5670522
                29100512
                5c18d892-e51b-409c-aa98-df14bab9ef2d
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 24 January 2017
                : 19 October 2017
                Funding
                Funded by: The Crikhet Network
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Bioinformatics & Computational biology
                clinical pathway,kidney transplantation,pediatrics,case management,business process management

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