Research

Current research projects

Fragile Hip Fracture Recovery (2019 – )

This study aims to provide evidence-based data and insights to better understand the care process and help improve the quality, efficiency and outcomes of care pathways for patients with fragile hip fractures. The study is a collaborative effort of 15 highly motivated European centers and is made possible by the support of Zimmer Biomet (special thanks to Didier Deltort, Marc S. Ostermann, Ann Van Bulck, and off course the 15 participating hospitals (from 11 European countries).

E-P-A team: Kris Vanhaecht, Cedric Slock, Ellen Coeckelberghs, Massimiliano Panella, An Sermon & Stefaan Nijs.

Academic output

Slock, C., Sermon, A., Nijs, S., Coeckelberghs, E., Bruyneel, L., Seys, D., Panella, M., Vanhaecht, K. (2019, November). Identification of indicators to assess the variation in Fragile Hip Fractures (FHF) recovery: A European Pathway Association study. Poster presented during the 12th International Conference on ORTHOPEDICS, OSTEOPOROSIS & TRAUMA, London, UK.

Model Pathway for benchmarking the treatment of Myasthenia Gravis (MPath MG) (2019 – )

The aim of this study is to build a comprehensive and integrated Model Care Pathway for the treatment of Myasthenia Gravis (MG). This will be achieved by studying existing variations in current practice for the treatment of MG across Europe, USA and Japan, and will include several phases: 1.) The definition of evidence-based best practices and indicators gathered from literature search and/or expert meetings. 2.) The identification of a potential gap between current practice and evidence. 3.) A direction to bridge identified gaps. This study is funded by UCB Pharma and facilitates knowledge sharing among the international community of experts in the care of MG patients.

Currently, study phase 1 is completed and we are planning to execute phase 2.

E-P-A team: Massimiliano Panella, Anil babu Payedimarri, Deborah Seys, Ellen Coeckelberghs, Alessandra Vasile, Riccardo Rescinito, Matteo Ratti & Kris Vanhaecht.

Academic output

Ratti, M., Milicia, O., Rescinito, R., Coeckelberghs, E., Seys, D., Vanhaecht, K., & Panella, M. (2023). The determinants of expert opinion in the development of care pathways: insights from an exploratory cluster analysis. BMC Health Services Research, 23(1), 211.

Completed research projects

Overview on the target population and methods used in care pathway projects (2020 – 2021)

The aim of this study is to evaluate the state-of-art of the most recent CP research, to identify knowledge sharing opportunities for researchers, practitioners, scientific societies, and policy makers. The rationale for the study is that there is no current overview for what patient groups care pathways are developed, nor how care pathways are studied and how evaluation is performed. Below you will find the abstract.

Background There is evidence that the efficiency and effectiveness of care processes can be improved in all countries. Care pathways (CPs) are proposed as a method to improve the quality of care by reducing variation. During the last decades, CPs have been intensively used in practice. The objective of this study is to examine the study designs for investigating CPs, for which pathologies CPs are used and what the reported indicators to measure the impact of CPs are.

Methods A narrative review of the literature published from 2015 to 2019 was performed.

Results We identified 286 studies, of which 207 evaluated the impact of CPs, 33 were review articles, 29 studies described the development of a CP, 12 were study protocols and 5 opinion papers. The most frequently reported study design for studying the impact of a CP is pre-posttest (n = 82), followed by cross-sectional studies (n = 50). Oncology, cardiovascular disease and abdominal surgery are the domains with the highest numbers of studies evaluating the impact of CPs. Financial (n = 86), process (n = 76) and clinical indicators (n = 74) are the most frequently reported indicators while service (n = 12) and team indicators (n = 6) are less reported.

Conclusions Based on the relative low number of identified studies compared with the number of CP projects in organisations, we conclude that the CP knowledge is not only found in the literature. We, therefore, argue that (inter)national scientific societies should not only focus on searching and spreading evidence on the content of care but also enhance their knowledge sharing initiatives on the organisation of care processes.

Academic output

Seys, D., Coeckelberghs, E., Sermeus, W., Van Zelm, R., Panella, M., Babu Payedimarri, A., & Vanhaecht, K. (2021). Overview on the target population and methods used in care pathway projects: A narrative review. International Journal of Clinical Practice, e14565.

CP4NutriGICan (2016 – 2019)

This was a research and quality improvement study on implementation of care pathways for surgical patients with nutrition problems in surgical colorectal cancer. The study was designed as a process evaluation and was performed in Belgium, France, Germany and The Netherlands (with unrestricted grant from Baxter EMEA, Baxter Belgium, France, Netherlands and Germany).

Academic output

van Zelm, R., Coeckelberghs, E., Sermeus, W., Panella, M., & Vanhaecht, K. (2022). Model for Implementation and Normalization of Care Pathways-a practical workshop. International Journal of Integrated Care (IJIC), 22.

van Zelm, R., Coeckelberghs, E., Sermeus, W., Wolthuis, A., Bruyneel, L., Panella, M., & Vanhaecht, K. (2021). A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory. BMC Health Services Research, 21(1), 1-15.

van Zelm, R., Coeckelberghs, E., Aeyels, D., Sermeus, W., Wolthuis, A., Panella, M., & Vanhaecht, K. (2021). Qualitative evaluation of the implementation of a care pathway for colorectal cancer surgery. Qualitative Health Research, 31(2), 241-253.

van Zelm, R., Coeckelberghs, E., Sermeus, W., Wolthuis, A., Bruyneel, L., Panella, M., & Vanhaecht, K. (2020). Effects of implementing a care pathway for colorectal cancer surgery in ten European hospitals: an international multicenter pre–post-test study. Updates in surgery, 72(1), 61-71.

Van Zelm, R., Coeckelberghs, E., Sermeus, W., Aeyels, D., Panella, M., & Vanhaecht, K. (2018). Protocol for process evaluation of evidence-based care pathways: the case of colorectal cancer surgery. JBI Evidence Implementation, 16(3), 145-153.

van Zelm, R., Coeckelberghs, E., Sermeus, W., van Overstraeten, A. D. B., Weimann, A., Seys, D., … & Vanhaecht, K. (2017). Variation in care for surgical patients with colorectal cancer: protocol adherence in 12 European hospitals. International journal of colorectal disease, 32(10), 1471-1478.

Van Zelm, R., Janssen, I., Vanhaecht, K., de Buck van Overstraeten, A., Panella, M., Sermeus, W., & Coeckelberghs, E. (2018). Development of a model care pathway for adults undergoing colorectal cancer surgery: Evidence‐based key interventions and indicators. Journal of evaluation in clinical practice, 24(1), 232-239.

CP4ACS (2014 – 2018)

The Care Pathway for Acute Coronary Syndrome is a controlled interrupted time series design study on the impact of care pathways for ST-elevated myocardial infarction (STEMI) performed in Belgium (with unrestricted grant from Astra Zeneca Belgium).

Academic output

Aeyels, D., Bruyneel, L., Seys, D., Sinnaeve, P. R., Sermeus, W., Panella, M., & Vanhaecht, K. (2019). Better Hospital context increases success of care pathway implementation on achieving greater teamwork: a multicenter study on STEMI care. International Journal for Quality in Health Care, 31(6), 442-448.

Aeyels, D., Bruyneel, L., Sinnaeve, P. R., Claeys, M. J., Gevaert, S., Schoors, D., … & Vanhaecht, K. (2018). Care pathway effect on in-hospital care for ST-elevation myocardial infarction. Cardiology, 140(3), 163-174.

Aeyels, D., Sinnaeve, P. R., Claeys, M. J., Gevaert, S., Schoors, D., Sermeus, W., … & Vanhaecht, K. (2018). Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey. Acta cardiologica, 73(6), 518-527.

Aeyels, D., Seys, D., Sinnaeve, P. R., Claeys, M. J., Gevaert, S., Schoors, D., … & Vanhaecht, K. (2018). Managing in-hospital quality improvement: An importance-performance analysis to set priorities for ST-elevation myocardial infarction care. European Journal of Cardiovascular Nursing, 17(6), 535-542.

Aeyels, D., Van Vugt, S., Sinnaeve, P. R., Panella, M., Van Zelm, R., Sermeus, W., & Vanhaecht, K. (2016). Lack of evidence and standardization in care pathway documents for patients with ST-elevated myocardial infarction. European Journal of Cardiovascular Nursing, 15(3), e45-e51.

EQCP study (2008 – 2018)

The European Quality of Care Pathways study is an international Cluster Randomised Controlled Trial on the effect of care pathways for COPD and Fractured Neck of Femur patients (with unrestricted grant from Phizer). The study was performed in Belgium, Ireland, Italy and Portugal. We have measured process and clinical outcomes on patient level and also included indicators on teamwork.

Academic output

Seys, D., Deneckere, S., Lodewijckx, C., Bruyneel, L., Sermeus, W., Boto, P., … & Vanhaecht, K. (2019). Impact of care pathway implementation on interprofessional teamwork: An international cluster randomized controlled trial. Journal of interprofessional care, 1-9.

Panella, M., Seys, D., Sermeus, W., Bruyneel, L., Lodewijckx, C., Deneckere, S., … & Vanhaecht, K. (2018). Minimal impact of a care pathway for geriatric hip fracture patients. Injury, 49(8), 1581-1586.

Seys, D., Sermon, A., Sermeus, W., Panella, M., Bruyneel, L., Boto, P., & Vanhaecht, K. (2018). Recommended care received by geriatric hip fracture patients: where are we now and where are we heading?. Archives of orthopaedic and trauma surgery, 138(8), 1077-1087.

Seys, D., Bruyneel, L., Sermeus, W., Lodewijckx, C., Decramer, M., Deneckere, S., … & Vanhaecht, K. (2018). Teamwork and adherence to recommendations explain the effect of a care pathway on reduced 30-day readmission for patients with a COPD exacerbation. COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(2), 157-164.

Seys, D., Bruyneel, L., Deneckere, S., Kul, S., Van der Veken, L., Van Zelm, R., … & Vanhaecht, K. (2017). Better organized care via care pathways: A multicenter study. PLoS One, 12(7), e0180398.

Seys, D., Bruyneel, L., Decramer, M., Lodewijckx, C., Panella, M., Sermeus, W., … & Vanhaecht, K. (2017). An international study of adherence to guidelines for patients hospitalised with a COPD exacerbation. COPD: Journal of Chronic Obstructive Pulmonary Disease, 14(2), 156-163.

Vanhaecht, K., Lodewijckx, C., Sermeus, W., Decramer, M., Deneckere, S., Leigheb, F., … & Panella, M. (2016). Impact of a care pathway for COPD on adherence to guidelines and hospital readmission: a cluster randomized trial. International journal of chronic obstructive pulmonary disease, 11, 2897.

Deneckere, S., Euwema, M., Lodewijckx, C., Panella, M., Mutsvari, T., Sermeus, W., & Vanhaecht, K. (2013). Better interprofessional teamwork, higher level of organized care, and lower risk of burnout in acute health care teams using care pathways: a cluster randomized controlled trial. Medical care, 99-107.

Leigheb, F., Vanhaecht, K., Sermeus, W., Lodewijckx, C., Deneckere, S., Boonen, S., … & Panella, M. (2013). The effect of care pathways for hip fractures: a systematic overview of secondary studies. European journal of orthopaedic surgery & traumatology, 23(7), 737-745.

Lodewijckx, C., Sermeus, W., Panella, M., Deneckere, S., Leigheb, F., Troosters, T., … & Vanhaecht, K. (2013). Quality indicators for in‐hospital management of exacerbation of chronic obstructive pulmonary disease: results of an international Delphi study. Journal of advanced nursing, 69(2), 348-362.

Seys, D., Deneckere, S., Sermeus, W., Van Gerven, E., Panella, M., Bruyneel, L., … & Vanhaecht, K. (2013). The Care Process Self-Evaluation Tool: a valid and reliable instrument for measuring care process organization of health care teams. BMC health services research, 13(1), 1-7.

Deneckere, S., Euwema, M., Lodewijckx, C., Panella, M., Sermeus, W., & Vanhaecht, K. (2012). The European quality of care pathways (EQCP) study on the impact of care pathways on interprofessional teamwork in an acute hospital setting: study protocol: for a cluster randomised controlled trial and evaluation of implementation processes. Implementation Science, 7(1), 1-12.

Deneckere, S., Euwema, M., Van Herck, P., Lodewijckx, C., Panella, M., Sermeus, W., & Vanhaecht, K. (2012). Care pathways lead to better teamwork: results of a systematic review. Social science & medicine, 75(2), 264-268.

Leigheb, F., Vanhaecht, K., Sermeus, W., Lodewijckx, C., Deneckere, S., Boonen, S., … & Panella, M. (2012). The effect of care pathways for hip fractures: a systematic review. Calcified tissue international, 91(1), 1-14.

Lodewijckx, C., Decramer, M., Sermeus, W., Panella, M., Deneckere, S., & Vanhaecht, K. (2012). Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation. Trials, 13(1), 1-12.

Deneckere, S., Robyns, N., Vanhaecht, K., Euwema, M., Panella, M., Lodewijckx, C., … & Sermeus, W. (2011). Indicators for follow-up of multidisciplinary teamwork in care processes: results of an international expert panel. Evaluation & the health professions, 34(3), 258-277.

Lodewijckx, C., Sermeus, W., Panella, M., Deneckere, S., Leigheb, F., Decramer, M., & Vanhaecht, K. (2011). Impact of care pathways for in-hospital management of COPD exacerbation: a systematic review. International journal of nursing studies, 48(11), 1445-1456.

Vanhaecht, K., Sermeus, W., Peers, J., Deneckere, S., Lodewijckx, C., Leigheb, F., & Panella, M. (2010). The European Quality of Care Pathway (EQCP) Study: history, project management and approach. International Journal of Care Pathways, 14(2), 52-56.

Vanhaecht, K., Sermeus, W., Peers, J., Lodewijckx, C., Deneckere, S., Leigheb, F., … & Panella, M. (2010). The impact of care pathways for exacerbation of chronic obstructive pulmonary disease: rationale and design of a cluster randomized controlled trial. Trials, 11(1), 1-7.

Lodewijckx, C., Sermeus, W., Vanhaecht, K., Panella, M., Deneckere, S., Leigheb, F., & Decramer, M. (2009). Inhospital management of COPD exacerbations: a systematic review of the literature with regard to adherence to international guidelines. Journal of evaluation in clinical practice, 15(6), 1101-1110.

Prevalence and use of clinical pathways in 23 countries (2006)

Objectives. To give an overview on the use and prevalence of clinical pathways.

Design. Cross-sectional descriptive study.

Study participants. European Pathway Association contact persons in 23 countries.

Results. Clinical pathways, also known as critical pathways or integrated-care pathways have been used in health care for 20 years. Although clinical pathways are well established, little information exists on their use and dissemination around the world. The European Pathway Association (www.E-P-A.org) has performed their first international survey on the use and dissemination of clinical pathways in 23 countries. At present, pathways are used with a minority of patients, mainly in acute hospital trusts. Our survey showed that clinical pathways were predominantly viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Pathways were also used as a communication tool between professionals to manage and standardise outcome-oriented care.

Conclusions. There is a future for the use of clinical pathways, but there is need for international benchmarking and knowledge sharing with regards to their development, implementation, and evaluation.

If you use these results in your papers or presentations, please refer to the survey correctly.

Academic output

Vanhaecht, K., Bollmann, M., Bower, K., Gallagher, C., Gardini, A., Guezo, J., Jansen, U., Massoud, R., Moody, K., Sermeus, W., Van Zelm, R., Whittle, C., Yazbeck, A., Zander, K., Panella, M. (2006). Prevalence and use of clinical pathways in 23 countries — an international survey by the European Pathway Association. Journal of Integrated Care Pathways, 10(1), 28-34.