Harmonizing allergy care–integrated care pathways and multidisciplinary approaches

There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a pro...

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Autores principales:	Lydia Daniels, BSc, Sally Barker, BSc, Yoon-Seok Chang, MD, PhD, Tinatin Chikovani, MD, PhD, Audrey DunnGalvin, PhD, Jennifer D. Gerdts, BComm, Roy Gerth Van Wijk, MD, PhD, Trevor Gibbs, MB. ChB, MD, Rosalaura V. Villarreal-Gonzalez, MD, Rosa I. Guzman-Avilan, MD, MHA, Heather Hanna, MSc, Elham Hossny, MD, PhD, Anastasia Kolotilina, MD, José Antonio Ortega Martell, MD, Punchama Pacharn, MD, Cindy E. de Lira Quezada, MD, Elopy Sibanda, MD, PhD, David Stukus, MD, Elizabeth Huiwen Tham, MBBS, MRCPCH, Carina Venter, PhD, RD, Sandra N. Gonzalez-Diaz, MD, PhD, Michael E. Levin, MD, PhD, Bryan Martin, DO, Daniel Munblit, MD, PhD, John O. Warner, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Allergy Integrated care pathways Multidisciplinary team Healthcare Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/398b1c4a397c416fb8d6152a88ee1930
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spelling	oai:doaj.org-article:398b1c4a397c416fb8d6152a88ee19302021-11-12T04:29:57ZHarmonizing allergy care–integrated care pathways and multidisciplinary approaches1939-455110.1016/j.waojou.2021.100584https://doaj.org/article/398b1c4a397c416fb8d6152a88ee19302021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1939455121000788https://doaj.org/toc/1939-4551There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the ''second translational gap''. A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care.We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidelines provide the core knowledge, the key component of implementation involves education, training, and support of all healthcare professionals (HCPs), patients and their caregivers.The pathways should define the level of competence required for each clinical task. It may be useful to leave the setting of care delivery or the specific HCP involved undefined to account for variable patterns of health service delivery as well as local socioeconomic, ethnic, environmental, and political imperatives. In all cases, where competence is exceeded, it is necessary to refer to the next stage in the pathway. The success and sustainability of ICPs would ideally be judged by patient experience, health outcomes, and health economics. We provide examples of successful programs, most notably from Finland, but recommend that further research is required in diverse settings to optimize outcomes worldwide.Lydia Daniels, BScSally Barker, BScYoon-Seok Chang, MD, PhDTinatin Chikovani, MD, PhDAudrey DunnGalvin, PhDJennifer D. Gerdts, BCommRoy Gerth Van Wijk, MD, PhDTrevor Gibbs, MB. ChB, MDRosalaura V. Villarreal-Gonzalez, MDRosa I. Guzman-Avilan, MD, MHAHeather Hanna, MScElham Hossny, MD, PhDAnastasia Kolotilina, MDJosé Antonio Ortega Martell, MDPunchama Pacharn, MDCindy E. de Lira Quezada, MDElopy Sibanda, MD, PhDDavid Stukus, MDElizabeth Huiwen Tham, MBBS, MRCPCHCarina Venter, PhD, RDSandra N. Gonzalez-Diaz, MD, PhDMichael E. Levin, MD, PhDBryan Martin, DODaniel Munblit, MD, PhDJohn O. Warner, MDElsevierarticleAllergyIntegrated care pathwaysMultidisciplinary teamHealthcareImmunologic diseases. AllergyRC581-607ENWorld Allergy Organization Journal, Vol 14, Iss 10, Pp 100584- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Allergy Integrated care pathways Multidisciplinary team Healthcare Immunologic diseases. Allergy RC581-607
spellingShingle	Allergy Integrated care pathways Multidisciplinary team Healthcare Immunologic diseases. Allergy RC581-607 Lydia Daniels, BSc Sally Barker, BSc Yoon-Seok Chang, MD, PhD Tinatin Chikovani, MD, PhD Audrey DunnGalvin, PhD Jennifer D. Gerdts, BComm Roy Gerth Van Wijk, MD, PhD Trevor Gibbs, MB. ChB, MD Rosalaura V. Villarreal-Gonzalez, MD Rosa I. Guzman-Avilan, MD, MHA Heather Hanna, MSc Elham Hossny, MD, PhD Anastasia Kolotilina, MD José Antonio Ortega Martell, MD Punchama Pacharn, MD Cindy E. de Lira Quezada, MD Elopy Sibanda, MD, PhD David Stukus, MD Elizabeth Huiwen Tham, MBBS, MRCPCH Carina Venter, PhD, RD Sandra N. Gonzalez-Diaz, MD, PhD Michael E. Levin, MD, PhD Bryan Martin, DO Daniel Munblit, MD, PhD John O. Warner, MD Harmonizing allergy care–integrated care pathways and multidisciplinary approaches
description	There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the ''second translational gap''. A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care.We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidelines provide the core knowledge, the key component of implementation involves education, training, and support of all healthcare professionals (HCPs), patients and their caregivers.The pathways should define the level of competence required for each clinical task. It may be useful to leave the setting of care delivery or the specific HCP involved undefined to account for variable patterns of health service delivery as well as local socioeconomic, ethnic, environmental, and political imperatives. In all cases, where competence is exceeded, it is necessary to refer to the next stage in the pathway. The success and sustainability of ICPs would ideally be judged by patient experience, health outcomes, and health economics. We provide examples of successful programs, most notably from Finland, but recommend that further research is required in diverse settings to optimize outcomes worldwide.
format	article
author	Lydia Daniels, BSc Sally Barker, BSc Yoon-Seok Chang, MD, PhD Tinatin Chikovani, MD, PhD Audrey DunnGalvin, PhD Jennifer D. Gerdts, BComm Roy Gerth Van Wijk, MD, PhD Trevor Gibbs, MB. ChB, MD Rosalaura V. Villarreal-Gonzalez, MD Rosa I. Guzman-Avilan, MD, MHA Heather Hanna, MSc Elham Hossny, MD, PhD Anastasia Kolotilina, MD José Antonio Ortega Martell, MD Punchama Pacharn, MD Cindy E. de Lira Quezada, MD Elopy Sibanda, MD, PhD David Stukus, MD Elizabeth Huiwen Tham, MBBS, MRCPCH Carina Venter, PhD, RD Sandra N. Gonzalez-Diaz, MD, PhD Michael E. Levin, MD, PhD Bryan Martin, DO Daniel Munblit, MD, PhD John O. Warner, MD
author_facet	Lydia Daniels, BSc Sally Barker, BSc Yoon-Seok Chang, MD, PhD Tinatin Chikovani, MD, PhD Audrey DunnGalvin, PhD Jennifer D. Gerdts, BComm Roy Gerth Van Wijk, MD, PhD Trevor Gibbs, MB. ChB, MD Rosalaura V. Villarreal-Gonzalez, MD Rosa I. Guzman-Avilan, MD, MHA Heather Hanna, MSc Elham Hossny, MD, PhD Anastasia Kolotilina, MD José Antonio Ortega Martell, MD Punchama Pacharn, MD Cindy E. de Lira Quezada, MD Elopy Sibanda, MD, PhD David Stukus, MD Elizabeth Huiwen Tham, MBBS, MRCPCH Carina Venter, PhD, RD Sandra N. Gonzalez-Diaz, MD, PhD Michael E. Levin, MD, PhD Bryan Martin, DO Daniel Munblit, MD, PhD John O. Warner, MD
author_sort	Lydia Daniels, BSc
title	Harmonizing allergy care–integrated care pathways and multidisciplinary approaches
title_short	Harmonizing allergy care–integrated care pathways and multidisciplinary approaches
title_full	Harmonizing allergy care–integrated care pathways and multidisciplinary approaches
title_fullStr	Harmonizing allergy care–integrated care pathways and multidisciplinary approaches
title_full_unstemmed	Harmonizing allergy care–integrated care pathways and multidisciplinary approaches
title_sort	harmonizing allergy care–integrated care pathways and multidisciplinary approaches
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/398b1c4a397c416fb8d6152a88ee1930
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Harmonizing allergy care–integrated care pathways and multidisciplinary approaches

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