Abstract
This meta-analysis was performed to assess the implementation effects of clinical pathways in patients with gastrointestinal cancer. A comprehensive search was conducted in the Cochrane Library, PubMed, EMBASE, Web of Science and Chinese Biomedical Literature Database (from inception to May 2014). Selection of studies, assessing risk of bias and extracting data were performed by two reviewers independently. Outcomes were analyzed by fixed-effects and random-effects model meta-analysis and reported as mean difference (MD), standardized mean difference (SMD) and odds ratio (OR) with 95% confidence intervals (CI). The Jadad methodological approach was used to assess the quality of included studies and the meta-analysis was conducted with RevMan 5.1 software. Nine citations (eight trials) involving 642 patients were included. The aggregate results showed that a shorter average length of stay [MD = -4.0; 95% CI (-5.1, -2.8); P < 0.00001] was observed with the clinical pathways as compared with the usual care. A reduction in inpatient expenditure [SMD = -1.5; 95% CI (-2.3, -0.7); P = 0.0001] was also associated with clinical pathways, along with higher patient satisfaction [OR = 4.9; 95% CI (2.2, 10.6); P < 0.0001]. Clinical pathways could improve the quality of care in patients with gastrointestinal cancer, as evidenced by a significant reduction in average length of stay, a decrease in inpatient expenditure and an improvement in patient satisfaction. Therefore, indicators and mechanisms within clinical pathways should be a focus in the future.
Highlights
As the second leading cause of death in developing countries and the leading cause of death in developed countries (Mathers et al, 2008), cancers have become a predominantly healthy problem worldwide
Outcomes were analyzed by fixed-effects and random-effects model meta-analysis and reported as mean difference (MD), standardized mean difference (SMD) and odds ratio (OR) with 95% confidence intervals (CI)
The aggregate results showed that a shorter average length of stay [MD = -4.0; 95% CI (-5.1, -2.8); P < 0.00001] was observed with the clinical pathways as compared with the usual care
Summary
As the second leading cause of death in developing countries and the leading cause of death in developed countries (Mathers et al, 2008), cancers have become a predominantly healthy problem worldwide. There were approximately 12.7 million cancer patients and 7.6 million died in 2008 (Jemal et al, 2011). With the arrival of aging population, gastrointestinal cancer is becoming a serious threaten to people’ health. Clinical pathways (CPW), called as critical pathways, critical paths or care paths (Every et al, 2000), were first introduced to standardize treatment in USA (Coffey et al, 1992; Pearson et al, 1995). The aim of CPW is to link evidence to practice for specific health conditions (Rotter et al, 2012). In the past few years, the implementation of CPW in clinical practices has increased significantly (Zander 2002; Vanhaecht et al, 2006; Zhu et al, 2014)
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