Abstract
BackgroundDespite the increased utilization of clinical pathways (CPWs) as a strategy to improve patient and system outcomes in hospitals, there remain ongoing challenges with their conceptualization, implementation, and evaluation. Theories that explain how CPWs work in hospitals are lacking, making it difficult to identify important factors for sustaining changes arising from CPWs implemented in hospitals. The objective of this realist review is to develop a program theory for CPWs in hospitals.MethodsThis is a protocol for a realist review. The review will use a six-step iterative process to develop a program theory for CPWs in hospitals: (1) development of a preliminary program theory; (2) search strategy and literature search; (3) study selection and appraisal; (4) data extraction; (5) data analysis and synthesis; and (6) stakeholder engagement. In addition to searching the gray literature and contacting authors, we will search electronic databases such as MEDLINE, NHSEED, CINAHL EBSCO, HMIC, and PsycINFO. Studies will be included based on their ability to provide data that test some aspect of the program theory. Two independent reviewers will select, screen, and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome heuristics that explains how CPWs implemented in hospitals translates to better health system outcomes.DiscussionOverall, the review aims to develop a program theory for CPWs in hospitals and to explore how, why, to what extent, and in what contexts does the implementation of CPWs in hospitals contribute to better health system outcomes. As a result, the review will provide a theoretical framework of how CPWs work in hospitals.Systematic review registrationPROSPERO CRD42018103220
Highlights
Despite the increased utilization of clinical pathways (CPWs) as a strategy to improve patient and system outcomes in hospitals, there remain ongoing challenges with their conceptualization, implementation, and evaluation
The proposed realist review will permit the development of testable hypotheses that can improve our understanding of CPWs in healthcare and how they contribute to better health system outcomes
Overall, the realist review aims to assess “how, why, to what extent and in what contexts does the effective implementation of clinical pathways in hospitals contribute to better health system outcomes?” As such, the review will create an evidence and theoretical base to support key decisionmakers involved with the implementation of CPWs in hospitals
Summary
The present protocol has been registered with the PROSPERO database (registration number: CRD42018103220) and is being reported in accordance with the reporting guidance the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement [28] (See PRISMA-P checklist in Additional file 1). Data extraction Two review authors will independently extract data from all included primary studies using a piloted draft proposition sheet to extract explanatory account propositions (EAPs) about the program theory for CPWs implementation in hospitals. Due to the focused scope of the review, we will only utilize key mechanisms in developing and refining the program theory; we will utilize mechanisms that yielded the largest impact on the outcomes of interest based on different contexts reported in the primary studies This approach makes the breadth and depth of the review manageable and tangible for translation and implementation. This process will be conducted in consultation with content specialists and other frontline users of CPWs in hospitals to refine the program theory. All stakeholders will be consulted for consent to participate and publish
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