Abstract
BackgroundClinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This paper describes efforts made by a team of Cochrane Review authors to develop criteria to assist in the objective identification of clinical pathway studies from the literature.MethodsWe undertook a four-stage process aiming to develop criteria to define a clinical pathway: (1) identify publications exploring the definition of a clinical pathway; (2) derive draft criteria; (3) pilot test the criteria; and (4) modify criteria to maximise agreement between review authors.ResultsPrevious literature and liaison with the European Pathways Association resulted in five criteria being used to define a clinical pathway: (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions'; (4) the intervention had timeframes or criteria-based progression; and (5) the intervention aimed to standardise care for a specific clinical problem, procedure or episode of healthcare in a specific population. After pilot testing it was decided that if an intervention met the first criteria (a structured multidisciplinary plan of care) plus three out of the other four criteria then it was included as a clinical pathway for the purposes of this review. In all, 27 studies were included in the final review. The authors of the included studies referred to these interventions as 'clinical pathways', 'protocols', 'care model', 'care map', 'multidisciplinary care', evidence-based care' and 'guideline'.ConclusionsThe criteria used for the identification of relevant studies for this Cochrane Review can be used as a foundation for the development of a standardised, internationally accepted definition of a clinical pathway.
Highlights
Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s
Criteria The following five criteria were derived from the three sentinel articles mentioned above: (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to channel the translation of guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions'; (4) the intervention had timeframes or criteria-based progression; and (5) the intervention aimed to standardise care for a specific clinical problem, procedure or episode of healthcare in a specific population
An intervention was defined as a clinical pathway if it was a structured multidisciplinary plan of care and at least three of the remaining four criteria were met
Summary
Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. There is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This represents an enormous resource commitment both in the development of pathways, the training of staff, and in the ongoing implementation of pathways in the hospital setting In this era of evidence informed practice, it is problematic that individual studies of the impact of clinical pathways are varied and contradictory [1] and that there is still no standardised definition of what a 'clinical pathway' constitutes. This lack of a uniformly accepted definition of what constitutes a clinical pathway impacts on capacity to empirically test the evidence base and compromises planning, resourcing, development and implementation of clinical pathways. The development of minimum criteria to define a clinical pathway
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