The rapidly evolving managed care environment is challenging physicians and other members of the health care team to demonstrate the value of the care they deliver to patients in new terms. Increasingly, third party payers and patients demand that medical care be cost effective, produce high quality outcomes and be provided in a manner that is satisfying to patients and their families.Clinical practice guidelines which outline proper care of medical conditions and performance of clinical procedures are being developed by groups throughout the healthcare industry, including federal and state governments, medical specialty societies, academic medical centers and others. It is anticipated that guidelines will reduce inappropriate care and help control rising costs 1 • Clinical pathways are tools developed at specific institutions by key members of the health care team to define and standardize care in a particular setting 2 '3 . While pathways must be congruent with existing practice guidelines, they provide a more focused, detailed reference for daily management of a specific phase or episode of care in a given hospital or health care system. Clinical pathways, when developed and utilized appropriately, provide a framework for continuously evaluating outcomes including cost, patient acceptance, traditional measures such as complication rates and quality of life data 4 • While many centers successfully develop (write) pathways, the incorporation of these tools into practice, and the ongoing evaluation of the impact of the pathway is often poorly executed.The experience developing and using a pathway for the management of pneumonia in patients with cystic fibrosis is described. The Cystic Fibrosis with Pneumonia pathway has clear criteria for hospital admission as well as identification of patients who can appropriately be managed in the home setting. Key cost, quality and patient satisfaction indicators were selected and tracked. Preliminary data suggest that we have been able to reduce costs while maintaining clinical outcomes and providing services that are well received by patients. CXR PA a. uteral (II not done w /In Spirometry 48') PFT (Spirometry) ll:• not done w /in 48' • age >5 ~·n