Using a 10-step framework to support the implementation of an evidence-based clinical pathways programme

Abstract

BackgroundIntegration of evidence into practice is suboptimal. Clinical pathways, defined as multidisciplinary care plans, are a method for translating evidence into local settings and have been shown to improve the value of patient care.ObjectiveTo describe the development of a clinical pathways programme across a large academic healthcare system.MethodsWe use a 10-step framework (grounded in the Knowledge-to-Action framework and ADAPTE Collaboration methodology for guideline adaptation) to support pathway development and dissemination, including facilitating clinical owner and stakeholder engagement, developing pathway prototypes based on rapid reviews of the existing literature, developing tools for dissemination and impact assessment. We use a cloud-based technology platform (Dorsata, Washington, DC) to assist with development and dissemination across our geographically distributed care settings and providers. Content is viewable through desktop and mobile applications. We measured programme adoption and penetration by examining number of pathways developed as well as mobile application use and pathway views.ResultsFrom 1 February 2016 to 30 April 2018, a total of 202 pathways were disseminated. The three most common clinical domains represented were oncology (46.5%, n=94), pulmonary/critical care (8.9%, n=18) and cardiovascular medicine (7.4%, n=15). Users opting to register for a personal account totalled 1279; the three largest groups were physicians (45.1%, n=504), advanced practice providers (19.5%, n=245) and nurses (19.1%, n=240). Pathway views reached an average of 2150 monthly views during the last 3 months of the period. The majority of pathways reference at least one evidence-based source (93.6%, n=180).ConclusionsA healthcare system can successfully use a framework and technology platform to support the development and dissemination of pathways across a multisite institution.

Paving the Way for Patient Pathways: Synthesizing a User-Centered Method Design with Results from a Systematic Literature Review

“…All existing approaches guide the practical steps or phases of preparing, developing, implementing, maintaining, and assessing/evaluating pathways. As apparent from Table 2, the approaches address various pathway concepts (clinical care maps [19], clinical pathways [20,21], (clinical) patient pathways [22], care pathways [20,23], pathway maps [24], medical processes [25], and critical pathways [17]). However, the terms are neither used uniformly nor selectively.…”

“…This method includes interviews, focus groups, surveys, or walkthroughs to understand how a patient passes through a care process and to assess patient satisfaction, expectations and preferences. While existing approaches focus mainly on intra-organizational pathways, cross-organizational patient pathways are also addressed in four of the reviewed articles ( [20,21,24,25]).…”

“…Focus and recognition: determine if pathway approach is appropriate [20], evaluate baseline data to identify need for pathway [18,20] Environmental context: domain analysis, perceive significant issues [25] Phase 2: Project management Initiate project [21] Define care process: define clinical question/problem and project scope [21,22], patient group (in-/exclusion criteria) and time period [20] Evaluate benefits and harms [18] Establish multidisciplinary development team [18,19,22,24]: define core team and broader working group [20], appoint pathway chair [24] Train and educate team on development process [19,20] Alignment: assure pathway project is in line with other projects [18] Set up project plan (timetable, tasks, assignments, resources) [18,20] Phase 3:…”

Next Steps in Improving Healthcare Value: AHRQ Evidence‐based Practice Center Program—Applying the Knowledge to Practice to Data Cycle to Strengthen the Value of Patient Care

“…The initial qualitative analysis focused on the feasibility of using the AHRQ report in an existing pathway development and dissemination framework. 18 It was found that clinical stakeholders identified the EPC report as trustworthy and more current than the society guidelines available at the time of development, particularly regarding the finding that vancomycin was more effective than metronidazole for the first occurrence of Clostridium difficile colitis. Additional qualitative analysis will be conducted to understand provider satisfaction with the pathway and practice impact.…”

Health Technology Assessment Centers—an Infrastructure for Health Systems to Translate Evidence into Practice

“…1 But synthesizing and translating evidence into practice remains a challenge. 2 What infrastructure do health systems need to facilitate consistent, evidence-based practice within their organizations?…”