Validation of descriptive clinical pathway criteria in the systematic identification of publications in emergency medicine

Abstract

Background: Heterogeneity in both the definition and terminology of clinical pathways presents a challenge to the systematic identification of primary studies for review purposes. Recently developed clinical pathway identification criteria may facilitate both the identification and assessment of clinical pathway studies. The goal of this publication is the validation of these five criteria in a descriptive systematic review of actively implemented clinical pathway studies in the emergency department setting. The main outcome measure is the inter-rater agreement of investigators using the clinical pathway criteria. Methods: We performed a systematic literature search from 2006 to 2015 using MEDLINE, EMBASE, CENTRAL, and CINAHL. All types of prospective trial designs were eligible. We identified relevant publications using the above-mentioned clinical pathway criteria. Two reviewers independently collected data using a piloted data abstraction tool. Results: We identified 5947 publications, with 472 potentially relevant full text publications retrieved. Of these, 357 did not meet preliminary study inclusion criteria, leaving 115 publications where the clinical pathway criteria were applied. Ultimately, 44 publications were included. The inter-rater agreement of the criteria was very good (k ¼ 0.81, 95% Confidence Interval ¼ 0.70-0.92). The vast majority of studies were excluded because the intervention did not meet the criterion of being multidisciplinary in nature. Conclusion: These criteria are a useful instrument to reliably identify clinical pathway publications for systematic review purposes in an emergency department setting. Future modification of these criteria may improve their usefulness. Particular attention should be placed on clarifying what is meant by multidisciplinary involvement within the context of clinical pathway interventions, with specific emphasis placed on delineating the level of involvement of each discipline and their decision-making responsibility.

Developing a Data-Driven Approach in Order to Improve the Safety and Quality of Patient Care

“…This inconsistency has unfavorable effects on the coherent transmission of scientific evidence of health care practices as well as on the design and implementation of CPs themselves. To overcome the problem of clinical pathways taxonomy, attempts to describe them and their impact on hospital governance have been made ( 16) and a minimum criterion has been identified (9,15,(17)(18)(19).…”

Are emergency department clinical pathway interventions adequately described, and are they delivered as intended? A systematic review

“…The methods of using these criteria to generate the publication set of the present systematic review are detailed in our recent publication. 38 The criteria are as follows:…”

“…The tables showing this data are presented elsewhere. 38 Reporting guidelines Table 5 shows reporting guidelines pertaining to complex interventions such as CPWs. We have divided the table into three columns, each reflecting the reporting elements of our three main outcome measures.…”

High-value care through better care coordination?

“…They conclude that case managers indeed have an important role to play, whilst emphasizing the importance of clearly explaining the role of each healthcare provider to patients and informal caregivers. 9 The challenges around the identification and assessment of the often used term 'clinical care pathways' are addressed by both Vrijhoef et al 10 and Adjemian et al 11 Vrijhoef et al 10 argue, based on a mixed methods approach, that IT-supported integrated care projects for people with diabetes reveal more heterogeneity than commonalities, hence making it impossible to define a blueprint for future IT-supported integrated care initiatives. By testing a set of five criteria to identify clinical care pathways in the field of emergency care, Adjemian et al find that, notwithstanding the very good applicability of the criteria, the lack of clarity of the term 'multidisciplinary' perhaps most clearly illustrates the inconsistent use of terminology when describing and evaluating clinical care pathways.…”

“…By testing a set of five criteria to identify clinical care pathways in the field of emergency care, Adjemian et al find that, notwithstanding the very good applicability of the criteria, the lack of clarity of the term 'multidisciplinary' perhaps most clearly illustrates the inconsistent use of terminology when describing and evaluating clinical care pathways. 11 Busetto et al 12 address a somewhat similar challenge regarding the term 'integrated care'. In their opinion paper, they argue that a universal typology of integrated care interventions should be developed to enable the comparison of interventions that are based on different understanding of integrated care.…”