What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review

Abstract

Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refinement of an operational definition for CPW research and proposes an operational definition for the future syntheses of CPWs literature. Following the approach proposed by Kinsman et al. (BMC Medicine 8(1):31, 2010) and Wieland et al. (Alternative Therapies in Health and Medicine 17(2):50, 2011), we used a four-stage process to generate a five criteria checklist for the definition of CPWs. We refined the operational definition, through consensus, merging two of the checklist’s criteria, leading to a more inclusive criterion for accommodating CPW studies conducted in various healthcare settings. The following four criteria for CPW operational definition, derived from the refinement process described above, are (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’ (i.e. the intervention had time-frames or criteria-based progression); and (4) the intervention aimed to standardize care for a specific population. An intervention meeting all four criteria was considered to be a CPW. The development of operational definitions for complex interventions is a useful approach to appraise and synthesize evidence for policy development and quality improvement.

Efficacy of a clinical pathway for patients with thyroid cancer

“…10 Clinical pathways may encourage the translation of national guidelines into local protocols and their subsequent application to clinical practice. 12 The advantages of introducing clinical pathways include improving patient outcomes and staff satisfaction, reduction of the length of stay, and the cost savings for hospital admission while maintaining quality of care. standardize care processes, maximizing patient outcomes, and improving organizational efficiency.…”

“…standardize care processes, maximizing patient outcomes, and improving organizational efficiency. 12 The advantages of introducing clinical pathways include improving patient outcomes and staff satisfaction, reduction of the length of stay, and the cost savings for hospital admission while maintaining quality of care. 13 Other studies, however, have raised questions about the effectiveness of clinical pathways and reported no benefits in reducing hospital charges and length of stay.…”

An umbrella review of clinical practice guidelines for the management of patients with hip fractures and a synthesis of recommendations for the pre‐operative period

“…The evolution of evidence‐informed health care and the need to improve healthcare quality and decrease costs has precipitated the development of various clinical decision‐aids (de Bleser et al., ; Lawal et al., ). According to the Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines (IOM, ), the most methodologically rigorous and transparent of these decision‐aids is the clinical practice guideline (CPG); however, not all CPGs are created equally (Graham & Harrison, ; IOM, ; Woolf, Grol, Hutchinson, Eccles, & Grimshaw, ).…”

Developing a patient driven head and neck cancer care pathway

“…One major initiative led by the PFAC was the development of a clinical care pathway for newly diagnosed patients with head and neck cancer. Clinical care pathways have become more prevalent in cancer care, and by definition, should be multidisciplinary in nature . Therefore, it was logical for the PFAC to drive the discussion.…”

“…Clinical care pathways have become more prevalent in cancer care, and by definition, should be multidisciplinary in nature. 4 Therefore, it was logical for the PFAC to drive the discussion. The conventional cancer care pathway had been focused on treatment modalities and addressing comorbidity issues secondarily in a reactionary model.…”