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What is a clinical pathway? Development of a definition to inform the debate

Citation

Kinsman, L and Rotter, T and James, E and Snow, P and Willis, J, What is a clinical pathway? Development of a definition to inform the debate, BMC Medicine, 8 Article 31. ISSN 1741-7015 (2010) [Refereed Article]


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Licensed under Creative Commons Attribution 2.0 Generic (CC BY 2.0) http://creativecommons.org/licenses/by/2.0/

DOI: doi:10.1186/1741-7015-8-31

Abstract

Background: Clinical 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.

Methods: We 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.

Results: Previous 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'.

Conclusions: The 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.

Item Details

Item Type:Refereed Article
Keywords:clinical pathways;
Research Division:Medical and Health Sciences
Research Group:Public Health and Health Services
Research Field:Health Care Administration
Objective Division:Health
Objective Group:Health and Support Services
Objective Field:Nursing
Author:Kinsman, L (Professor Leigh Kinsman)
ID Code:97794
Year Published:2010
Web of Science® Times Cited:94
Deposited By:Health Sciences B
Deposited On:2015-01-13
Last Modified:2015-04-09
Downloads:219 View Download Statistics

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