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

Adegboyega K Lawal, Thomas Rotter, Leigh Kinsman, Andreas Machotta, Ulrich Ronellenfitsch, Shannon D Scott, Donna Goodridge, Christopher Plishka, Gary Groot, Adegboyega K Lawal, Thomas Rotter, Leigh Kinsman, Andreas Machotta, Ulrich Ronellenfitsch, Shannon D Scott, Donna Goodridge, Christopher Plishka, Gary Groot

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.

References

    1. Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clin Proc. 2007;82(6):735–739. doi: 10.1016/S0025-6196(11)61194-4.
    1. Scott I. What are the most effective strategies for improving quality and safety of health care? Intern Med J. 2009;39(6):389–400. doi: 10.1111/j.1445-5994.2008.01798.x.
    1. Wachter RM. Patient safety at ten: unmistakable progress, troubling gaps. Health Aff. 2010;29(1):165–173. doi: 10.1377/hlthaff.2009.0785.
    1. Vanhaecht K, De Witte K, Panella M, Sermeus W. Do pathways lead to better organized care processes? J Eval Clin Pract. 2009;15(5):782–788. doi: 10.1111/j.1365-2753.2008.01068.x.
    1. Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010;3:CD006632.
    1. Vanhaecht K, Ovretveit J, Elliott MJ, Sermeus W, Ellershaw J, Panella M. Have we drawn the wrong conclusions about the value of care pathways? Is a Cochrane review appropriate? Eval Health Prof. 2012;35(1):28–42. doi: 10.1177/0163278711408293.
    1. Kinsman L, Rotter T, James E, Snow P, Willis J. What is a clinical pathway? Development of a definition to inform the debate. BMC Med. 2010;8(1):31. doi: 10.1186/1741-7015-8-31.
    1. Rotter T, Machotta A, Kinsman L, Champion R. Evaluation of a clinical pathway for ‘radical laparoscopic prostatectomy’: an interrupted time series study. Int J Urol Nursing. 2014;8(2):84–89. doi: 10.1111/ijun.12036.
    1. Vanhaecht K, Bollmann M, Bower K, Gallagher C, Gardini A, Guezo J, et al. Prevalence and use of clinical pathways in 23 countries–an international survey by the European Pathway Association. J Integr Pathw. 2006;10(1):28–34. doi: 10.1258/j.jicp.2006.124.
    1. Baumbusch JL, Kirkham SR, Khan KB, McDonald H, Semeniuk P, Tan E, et al. Pursuing common agendas: a collaborative model for knowledge translation between research and practice in clinical settings. Res Nurs Health. 2008;31(2):130–140. doi: 10.1002/nur.20242.
    1. Aizawa T, Kin T, Kitsukawa S-i, Mamiya Y, Akiyama A, Ohno Y, et al. [Impact of a clinical pathway in cases of transurethral resection of the prostate] Nihon Hinyokika Gakkai Zasshi. 2002;93(3):463–468.
    1. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Policy Ment Health. 2011;38(2):65–76. doi: 10.1007/s10488-010-0319-7.
    1. De Bleser L, Depreitere R, Waele KD, Vanhaecht K, Vlayen J, Sermeus W. Defining pathways. J Nurs Manag. 2006;14(7):553–563. doi: 10.1111/j.1365-2934.2006.00702.x.
    1. Campbell H, Hotchkiss R, Bradshaw N, Porteous M. Integrated care pathways. BMJ. 1998;316(7125):133. doi: 10.1136/bmj.316.7125.133.
    1. Vanhaecht K, Witte KD, Depreitere R, Sermeus W. Clinical pathway audit tools: a systematic review. J Nurs Manag. 2006;14(7):529–537. doi: 10.1111/j.1365-2934.2006.00705.x.
    1. Wieland LS, Manheimer E, Berman BM. Development and classification of an operational definition of complementary and alternative medicine for the Cochrane collaboration. Altern Ther Health Med. 2011;17(2):50.
    1. Rotter T, Kinsman L, Machotta A, Zhao F-L, van der Weijden T, Ronellenfitsch U, et al. Clinical pathways for primary care: effects on professional practice, patient outcomes, and costs. Cochrane Database Syst Rev. 2013;8
    1. Martin I, McNamara D, Sutherland F, Tilyard M, Taylor D. Care plans for acutely deteriorating COPD: a randomized controlled trial. Chron Respir Dis. 2004;1(4):191–195. doi: 10.1191/1479972304cd047oa.
    1. Mitchell EA, Didsbury P, Kruithof N, Robinson E, Milmine M, Barry M, et al. A randomized controlled trial of an asthma clinical pathway for children in general practice. Acta Paediatr. 2005;94(2):226–233. doi: 10.1080/08035250410020235.
    1. Flottorp S, Oxman AD, Håvelsrud K, Treweek S, Herrin J. Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat. BMJ. 2002;325(7360):367. doi: 10.1136/bmj.325.7360.367.
    1. Casas A, Troosters T, Garcia-Aymerich J, Roca J, Hernández C, Alonso A, et al. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J. 2006;28(1):123–130. doi: 10.1183/09031936.06.00063205.
    1. Carusone SC, Loeb M, Lohfeld L. A clinical pathway for treating pneumonia in the nursing home. Part I: the nursing perspective. J Am Med Dir Assoc. 2006;7(5):271–278. doi: 10.1016/j.jamda.2005.11.004.
    1. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37(5):360–363.
    1. Mullins IL. Strategies for theory construction in nursing 4th edition. Clin Nurse Spec. 2006;20(6):308. doi: 10.1097/00002800-200611000-00014.

Source: PubMed

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