Basis for Developing System-wide Clinical Pathways

Kinsman, L., Rotter, T., James, E., Snow, P. & Willis, J. (2010). What is a clinical pathway? Development of a definition to inform the debate. BMC medicine, 8 (1), 31.

The article talks about Clinical Pathways, which are tools that guide evidence-based healthcare.  But, there is a widespread disagreement about their impact on hospital resources and patient outcomes.  This stems from confusion among researchers and healthcare personnel regarding what makes up a clinical pathway.  In an effort in that direction, a team of Cochrane review authors decided to create a criteria to assist in the objective identification of clinical pathways studies from the literature.

In an effort to device a criteria to define a clinical pathway, the undertook a four-stage process:  do literature review to define clinical pathway; develop a draft criteria; pilot test the criteria; and modify the criteria based on over all literature review.

Literature review and their liaison with the European Pathways Association resulted in creation of five criteria used to define a clinical pathway: (1) intervention should be structured multidisciplinary plan of care; (2) it should translate guidelines or evidence into local structures; (3) it should detail the steps in the course of treatment or care or criteria based progression; (4) it should have timeframes or criteria-based progression; and (5) it should aim to standardize care for a specific clinical problem or episode of healthcare in a specific population. 

After pilot testing it was concurred that if an intervention met the first criteria, and in addition three out of the other four, then it should be considered as a clinical pathway.  Therefore, this criteria can be used as a basis of development of standardized, internationally accepted definition of a clinical pathway, and for the pathways themselves. 

The method employed is simple and credible.  It stress on the fact that there is widespread disagreement over their impact on hospital resources and patient outcomes.  I believe the disagreement comes for conflicting priorities on the management and the physicians.  However, it is not difficult to resolves as such conflicts happen across the spectrum of healthcare delivery.  Further, I believe that care pathways should have flexibility built in to allow customization based on patient’s needs and that of the providers.  So long as the patient reach the right destination within the broad parameters of pathways it is fine.  Keeping this way we will be able to balance both outcome and resources.

Also, there is need to have multi-disciplinary teams to discuss clinical pathways, so that everybody’s perspective is taken into account, and appropriate clinical pathways are developed.  These teams “should” have representation from every possible sector and profession that may be required to participate in the delivery of care.

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