Walter Sermeus

Effects of Clinical Pathways: Do They Work?:

Objective: Evaluation of the effect of implementing clinical pathways is a relatively new field in health care research. Little is known about the way in which practice is influenced by the implementation of clinical pathways, and to what degree. This review takes significant steps in answering these questions by describing the parameters that are used in literature as indicators to evaluate clinical pathways. Methods: A Medline-based review of literature published between 2000 and 2002 was carried out using the keywords ‘clinical pathway’, ‘critical pathway’, ‘care map’, ‘care pathway’ and ‘integrated care pathway’. Articles were selected if they contained any form of evaluation, outcome or indicator concerning the use of clinical pathways. This included all types of research design and sample size. A total of 200 articles were selected. Relevant data were summarized using the following characteristics: country of origin, clinical field of expertise, research design, sample size, clinical outcome indicators, service indicators, team indicators, process indicators and financial indicators. For each domain a positive, negative or ‘no effect’ conclusion was recorded. Excel® and Statistica® were used to obtain percentages and graphics. Results: A total of 34% of the articles on clinical pathways contained some form of evaluation concerning the effect of the implementation. Out of these articles, clinical outcome was emphasized in 65.5%, financial effects in 53%) and process effects were investigated by 50% of the studies. Team and service effects were discussed less often (24% and 18.5%), respectively). For clinical outcome, team, process and financial effects a variety of indicators were recorded. Service effects were almost always measured as ‘patient satisfaction’. The majority of the literature concluded that positive effects result from the implementation of clinical pathways. Conclusion: On a macro level clinical pathways result globally in positive effects. Negative results, however, were also present in the literature. In particular for process, team and service evaluation concerning the use of clinical pathways there is still a great need for research.

Development and validation of a care process self-evaluation tool

Clinical pathways are used as a method of organizing care processes. Although they are used worldwide, the concept remains unclear, with little understanding of what exactly is being implemented. A recent systematic review revealed that, although a tool exists to score the instrumental qualities of clinical pathways, no tools are available to assess how the clinical pathway influences the process of care. These tools are needed for a better understanding of the impact of clinical pathways on the length of hospital stay and patient outcomes. In this study, a Care Process Self-Evaluation Tool (CPSET), based on the clinical pathway concept, for assessing the organization of the process of care has been developed and tested. Qualitative and quantitative methods, involving 885 professionals and patients, were used in the development and validation. The CPSET is a valid and reliable 29-item instrument for assessing how the process of care is organized. The CPSET has five subscales: patient-focused organization, coordination of care, communication with patients and family, cooperation with primary care and monitoring/follow-up of the care process. The CPSET can be used in the audit and accreditation of care processes and will help managers and clinicians to understand better how care processes are organized.

The Leuven Clinical Pathway Compass

A vast amount of literature exists on clinical pathways. When reviewing literature from 2000-2002 on Medline, 597 articles about clinical pathways were found. Only 22% of these articles included outcome indicators. The majority of the articles described how the pathway was developed. Therefore, there is a clear lack of articles evaluating the impact of the clinical pathway. Moreover, there is very little known about the definition and the implementation of a clinical pathway. The pathway itself can have a very high standard, but when it is followed by a loose implementation process, with a very low degree of acceptance by the clinicians, or a low degree of impact in the organisation, the results can be very poor. The narrative way that most of the clinical pathways are described and introduced, leads to many ambiguous results in the implementation of clinical pathways.2,3 Maybe it could be related to the real impact of clinical pathways, but it could also be a result of the quality of the evaluation process. If you cant measure it, you cant manage it.This old management phrase still rings true, especially in clinical m e d i ~ i n e . ~ When we use this saying for clinical pathways, the rigorous evaluation of the implementation of the clinical pathway by means of preand post-tests is a bare necessity. This evaluation

The Belgian—Dutch Clinical Pathway Network

In 2000, the Centre for Health Services & Nursing Research, Catholic University Leuven, Belgium, launched the Belgian—Dutch Clinical Pathway Network. This is a joint effort by both Belgian and Dutch hospitals to implement clinical pathways in the organisation of their practice. This article describes why the network was started, the core objectives and the organisation of the network.