Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs

  • Protocol
  • Intervention

Authors


Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows:

This review addresses the following question:
What is the effect of clinical pathways (CPWs) on professional practice, patient outcomes, length of stay (LOS) or hospital costs?

The specific objectives of this review are:
(1) To search the literature for studies which evaluate CPW interventions.
(2) To identify relevant studies according to methodological and contextual inclusion criteria.
(3) To summarise included studies narratively and according to methodological quality.
(4) To describe the overall effects of CPWs on health professional practice, patient outcomes, LOS and hospital costs.
(5) To identify factors that may contribute to the effectiveness of CPWs. Factors will be categorised as:

  • Setting (inpatient, outpatient, medical, surgical, critical care, emergency, rehabilitation, aged care)

  • Implementation process (multifaceted, local consensus)

  • Invasive or non-invasive nature of patient management guided by CPW (e.g. CPW for gastrectomy; PTCA; laparoscopic cholecystectomy; hip and knee arthroplasty etc. versus CPW for stroke; pneumonia; asthma etc.)

  • Specified conditions or interventions guided by CPW (e.g. CPW for PTCA; hip and knee arthroplasty and pneumonia).

(6) To apply statistical meta-analysis to included studies if supported by adequate quality and homogeneity.

To address these objectives, the following comparisons are planned:
(1) Patients managed according to CPW compared to usual care. Impact on patient outcomes, professional practice, length of hospital stay and hospital costs.
(2) Patients managed within a multifaceted intervention with a CPW compared to the same intervention without a CPW. Impact on patient outcomes, professional practice, length of hospital stay and hospital costs.

We will also explore the effects of the following characteristics of the intervention on the magnitude of effect across studies (subgroup analysis):
(1) Effect of high quality studies versus low quality studies (Subgroup analysis regarding the study design).
(2) Country(s) where the study was carried out.
(3) The date of study/year of publication (adjusting for temporal trends).