Address correspondence to Sydney M. Dy, M.D, M.Sc., Associate Medical Director, Maryland Community Hospice, Room 609, 624N. Broadway, Baltimore, MD 21205. Sydney M. Dy, M.D., and Albert W. Wu, M.D., M.P.H., are with the Department of Health Policy & Management and School of Medicine, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore. Pushkal Garg, M.D., is with the Brighams Women's Hospital, Boston. Dorothy Nyberg, M.S., R.N., is with the Suburban Hospital Healthcare System, Outcomes Management Department, Bethesda, MD. Patricia B. Dawson, is with the Department of Nursing, The Johns Hopkins Hospital, Baltimore. Peter J. Pronovost, M.D., is with the Anesthesiology & Critical Care Medicine, School of Medicine, The Johns Hopkins University, Baltimore. Laura Morlock, Ph.D., is with the Department of Health Policy & Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore. Haya Rubin, is with the Department of Health Policy & Management, and School of Medicine, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore.
Critical Pathway Effectiveness: Assessing the Impact of Patient, Hospital Care, and Pathway Characteristics Using Qualitative Comparative Analysis
Article first published online: 10 MAR 2005
Health Services Research
Volume 40, Issue 2, pages 499–516, April 2005
How to Cite
Dy, S. M., Garg, P., Nyberg, D., Dawson, P. B., Pronovost, P. J., Morlock, L., Rubin, H. and Wu, A. W. (2005), Critical Pathway Effectiveness: Assessing the Impact of Patient, Hospital Care, and Pathway Characteristics Using Qualitative Comparative Analysis. Health Services Research, 40: 499–516. doi: 10.1111/j.1475-6773.2005.0r370.x
- Issue published online: 10 MAR 2005
- Article first published online: 10 MAR 2005
- Critical pathways;
- quality improvement;
- length of stay
Objective. To qualitatively describe patient, hospital care, and critical pathway characteristics that may be associated with pathway effectiveness in reducing length of stay.
Data Sources/Study Setting. Administrative data and review of pathway documentation and a sample of medical records for each of 26 surgical critical pathways in a tertiary care center's department of surgery, 1988–1998.
Study Design. Retrospective qualitative study.
Data Collection/Abstraction Methods. Using information from a literature review and consultation with experts, we developed a list of characteristics that might impact critical pathway effectiveness. We used hypothesis-driven qualitative comparative analysis to describe key primary and secondary characteristics that might differentiate effective from ineffective critical pathways.
Principal Findings. All 7 of the 26 pathways associated with a reduced length of stay had at least one of the following characteristics: (1) no preexisting trend toward lower length of stay for the procedure (71 percent), and/or (2) it was the first pathway implemented in its surgical service (71 percent). In addition, pathways effective in reducing length of stay tended to be for procedures with lower patient severity of illness, as indicated by fewer intensive care days and lower mortality. Effective pathways tended to be used more frequently than ineffective pathways (77 versus 59 percent of medical records with pathway documents present), but high rates of documented pathway use were not necessary for pathway effectiveness.
Conclusions. Critical pathway programs may have limited effectiveness, and may be effective only in certain situations. Because pathway utilization was not a strong predictor of pathway effectiveness, the mechanism by which critical pathways may reduce length of stay is unclear.