A systematic review of the effects of implementing clinical pathways supported by health information technologies

Abstract

Objective Health information technology (HIT) interventions include electronic patient records, prescribing, and ordering systems. Clinical pathways are multidisciplinary plans of care that enable the delivery of evidence-based healthcare. Our objective was to systematically review the effects of implementing HIT-supported clinical pathways. Materials and Methods A systematic review protocol was developed including Medline, Embase, and CENTRAL database searches. We recorded data relating to study design, participants, intervention, and outcome characteristics and formally assessed risk of bias. Results Forty-four studies involving more than 270 000 patients were included. Investigation methodologies included before-after (n = 16, 36.4%), noncomparative (n = 14, 31.8%), interrupted time series (n = 5, 11.4%), retrospective cohort (n = 4, 9.1%), cluster randomized (n = 2, 4.5%), controlled before-after (n = 1, 2.3%), prospective case-control (n = 1, 2.3%), and prospective cohort (n = 1, 2.3%) study designs. Clinical decision support (n = 25, 56.8%), modified electronic documentation (n = 23, 52.3%), and computerized provider order entry (n = 23, 52.3%) were the most frequently utilized HIT interventions. The majority of studies (n = 38, 86.4%) reported benefits associated with HIT-supported pathways. These included reported improvements in objectively measured patient outcomes (n = 15, 34.1%), quality of care (n = 29, 65.9%), and healthcare resource utilization (n = 10, n = 22.7%). Discussion Although most studies reported improvements in outcomes, the strength of evidence was limited by the study designs that were utilized. Conclusions Ongoing evaluations of HIT-supported clinical pathways are justified but would benefit from study designs that report key outcomes (including adverse events) and minimize the risk of bias.

The Financial and Clinical Impact of an Electronic Health Record Integrated Pathway in Elective Colon Surgery

“…Prior work has suggested that several factors may contribute to success of clinical pathways. 22,23 Some of these potential factors are related to health information technology (HIT), including using HIT to support quality, execution, and adherence to protocols. Our results support our hypothesis that use of the EHR to implement evidence-based ERAS guidelines can decrease costs without a resultant increase in 30-day readmissions.…”

“…However, we implemented a rigorous methodology to control for both temporal trends and important confounder, a significant improvement over other studies that have attempted to evaluate pathways. 23 Furthermore, we used a similar surgical control group as a historical control. Third, given the low base rate of surgical complications in this population, we were not powered to detect differences in this important clinical outcome in the 18-month postimplementation phase.…”

Advancing biomedical and health informatics knowledge through reviews of existing research

“…Given the informatics focus of the reviews, interventions were typically classified by a set of characteristics suitable for the types of technologies studied. Examples include clinical pathways (eg, clinical decision support, clinical documentation, dashboards) 9 and visualizations (eg, type of intervention [dashboard, mobile app, etc. ], type of visualization [planar, volumetric, network, etc.…”

“…Moreover, it is important that multiple databases are searched and that the databases are a match for the review topic. For example, Neame et al 9…”

“…Only 2 systematic reviews 9,11 in this issue, both from the United Kingdom, were registered in PROSPERO, an international database of prospectively registered systematic reviews in health and social care, welfare, public health, education, crime, justice, and international development, in which there is a health-related outcome. 14 Similar to other prospective study registration sites, such as www.…”