Have We Drawn the Wrong Conclusions About the Value of Care Pathways? Is a Cochrane Review Appropriate?

Abstract

Care pathways are used increasingly worldwide to organize patient care. However, different views exist about their effectiveness. One of the reasons for this is that pathways are complex interventions. A recent Cochrane review was published which reported positive results, but although the Cochrane team performed excellent work with an enormous commitment, the conclusions may be inappropriate. To fully understand the potential and problems of care pathways, it is important to define (a) exactly what we are talking about (b) whether the study methods are appropriate, and (c) whether we can properly define the outcomes.

The Effect of Care Pathways for Hip Fractures: A Systematic Review

“…The magnitude of risk difference for some outcome measures, including mortality was very small and its clinical significance unclear. It would seem, therefore, that CPs need to be further evaluated with well-designed studies and well-selected Admitted from place other than a nursing home and discharged to a nursing home: CP 6.8 % vs. Ctrl 7.8 %, p = NS [35] New nursing home placement 4 months postdischarge NS: NS difference [37] Accommodations at home 6 months postoperation NS: CP 30.9 % vs. Ctrl 17.7 %, p = 0.06 [34] ADL [35] outcome measures [16,54]. This review was primarily focused upon the hospital admission processes rather than, for example, issues around future fracture risk.…”

“…The aim of a CP is to enhance the quality of care across the continuum by improving risk-adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources [16,28].…”

“…To address this issue, care pathways (CPs) may be an appropriate response. CPs are complex interventions [11][12][13], designed to optimize clinical outcome and resource use [14][15][16], and used worldwide for a variety of patient groups [17,18].…”

Is it possible to detect an improvement in cancer pain management? A comparison of two Norwegian cross-sectional studies conducted 5 years apart

“…A standardized care pathway (SCP) might be an effective method to improve implementation (38,39) (40,41). Several studies recommend SCPs as one way to overcome the shift from EBM to EBP (40).…”

Why are they waiting? Exploring professional perspectives and developing solutions to delayed diagnosis of autism spectrum disorder in adults and children

“…They are dynamic and complex interventions, which enhance evidence based practice, efficiency and multi-disciplinary working through their collaborative development (Vanhaecht et al, 2012) and typically include time frames or criteria based progression (Rotter et al, 2011). In common with compelling research evidence (McClure et al, 2010), the majority of ASD services consulted with, agreed on the need to improve efficiency in the diagnostic process, through the use of effective care pathways (NICE, 2011;NICE, 2015).…”