Reducing clinical variations with clinical pathways: do pathways work?

Panella, Massimiliano

doi:10.1093/intqhc/mzg057

Cited by 344 publications

(290 citation statements)

References 30 publications

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“…Implementation of routine distress screening programs in Canada and the US provides practical guidance for successful implementation [9,10,32] as the barriers and facilitators identified were similar to those identified in our pilot research [23]. Recommendations related to active engagement with local teams and identification of local champions [16,33 ] have informed our approach to local implementation. An educational outreach program, an important component of change management within healthcare [34], is also currently being piloted.…”

Section: Discussionmentioning

confidence: 63%

“…Our results confirmed multidisciplinary support for routine formal screening of anxiety/depression in oncology, combined with a stepped-care model of treatment and review. A key factor in the successful translation of pathways into practice is ownership by all health professionals during the development phase [16].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical pathways (multidisciplinary management plans that standardise care [16]), combined with audit and staff training, have the potential to increase the occurrence, accuracy and consistency of distress screening and management, and therefore patient outcomes [17]. Existing international clinical practice guidelines [18][19][20][21] have raised awareness and acceptance of psychosocial care as integral to multi-disciplinary care, but lack the specific guidance that is the hallmark of effective clinical pathways, and evidence-based tailored implementation strategies to embed recommended strategies into routine care [22].…”

Section: Introductionmentioning

confidence: 99%

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Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process

Shaw

Price

Clayton

et al. 2015

Support Care Cancer

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Purpose: People with cancer and their families experience high levels of psychological morbidity. However many cancer services do not routinely screen patients for anxiety and depression and there are no standardized clinical referral pathways. This study aimed to establish consensus on elements of a draft clinical pathway tailored to the Australian context. Methods:A two-round Delphi study was conducted to gain consensus among Australian oncology and psycho-oncology clinicians about the validity of 39 items that form the basis of a clinical pathway that includes screening, assessment, referral and stepped-care management of anxiety and depression in the context of cancer. The expert panel comprised 87 multidisciplinary clinician members of the Australian Psycho-oncology Cooperative Research Group (PoCoG). Respondents rated their level of agreement with each statement on a 5-point likert scale. Consensus was defined as >80% of respondents scoring within 2 points on the likert scale.Results: Consensus was reached for 21 of 39 items, and a further 15 items approached consensus except for specific contextual factors, after 2 Delphi rounds. Formal screening for anxiety and depression, a stepped care model of management and recommendations for inclusion of length of treatment and time to review were endorsed. Consensus was not reached on items related to roles and responsibilities, particularly those not applicable across cancer settings. Conclusions:This study identified a core set of evidence-and consensus-based principles considered essential to a stepped care model of care incorporating identification, referral and management of anxiety and depression in adult cancer patients.3

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process

Shaw

Price

Clayton

et al. 2015

Support Care Cancer

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“…10 In health care the professional autonomy of clinicians creates a barrier to the implementation of standardised clinical pathways. 11 We believe that variance analysis can assist in addressing the difficulties experienced in introducing standardised care by enabling clinicians to implement an objective measure to review practice. Additionally, with the ageing population in Australia, patients tend to present with more comorbidities 12 and treatment plans need to be flexible enough to accommodate specific patient needs.…”

Section: Discussionmentioning

confidence: 99%

Valuing variance: the importance of variance analysis in clinical pathways utilisation

Podosky²,

Santamaria³

et al. 2007

Aust. Health Review

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Variations from the anticipated course of events in clinical pathways provide valuable information that could be used to improve clinical practice and health service planning. Surprisingly, variance data are rarely collected in health care organisations using clinical pathways. This paper describes a project which aimed to improve reporting and analysis of variance data in a large regional and a smaller rural hospital using clinical pathways for a number of surgical, medical and obstetric procedures. The project used change management techniques and a variance analysis software program to inform IN A HIGH-RISK industry such as health care, we are constantly striving to improve our practice to improve patient outcomes. Important information for these improvements is the understanding of the variance between what is anticipated to happen during a patient' s course of hospitalisation and what actually occurs. Over the past decade the health care sector has introduced clinical pathways to standardise care and improve the quality of care by shifting the focus from task orientation to patient outcomes. 1 The ultimate purpose of clinical pathways is to improve patient outcomes, but insufficient account is given to the fact that things don't always go to plan. Everyone knows that deviations arise, but little analysis is completed of the deviations.Evidence-based clinical pathways enable clinicians to identify unexpected events (ie, variances) that can be positive or negative for patient outcomes; positive variances include early discharge, while negative variance may consist of unplanned return for surgery. Variance data can be used to build a body of evidence to help improve systems and clinical practice, and assist in planning health service delivery. Use of variance data to examine cohorts of patients who experienced similar variances from a specific clinical pathway can enable identification of factors that contribute to the variance, resulting in interventions that address negative variances. 2 The process of examining variances is referred to as variance analysis and forms a critical part of the quality improvement cycle for clinical pathways. What is known about the topic? There has been limited focus on collecting, analysing and using information on variances from clinical pathways in managing health services. What does this paper add?This paper provides a case study of a project that implemented clinical pathway variance analysis in two hospitals. What are the implications for practitioners?This case study suggests that managers and clinicians should pay more attention to clinical pathway variance analysis, as the variance data can be used to improve the pathways and enhance patient care processes.

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“…Numerous studies, including six RCTs [4,7,38,51,63,71], failed to show any positive effects on quality associated with practice guidelines [5,10,20,25,26,36]. Results were mixed in 12 studies, in which practice guidelines improved quality for certain outcomes or patient subgroups but not others [8,23,24,41,43,52,54,55,58,59,73,74]. Finally, three systematic reviews reported that clinical practice guidelines could improve the efficacy, efficiency, and cost-effectiveness of care; however, the size of effect was variable and generally small [6,27,47].…”

Section: Do Practice Guidelines Improve Quality Of Care?mentioning

confidence: 99%

The Use of Three Strategies to Improve Quality of Care at a National Level

Wright

2012

Clinical Orthopaedics &Amp; Related Research

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Background Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial. Questions/purposes The purpose of this review was to address three questions: (1) does pay-for-performance improve the quality of care; (2) do surgical safety checklists improve the quality of surgical care; and (3) do practice guidelines improve the quality of care? These three strategies were chosen because there has been some research assessing their effectiveness in improving quality, and implementation had been attempted on a large scale such as entire countries.Methods We performed a literature review from 1950 forward using Medline to identify Level I and II studies. We evaluated the three strategies and their effects on processes and outcomes of care. When possible, we examined strategy implementation, patients, and systems, including provider characteristics, which may affect the relationship between intervention and outcomes with a focus on factors that may have influenced effect size. Results Pay-for-performance improved the process and to a lesser extent the outcome of care. Surgical checklists reduced morbidity and mortality. Explicit practice guidelines influenced the process and to a lesser extent the outcome of care. Although not definitively showed, clinician involvement during development of intervention and outcomes, with explicit strategies for communication and implementation, appears to increase the likelihood of positive results. Conclusion Although the cost-effectiveness of these three strategies is unknown, quality of care could be enhanced by implementing pay-for-performance, surgical safety checklists, and explicit practice guidelines. However, this review identified that the effectiveness of these strategies is highly context-specific.

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Reducing clinical variations with clinical pathways: do pathways work?

Cited by 344 publications

References 30 publications

Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process

Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process

Valuing variance: the importance of variance analysis in clinical pathways utilisation

The Use of Three Strategies to Improve Quality of Care at a National Level

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