Use of a Clinical Pathway To Facilitate the Translation and Utilization of AHRQ EPC Report Findings

Abstract

Pilot Project PurposeClinical pathways are one method of integrating evidence into local health care settings and structures. The purpose of this ECRI Institute -Penn Medicine EPC project was to evaluate the feasibility of using the updated 2016 AHRQ EPC report on the Early Diagnosis, Prevention, and Treatment of Clostridium difficile in our standard clinical pathway and dissemination process to develop an evidence-based clinical pathway for the treatment of Clostridium difficile infection (CDI) in the acute care setting. Key Messages• The AHRQ EPC report provided value by presenting an overview of the most updated evidence for antibiotic treatment for our stakeholder group, which included clinical and non-clinical members. We found that the AHRQ EPC Report served as an evidence standard and was particularly valuable given that the existing guidelines were outdated. Discrepancies found between the more recent AHRQ EPC report and the dated guidelines prompted critical discussions regarding the comparative efficacy of available treatments. • This AHRQ EPC report would have been more useful in our pathway development process if it included a summary of recommendations from recent guidelines. The lack of a guideline synthesis reduced our ability to use this source as the sole resource to develop a clinical pathway. • Access to up to date AHRQ EPC reports can be a useful resource to inform pathway development in the context of outdated guidelines. We recommend that AHRQ prioritize updating reports that are of particular value to health systems and develop communication channels with societies and professional organizations to alert them to newly published EPC reports, especially when findings have changed from previous standards of care. • Additional recommendations for the AHRQ EPC program include (1) facilitating the sharing of clinical pathways across health systems by providing a moderated platform to host evidence-based clinical pathways from health systems or other organizations and (2) developing a methodology or grading tool for assessing the trustworthiness of clinical pathways.

Translation of a C. difficile Treatment Clinical Pathway Into Machine-Readable Clinical Decision Support Artifacts Prototyped for Electronic Health Record Integration

“…Using a systematic approach and an existing, trustworthy evidence-based clinical pathway to develop a shareable CDS artifact offers one method for improving large-scale translation and dissemination of evidence into health systems and clinical practice. The purpose of this ECRI Institute-Penn Medicine EPC methods project was to use a systematic approach to translate a previously developed evidence-based clinical pathway (L2) for C. difficile infection (CDI) treatment 29 into a structured (L3) artifact and to identify an optimal CDS intervention type in which to implement recommendations, using the UPHS EHR environment as an exemplar.…”

“…We used an existing CDI treatment pathway developed as part of a previous ECRI Institute-Penn Medicine AHRQ EPC methods project as the basis for this methods project. 29 During the clinical pathway development process, the team incorporated several design principles proposed by Lawal et al 38 that expedited our team's initial steps for L3 CDS development. We incorporated timeframes and criteria based progression, used concise statements to detail steps in care, and organized the pathway representation into algorithm format by treatment scenarios that account for local workflows and structures.…”

Clostridioides difficile dynamic electronic order panel, an effective automated intervention to reduce inappropriate inpatient ordering

“…1 online). 3,19 A multidisciplinary stakeholder panel participated in the development of the clinical pathway, including experts from infectious diseases, infection control, antimicrobial stewardship, pharmacy, hospital medicine, nursing, and clinical informatics.…”