The Effects of Clinical Pathways on Professional Practice, Patient Outcomes, Length of Stay, and Hospital Costs: Cochrane Systematic Review and Meta-Analysis

Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.
Evaluation &amp the Health Professions (Impact Factor: 1.91). 05/2011; 35(1):3-27. DOI: 10.1177/0163278711407313
Source: PubMed


This paper is a summary version of the previously published Cochrane review. It may increase the reach of the topic to health researchers and practitioners and encourage further discussion. The systematic review aims to summarize the evidence and assess the effect of clinical pathways on professional practice, patient outcomes, length of hospital stay, and hospital costs. The authors searched the Database of Abstracts of Reviews of Effectiveness, the Effective Practice and Organisation of Care Register, the Cochrane Central Register of Controlled Trials and bibliographic databases including MEDLINE, EMBASE, CINAHL, NHS EED, and Global Health. Twenty-seven studies considering a total of 11,398 participants were included for analysis. The main results were a reduction in in-hospital complications (odds ratio 0.58: 95% CI [0.36, 0.94] and improved documentation (odds ratio 11.95: 95% CI [4.72, 30.30]) associated with clinical pathways. Considerable variation in study design and settings prevented statistical pooling of results for length of stay (LOS) and hospital costs. The authors concluded that clinical pathways are associated with reduced in-hospital complications and improved documentation.

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    • "The outcomes from the majority of clinical care pathways have resulted in significantly lower cost and other surrogate measures in terms of hospitalization costs and charges or insurance points for pathway groups [8]. Therefore, clinical care pathways are associated with a more efficient use of resources and efficiency of care [8]. "
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    • "Nevertheless, there is little sound evidence for an unambiguous causal relationship between mortality and process measures in stroke care [15]. The development and maintenance of complex cross-boundary SCPs therefore remains an important challenge for clinicians, healthcare managers, and policymakers [16,17]. Fragmented pathways, suboptimal care coordination and poor staff collaboration have hampered the translation of major advances in diagnosis and treatment into clinical practice, resulting in wasted resources and disappointing outcomes [18-20]. "
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