The quality of the evidence base for clinical pathway effectiveness: room for improvement in the design of evaluation trials.

Title

The quality of the evidence base for clinical pathway effectiveness: room for improvement in the design of evaluation trials.

Creator

Kinsman L; James E; Machotta A; Steyerberg EW

Publisher

Bmc Medical Research Methodology

Date

2012

Subject

Humans; Length of Stay; Risk Assessment; Clinical Trials as Topic; Reproducibility of Results; Randomized Controlled Trials as Topic; Bias (Epidemiology); Meta-Analysis as Topic; Evidence-Based Medicine; Selection Bias; Critical Pathways/st [Standards]; Guidelines as Topic; Outcome and Process Assessment (Health Care); Research Design/st [Standards]

Description

BACKGROUND: The purpose of this article is to report on the quality of the existing evidence base regarding the effectiveness of clinical pathway (CPW) research in the hospital setting. The analysis is based on a recently published Cochrane review of the effectiveness of CPWs., METHODS: An integral component of the review process was a rigorous appraisal of the methodological quality of published CPW evaluations. This allowed the identification of strengths and limitations of the evidence base for CPW effectiveness. We followed the validated Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria for randomized and non-randomized clinical pathway evaluations. In addition, we tested the hypotheses that simple pre-post studies tend to overestimate CPW effects reported., RESULTS: Out of the 260 primary studies meeting CPW content criteria, only 27 studies met the EPOC study design criteria, with the majority of CPW studies (more than 70%) excluded from the review on the basis that they were simple pre-post evaluations, mostly comparing two or more annual patient cohorts. Methodologically poor study designs are often used to evaluate CPWs and this compromises the quality of the existing evidence base., CONCLUSIONS: Cochrane EPOC methodological criteria, including the selection of rigorous study designs along with detailed descriptions of CPW development and implementation processes, are recommended for quantitative evaluations to improve the evidence base for the use of CPWs in hospitals.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

80-80

Issue

100968545

Volume

12

Citation

Kinsman L; James E; Machotta A; Steyerberg EW, “The quality of the evidence base for clinical pathway effectiveness: room for improvement in the design of evaluation trials.,” Pediatric Palliative Care Library, accessed September 28, 2021, https://pedpalascnetlibrary.omeka.net/items/show/11438.

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