Oncology Clinical Pathways Congress. About the Journal. Advertising Information. Editorial Advisory Board. Editorial Team. Contact Us. Gordon Kuntz—Column Editor. Log in or register to view. Copied to clipboard. The Impetus for Clinical Pathways in Cancer Care The development of clinical pathways has been especially effective in treatment planning for cancer care. The treatment of cancer lends itself to the use of more complex protocols, ie, pathways, for several reasons: Cancer itself is complex.
So, What Are Pathways? Pathway Types There are 2 major types of pathways: payer-initiated and provider-initiated, referring to the type of organization sponsoring the pathway and controlling its design.
How Pathways Are Developed The process used in developing a set of pathways starts with identification of the need for a new pathway, often due to the publication of some new piece of research describing a potential new standard of care for a specific disease presentation or based on a scheduled review of an existing pathway.
The following evaluation process is used by most of the vendor and institution pathways developers in the United States those operating in different health systems such as the United Kingdom may follow a different approach : The committee first reviews the literature to identify the treatment s that are most effective in treating the disease.
Pharmaceutical Manufacturers Many pharmaceutical manufacturers see pathways as a barrier to product adoption. Payers Payers also have an interest in the pathway solutions chosen by network providers. Physicians Obviously the oncologists involved with the practice have a direct interest in securing high-quality, reliable pathways content delivered by an efficient tool. Patients Many oncologists are hesitant to share details of the pathway process with patients out of concern that the patient will feel that they are getting a cookie-cutter treatment plan for their cancer.
Conclusion Again, the cancer center implementing pathways is the most significant stakeholder of all, from leadership to all members of the care team. References 1. Submit Feedback. Email Address. A panel chose the scale based on its simplicity and existing popularity.
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Lymphoma, Leukemia and Myeloma. NCAD East. Personalized Therapies in Thoracic Oncology. Post Acute Care Symposium. An intervention was considered to be a CPW if it met the first criterion together with three of the other four criteria. The operational definition further supported the identification of relevant full text studies that were eventually used in finalizing the first systematic review on CPWs in hospital care in [ 7 ]. A recent attempt by the review team to conduct a systematic review on CPWs in primary care was hampered by the challenge of applying the above operational definition in a primary care setting, with the major problem during the protocol development for the systematic review [ 17 ] being the identification of relevant CPW studies in a primary care context.
This is due to the requirements of criteria numbers 3 and 4. The application of these two criteria is problematic, because several articles explicitly met criterion 3 but not criterion 4, or vice versa, and thus had to be excluded. TR and LK pilot tested the new criteria on five CPWs studies [ 18 — 22 ] in primary care identified during the protocol development for a systematic review on CPWs in primary care [ 17 ].
Consensus was reached among review authors that, by merging the two criteria, the definition would be more inclusive. Thus, the new operational definition for CPWs was narrowed to a four criteria checklist. Two review authors CP and AB independently pilot-tested the refined operational definition containing the four criteria checklist, with LA serving as an arbitrator to resolve any disagreement during the process.
The two review authors had no contact during the pilot test. The pilot test was conducted on 20 articles selected randomly from the 27 included articles from the Cochrane systematic review on CPWs in hospitals. The aim of the pilot-test was to ensure that the number of articles retrieved for the full text extraction phase in remained unchanged when using the modified criteria.
The results of the pilot-test were collated and a reliability analysis for qualitative variables was estimated using the kappa statistic [ 23 ]. Table 1 depicts the data layout for the statistical analysis. For the reliability analysis, the kappa test statistic was 0. The four criteria derived from the refinement process described above are 1 Is it a structured multidisciplinary care plan?
Henceforth, an intervention was considered a CPW if it contained all of the four criteria in the new operational definition. Subsequently, the new definition will be applied to identify 1 relevant titles and abstracts for an on-going update of a Cochrane systematic review on CPWs in hospitals, and 2 a new Cochrane systematic review on CPWs in primary care.
Prospectively, the systematic review will follow the validated Cochrane Effective Practice and Organization of Care EPOC methodology for complex interventions, and will consider randomized controlled trials, non-randomized controlled trials, controlled before and after, and interrupted time series study designs [ 18 ]. This article describes the process of development, refinement, and testing of a practical working definition for CPWs.
It also supports the inclusion of relevant primary research articles only in our Cochrane systematic review update on CPW effectiveness in hospital and primary care. The initial criteria, rigorously developed in using the Kinsman et al. It is imperative to understand that we created an operational definition for CPWs in hospital and primary care settings, rather than undergoing a scientific concept analysis [ 24 ]. We propose the development of minimum inclusion criteria and an operational definition for systematic reviews of complex interventions such as CPWs.
Our belief is that this approach serves as a preliminary step to ensure all-important studies are catalogued while simultaneously including only the relevant evidence. Future work will be conducted to ascertain the sensitivity of the refined criteria in identifying pathway studies in primary care. Although it has been established in previous literature that CPWs are complex interventions, this information is not sufficient and useful for the development of an evidence base for CPWs in the international literature.
There is variation in the terms used to depict a CPW, therefore referring to a CPW as a complex intervention without standardizing its elements only adds to complexity and confusion towards the attainment of a standard definition. The pilot test for the operational criteria and reliability analysis shows a significant high level of agreement among reviewers. This demonstrates that the resulting criteria have the potential to be clear and objective enough to permit further research relevant to the field of CPWs.
This methodology may be refined and applied to similar fields also challenged with the issue of cataloguing and reviewing the evidence for complex health service interventions. An internationally agreed operational definition for CPWs will 1 limit the confusion regarding CPWs, interventions that have been attributed to a naming system in different contexts; 2 ultimately generate a positive discourse among researchers and frontline providers; 3 provide an adequate understanding of what actually constitutes a CPW; and 4 will permit the utilization of rigorous designs, such as realist and systematic reviews, to appraise effectiveness, contextual factors, and mechanisms that may further improve CPW implementation in different healthcare settings.
Employing appropriate implementation theories and taking into account the level of implementation will enhance the long-term sustainability and uptake of CPWs in healthcare. This will lead to a better understanding of how CPWs may contribute to better healthcare. Worldwide CPW implementation and usage in healthcare is on the rise. This paper describes the process of developing, refining, and pilot testing a set of criteria to be used for a practical operational definition for CPWs in healthcare, following the Kinsman et al.
Future researchers considering the development, implementation, and evaluation of CPWs should adopt the developed definition or modify them to fit into their future research. This will advance the discourse towards an internationally agreed-upon definition of what constitutes a CPW in healthcare. Basics of quality improvement in health care. Mayo Clin Proc. Article PubMed Google Scholar. Scott I. What are the most effective strategies for improving quality and safety of health care?
Intern Med J. Wachter RM. Show More. Views Total views. Actions Shares. No notes for slide. Discuss the definition of clinical pathway and clinical practice guidelines. Identify all involved staff common goals and helping them to understand their roles in the entire care process. Discuss the framework for collecting and analysing data on the care process. Explain how to improve patient satisfaction through improved patient education e. Techniques of Quality Management Science are among the newer approaches to managing the delivery of healthcare.
One such application of this science to healthcare is Clinical Pathways. Like the critical pathway, the goal of the clinical protocol may be to decrease treatment variation. Total views 21, On Slideshare 0. From embeds 0. Number of embeds Downloads Shares 0. Comments 0. Respir Care ; 60 3 : — Congenit Heart Dis ; 5 4 : — Previous Next.
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