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What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review

机译：什么是临床途径？完善操作定义以识别Cochrane系统评价的临床途径研究

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Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refinement of an operational definition for CPW research and proposes an operational definition for the future syntheses of CPWs literature. Following the approach proposed by Kinsman et al. (BMC Medicine 8(1):31, 2010) and Wieland et al. (Alternative Therapies in Health and Medicine 17(2):50, 2011), we used a four-stage process to generate a five criteria checklist for the definition of CPWs. We refined the operational definition, through consensus, merging two of the checklist’s criteria, leading to a more inclusive criterion for accommodating CPW studies conducted in various healthcare settings. The following four criteria for CPW operational definition, derived from the refinement process described above, are (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other ‘inventory of actions’ (i.e. the intervention had time-frames or criteria-based progression); and (4) the intervention aimed to standardize care for a specific population. An intervention meeting all four criteria was considered to be a CPW. The development of operational definitions for complex interventions is a useful approach to appraise and synthesize evidence for policy development and quality improvement.
机译：临床途径（CPW）是寻求改善健康质量的常见组成部分。 CPW用于减少差异，提高护理质量并使特定患者群体的治疗效果最大化。一项持续的挑战是在医疗保健中实施CPW的定义。这可能归因于临床途径领域的定义差异和缺乏概念化。这篇对应文章描述了CPW研究操作定义的改进过程，并为CPW文献的未来综合提出了操作定义。按照金斯曼等人提出的方法。 （BMC Medicine 8（1）：31，2010）和Wieland等人。 （《健康与医学替代疗法》 17（2）：50，2011年），我们使用了四个阶段的过程来生成CPW定义的五个标准清单。通过协商一致，我们将清单中的两个标准进行了合并，从而完善了操作定义，从而为在各种医疗机构中进行CPW研究提供了更具包容性的标准。从上述改进过程中得出以下四个CPW操作定义标准：（1）干预是结构化的多学科护理计划； （2）采取干预措施将准则或证据转化为当地结构； （3）干预措施详细说明了计划，途径，算法，指南，协议或其他“行动清单”中治疗或护理过程的步骤（即干预措施具有时限或基于标准的进展）； （4）旨在规范特定人群护理的干预措施。符合所有四个标准的干预措施被视为CPW。制定复杂干预措施的业务定义是评估和综合政策制定和质量改进证据的有用方法。

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