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Reducing clinical variations with clinical pathways: do pathways work?

M Panella1, S Marchisio, F Di Stanislao

  • 1Department of Medical Sciences, Section of Public Health, University of Eastern Piedmont A. Avogadro, Novara, Italy. panella@med.unipmn.it

International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care
|December 9, 2003
PubMed
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Clinical pathways successfully reduced variations in healthcare processes and outcomes across Italian organizations. Successful implementation led to improved patient outcomes, particularly for heart failure patients.

Area of Science:

  • Health Services Research
  • Healthcare Management
  • Clinical Quality Improvement

Background:

  • Healthcare organizations face challenges in standardizing care and reducing process and outcome variations.
  • Clinical pathways aim to coordinate care, minimize fragmentation, and control costs.

Purpose of the Study:

  • To evaluate the effectiveness of clinical pathways in reducing variations in healthcare processes and outcomes.
  • To assess the impact of clinical pathway implementation on patient care quality and costs.

Main Methods:

  • Development of specific indicators to measure variations in care processes and outcomes for each clinical pathway.
  • Utilized a pre- and post-analysis model to assess the impact of clinical pathways across six diverse Italian healthcare settings.

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Main Results:

  • Sites with successful clinical pathway implementation demonstrated reductions in macro-variation (e.g., length of stay) and micro-variation (e.g., prescription patterns).
  • A significant improvement in patient outcomes was observed for those treated via the heart failure clinical pathway.

Conclusions:

  • Clinical pathways can effectively coordinate care, reduce fragmentation, and improve patient outcomes.
  • Despite ongoing debates, clinical pathways show potential for positive impact on healthcare quality and cost-efficiency.