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Using a 10-step framework to support the implementation of an evidence-based clinical pathways programme.

Emilia J Flores1,2, Nikhil K Mull3,4, Julia G Lavenberg3

  • 1University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA emilia.flores@uphs.upenn.edu.

BMJ Quality & Safety
|November 23, 2018
PubMed
Summary

A structured 10-step framework and technology platform successfully supported the development and dissemination of clinical pathways across a large healthcare system, improving evidence-based practice integration. This initiative enhanced patient care value through multidisciplinary care plans.

Keywords:
clinical decision supportclinical pathwaydissemination and implementationevidence based medicineevidence-based frameworkquality improvement

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Area of Science:

  • Healthcare Management
  • Clinical Informatics
  • Evidence-Based Practice

Background:

  • Integration of evidence into clinical practice remains suboptimal.
  • Clinical pathways, as multidisciplinary care plans, are crucial for translating evidence into local healthcare settings.
  • These pathways have demonstrated potential to enhance the value of patient care.

Purpose of the Study:

  • To outline the development of a comprehensive clinical pathways program within a large academic healthcare system.
  • To describe the implementation of a structured framework and technology for pathway creation and dissemination.

Main Methods:

  • A 10-step framework, integrating Knowledge-to-Action and ADAPTE Collaboration methodologies, guided pathway development.
  • A cloud-based technology platform (Dorsata) facilitated development and dissemination across geographically dispersed sites.
  • Programme adoption was measured by the number of pathways developed and user engagement with the platform.

Main Results:

  • Over 200 clinical pathways were disseminated between February 2016 and April 2018, with oncology being the most represented domain.
  • The platform registered 1279 users, primarily physicians, advanced practice providers, and nurses.
  • An average of 2150 monthly pathway views were recorded, with 93.6% of pathways referencing evidence-based sources.

Conclusions:

  • A healthcare system can effectively implement a framework and technology platform to support clinical pathway development and dissemination.
  • This approach facilitates the integration of evidence-based practices across multiple sites within an institution.
  • The program demonstrated successful adoption and engagement, indicating a viable model for improving patient care.