Protocol for a realist evaluation of a COPD clinical pathway in Saskatchewan, Canada

Chronic obstructive pulmonary disease (COPD) is a complex and common condition with significant health, social, and economic burdens, especially due to frequent hospitalizations and comorbidities. International research shows current care for COPD is limited by delayed diagnosis, poor coordination among providers, and inconsistent adherence to treatment guidelines, which negatively impacts patient outcomes. Clinical pathways offer a promising solution by improving care coordination, aligning treatment with evidence-based guidelines, and enhancing both patient experiences and system efficiency; however, questions remain about how, for whom, and in which contexts they are most effective. Using a realist evaluation approach, our study will evaluate how, for whom, and in which circumstances an integrated clinical pathway for COPD works in Saskatchewan, Canada. First, we will develop initial program theories based on literature and stakeholder input. Second, we will test these theories using administrative data and realist interviews with healthcare staff, managers, providers, COPD patients, and caregivers. Third, we will refine our theories based on data collected. Fourth, we will translate our findings to enhance future implementation. These phases will be repeated over a three-year span to continuously improve pathway implementation processes and monitor improvements in patient outcomes. Findings will be shared through integrated knowledge translation with system decision-makers and patients. Findings will also be disseminated to the broader research community through conference presentations and peer-reviewed publications.