Developing evidence-based practice guidelines and pathways: the experience at the local hospital level

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Evidence-Based Medicine

Background:

• Local development of evidence-based clinical practice guidelines enhances clinician implementation.
• Cedars-Sinai Health System piloted the Clinical Cost-Reduction System (CCRS) software for length-of-stay guidelines in 1994.
• Ongoing data collection assesses CCRS's impact on length of stay and patient outcomes.

Purpose of the Study:

• To develop a software system that presents organized medical information to hospitals.
• To actively involve clinicians in the development of evidence-based clinical pathways.
• To support hospitals in designing their own clinical pathways.

Main Methods:

• The Clinical Pathway Constructor (CPC) is a computerized grid for writing clinical pathways.
• It is supported by a database of information for selected clinical conditions and care categories.
• Multidisciplinary teams review evidence and determine guidelines to encode into pathways.

Main Results:

• The CPC program allows multidisciplinary teams to design their own evidence-based pathways.
• The software aids in developing appropriate guidelines, rather than legislating them.
• Data on the program's "portability" are still being collected.

Conclusions:

• The CPC software facilitates the creation of customized, evidence-based clinical pathways.
• It empowers multidisciplinary teams to tailor guidelines to their specific needs.
• Further evaluation is needed to assess the program's broader applicability and impact.