Background:
The purpose of this article is to report on the quality of the existing evidence base regardingthe effectiveness of clinical pathway (CPW) research in the hospital setting. The analysis isbased on a recently published Cochrane review of the effectiveness of CPWs.
Methods:
An integral component of the review process was a rigorous appraisal of the methodologicalquality of published CPW evaluations. This allowed the identification of strengths andlimitations of the evidence base for CPW effectiveness. We followed the validated CochraneEffective Practice and Organisation of Care Group (EPOC) criteria for randomized and nonrandomizedclinical pathway evaluations. In addition, we tested the hypotheses that simplepre-post studies tend to overestimate CPW effects reported.
Results:
Out of the 260 primary studies meeting CPW content criteria, only 27 studies met the EPOCstudy design criteria, with the majority of CPW studies (more than 70 %) excluded from thereview on the basis that they were simple pre-post evaluations, mostly comparing two ormore annual patient cohorts. Methodologically poor study designs are often used to evaluateCPWs and this compromises the quality of the existing evidence base.
Conclusions:
Cochrane EPOC methodological criteria, including the selection of rigorous study designsalong with detailed descriptions of CPW development and implementation processes, arerecommended for quantitative evaluations to improve the evidence base for the use of CPWsin hospitals.