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Meta-Analysis
. 2025 May 14;5(5):CD006632.
doi: 10.1002/14651858.CD006632.pub3.

Clinical pathways for secondary care and the effects on professional practice, patient outcomes, length of stay and hospital costs

Thomas Rotter  1 , Leigh D Kinsman  2 , Agnès Alsius  3 , Shannon D Scott  4 , Adegboyega Lawal  5 , Ulrich Ronellenfitsch  6 , Christopher Plishka  5 , Gary Groot  7 , Phil Woods  8 , Chloe Coulson  3 , Leigh Anne Bakel  9 , Kim Sears  10 , Amanda Ross-White  11   12 , Andreas Machotta  13 , Timothy J Schultz  14
Affiliations
Meta-Analysis

Clinical pathways for secondary care and the effects on professional practice, patient outcomes, length of stay and hospital costs

Thomas Rotter et al. Cochrane Database Syst Rev. .

Abstract

Background: Clinical pathways (CPWs) are structured multidisciplinary care plans. They aim to translate evidence into practice and optimize clinical outcomes. This is the first update of the previous systematic review.

Objectives: To investigate the effect of CPWs on patient outcomes, length of stay, costs and charges, adherence to recommended practice, and to measure the impact of different approaches to implementation of CPWs.

Search methods: For this update, CENTRAL, MEDLINE, and Embase were searched on 25 July 2024. Two trial registries were searched on 26 July 2024, along with reference checking, citation searching and contacting authors to identify additional studies.

Selection criteria: We considered two groups of participants: health professionals involved in CPW utilization, including (but not limited to) physicians, nurses, physiotherapists, pharmacists, occupational therapists and social workers; and patients managed using a CPW. We included randomized trials, non-randomized trials, controlled before-after (CBA) studies, and interrupted time-series (ITS) studies comparing (1) stand-alone clinical pathways with usual care, and (2) clinical pathways as part of a multifaceted intervention with usual care.

Data collection and analysis: Two authors independently screened all titles, abstracts and full-text manuscripts to assess eligibility and the methodological quality of included studies using the Cochrane Effective Practice and Organization of Care 'Risk of Bias' tool. Certainty of evidence was assessed by two authors independently. Interventions were scored as 'high', 'moderate' or 'low' for the evidence-based implementation process.

Main results: The update provided 31 additional studies for a total of 58 included studies (24,841 patients and 2027 healthcare professionals). Forty-one (71%) were randomized trials, four (7%) non-randomized trials, four (7%) CBA studies and nine (16%) ITS studies. Forty-nine studies compared stand-alone CPWs to usual care and nine compared multifaceted interventions including a CPW to usual care. Collectively, the risk of bias was high due to potential contamination by healthcare professionals, lack of blinding of patients and personnel, lack of allocation concealment and selective reporting in ITS studies. Stand-alone clinical pathway interventions It is uncertain whether stand-alone CPWs reduce inhospital mortality (13% v 16%: OR 0.79, 95% CI 0.53 to 1.20; P = 0.27; I² = 65%; 7 randomized trials; n = 4603; low-certainty evidence due to serious imprecision and inconsistency) or mortality (up to 6 months) (4% v 3%: OR 1.37, 95% CI 0.72 to 2.60; P = 0.34; I² = 20%; 3 randomized trials, n = 805; low-certainty evidence due to serious risk of bias and imprecision). Stand-alone CPWs likely reduce inhospital complications (10% v 17%: OR 0.57, 95% CI 0.41 to 0.80; P = 0.001; I² = 52%; 11 randomized trials, n = 3668; moderate-certainty evidence due to serious risk of bias). It is very uncertain whether stand-alone CPWs reduce hospital readmissions (up to 6 months) (9% v 13%: OR 0.67, 95% CI 0.44 to 1.03; P = 0.07; I² = 11%; 9 randomized trials, n = 1578; very low-certainty evidence due to serious risk of bias and very serious imprecision). Stand-alone CPWs likely reduce the length of hospital stay compared to usual care (MD -1.12 days, 95% CI -1.60 to -0.65; P < 0.00001; I² = 64%; 21 studies; n = 5201; moderate-certainty evidence due to serious inconsistency). Costs and charges were generally lower in CPWs as indicated by negative MDs in nine studies (10 studies, n = 2113, data not pooled; very low-certainty evidence due to serious indirectness and very serious inconsistency). Stand-alone CPWs may slightly increase adherence to recommended practice compared with usual care (3 randomized studies, n = 573; data not pooled; low-certainty evidence due to serious risk of bias and serious inconsistency). Multifaceted clinical pathway interventions It is uncertain whether multifaceted CPWs reduce inhospital mortality (2 randomized studies, n = 6304, data not pooled; low-certainty evidence due to very serious inconsistency). Multifaceted CPWs may make little or no difference to mortality (up to 6 months) (9% v 8%: OR 1.05, 95% CI 0.88 to 1.25; P = 0.61; I² = 0%; 3 randomized studies; n = 6531; low-certainty evidence due to serious imprecision and serious risk of bias). It is uncertain whether multifaceted CPWs reduce inhospital complications (9% v 23%: OR 0.32, 95% CI 0.12 to 0.87; 1 study, n = 140; low-certainty evidence due to very serious imprecision). It is uncertain whether multifaceted CPWs reduce hospital readmission (up to 6 months) (2 randomized studies, n =1569, data not pooled; low-certainty evidence due to very serious inconsistency), or length of stay (4 randomized studies, n = 1936, data not pooled; low-certainty evidence due to very serious inconsistency), or hospital costs and charges (4 randomized studies, n = 2015, data not pooled; very low-certainty evidence due to very serious imprecision and serious indirectness in outcome measures). It is uncertain whether multifaceted CPWs increase adherence to recommended practice (2 randomized studies, n = 6304, data not pooled, low-certainty evidence due to very serious inconsistency). Key study characteristics The highest proportion of included studies were from the USA (36%), followed by Australia (10%), China (10%), Japan (5%), the UK (5%), Canada (5%), Italy (5%), and Germany (5%). More than half of the included studies tested CPW in general acute wards (53%), followed by emergency departments (17%), intensive care (14%), and extended-stay facilities (10%). The most common clinical conditions were asthma (16%), stroke (10%), mechanical ventilation (9%) and myocardial infarction (7%).

Authors' conclusions: Stand-alone CPWs are likely to reduce inhospital complications and length of hospital stay and may slightly increase adherence to recommended practice. There was little conclusive evidence for multifaceted CPWs due to mixed results from a limited number of included studies. It is uncertain whether stand-alone CPWs or CPWs, as part of a multifaceted approach, reduce inhospital mortality, mortality (up to 6 months), hospital readmission (up to 6 months) or costs and charges.

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Conflict of interest statement

Thomas Rotter (TR): Author of one of the included studies. The evaluation of this study, including data extraction and risk of bias assessment, was conducted by two other authors not involved in the study. No other conflicts known.

Leigh Kinsman (LK): Author of two of the included studies. The evaluation of these studies, including data extraction and risk of bias assessment, was conducted by two other authors not involved in either of the studies. No other conflicts known.

Agnes Alsius (AA): none known.

Shannon D. Scott (SS): none known.

Adegboyega Lawal (AL): none known.

Ulrich Ronellenfitsch (UR): none known.

Christopher Plishka (CP): none known.

Gary Groot (GG): none known.

Phil Woods (PW): none known.

Chloe Coulson (CC): none known.

Leigh Anne Bakel (LAB): none known.

Kimberly Sears (KS): none known.

Amanda Ross‐White (ARW): none known.

Andreas Machotta (AM): Author of one of the included studies. The evaluation of this study, including data extraction and risk of bias assessment, was conducted by two other authors not involved in the study. No other conflicts known.

Timothy J Schultz (TS): none known.

Update of

References

References to studies included in this review

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References to studies excluded from this review

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    1. Barlow G, Nathwani D, Williams F, Ogston S, Winter J, Jones M, et al. Reducing door-to-antibiotic time in community-acquired pneumonia: controlled before-and-after evaluation and cost-effectiveness analysis. Thorax 2007;62(1):67-74. [PMID: ] - PMC - PubMed
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Bertram 2023 {published data only}
    1. Bertram W, Wylde V, Howells N, Shirkey B, Peters TJ, Zhu L, et al. The STAR care pathway for patients with chronic pain after total knee replacement: four-year follow-up of a randomised controlled trial. BMC Musculoskeletal Disorders 2023;24(1):972. [DOI: 10.1186/s12891-023-07099-x] - DOI - PMC - PubMed
Bhat 2024 {published data only}
    1. Bhat JN, Amato A, Schultz S, Gomez R. Protocol-based standardized endocrinological evaluation of children with traumatic brain injury: a quality improvement initiative. Clinical Pediatrics 2024;63(11):1551-8. [DOI: 10.1177/00099228241230390] - DOI - PubMed
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    1. Brunenberg DE, Van Steyn MJ, Sluimer JC, Bekebrede LL, Bulstra SK, Joore MA. Joint recovery programme versus usual care: an economic evaluation of a clinical pathway for joint replacement surgery. Medical Care 2005;43(10):1018-26. [0025-7079] [PMID: ] - PubMed
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    1. Burns SP, Nelson AL, Bosshart HT, Goetz L, Harrow JJ, Gerhart KD, et al. Implementation of clinical practice guidelines for prevention of thromboembolism in spinal cord injury. Journal of Spinal Cord Medicine 2005;28(1):33-42. [PMID: ] - PubMed
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    1. Cabezas C, Martin C, Granollers S, Morera C, Ballve JL, Zarza E, et al. Effectiveness of a stepped primary care smoking cessation intervention (ISTAPS study): design of a cluster randomised trial. BioMed Central Public Health 2009;9(1):48. - PMC - PubMed
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Carpintero 2009 {published data only}
    1. Carpintero P, Gil-Garay E, Hernandez-Vaquero D, Ferrer H, Munuera L. Interventions to improve inpatient osteoporosis management following first osteoporotic fracture: the PREVENT project. Archives of Orthopaedic and Trauma Surgery 2009;129(2):245-50. - PubMed
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    1. Carr DA, Saigal R, Zhang F, Bransford RJ, Bellabarba C, Dagal A. Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery. Neurosurgery 2019;46(4):E5. - PubMed
Carratala 2012 {published data only}
    1. Carratala J, Garcia-Vidal C, Ortega L, Fernandez-Sabe N, Clemente M, Albero G, et al. Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: a randomized controlled trial. Archives of Internal Medicine 2012;172:922-8. - PubMed
Carter‐Brooks 2018 {published data only}
    1. Carter-Brooks CM, Du AL, Ruppert KM, Romanova AL, Zyczynski HM. Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway. American Journal of Obstetrics and Gynecology 2018;219(5):495.e1-495.e10. - PMC - PubMed
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    1. Casalta J, Botelho-Nevers E, Thuny F, Gouriet HG, Raoult D, Riberi A, et al. How management-based approach of infectious endocarditis (IE) treatment led to a dramatic fall in mortality. International Journal of Antimicrobial Agents 2009;33:S19.
Casas 2006 {published data only}
    1. Casas A, Troosters T, Garcia-Aymerich J, Roca J, Hernandez C, Alonso A, et al. Integrated care prevents hospitalisations for exacerbations in COPD patients. European Respiratory Journal 2006;28(1):123-30. - PubMed
Chamouard 2023 {published data only}
    1. Chamouard V, Freyssenge J, Duport G, Volot F, Varin R, Giraud N, et al. Evaluation of the care pathway in the context of the dispensing of emicizumab (Hemlibra) in community and hospital pharmacies in France: a patient satisfaction survey. Haemophilia 2023;29:1490-8. - PubMed
Chen 2022 {published data only}
    1. Chen J, Wen Y, Jin L, Peng J, Ji J. Effect of clinical nursing pathway intervention based on evidence-based medicine on venous thrombosis in long-term bedridden patients. Journal of Healthcare Engineering 2022;2022:5120569. [DOI: 10.1155/2022/5120569] - DOI - PMC - PubMed
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    1. Cheney J, Barber S, Altamirano L, Medico Cirujano, Cheney M, Williams C, et al. A clinical pathway for bronchiolitis is effective in reducing readmission rates. Journal of Pediatrics 2005;147(5):622-6. [PMID: ] - PubMed
Chu 2001a {published data only}
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    1. Conway B. Prevention and management of postoperative nausea and vomiting in adults. Association of PeriOperative Registered Nurses Journal 2009;90(3):391-413. - PubMed
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Counsell 2007 {published data only}
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    1. Covinsky KE, Palmer RM, Kresevic DM, Kahana E, Counsell SR, Fortinsky RH, et al. Improving functional outcomes in older patients: lessons from an acute care for elders unit. Joint Commission Journal on Quality Improvement 1998;24(2):63-76. [PMID: ] - PubMed
D'Souza 2019 {published data only}
    1. D'Souza K, Choi JI, Wootton J, Wallace T. Impact of sequential implementation of multimodal perioperative care pathways on colorectal surgical outcomes. Canadian Journal of Surgery [Journal Canadien de Chirurgie] 2019;62(1):25-32. - PMC - PubMed
DeLuca 2009 {published data only}
    1. De Luca A, Toni D, Lauria L, Sacchetti ML, Giorgi Rossi P, Ferri M, et al, IMPLementazione Percorso Clinico Assistenziale ICtus Acuto (IMPLICA) Study Group. An emergency clinical pathway for stroke patients - results of a cluster randomised trial (ISRCTM41456865). BioMed Central Health Services Research 2009;21(9):14. - PMC - PubMed
Denbo 2018 {published data only}
    1. Denbo JW, Bruno M, Dewhurst W, Kim MP, Tzeng CW, Aloia TA, et al. Risk-stratified clinical pathways decrease the duration of hospitalization and costs of perioperative care after pancreatectomy. Surgery 2018;164(3):424-31. - PMC - PubMed
Deneckere 2013 {published data only}
    1. Deneckere S, Euwema M, Lodewijckx C, Panella M, Mutsvari T, Sermeus W, et al. Better interprofessional teamwork, higher level of organized care, and lower risk of burnout in acute health care teams using care pathways: a cluster randomized controlled trial. Medical Care 2013;51(1):99-107. - PubMed
Dragun 2024 {published data only}
    1. Dragun A, Fabiano A, Weber T, Hall K, Bagley C. Evaluation of ERAS protocol implementation on complex spine surgery complications and length of stay: a single institution study. Spine Journal 2024;24(10):1811-6. - PubMed
Du 2014 {published data only}
    1. Du X, Gao R, Turnbull F, Wu Y, Rong Y, Lo S, et al, CPACS Investigators. Hospital quality improvement initiative for patients with acute coronary syndromes in China: a cluster randomized, controlled trial. Circulation: Cardiovascular Quality and Outcomes 2014;7(2):217-26. - PubMed
Duncan 2013 {published data only}
    1. Duncan CM, Moeschler SM, Horlocker TT, Hanssen AD, Hebl JR. A self-paired comparison of perioperative outcomes before and after implementation of a clinical pathway in patients undergoing total knee arthroplasty. Regional Anesthesia and Pain Medicine 2013;38(6):533-8. - PubMed
Dunn 2022 {published data only}
    1. Dunn M, Savoie K, Erdem G, Dykes MW, Buckingham D, Spencer S, et al. Quality improvement methodology can reduce hospitalisation for abscess management. Emergency Medicine Journal 2022;January 11:Epub ahead of print. [DOI: 10.1136/emermed-2021-211466] - DOI - PubMed
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    1. Eagle KA, Mulley AG, Skates SJ, Reder VA, Nicholson BW, Sexton JO, et al. Length of stay in the intensive care unit. Effects of practice guidelines and feedback. Journal of the American Medical Association 1990;264(8):992-7. [PMID: ] - PubMed
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    1. Edworthy SM, Baptie B, Galvin D, Brant RF, Churchill-Smith T, Manyari D, et al. Effects of an enhanced secondary prevention program for patients with heart disease: a prospective randomized trial. Canadian Journal of Cardiology 2007;23(13):1066-72. [PMID: ] - PMC - PubMed
Featherall 2018 {published data only}
    1. Featherall J, Brigati DP, Faour M, Messner W, Higuera CA. Implementation of a total hip arthroplasty care pathway at a high-volume health system: effect on length of stay, discharge disposition, and 90-day complications. Journal of Arthroplasty 2018;33(6):1675-80. - PubMed
Ferri 2006 {published data only}
    1. Ferri LE, Feldman LS, Stanbridge DD, Fried GM. Patient perception of a clinical pathway for laparoscopic foregut surgery. Journal of Gastrointestinal Surgery 2006;10(6):878-82. [1091-255X] [PMID: ] - PubMed
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    1. Finotto S, Artioli G, Davoli L, Barbara B. Nursing interventions for the prevention of the delirium in intensive care unit (ICU): a randomized study. Professioni Infermieristiche 2006;59(4):228-32. [PMID: ] - PubMed
Fletcher 2017 {published data only}
    1. Fletcher ND, Andras LM, Lazarus DE, Owen RJ, Geddes BJ, Cao J, et al. Use of a novel pathway for early discharge was associated with a 48% shorter length of stay after posterior spinal fusion for adolescent idiopathic scoliosis. Journal of Pediatric Orthopedics 2017;37(2):92-7. - PubMed
Garcia‐Aymerich 2007 {published data only}
    1. Garcia-Aymerich J, Hernandez C, Alonso A, Casas A, Rodriguez-Roisin R, Anto JM, et al. Effects of an integrated care intervention on risk factors of COPD readmission. Respiratory Medicine 2007;101(7):1462-9. [PMID: ] - PubMed
Garin 2011 {published data only}
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Gas 2019 {published data only}
    1. Gas J, Liaigre-Ramos A, Caubet-Kamar N, Beauval JB, Lesourd M, Prudhomme T, et al. Evaluation of the impact of a clinical pathway on the progression of acute urinary retention. Neurourology and Urodynamics 2019;38(1):387-92. - PubMed
Gellert 2019 {published data only}
    1. Gellert GA, Davenport CM, Minard CG, Castano C, Bruner K, Hobbs D. Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry. Journal of Asthma 2019;25:1-13. - PubMed
Gerard 2018 {published data only}
    1. Gerard RR, Kielhorn BA, Petersen B, Mullard AJ, McCahill LE. Post-operative management of perforated appendicitis: can clinical pathways improve outcomes? American Journal of Surgery 2018;215(4):593-8. - PubMed
Gibbon 2002 {published data only}
    1. Gibbon B, Watkins C, Barer D, Waters K, Davies S, Lightbody L, et al. Can staff attitudes to team working in stroke care be improved? Journal of Advanced Nursing 2002;40(1):105-11. [PMID: ] - PubMed
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    1. Givens M, Rutherford C, Joshi G, Delaney K. Impact of an emergency department pain management protocol on the pattern of visits by patients with sickle cell disease. Journal of Emergency Medicine 2007;32(3):239-43. [PMID: ] - PubMed
Glotzbecker 2019 {published data only}
    1. Glotzbecker M, Troy M, Miller P, Berry J, Cohen L, Gryzwna A, et al. Implementing a multidisciplinary clinical pathway can reduce the deep surgical site infection rate after posterior spinal fusion in high-risk patients. Spine Deformity 2019;7(1):33-9. - PubMed
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    1. Gounder PP, Rhew DC, Landry L, Sklar T, Dorn GH, Wong JY, et al. A multicenter intervention to improve the care of hospitalized patients with community-acquired pneumonia. Journal of Clinical Outcomes Management 2003;10(8):431-8.
Hanekom 2013 {published data only}
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Hashine 2021 {published data only}
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Horn 2007 {published data only}
    1. Horn EK, Van Benthem TB, Hakkaart-Van Roijen L, Van Marwijk HWJ, Beekman AT, Rutten FF, et al. Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial. BioMed Central Health Services Research 2007;7:2007. - PMC - PubMed
Hussain 2017 {published data only}
    1. Hussain ZI, Lim M, Stojkovic S. Role of clinical pathway in improving the quality of care for patients with faecal incontinence: a randomised trial. World Journal of Gastrointestinal Pharmacology and Therapeutics 2017;8(1):81-9. - PMC - PubMed
Kaiser 2018 {published data only}
    1. Kaiser SV, Rodean J, Bekmezian A, Hall M, Shah SS, Mahant S, et al. Effectiveness of pediatric asthma pathways for hospitalized children: a multicenter, national analysis. Journal of Pediatrics 2018;197:165-171.e2. - PubMed
Kajikawa 2004 {published data only}
    1. Kajikawa H, Kubo T, Nario K, Miyahara H. The usefulness of a clinical pathway for patient care management following tonsillectomy. Practica Oto-Rhino-Laryngologica 2004;97(10):905-9.
Kazui 2004 {published data only}
    1. Kazui H, Hashimoto M, Nakano Y, Matsumoto K, Yamamura S, Nagaoka K, et al. Effectiveness of a clinical pathway for the diagnosis and treatment of dementia and for the education of families. International Journal of Geriatric Psychiatry 2004;19(9):892-7. [PMID: ] - PubMed
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    1. Ke L, Lin J, Doig GS, Van Zanten AR, Wang Y, Xing J, et al. Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial. Critical Care (London, England) 2022;26(1):46. [DOI: 10.1186/s13054-022-03921-5] - DOI - PMC - PubMed
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    1. Kelly RE Jr, Wenger A, Horton C Jr, Nuss D, Croitoru DP, Pestian JP. The effects of a pediatric unilateral inguinal hernia clinical pathway on quality and cost. Journal of Pediatric Surgery 2000;35(7):1045-8. [0022-3468] [PMID: ] - PubMed
Kight 1999 {published data only}
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    1. Lange M, Badjatia N, Chang WT. Implementation of a clinical pathway to reduce rates of postextubation stridor. Critical Care Nurse 2018;38(5):34-41. - PubMed
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    1. Lee SC, Tseng HY, Wang KY, Lee LC. Effect of a clinical pathway on selected clinical outcomes of pulmonary lobectomy. Zhonghua Yi Xue za Zhi [Chinese Medical Journal] 2002;65(1):7-12. [0578-1337] [PMID: ] - PubMed
Lee 2023 {published data only}
    1. Lee DS, Straus SE, Farkouh ME, Austin PC, Taljaard M, Chong A, et al. Trial of an intervention to improve acute heart failure outcomes. New England Journal of Medicine 2023;388(1):22-32. [DOI: 10.1056/NEJMoa2211680] - DOI - PubMed
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    1. Lei W, Minzhou Z, Liheng G, Jianyong Q, Jun Z, Xujie Z, et al. The influence of integrative medicine clinical pathways on prognosis for acute myocardial infarction: a non-randomised controlled trial. Heart (British Cardiac Society) 2012;98:E192.
Letton 2013 {published data only}
    1. Letton C, Cheung C, Nordin A. Does an enhanced recovery integrated care pathway (ICP) encourage adherence to prescribing guidelines, accelerate postoperative recovery and reduce the length of stay for gynaecological oncology patients? Journal of Obstetrics and Gynaecology 2013;33(3):296-7. - PubMed
Li 2016 {published data only}
    1. Li W, Gao J, Wei S, Wang D. Application values of clinical nursing pathway in patients with acute cerebral hemorrhage. Experimental and Therapeutic Medicine 2016;11(2):490-4. - PMC - PubMed
Li 2018b {published data only}
    1. Li M, Zhang J, Gan TJ, Qin G, Wang L, Zhu M, et al. Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. European Journal of Cardio-Thoracic Surgery 2018;54(3):491-7. - PubMed
Lindberg 2016 {published data only}
    1. Lindberg P, Steinger B, Koller M, Farst A, Kastel M, Obermaier R, et al. Implementing a clinical pathway with quality of life diagnosis and therapy of patients with primary colorectal cancer: a randomised controlled trial. Oncology Research and Treatment 2016;39:137.
Loeb 2006 {published data only}
    1. Loeb M, Carusone SC, Goeree R, Walter SD, Brazil K, Krueger P, et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: a randomized controlled trial. Journal of the American Medical Association 2006;295(21):2503-10. [PMID: ] - PubMed
Lu 2019 {published data only}
    1. Lu XE, Chen JC, He HY, Yuan L, Xiao YC, Liu MT. Application of clinical nursing pathway reduced the incidence of bedsores and improved rehabilitation in senile bedridden patients. International Journal of Clinical and Experimental Medicine 2019;12(2):1857-63.
Luo 2021 {published data only}
    1. Luo S, Wu C, Luo Q, Ran M, Liu Y, Lei F, et al. The design and evaluation of clinical pathway for disease management to maximize public health benefit. Risk Management and Healthcare Policy 2021;14:5047-57. - PMC - PubMed
Ma 2017 {published data only}
    1. Ma J, Yan HY, Yang YH. Clinical effects of clinical nursing pathway for acute pancreatitis. World Chinese Journal of Digestology 2017;25(9):816-21.
Mattart 2017 {published data only}
    1. Mattart L, Stevens M, Magis D, Magotteaux P, Jehaes C, Monami B, et al. Clinical pathway evaluation for left colectomy in abdominal surgery. La Revue Medicale de Liege 2017;72(1):45-50. - PubMed
Mo 2010 {published data only}
    1. Mo J, Oh H, Ahn Y, Seo W. Implementation of a clinical pathway in primary spontaneous pneumothorax patients treated by wedge resection surgery. Clinical Nurse Specialist 2010;24(6):295-303. - PubMed
Mohamed 2018 {published data only}
    1. Mohamed WR, Leach MJ, Reda NA, Abd-Ellatif MM, Mohammed MA, Abd-Elaziz MA. The effectiveness of clinical pathway-directed care on hospitalisation-related outcomes in patients with severe traumatic brain injury: a quasi-experimental study. Journal of Clinical Nursing 2018;27:e820-e832. - PubMed
Moller 2011 {published data only}
    1. Moller MH, Adamsen S, Thomsen RW, Moller AM, Peptic Ulcer Perforation trial group. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. British Journal of Surgery 2011;98(6):802-10. - PubMed
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Mooney 2022 {published data only}
    1. Mooney SS, Gill GK, Readman E. Virtual clinics in gynaecology - can we shorten the wait? A randomised controlled trial implementing a novel care pathway for postmenopausal bleeding. Australian & New Zealand Journal of Obstetrics & Gynaecology 2022;62(5):732-9. [DOI: 10.1111/ajo.13573] - DOI - PubMed
Morse 2018 {published data only}
    1. Morse E, Henderson C, Carafeno T, Dibble J, Longley P, Chan E, et al. A clinical care pathway to reduce ICU usage in head and neck microvascular reconstruction. Otolaryngology Head and Neck Surgery 2018;160(5):783-90. - PubMed
Mou 2013 {published data only}
    1. Mou L. Application of clinical pathway in cyclocryotherapy in treatment of refractory glaucoma. International Eye Science 2013;13(5):947-9.
Nucifora 2009 {published data only}
    1. Nucifora G, Badano LP, Sarraf-Zadegan N, Karavidas A, Trocino G, Scaffidi G, et al. Effect on quality of life of different accelerated diagnostic protocols for management of patients presenting to the emergency department with acute chest pain. American Journal of Cardiology 2009;103(5):592-7. - PubMed
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Owen 2006 {published data only}
    1. Owen JE, Walker RJ, Edgell L, Collie J, Douglas L, Hewitson TD, et al. Implementation of a pre-dialysis clinical pathway for patients with chronic kidney disease. International Journal for Quality in Health Care 2006;18(2):145-51. [1353-4505] [PMID: ] - PubMed
Paskowski 2011 {published data only}
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Pinzon 2009 {published data only}
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Qin 2019 {published data only}
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Ritchie 2024 {published data only}
    1. Ritchie L, Harrison S, Penson P, Akbari A, Torabi F, Hollinghurst J, et al. Adherence to the Atrial fibrillation Better Care pathway and the risk of adverse health outcomes in older care home residents with atrial fibrillation: a retrospective data linkage study 2003-18. Age and Ageing 2024;53(2):1-10. - PMC - PubMed
Rolnick 1998 {published data only}
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Ross 2004 {published data only}
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Schroeder 2024 {published data only}
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Schwarzbach 2010 {published data only}
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Shabunin 2021 {published data only}
    1. Shabunin AV, Arablinskiy AV, Drozdov PA, Nesterenko IV, Makeev DA, Rumer VB, et al. Therapeutic and diagnostic algorithm for the treatment of lymphocele in renal transplant recipients. Medical Visualization 2021;25(2):42-9.
Shahid 2024 {published data only}
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Short 1997 {published data only}
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Smulowitz 2018 {published data only}
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Soria‐Aledo 2008 {published data only}
    1. Soria-Aledo V, Flores-Pastor B, Candel-Arenas MF, Carrillo-Alcaraz A, Campillo-Soto A, Miguel-Perello J, et al. Evaluation and monitoring of the clinical pathway for thyroidectomy. American Surgeon 2008;74(1):29-36. [PMID: ] - PubMed
Srinivasan 2009 {published data only}
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Summers 1998 {published data only}
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    1. Ten Berge DM, Braem MJ, Altenburg A, Dieltjens M, Van de Heyning PH, Vanhaecht K, et al. Evaluation of the impact of a clinical pathway on the organization of a multidisciplinary dental sleep clinic. Sleep & Breathing 2014;18(2):325-34. - PubMed
Thilly 2003 {published data only}
    1. Thilly N, Briancon S, Juilliere Y, Dufay E, Zannad F. Improving ACE inhibitor use in patients hospitalized with systolic heart failure: a cluster randomized controlled trial of clinical practice guideline development and use. Journal of Evaluation in Clinical Practice 2003;9(3):373-82. [PMID: ] - PubMed
Tosun 2006 {published data only}
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Unemura 2002 {published data only}
    1. Unemura Y, Toriumi H, Nogi H, Saeki T, Shioya H, Misawa T, et al. Introduction of a unique clinical pathway for colorectal polypectomy and analysis of its value. Tokyo Jikeikai Ika Daigaku Zasshi [Tokyo Jikeikai Medical Journal] 2002;117(6):419-26. [EMBASE: 2003256823] [0375-9172]
Van der Kolk 2017 {published data only}
    1. Van der Kolk M, Van den Boogaard M, Becking-Verhaar F, Custers H, Van der Hoeven H, Pickkers P, et al. Implementation and evaluation of a clinical pathway for pancreaticoduodenectomy procedures: a prospective cohort study. Journal of Gastrointestinal Surgery 2017;21(9):1428-41. - PubMed
Van der Kolk 2018 {published data only}
    1. Van der Kolk BM, Van den Boogaard M, Van der Hoeven JG, Noyez L, Pickkers P. Sustainability of clinical pathway guided care in cardiac surgery ICU patients; 9-years experience in over 7500 patients. International Journal of Quality in Health Care 2018;1:1. - PubMed
Verdu 2009 {published data only}
    1. Verdu A, Maestre A, Lopez P, Gil V, Martin-Hidalgo A, Castano JA. Clinical pathways as a healthcare tool: design, implementation and assessment of a clinical pathway for lower-extremity deep venous thrombosis. Quality & Safety in Health Care 2009;18:314-20. - PubMed
Walsh 2001 {published data only}
    1. Walsh MD, Barry M, Scott TE, Lamorte WW, Menzoian JO. The role of a nurse case manager in implementing a critical pathway for infrainguinal bypass surgery. Joint Commission Journal on Quality and Safety 2001;27(4):230-8. [PMID: ] - PubMed
Wang 2002 {published data only}
    1. Wang TJ, Mort EA, Nordberg P, Chang Y, Cadigan ME, Mylott L, et al. A utilization management intervention to reduce unnecessary testing in the coronary care unit. Archives of Internal Medicine 2002;162(16):1885-90. [PMID: ] - PubMed
Wang 2011 {published data only}
    1. Wang L, Zhang MZ, Zhang J. Establishment and testing practice of an integrative medical pathway for clinical management of acute myocardial infarction. Zhongguo Zhong Xi Yi Jie He za Zhi [Chinese Journal of Integrated Traditional and Western Medicine] 2011;31(1):7-10. - PubMed
Wang 2018b {published data only}
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Yamana 2009 {published data only}
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Zhou 2018 {published data only}
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References to studies awaiting assessment

Cadilhac 2022 {published data only}
    1. Cadilhac DA, Marion V, Andrew NE, Breen SJ, Grabsch B, Purvis T, et al. A stepped-wedge cluster-randomized trial to improve adherence to evidence-based practices for acute stroke management. Joint Commission Journal on Quality and Patient Safety 2022;48(12):653-64. [DOI: 10.1016/j.jcjq.2022.09.003] - DOI - PubMed
Chong 2013 {published data only}
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Courtney 2022 {published data only}
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Hsu 2020 {published data only}
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Karimi 2023 {published data only}
    1. Karimi S, Kolyaei E, Karimi P, Rahmani K. Effectiveness of supervised implementation of an oral health care protocol on ventilator-associated pneumonia patients in intensive care units: a double-blind multicenter randomized controlled trial. Infection Prevention in Practice 2023;5(3):100295. [DOI: 10.1016/j.infpip.2023.100295] - DOI - PMC - PubMed
Kumar 2024 {published data only}
    1. Kumar S, Bugalia RP, Meena J. Prospective study of role of multimodal perioperative management protocol in colorectal cancer surgery. Journal of Cardiovascular Disease Research 2024;15(3):867-76. [DOI: 10.48047/jcdr.2024.15.03.100] - DOI
Li 2015 {published data only}
    1. Li J-Y, Huang L-M, Fang Z. Clinical effects of implementation of clinical nursing pathway in patients undergoing laparoscopic cholecystectomy [临床护理路径应用于腹腔镜胆囊切除术患者的疗效李金英, 黄丽美, 方珍. 临床护理路径应用于腹腔镜胆囊切除术患者的疗效. 世界华人消化杂志 ]. World Journal of Chinese Digestion 2015;23(7):1170‐73. [DOI: 10.11569/wcjd.v23.i7.1170] - DOI
Mahant 2023 {published data only}
    1. Mahant S, Guan J, Zhang J, Gandhi S, Propst EJ, Guttmann A. Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis. BMJ Quality & Safety 2023;32(9):526-35. [DOI: 10.1136/bmjqs-2021-013110] - DOI - PubMed
McKee 2024 {published data only}
    1. McKee KE, Knighton AJ, Veale K, Martinez J, McCann C, Anderson JW, et al. Impact of local tailoring on acute stroke care in 21 disparate emergency departments: a prospective stepped wedge type III hybrid effectiveness-implementation study. Circulation: Cardiovascular Quality and Outcomes 2024;17(5):E010477. [DOI: 10.1161/CIRCOUTCOMES.123.010477] - DOI - PMC - PubMed
Park 2022 {published data only}
    1. Park S, Kim S, Kim Hong B, Youn Sang W, Ahn S, Kim K. Effects of implementing a clinical pathway on antibiotic prophylaxis for patients who underwent an elective surgery. Scientific Reports 2022;12(1):20176. [DOI: 10.1038/s41598-022-24145-1] - DOI - PMC - PubMed
Puchalski 2022 {published data only}
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Vogel 2024 {published data only}
    1. Vogel JP, Pujar Y, Vernekar SS, Armari E, Pingray V, Althabe F, et al. Effects of the WHO Labour Care Guide on cesarean section in India: a pragmatic, stepped-wedge, cluster-randomized pilot trial. Nature Medicine 2024;30(2):463-9. [DOI: 10.1038/s41591-023-02751-4] - DOI - PMC - PubMed
Yeates 2023 {published data only}
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References to other published versions of this review

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MeSH terms

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