Critical pathway effectiveness: assessing the impact of patient, hospital care, and pathway characteristics using qualitative comparative analysis.
OBJECTIVE
To qualitatively describe patient, hospital care, and critical pathway characteristics that may be associated with pathway effectiveness in reducing length of stay.


METHODS
Administrative data and review of pathway documentation and a sample of medical records for each of 26 surgical critical pathways in a tertiary care center's department of surgery, 1988-1998.


METHODS
Retrospective qualitative study. DATA COLLECTION/ABSTRACTION METHODS: Using information from a literature review and consultation with experts, we developed a list of characteristics that might impact critical pathway effectiveness. We used hypothesis-driven qualitative comparative analysis to describe key primary and secondary characteristics that might differentiate effective from ineffective critical pathways.


RESULTS
" All 7 of the 26 pathways associated with a reduced length of stay had at least one of the following characteristics: (1) no preexisting trend toward lower length of stay for the procedure (71 percent), and/or (2) it was the first pathway implemented in its surgical service (71 percent). In addition, pathways effective in reducing length of stay tended to be for procedures with lower patient severity of illness, as indicated by fewer intensive care days and lower mortality. Effective pathways tended to be used more frequently than ineffective pathways (77 versus 59 percent of medical records with pathway documents present), but high rates of documented pathway use were not necessary for pathway effectiveness.


CONCLUSIONS
Critical pathway programs may have limited effectiveness, and may be effective only in certain situations. Because pathway utilization was not a strong predictor of pathway effectiveness, the mechanism by which critical pathways may reduce length of stay is unclear.
Dy
Sydney M
SM
Maryland Community Hospice, Room 609, 624N. Broadway, Baltimore, MD 21205, USA.
Garg
Pushkal
P
Nyberg
Dorothy
D
Dawson
Patricia B
PB
Pronovost
Peter J
PJ
Morlock
Laura
L
Rubin
Haya
H
Wu
Albert W
AW
D015142:Baltimore; D015331:Cohort Studies; D019091:Critical Pathways / Q000592:standards* / Q000706:statistics & numerical data; D006302:Health Services Research; D006785:Hospitals, University / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008485:Medical Audit; D011182:Postoperative Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013503:Surgery Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000592:standards*; D016896:Treatment Outcome