title: Effects of care pathways on the in-hospital treatment of heart failure: a systematic review.
abstract: BACKGROUND
  Care pathways have become a popular tool to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. We performed a disease specific systematic review to determine how care pathways in the hospital treatment of heart failure affect in-hospital mortality, length of in-hospital stay, readmission rate and hospitalisation cost when compared with standard care.
  
  
  METHODS
  Medline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched from 1985 to 2010. Each study was assessed independently by two reviewers. Methodological quality of the included studies was assed using the Jadad methodological approach for randomised controlled trials, controlled clinical trials and the New Castle Ottawa Scale for case-control studies, cohort studies and time interrupted series.
  
  
  RESULTS
  Seven studies met the study inclusion criteria and were included in the systematic review with a total sample of 3,690 patients. The combined overall results showed that care pathways have a significant positive effect on mortality and readmission rate. A shorter length of hospital stay was also observed compared with the standard care group. No significant difference was found in the hospitalisation costs. More positive results were observed in controlled trials compared to randomized controlled trials.
  
  
  CONCLUSIONS
  By combining all possible results, it can be concluded that care pathways for treatment of heart failure decrease mortality rates and length of hospital stay, but no statistically significant difference was observed in the readmission rates and hospitalisation costs. However, one should be cautious with overall conclusions: what works for one organization may not work for another because of the subtle differences in processes and bottlenecks.
authors.affiliation: Department of Biostatistics, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey. sevalkul@gantep.edu.tr
authors.forename: Seval
authors.initials: S
authors.lastname: Kul
authors.forename: Antonella
authors.initials: A
authors.lastname: Barbieri
authors.forename: Erika
authors.initials: E
authors.lastname: Milan
authors.forename: Ilke
authors.initials: I
authors.lastname: Montag
authors.forename: Kris
authors.initials: K
authors.lastname: Vanhaecht
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Panella
mesh_terms: D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission