title: Evaluating the effect of clinical care pathways on quality of cancer care: analysis of breast, colon and rectal cancer pathways.
abstract: OBJECTIVE
  Substantial gaps exist between clinical practice and evidence-based cancer care, potentially leading to adverse clinical outcomes and decreased quality of life for cancer patients. This study aimed to evaluate the usefulness of clinical pathways as a tool for improving quality of cancer care, using breast, colon, and rectal cancer pathways as demonstrations.
  
  
  METHODS
  Newly diagnosed patients with invasive breast, colon, and rectal cancer were enrolled as pre-pathway groups, while patients with the same diagnoses treated according to clinical pathways were recruited for post-pathway groups.
  
  
  RESULTS
  Compliance with preoperative core biopsy or fine-needle aspiration, utilization of sentinel lymph node biopsy, and proportion of patients whose tumor hormone receptor status was stated in pathology report were significantly increased after implementation of clinical pathway for breast cancer. For colon cancer, compliance with two care processes was significantly improved: surgical resection with anastomosis and resection of at least 12 lymph nodes. Regarding rectal cancer, there was a significant increase in compliance with preoperative evaluation of depth of tumor invasion, total mesorectal excision treatment of middle- or low-position rectal cancer, and proportion of patients who had undergone rectal cancer surgery whose pathology report included margin status. Moreover, total length of hospital stay was decreased remarkably for all three cancer types, and postoperative complications remained unchanged following implementation of the clinical pathways.
  
  
  CONCLUSIONS
  Clinical pathways can improve compliance with standard care by implementing evidence-based quality indicators in daily practice, which could serve as a useful tool for narrowing the gap between clinical practice and evidence-based care.
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang, People's Republic of China.
authors.forename: Han
authors.initials: H
authors.lastname: Bao
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang, People's Republic of China.
authors.forename: Fengjuan
authors.initials: F
authors.lastname: Yang
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang, People's Republic of China.
authors.forename: Shaofei
authors.initials: S
authors.lastname: Su
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang, People's Republic of China.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang, People's Republic of China.
authors.forename: Meiqi
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang, People's Republic of China.
authors.forename: Yaming
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang, People's Republic of China.
authors.forename: Jiaying
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang, People's Republic of China. liumeina369@163.com.
authors.forename: Meina
authors.initials: M
authors.lastname: Liu
mesh_terms: D001943:Breast Neoplasms / Q000517:prevention & control*; D003110:Colonic Neoplasms / Q000517:prevention & control*; D019091:Critical Pathways / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011787:Quality of Health Care; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000517:prevention & control*
keywords: Cancer; Clinical pathway; Quality improvement; Quality of care