title: Care pathways in US healthcare settings: current successes and limitations, and future challenges.
abstract: OBJECTIVE
  Care pathways are used widely in US healthcare settings and are expected to have greater influence on quality of care and patient outcomes in the future. We conducted qualitative research to evaluate the state of care pathways and their impact in the United States.
  
  
  METHODS
  Targeted literature review followed by an online survey and in-person interviews.
  
  
  METHODS
  The PubMed and Cochrane databases were searched for publications on care pathways (January 1, 2005, to July 21, 2014) to inform the subsequent surveys and interviews with payers, providers, and pathway vendors regarding care pathway design, development, and management. A targeted hand search was completed in May 2015 to supplement the earlier review.
  
  
  RESULTS
  Twenty-nine publications, posters, or abstracts on specific care pathways were identified; the online survey and follow-up interviews included 26 and 18 respondents, respectively. Positive trends in current care pathways development and implementation include prioritization of high-quality evidence, enhancing the role of providers in development and implementation, and flexibility for providers to tailor treatment decisions to patients' needs. Nevertheless, there are some limitations in methodology for development and implementation, in criteria for evaluation, and in the degree of transparency surrounding these activities.
  
  
  CONCLUSIONS
  Our research confirms that high-quality evidence of efficacy and safety are expected to be central to future pathway development, and that physicians play a major role in development and implementation. To achieve the goals of improving quality of care while managing costs, further efforts are required regarding systematic development and evaluation, consistent implementation and compliance metrics, and transparency in implementation outcomes and financial motivators.
authors.affiliation: Analysis Group, 1010 El Camino Real, Ste 310, Menlo Park, CA 94025-4355. E-mail: anita.chawla@analysisgroup.com.
authors.forename: Anita
authors.initials: A
authors.lastname: Chawla
authors.forename: Kimberly
authors.initials: K
authors.lastname: Westrich
authors.forename: Susanna
authors.initials: S
authors.lastname: Matter
authors.forename: Anna
authors.initials: A
authors.lastname: Kaltenboeck
authors.forename: Robert
authors.initials: R
authors.lastname: Dubois
mesh_terms: D019091:Critical Pathways / Q000639:trends; D006801:Humans; D007407:Interviews as Topic; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States