title: What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review.
abstract: Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refinement of an operational definition for CPW research and proposes an operational definition for the future syntheses of CPWs literature. Following the approach proposed by Kinsman et al. (BMC Medicine 8(1):31, 2010) and Wieland et al. (Alternative Therapies in Health and Medicine 17(2):50, 2011), we used a four-stage process to generate a five criteria checklist for the definition of CPWs. We refined the operational definition, through consensus, merging two of the checklist's criteria, leading to a more inclusive criterion for accommodating CPW studies conducted in various healthcare settings. The following four criteria for CPW operational definition, derived from the refinement process described above, are (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions' (i.e. the intervention had time-frames or criteria-based progression); and (4) the intervention aimed to standardize care for a specific population. An intervention meeting all four criteria was considered to be a CPW. The development of operational definitions for complex interventions is a useful approach to appraise and synthesize evidence for policy development and quality improvement.
authors.affiliation: College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada. lawal.kazeem@usask.ca.
authors.forename: Adegboyega K
authors.initials: AK
authors.lastname: Lawal
authors.affiliation: College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada. Thomas.rotter@usask.ca.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rotter
authors.affiliation: University of Tasmania and Tasmanian Health Organisation (North), Launceston, Tasmania, Australia. leigh.kinsman@utas.edu.au.
authors.forename: Leigh
authors.initials: L
authors.lastname: Kinsman
authors.affiliation: Department of Anesthesiology, Sophia Children's Hospital, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands. a.machotta@erasmusmc.nl.
authors.forename: Andreas
authors.initials: A
authors.lastname: Machotta
authors.affiliation: University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Department of Surgery, Mannheim, Germany. ulrich.ronellenfitsch@medma.uni-heidelberg.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ronellenfitsch
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. ss14@ualberta.ca.
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Scott
authors.affiliation: College of Medicine, University of Saskatchewan, Saskatoon, Canada. donna.goodridge@usask.ca.
authors.forename: Donna
authors.initials: D
authors.lastname: Goodridge
authors.affiliation: College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada. chris.plishka@usask.ca.
authors.forename: Christopher
authors.initials: C
authors.lastname: Plishka
authors.affiliation: College of Medicine, University of Saskatchewan, Saskatoon, Canada. garygroot@gmail.com.
authors.forename: Gary
authors.initials: G
authors.lastname: Groot
mesh_terms: D015982:Bias; D019091:Critical Pathways / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D012107:Research Design / Q000592:standards*; D009626:Terminology as Topic