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The quality of the evidence base for clinical pathway effectiveness: Room for improvement in the design of evaluation trials

Date and Location

Session: 

O4.01.1

Date

Monday 23 September 2013 - 13:30 - 15:00

Location

Presenting author and contact person

Presenting author

Thomas Rotter

Contact person

Thomas Rotter
Abstract text
Background/Objectives The purpose of this presentation is to report on the quality of the existing evidence base regarding the effectiveness of clinical pathway (CPW) research in the hospital setting. The analysis is based on a recently published Cochrane review of the effectiveness of CPWs. Methods An integral component of the review process was a rigorous appraisal of the methodological quality of published CPW evaluations. This allowed the identification of strengths and limitations of the evidence base for CPW effectiveness. We followed the validated Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria for randomized and non-randomized clinical pathway evaluations. In addition, we tested the hypotheses that simple pre-post studies tend to overestimate CPW effects reported. Results Out of the 260 primary studies meeting CPW content criteria, only 27 studies met the EPOC study design criteria, with the majority of CPW studies (more than 70 %) excluded from the review on the basis that they were simple pre-post evaluations, mostly comparing two or more annual patient cohorts. Methodologically poor study designs are often used to evaluate CPWs and this compromises the quality of the existing evidence base. Considering the second objective of this presentation, the meta-analytic comparison supports other evidence that simple pre-post study designs tend to overestimate intervention effects reported. Conclusions Cochrane EPOC methodological criteria, including the selection of rigorous study designs along with detailed descriptions of CPW development and implementation processes, are recommended for quantitative evaluations to improve the evidence base for the use of CPWs in hospitals.
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