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Original research
Using a 10-step framework to support the implementation of an evidence-based clinical pathways programme
  1. Emilia J Flores1,2,
  2. Nikhil K Mull1,3,
  3. Julia G Lavenberg1,
  4. Matthew D Mitchell1,
  5. Brian F Leas1,
  6. Austin Williams1,
  7. Patrick J Brennan1,3,
  8. Craig A Umscheid1,3
  1. 1 University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
  2. 2 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Emilia J Flores, Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA; emilia.flores{at}uphs.upenn.edu

Abstract

Background Integration of evidence into practice is suboptimal. Clinical pathways, defined as multidisciplinary care plans, are a method for translating evidence into local settings and have been shown to improve the value of patient care.

Objective To describe the development of a clinical pathways programme across a large academic healthcare system.

Methods We use a 10-step framework (grounded in the Knowledge-to-Action framework and ADAPTE Collaboration methodology for guideline adaptation) to support pathway development and dissemination, including facilitating clinical owner and stakeholder engagement, developing pathway prototypes based on rapid reviews of the existing literature, developing tools for dissemination and impact assessment. We use a cloud-based technology platform (Dorsata, Washington, DC) to assist with development and dissemination across our geographically distributed care settings and providers. Content is viewable through desktop and mobile applications. We measured programme adoption and penetration by examining number of pathways developed as well as mobile application use and pathway views.

Results From 1 February 2016 to 30 April 2018, a total of 202 pathways were disseminated. The three most common clinical domains represented were oncology (46.5%, n=94), pulmonary/critical care (8.9%, n=18) and cardiovascular medicine (7.4%, n=15). Users opting to register for a personal account totalled 1257; the three largest groups were physicians (45.1%, n=567), advanced practice providers (19.5%, n=245) and nurses (19.1%, n=240). Pathway views reached an average of 2150 monthly views during the last 3 months of the period. The majority of pathways reference at least one evidence-based source (93.6%, n=180).

Conclusions A healthcare system can successfully use a framework and technology platform to support the development and dissemination of pathways across a multisite institution.

  • evidence based medicine
  • clinical decision support
  • clinical pathway
  • evidence-based framework
  • dissemination and implementation
  • quality improvement

https://doi.org/10.1136/bmjqs-2018-008454

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    Footnotes

    • Presented at Earlier versions of this work were presented as posters at the Society of Hospital Medicine Annual Meeting, April 2016, San Diego, CA; the Health Technology Assessment International Annual Meeting, June 2017, Rome, Italy; and the Academy Health Annual Research Meeting, June 2017, New Orleans, LA; and as a podium presentation at the AMIA Clinical Informatics Conference, May 2018, Scottsdale, AZ.

    • Contributors All authors have read and approved the submission of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.