A systematic review of the effects of implementing clinical pathways supported by health information technologies



Neame, Matthew T, Chacko, Jerry, Surace, Anna E ORCID: 0000-0001-9589-3005, Sinha, Ian P and Hawcutt, Daniel B ORCID: 0000-0002-8120-6507
(2019) A systematic review of the effects of implementing clinical pathways supported by health information technologies. JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, 26 (4). pp. 356-363.

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Abstract

<h4>Objective</h4>Health information technology (HIT) interventions include electronic patient records, prescribing, and ordering systems. Clinical pathways are multidisciplinary plans of care that enable the delivery of evidence-based healthcare. Our objective was to systematically review the effects of implementing HIT-supported clinical pathways.<h4>Materials and methods</h4>A systematic review protocol was developed including Medline, Embase, and CENTRAL database searches. We recorded data relating to study design, participants, intervention, and outcome characteristics and formally assessed risk of bias.<h4>Results</h4>Forty-four studies involving more than 270 000 patients were included. Investigation methodologies included before-after (n = 16, 36.4%), noncomparative (n = 14, 31.8%), interrupted time series (n = 5, 11.4%), retrospective cohort (n = 4, 9.1%), cluster randomized (n = 2, 4.5%), controlled before-after (n = 1, 2.3%), prospective case-control (n = 1, 2.3%), and prospective cohort (n = 1, 2.3%) study designs. Clinical decision support (n = 25, 56.8%), modified electronic documentation (n = 23, 52.3%), and computerized provider order entry (n = 23, 52.3%) were the most frequently utilized HIT interventions. The majority of studies (n = 38, 86.4%) reported benefits associated with HIT-supported pathways. These included reported improvements in objectively measured patient outcomes (n = 15, 34.1%), quality of care (n = 29, 65.9%), and healthcare resource utilization (n = 10, n = 22.7%).<h4>Discussion</h4>Although most studies reported improvements in outcomes, the strength of evidence was limited by the study designs that were utilized.<h4>Conclusions</h4>Ongoing evaluations of HIT-supported clinical pathways are justified but would benefit from study designs that report key outcomes (including adverse events) and minimize the risk of bias.

Item Type: Article
Uncontrolled Keywords: critical pathways, medical informatics, evidence-based medicine
Depositing User: Symplectic Admin
Date Deposited: 28 Feb 2019 12:05
Last Modified: 19 Jan 2023 01:01
DOI: 10.1093/jamia/ocy176
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3033515