Key factors affecting the implementation of clinical pathways: a systematic review
10.3760/cma.j.issn.1000-6672.2019.09.009
- VernacularTitle: 临床路径实施影响因素的系统评价
- Author:
Shunhong CHENG
1
;
Tao YUAN
2
;
Liang YAO
3
;
Dang WEI
4
;
Xiuxia LI
5
;
Zhenggang BAI
6
;
Kehu YANG
2
Author Information
1. Emergency Department, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou 730000, China
2. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
3. School of Chinese Medicine, Hong Kong Baptist University, China
4. Department of Public Health Sciences, Karolinska Institutet, Sweden
5. School of Public Health, Lanzhou University, Lanzhou 730000, China
6. Center for Evidence-Based Social Science and Health Research, Nanjing University of Science and Technology, Nanjing 210000, China
- Publication Type:Journal Article
- Keywords:
Clinical pathways;
Implementation;
Barrier;
Facilitator;
Systematic review
- From:
Chinese Journal of Hospital Administration
2019;35(9):746-751
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To systematically review the barriers and facilitators affecting the implementation of clinical pathways for the clinical pathways.
Methods:PubMed, Embase, CNKI, CBM, Wanfang, Cvip databases were searched to collect articles about clinical pathways implementation barriers and facilitators from inception to January 4th, 2019. The tool of confidence in the evidence from reviews of qualitative research(CERQual)was used to grade the confidence of each study.
Results:A total of 43 articles from 12 countries were included.There were 8 main categories and 31 subcategories of the barriers about clinical pathways, including content of the clinical pathways, negative outcomes of clinical pathways, physicians knowledge, physicians attitude, resource availability, implementation of activities, patients factors and social factors. The first three barriers of high confidence were lacking of time, capital, equipment, staff and other resources(15 articles, 34.9%), increasing workload(14 articles, 32.6%), unrecognizing pathways(12 articles, 27.9%). There were 6 main categories and 28 subcategories of the facilitators about clinical pathways, including pathways content related, physician related, resource factor and implementation activity. The first three facilitators of high confidence were communication, education and training(25 articles, 58.1%), supporting from managers and colleagues(21 articles, 48.8%)and establishing a clinical pathway facilitation committee(17 articles, 39.5%).
Conclusions:The successful implementation of clinical pathways connects with its development process, aftereffect evaluation and feedback. It will be implemented effectively only by the completely and environmentally acceptable pathways design, adequate resources, effective organizational activities, continuous audit, evaluation and feedback and physicians active cooperation.
