 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 December 1995 | Volume 123 Issue 12 | Pages 941-948
In an era of increasing competition in medical care, critical pathway guidelines have emerged as one of the most popular new initiatives intended to reduce costs while maintaining or even improving the quality of care.Developed primarily for high-volume hospital diagnoses, critical pathways display goals for patients and provide the corresponding ideal sequence and timing of staff actions for achieving those goals with optimal efficiency.
Despite the rapid dissemination of critical pathway programs in hospitals throughout the United States, many uncertainties remain about their development, implementation, and evaluation.In addition, serious concerns have been raised about their effect on patient outcomes and satisfaction with care, physician autonomy, malpractice risks, and the teaching and research missions of many hospitals. Underlying these concerns is the absence of data from controlled trials to evaluate the effects of critical pathways.
Physicians should understand the potential benefits and problems associated with critical pathways because physicians are increasingly being asked to provide leadership for pathway programs.Physicians and other health service investigators should also develop methods to study pathways in evolving health care settings. Although the promise of reduced costs and improved quality is enticing, the gaps in our knowledge about critical pathways are extensive; therefore, like any new health care technology, pathway programs should be fully evaluated in order to understand the conditions under which that promise may be fulfilled.
Author and Article Information
From Brigham and Women's Hospital, Harvard Medical School, Harvard Pilgrim Health Care, and Partners Community Health-Care, Inc., Boston, Massachusetts.
ACADEMIA AND CLINIC
Critical Pathways as a Strategy for Improving Care: Problems and Potential
Grant Support: Dr. Lee is an Established Investigator (900119) of the American Heart Association.
Requests for Reprints: Thomas H. Lee, MD, Partners Community Healthcare, Inc., Prudential Tower, Suite 1150, 800 Boylston Street, Boston, MA 02199-8001.
Current Author Addresses: Dr. Pearson: Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, 126 Brookline Avenue, Boston, MA 02215.
Ms. Goulart-Fisher: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Dr. Lee: Partners Community Healthcare, Inc., Prudential Tower, Suite 1150, 800 Boylston Street, Boston, MA 02199-8001.
This article has been cited by other articles:
|
|
 |
|
  L. M. Downey, C. L. Ireson, S. Slavova, and G. McKee Defining Elements of Success: A Critical Pathway of Coalition Development Health Promot Pract, April 1, 2008; 9(2): 130 - 139. [Abstract] [PDF]
|
|
|
|
 |
|
 Y. A. Zausig, Y. Bayer, N. Hacke, B. Sinner, W. Zink, C. Grube, and B. M. Graf Simulation as an additional tool for investigating the performance of standard operating procedures in anaesthesia Br. J. Anaesth., November 1, 2007; 99(5): 673 - 678. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Bobb, T. H. Payne, and P. A. Gross Viewpoint: Controversies Surrounding Use of Order Sets for Clinical Decision Support in Computerized Provider Order Entry J. Am. Med. Inform. Assoc., January 1, 2007; 14(1): 41 - 47. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Rosborough Cardiac Surgery in Elderly Patients: Strategies to Optimize Outcomes Crit. Care Nurse, October 1, 2006; 26(5): 24 - 31. [Full Text] [PDF]
|
|
|
|
|
|
A. Ozdas, T. Speroff, L. R. Waitman, J. Ozbolt, J. Butler, and R. A. Miller Integrating "Best of Care" Protocols into Clinicians' Workflow via Care Provider Order Entry: Impact on Quality-of-Care Indicators for Acute Myocardial Infarction J. Am. Med. Inform. Assoc., March 1, 2006; 13(2): 188 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Alberts, R. E. Latchaw, W. R. Selman, T. Shephard, M. N. Hadley, L. M. Brass, W. Koroshetz, J. R. Marler, J. Booss, R. D. Zorowitz, et al. Recommendations for Comprehensive Stroke Centers: A Consensus Statement From the Brain Attack Coalition Stroke, July 1, 2005; 36(7): 1597 - 1616. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. S. Hill Practice Guidelines for Noninvasive Positive-Pressure Ventilation: Help or Hindrance? Chest, June 1, 2003; 123(6): 1784 - 1786. [Full Text] [PDF]
|
|
|
|
|
|
T. Sinuff, D. J. Cook, J. Randall, and C. J. Allen Evaluation of a Practice Guideline for Noninvasive Positive-Pressure Ventilation for Acute Respiratory Failure Chest, June 1, 2003; 123(6): 2062 - 2073. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Spertus, M. J. Radford, N. R. Every, E. F. Ellerbeck, E. D. Peterson, and H. M. Krumholz Challenges and opportunities in quantifying the quality of care for acute myocardial infarction: Summary from the acute myocardial infarction working group of the American heart association/American college of cardiology first scientific forum on quality of care and outcomes research in cardiovascular disease and stroke J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1653 - 1663. [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Spertus, M. J. Radford, N. R. Every, E. F. Ellerbeck, E. D. Peterson, and H. M. Krumholz Challenges and Opportunities in Quantifying the Quality of Care for Acute Myocardial Infarction: Summary From the Acute Myocardial Infarction Working Group of the American Heart Association/American College of Cardiology First Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Circulation, April 1, 2003; 107(12): 1681 - 1691. [Full Text] [PDF]
|
|
|
|
 |
|
 T B Hassan Clinical decision units in the emergency department: old concepts, new paradigms, and refined gate keeping Emerg. Med. J., March 1, 2003; 20(2): 123 - 125. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Senagore, K. M. Madbouly, V. W. Fazio, H. J. Duepree, K. M. Brady, and C. P. Delaney Advantages of Laparoscopic Colectomy in Older Patients Arch Surg, March 1, 2003; 138(3): 252 - 256. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Yueh, E. M. Weaver, E. H. Bradley, H. M. Krumholz, P. Heagerty, A. Conley, and C. T. Sasaki A Critical Evaluation of Critical Pathways in Head and Neck Cancer Arch Otolaryngol Head Neck Surg, January 1, 2003; 129(1): 89 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Gendron, S. Y. Lai, G. S. Weinstein, A. A. Chalian, J. M. Husbands, P. F. Wolf, L. DiDonato, and R. S. Weber Clinical Care Pathway for Head and Neck Cancer: A Valuable Tool for Decreasing Resource Utilization Arch Otolaryngol Head Neck Surg, March 1, 2002; 128(3): 258 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Schmidt, P. K. Lindenauer, J. L. Fitzgerald, and E. M. Benjamin Forecasting the Impact of a Clinical Practice Guideline for Perioperative {beta}-Blockers to Reduce Cardiovascular Morbidity and Mortality Arch Intern Med, January 14, 2002; 162(1): 63 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Rogers, J. G. Canto, C. T. Lambrew, A. J. Tiefenbrunn, B. Kinkaid, D. A. Shoultz, P. D. Frederick, N. Every, and for the Investigators in the National Registry of Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the U.S. from 1990 through 1999: The National Registry of Myocardial Infarction 1, 2 and 3 J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2056 - 2063. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Farquhar Use of a critical pathway for the management of community-acquired pneumonia: the CAPITAL study Can. Med. Assoc. J., September 1, 2000; 163(6): 755 - 755. [Full Text] [PDF]
|
|
|
|
|
|
T. H. Lee Gaps In Quality of Cardiovascular Care Transcend Social Bias Circulation, August 29, 2000; 102(9): 943 - 944. [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Holmboe, T. P. Meehan, M. J. Radford, Y. Wang, and H. M. Krumholz What's Happening in Quality Improvement at the Local Hospital: A State Wide Study From the Cooperative Cardiovascular Project American Journal of Medical Quality, May 1, 2000; 15(3): 106 - 113. [Abstract] [PDF]
|
|
|
|
 |
|
 M. J. Kucenic, D. G. Meyers, and D. G. Meyers Impact of a Clinical Pathway on the Care and Costs of Myocardial Infarction Angiology, May 1, 2000; 51(5): 393 - 404. [Abstract] [PDF]
|
|
|
|
 |
|
 M. R. Sills, Z. J. Huang, C. Shao, M. F. Guagliardo, J. M. Chamberlain, and J. G. Joseph Pediatric Milliman and Robertson Length-of-Stay Criteria: Are They Realistic? Pediatrics, April 1, 2000; 105(4): 733 - 737. [Abstract] [Full Text]
|
|
|
|
|
|
G. A. Ewy and J. P. Ornato Emergency cardiac care: introduction J. Am. Coll. Cardiol., March 15, 2000; 35(4): 825 - 880. [Full Text] [PDF]
|
|
|
|
 |
|
 T. J. Marrie, C. Y. Lau, S. L. Wheeler, C. J. Wong, M. K. Vandervoort, B. G. Feagan, and for the CAPITAL Study Investigators A Controlled Trial of a Critical Pathway for Treatment of Community-Acquired Pneumonia JAMA, February 9, 2000; 283(6): 749 - 755. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Kollef, S. D. Shapiro, D. Clinkscale, L. Cracchiolo, D. Clayton, R. Wilner, and L. Hossin The Effect of Respiratory Therapist-Initiated Treatment Protocols on Patient Outcomes and Resource Utilization Chest, February 1, 2000; 117(2): 467 - 475. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. R. Every, J. Hochman, R. Becker, S. Kopecky, and C. P. Cannon Critical Pathways : A Review Circulation, February 1, 2000; 101(4): 461 - 465. [Full Text] [PDF]
|
|
|
|
|
|
C. Wong, F. Visram, D. Cook, L. Griffith, J. Randall, B. O'Brien, and D. Higgins Development, dissemination, implementation and evaluation of a clinical pathway for oxygen therapy Can. Med. Assoc. J., January 1, 2000; 162(1): 29 - 33. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Kuntz, J. Tsevat, M. C. Weinstein, and L. Goldman Expert Panel vs Decision-Analysis Recommendations for Postdischarge Coronary Angiography After Myocardial Infarction JAMA, December 15, 1999; 282(23): 2246 - 2251. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Hale, L. Crofts, and L. Stokoe Managed care, case management and multidisciplinary pathways of care: A selective review for the RCN R&D priority-setting exercise Journal of Research in Nursing, September 1, 1999; 4(5): 366 - 376. [Abstract] [PDF]
|
|
|
|
 |
|
 R. G. Holloway, B. G. Vickrey, C. M. Keran, E. Lesser, D. Iverson, W. Larson, and K. Swarztrauber US neurologists in the 1990s: Trends in practice characteristics Neurology, April 1, 1999; 52(7): 1353 - 1353. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Shortell, T. M. Waters, K. W. B. Clarke, and P. P. Budetti Physicians as Double Agents: Maintaining Trust in an Era of Multiple Accountabilities JAMA, September 23, 1998; 280(12): 1102 - 1108. [Full Text] [PDF]
|
|
|
|
|
|
E. A. Halm, M. J. Fine, T. J. Marrie, C. M. Coley, W. N. Kapoor, D. S. Obrosky, and D. E. Singer Time to Clinical Stability in Patients Hospitalized With Community-Acquired Pneumonia: Implications for Practice Guidelines JAMA, May 13, 1998; 279(18): 1452 - 1457. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Bates, S. J. Soldin, P. M. Rainey, and J. N. Micelli Strategies for physician education in therapeutic drug monitoring Clin. Chem., February 1, 1998; 44(2): 401 - 407. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Schneider, J. S. Droste, and J. F. Golan Impact of Carotid Endarterectomy Critical Pathway on Surgical Outcome and Hospital Stay Vascular and Endovascular Surgery, November 1, 1997; 31(6): 685 - 692. [Abstract] [PDF]
|
|
|
|
 |
|
 R. A. Holecek and S. M. Sellards Use of a Detailed Clinical Pathway for Bone Marrow Transplant Patients Journal of Pediatric Oncology Nursing, January 1, 1997; 14(4): 252 - 257. [PDF]
|
|
|
|
|
|
T. A. Merritt, D. Palmer, D. A. Bergman, and P. H. Shiono Clinical Practice Guidelines in Pediatric and Newborn Medicine: Implications for Their Use in Practice Pediatrics, January 1, 1997; 99(1): 100 - 114. [Abstract] [Full Text] [PDF]
|
|
Article
