A framework for clinical care pathway renewal: an example from inflammatory bowel disease.

Abstract

Background: Clinical care pathways (CCPs) contribute to standardized, high-quality care and reduce variation in healthcare delivery. However, CCPs must be regularly reviewed and updated to reflect current evidence-based clinical practice guidelines. In the literature, the development and implementation of CCPs is well described, but there is little to guide the process for renewal of CCPs as new evidence becomes available.

Methods: We sought to develop a recurrent framework for CCP renewal and apply this to provincial established CCPs for inflammatory bowel disease (IBD). The proposed framework was guided by a review matrix stratified based on two factors: risk to change and clinical impact of the CCPs. An in-person CCP workshop was conducted to facilitate advisor engagement, establish consensus on the review process, and apply the review matrix to existing IBD CCPs. Attendees, including gastroenterologists, nurses, pharmacists, colorectal surgeons, and a family physician, were invited to offer feedback on the proposed framework and vote on the definitions associated with each level of the matrix. They then applied the framework to existing CCPs in two voting rounds.

Results: A proposed framework for CCP renewal was drafted by a multidisciplinary leadership group and presented to 22 IBD stakeholders at the in-person workshop. After a discussion, attendees agreed the matrix should include four levels, based on either high or low risk to change and high or low clinical impact. Risk to change was defined as how quickly new evidence would evolve and render the CCP out of date, and clinical impact was defined as how important the CCP is to quality IBD care. Using the revised review matrix, the attendees were able to reach agreement regarding the level to be assigned to each existing CCP.

Conclusions: The framework, based on risk to change and clinical impact is a valuable starting point to standardize the process of updating and renewing clinical pathways. Revising CCPs using our proposed framework ensures pathways are up-to-date and available to assist healthcare professionals in clinical decision-making. This framework can be adapted and customized to suit CCPs across healthcare disciplines and to facilitate the establishment of a renewal process.