Key factors affecting the implementation of clinical pathways: a systematic review

中华医院管理杂志 Pub Date : 2019-09-02 DOI:10.3760/CMA.J.ISSN.1000-6672.2019.09.009

S. Cheng, Tao Yuan, L. Yao, D. Wei, Xiuxia Li, Zhenggang Bai, Kehu Yang

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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. Key words: Clinical pathways; Implementation; Barrier; Facilitator; Systematic review

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影响临床路径实施的关键因素:系统综述

目的系统探讨影响临床路径实施的障碍和促进因素。方法检索PubMed、Embase、CNKI、CBM、万方、Cvip等数据库，收集自建库至2019年1月4日有关临床路径实施障碍和促进因素的文章。使用定性研究综述证据的可信度工具(CERQual)对每项研究的可信度进行分级。结果共纳入来自12个国家的43篇文献。临床路径障碍包括临床路径内容、临床路径负面结果、医师知识、医师态度、资源可得性、活动实施、患者因素、社会因素等8大类31小类。自信心高的前三个障碍分别是缺乏时间、资金、设备、人员等资源(15篇，34.9%)、工作量增加(14篇，32.6%)、途径不认识(12篇，27.9%)。临床路径促进者有路径内容相关、医师相关、资源因素和实施活动等6大类28类。可信度较高的前3位促进因素为沟通、教育和培训(25篇，58.1%)、管理人员和同事的支持(21篇，48.8%)和建立临床路径促进委员会(17篇，39.5%)。结论临床路径的成功实施与其发展过程、效果评价和反馈密切相关。只有通过完全和环境上可接受的途径设计、充足的资源、有效的组织活动、持续的审计、评价和反馈以及医生的积极合作，才能有效地执行。关键词:临床路径;实施;屏障;主持人;系统综述

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中华医院管理杂志

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