Critical Pathway Effectiveness: Assessing the Impact of Patient, Hospital Care, and Pathway Characteristics Using Qualitative Comparative Analysis
Open accessAbstract
Objective. To qualitatively describe patient, hospital care, and critical pathway characteristics that may be associated with pathway effectiveness in reducing length of stay. Data Sources/Study Setting. Administrative data and review of pathway documentation and a sample of medical records for each of 26 surgical critical pathways in a tertiary care center's department of surgery, 1988–1998. Study Design. Retrospective qualitative study. Data Collection/Abstraction Methods. Using information from a literature review and consultation with experts, we developed a list of characteristics that might impact critical pathway effectiveness. We used hypothesis‐driven qualitative comparative analysis to describe key primary and secondary characteristics that might differentiate effective from ineffective critical pathways. Principal Findings. All 7 of the 26 pathways associated with a reduced length of stay had at least one of the following characteristics: (1) no preexisting trend toward lower length of stay for the procedure (71 percent), and/or (2) it was the first pathway implemented in its surgical service (71 percent). In addition, pathways effective in reducing length of stay tended to be for procedures with lower patient severity of illness, as indicated by fewer intensive care days and lower mortality. Effective pathways tended to be used more frequently than ineffective pathways (77 versus 59 percent of medical records with pathway documents present), but high rates of documented pathway use were not necessary for pathway effectiveness. Conclusions. Critical pathway programs may have limited effectiveness, and may be effective only in certain situations. Because pathway utilization was not a strong predictor of pathway effectiveness, the mechanism by which critical pathways may reduce length of stay is unclear.
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There are growing number of descriptive epidemiological studies using QCA to explore factors predicting outcomes across diverse areas.
“Similarly, there are growing number of descriptive epidemiological studies using QCA to explore factors predicting outcomes across such diverse areas as lupus and quality of life [68]; length of hospital stay [69]; constellations of factors predicting injury [70]; or the role of austerity, crisis and recession in predicting public health outcomes [71].”
From The use of Qualitative Comparative Analysis (QCA) to address causality in complex systems: a systematic review of research on public health interventions (2021) · cites this paper as [69]
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- Authors
- Dy, S. M., Garg, P., Nyberg, D., Dawson, P. B., Pronovost, P. J., Morlock, L., Rubin, H., & Wu, A. W.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Dy, Sydney M.
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2005-03-10
- Volume
- 40
- Issue
- 2
- Pages
- 499-516
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC1361153
- OpenAlex
- W3196469957
- Cited by
- 128
- References
- 26
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 5 · 2022: 8 · 2021: 6 · 2020: 2 · 2019: 7 · 2018: 6 · 2017: 4 · 2016: 6 · 2015: 2 · 2014: 8 · 2013: 6 · 2012: 5
- FWCI
- 9.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Services Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- PubMed
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- care pathways, surgical care, length of hospital stay, mortality, pathway implementation
- MeSH terms
- Health Services Research, Hospitals, University, Humans, Length of Stay, Medical Audit, Postoperative Care, Quality Assurance, Health Care, Retrospective Studies, Severity of Illness Index, Surgery Department, Hospital, Surgical Procedures, Operative, Baltimore, Cohort Studies, Treatment Outcome, Critical Pathways, Quality Indicators, Health Care
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