Cannon Christopher P, Hand Mary H, Bahr Raymond, Boden William E, Christenson Robert, Gibler W Brian, Eagle Kim, Lambrew Costas T, Lee Thomas H, MacLeod Bruce, Ornato Joseph P, Selker Harry P, Steele Pamela, Zalenski Robert J
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
Am Heart J. 2002 May;143(5):777-89. doi: 10.1067/mhj.2002.120260.
The use of critical pathways for a variety of clinical conditions has grown rapidly in recent years, particularly pathways for patients with acute coronary syndromes (ACS). However, no systematic review exists regarding the value of critical pathways in this setting.
The National Heart Attack Alert Program established a Working Group to review the utility of critical pathways on quality of care and outcomes for patients with ACS. A literature search of MEDLINE, cardiology textbooks, and cited references in any article identified was conducted regarding the use of critical pathways for patients with ACS.
Several areas for improving the care of patients with ACS through the application of critical pathways were identified: increasing the use of guideline-recommended medications, targeting use of cardiac procedures and other cardiac testing, and reducing the length of stay in hospitals and intensive care units. Initial studies have shown promising results in improving quality of care and reducing costs. No large studies designed to demonstrate an improvement in mortality or morbidity were identified in this literature review.
Critical pathways offer the potential to improve the care of patients with ACS while reducing the cost of care. Their use should improve the process and cost-effectiveness of care, but further research in this field is needed to determine whether these changes in the process of care will translate into improved clinical outcomes.
近年来，针对各种临床病症使用关键路径的情况迅速增多，尤其是针对急性冠状动脉综合征（ACS）患者的路径。然而，对于在此背景下关键路径的价值尚无系统综述。
国家心脏病发作警报计划成立了一个工作组，以审查关键路径对ACS患者护理质量和结局的效用。对MEDLINE、心脏病学教科书以及所确定的任何文章中的参考文献进行了文献检索，以了解ACS患者使用关键路径的情况。
通过应用关键路径确定了几个可改善ACS患者护理的领域：增加指南推荐药物的使用、针对心脏手术和其他心脏检查的使用、以及缩短住院时间和重症监护病房停留时间。初步研究已显示在改善护理质量和降低成本方面取得了有前景的结果。在该文献综述中未发现旨在证明死亡率或发病率有所改善的大型研究。
关键路径有潜力改善ACS患者的护理，同时降低护理成本。其使用应能改善护理过程和成本效益，但该领域需要进一步研究以确定护理过程中的这些变化是否会转化为改善的临床结局。
