Office of the Dean, School for Public Health and Primary Care, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.
BMC Med Res Methodol. 2012 Jun 18;12:80. doi: 10.1186/1471-2288-12-80.
The purpose of this article is to report on the quality of the existing evidence base regarding the effectiveness of clinical pathway (CPW) research in the hospital setting. The analysis is based on a recently published Cochrane review of the effectiveness of CPWs.
An integral component of the review process was a rigorous appraisal of the methodological quality of published CPW evaluations. This allowed the identification of strengths and limitations of the evidence base for CPW effectiveness. We followed the validated Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria for randomized and non-randomized clinical pathway evaluations. In addition, we tested the hypotheses that simple pre-post studies tend to overestimate CPW effects reported.
Out of the 260 primary studies meeting CPW content criteria, only 27 studies met the EPOC study design criteria, with the majority of CPW studies (more than 70 %) excluded from the review on the basis that they were simple pre-post evaluations, mostly comparing two or more annual patient cohorts. Methodologically poor study designs are often used to evaluate CPWs and this compromises the quality of the existing evidence base.
Cochrane EPOC methodological criteria, including the selection of rigorous study designs along with detailed descriptions of CPW development and implementation processes, are recommended for quantitative evaluations to improve the evidence base for the use of CPWs in hospitals.
本文旨在报告现有关于临床路径（CPW）在医院环境中有效性的证据基础的质量。该分析基于最近发表的 Cochrane 综述，对 CPWs 的有效性进行评估。
综述过程的一个组成部分是对已发表的 CPW 评估的方法学质量进行严格评估。这使得能够确定 CPW 有效性证据基础的优缺点。我们遵循经过验证的 Cochrane 有效实践和组织护理小组（EPOC）标准，对随机和非随机临床路径评估进行评估。此外，我们还检验了以下假设，即简单的前后研究往往会高估 CPW 报告的效果。
在符合 CPW 内容标准的 260 项主要研究中，只有 27 项研究符合 EPOC 研究设计标准，而大多数 CPW 研究（超过 70%）由于采用简单的前后评估，大多比较两个或多个年度患者队列，而被排除在综述之外。方法学上较差的研究设计通常用于评估 CPWs，这会影响现有证据基础的质量。
建议采用 Cochrane EPOC 方法学标准，包括选择严格的研究设计以及详细描述 CPW 的开发和实施过程，对 CPWs 在医院中的使用进行定量评估，以提高证据基础。
