Dong W, Huang Z
Cardiology Department, Chinese PLA General Hospital , Beijing, China.
College of Biomedical Engineering and Instrument Science, Zhejiang University , Hangzhou, China.
Appl Clin Inform. 2015 Nov 4;6(4):650-68. doi: 10.4338/ACI-2015-05-RA-0054. eCollection 2015.
Clinical pathways (CPs) have been viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Despite widespread enthusiasm for CPs, research has shown that many CP initiatives are unsuccessful. To this end, this study provides a methodology to evaluate critical success factors (CSFs) that can aid healthcare organizations to achieve successful CP implementation.
This study presents a new approach to evaluate CP implementation CSFs, with the aims being: (1) to identify CSFs for implementation of CPs through a comprehensive literature review and interviews with collaborative experts; (2) to use a filed study data with a robust fuzzy DEMATEL (the decision making trial and evaluation laboratory) approach to visualize the structure of complicated causal relationships between CSFs and obtain the influence level of these factors.
The filed study data is provided by ten clinical experts of a Chinese hospital.
23 identified CSF factors which are initially identified through a review of the literature and interviews with collaborative experts. Then, a number of direct and indirect relationships are derived from the data such that different perceptions can be integrated into a compromised cause and effect model of CP implementation.
The results indicate that the proposed approach can systematically evaluate CSFs and realize the importance of each factor such that the most common causes of failure of CP implementation could be eliminated or avoided. Therefore, the tool proposed would help healthcare organizations to manage CP implementation in a more effective and proactive way.
临床路径（CPs）被视为一种多学科工具，用于提高循证医疗的质量和效率。尽管对临床路径普遍充满热情，但研究表明，许多临床路径倡议并不成功。为此，本研究提供了一种方法来评估关键成功因素（CSFs），这有助于医疗机构成功实施临床路径。
本研究提出了一种评估临床路径实施关键成功因素的新方法，目标如下：（1）通过全面的文献综述和与合作专家的访谈，确定临床路径实施的关键成功因素；（2）使用实地研究数据和强大的模糊DEMATEL（决策试验与评价实验室）方法，直观呈现关键成功因素之间复杂因果关系的结构，并得出这些因素的影响程度。
实地研究数据由一家中国医院的十位临床专家提供。
通过文献综述和与合作专家的访谈，初步确定了23个关键成功因素。然后，从数据中得出了一些直接和间接关系，以便将不同的观点整合到一个临床路径实施的折衷因果模型中。
结果表明，所提出的方法可以系统地评估关键成功因素，并认识到每个因素的重要性，从而消除或避免临床路径实施失败的最常见原因。因此，所提出的工具将有助于医疗机构以更有效和积极主动的方式管理临床路径的实施。
