College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
College of Medicine, University of Saskatchewan, Saskatoon, Canada.
Syst Rev. 2019 Jun 8;8(1):136. doi: 10.1186/s13643-019-1046-0.
Despite the increased utilization of clinical pathways (CPWs) as a strategy to improve patient and system outcomes in hospitals, there remain ongoing challenges with their conceptualization, implementation, and evaluation. Theories that explain how CPWs work in hospitals are lacking, making it difficult to identify important factors for sustaining changes arising from CPWs implemented in hospitals. The objective of this realist review is to develop a program theory for CPWs in hospitals.
This is a protocol for a realist review. The review will use a six-step iterative process to develop a program theory for CPWs in hospitals: (1) development of a preliminary program theory; (2) search strategy and literature search; (3) study selection and appraisal; (4) data extraction; (5) data analysis and synthesis; and (6) stakeholder engagement. In addition to searching the gray literature and contacting authors, we will search electronic databases such as MEDLINE, NHSEED, CINAHL EBSCO, HMIC, and PsycINFO. Studies will be included based on their ability to provide data that test some aspect of the program theory. Two independent reviewers will select, screen, and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome heuristics that explains how CPWs implemented in hospitals translates to better health system outcomes.
Overall, the review aims to develop a program theory for CPWs in hospitals and to explore how, why, to what extent, and in what contexts does the implementation of CPWs in hospitals contribute to better health system outcomes. As a result, the review will provide a theoretical framework of how CPWs work in hospitals.
PROSPERO CRD42018103220.
尽管临床路径（CPWs）作为改善医院患者和系统结果的策略得到了越来越多的应用，但在其概念化、实施和评估方面仍存在持续的挑战。缺乏解释 CPWs 在医院中如何发挥作用的理论，因此难以确定从医院实施的 CPWs 中产生的持续变化的重要因素。本研究的目的是为医院的 CPWs 制定一个方案理论。
这是一个关于真实审查的方案。该审查将使用六步迭代过程为医院的 CPWs 制定一个方案理论：（1）初步方案理论的制定；（2）搜索策略和文献搜索；（3）研究选择和评估；（4）数据提取；（5）数据分析和综合；（6）利益相关者的参与。除了搜索灰色文献和联系作者外，我们还将搜索电子数据库，如 MEDLINE、NHSEED、CINAHL EBSCO、HMIC 和 PsycINFO。研究将根据其提供数据以测试方案理论的某个方面的能力进行选择。两名独立的评论员将从所有相关来源中选择、筛选和提取与方案理论相关的数据。将使用真实主义逻辑分析来识别解释 CPWs 在医院中的实施如何转化为更好的卫生系统结果的所有背景-机制-结果启发式。
总的来说，审查旨在为医院的 CPWs 制定一个方案理论，并探讨 CPWs 在医院中的实施如何、为什么、在何种程度和何种情况下有助于改善卫生系统结果。因此，该审查将提供一个 CPWs 在医院中运作的理论框架。
PROSPERO CRD42018103220。
