Chappell K D, Olayinka L, Sutton R, Seow C H, deBruyn J, van Zanten S V, Ma C, Halloran B, Dieleman L A, Wong K, Panaccione R, Kroeker K I
Division of Gastroenterolgy, Department of Medicine, University of Alberta, Edmonton, Zeidler Ledcor Building; 8540 - 112 Street, AB, T6G 2X8, Canada.
Alberta Precision Laboratories, Edmonton, AB, Canada.
BMC Med Res Methodol. 2025 Jul 9;25(1):173. doi: 10.1186/s12874-025-02616-z.
Clinical care pathways (CCPs) contribute to standardized, high-quality care and reduce variation in healthcare delivery. However, CCPs must be regularly reviewed and updated to reflect current evidence-based clinical practice guidelines. In the literature, the development and implementation of CCPs is well described, but there is little to guide the process for renewal of CCPs as new evidence becomes available.
We sought to develop a recurrent framework for CCP renewal and apply this to provincial established CCPs for inflammatory bowel disease (IBD). The proposed framework was guided by a review matrix stratified based on two factors: risk to change and clinical impact of the CCPs. An in-person CCP workshop was conducted to facilitate advisor engagement, establish consensus on the review process, and apply the review matrix to existing IBD CCPs. Attendees, including gastroenterologists, nurses, pharmacists, colorectal surgeons, and a family physician, were invited to offer feedback on the proposed framework and vote on the definitions associated with each level of the matrix. They then applied the framework to existing CCPs in two voting rounds.
A proposed framework for CCP renewal was drafted by a multidisciplinary leadership group and presented to 22 IBD stakeholders at the in-person workshop. After a discussion, attendees agreed the matrix should include four levels, based on either high or low risk to change and high or low clinical impact. Risk to change was defined as how quickly new evidence would evolve and render the CCP out of date, and clinical impact was defined as how important the CCP is to quality IBD care. Using the revised review matrix, the attendees were able to reach agreement regarding the level to be assigned to each existing CCP.
The framework, based on risk to change and clinical impact is a valuable starting point to standardize the process of updating and renewing clinical pathways. Revising CCPs using our proposed framework ensures pathways are up-to-date and available to assist healthcare professionals in clinical decision-making. This framework can be adapted and customized to suit CCPs across healthcare disciplines and to facilitate the establishment of a renewal process.
临床护理路径（CCP）有助于实现标准化、高质量的护理，并减少医疗服务中的差异。然而，CCP必须定期进行审查和更新，以反映当前基于证据的临床实践指南。在文献中，CCP的制定和实施已有详细描述，但对于随着新证据的出现如何更新CCP的过程，几乎没有相关指导。
我们试图开发一个用于CCP更新的循环框架，并将其应用于省级已制定的炎症性肠病（IBD）CCP。所提出的框架以一个基于两个因素分层的审查矩阵为指导：CCP的变更风险和临床影响。举办了一次面对面的CCP研讨会，以促进顾问参与，就审查过程达成共识，并将审查矩阵应用于现有的IBD CCP。邀请了包括胃肠病学家、护士、药剂师、结直肠外科医生和一名家庭医生在内的与会者对所提出的框架提供反馈，并就与矩阵每个级别相关的定义进行投票。然后，他们在两轮投票中对现有CCP应用该框架。
一个多学科领导团队起草了一个CCP更新的提议框架，并在面对面研讨会上向22名IBD利益相关者展示。经过讨论，与会者一致认为该矩阵应包括四个级别，基于变更风险的高或低以及临床影响的高或低。变更风险被定义为新证据演变并使CCP过时的速度，临床影响被定义为CCP对IBD优质护理的重要性。使用修订后的审查矩阵，与会者能够就每个现有CCP应分配的级别达成一致。
基于变更风险和临床影响的框架是规范临床路径更新和修订过程的有价值的起点。使用我们提出的框架修订CCP可确保路径是最新的，并有助于医疗专业人员进行临床决策。该框架可以进行调整和定制，以适用于各个医疗学科的CCP，并促进建立更新过程。
