The strategy of development and implementation of care pathway: literature review

Background: The literature review on the implementation of care pathways is very diverse, there are active implementation and passive implementation. Therefore, the best strategy of implementation of the care pathway is still unclear. Objective: This literature review aimed to identify the component of the development and implementation of the care pathway. Methods: The research was conducted on five research databases. To optimize the research strategy, keywords used were identified via the medical subject headings (Mesh terms), their synonyms, and using operators such as truncation, wildcard, and Boolean operators. For quantitative studies, JBI Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) was utilized to assess the quality of studies. Furthermore, the quality assessment of qualitative studies was based on JBI Qualitative Assessment and Review Instrument (QARI). Results: The search revealed 1015 articles. Of these, 11 articles met the inclusion criteria for this review. One randomized controlled trial was reported. The majority of these articles reported baseline and post-implementation pathway. The studies emerged from the United Kingdom, the United States, Singapore, the Netherlands, Canada, and Australia. The implementation process is completed through four phases. The planning phase assesses the current practice and determines whether the provided health care is in compliance with the guidelines, a crucial step before implementing care pathways. The reviewed studies reported different methods: site visiting, pre-audit chart, structured questionnaire. The design phase begins with the selection of an appropriate clinical condition, then an agreement about the components of care pathways which based on the questionnaire and Delphi.  The majority of reviewed studies reported that the implementation phase is based on the education of staff. However, specific details related to the education sessions of the care pathways were not discussed.  Finally, the evaluation phase was used audit charts, questionnaire and focus group. Inadequate reliability and validity of the questionnaire were noted. Conclusions: Existing data demonstrate there is agreement on four mean phases when applying care pathways, however, there are still a diversity of key factors of each phase.