Effects of clinical pathways for chronic obstructive pulmonary disease (COPD) on patient, professional and systems outcomes: A systematic review

Abstract Background Chronic obstructive pulmonary disease (COPD) has a substantial burden seen in both patient quality of life and healthcare costs. One method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs bring the best available evidence to a range of healthcare professionals by adapting guidelines to a local context and detailing essential steps in care. Methods We conducted a systematic review to address the following question: what are the effects of CPWs for COPD on patient, professional and systems level outcomes. The review utilized methods outlined by the Cochrane Collaboration. We included all studies which met our operational definition for CPWs and focused on COPD. All studies were evaluated for risk of bias. All data regarding patient, professional and systems outcomes was extracted. Results Our search strategy identified 497 potentially relevant titles. Of these 13 studies were included in the review. These studies reported a total of 398 outcomes, with sufficient data for meta-analysis of five outcomes: complications, length of stay, mortality, readmissions and quality of life. Results showed statistically significant reductions in complications, readmissions and length of stay but did not demonstrate changes in mortality or quality of life. Conclusions This systematic review reveals evidence to suggest that CPWs for COPD have the potential to reduce complications, readmissions and length of stay without negatively influencing mortality or quality of life. However, quality of evidence was generally low, therefore the authors acknowledge that results should be interpreted with caution and note the need for additional research in this area.