PDF(Pubmed)
Abstract：
BACKGROUND: Healthcare systems are transforming into learning health systems that use data-driven and research-informed approaches to achieve continuous improvement. One of these approaches is the use of clinical pathways, which are tools to standardize care for a specific population and improve healthcare quality. Evaluating the maturity of clinical pathways is necessary to inform pathway development teams and health system decision makers about required pathway revisions or implementation supports. In an effort to improve the development, implementation, and sustainability of provincial clinical pathways, we developed a clinical pathways maturity evaluation matrix. To explore the initial content and face validity of the matrix, we used it to evaluate a case pathway within a provincial health authority in Saskatchewan, Canada.
METHODS: By using iterative consensus-based processes, we gathered feedback from stakeholders including patient and family partners, policy makers, clinicians, and quality improvement specialists, to rank, retain, or remove enablers and sub-enablers of the draft matrix. We tested the matrix on the Chronic Pain Pathway (CPP) for primary care in a local pilot area and revised the matrix based on feedback from the CPP development team leader.
RESULTS: The final matrix contains five enablers (i.e., Design, Ownership and Performer, Infrastructure, Performance Management, and Culture), 20 sub-enablers, and three trajectory definitions for each sub-enabler. Supplemental documents were created for six sub-enablers. The CPP scored 15 out of 40 possible points of maturity. Although the pathway scored highest in the Design enabler (10/12), it requires more attention in several areas, specifically the Ownership and Performer and the Performance Management enablers, each of which scored zero. Additionally, the Infrastructure and Culture enablers scored 2/4 and 3/8 points, respectively. These areas of the CPP are in need of improvement in order to enhance the overall maturity of the CPP.
CONCLUSIONS: We developed a clinical pathways maturity matrix to evaluate the various dimensions of clinical pathways\' development and implementation. The goals of this initial work were to develop and validate a tool to assess the maturity and readiness of new or existing pathways and to track pathways\' revisions and improvements.
METHODS: By using iterative consensus-based processes, we gathered feedback from stakeholders including patient and family partners, policy makers, clinicians, and quality improvement specialists, to rank, retain, or remove enablers and sub-enablers of the draft matrix. We tested the matrix on the Chronic Pain Pathway (CPP) for primary care in a local pilot area and revised the matrix based on feedback from the CPP development team leader.
RESULTS: The final matrix contains five enablers (i.e., Design, Ownership and Performer, Infrastructure, Performance Management, and Culture), 20 sub-enablers, and three trajectory definitions for each sub-enabler. Supplemental documents were created for six sub-enablers. The CPP scored 15 out of 40 possible points of maturity. Although the pathway scored highest in the Design enabler (10/12), it requires more attention in several areas, specifically the Ownership and Performer and the Performance Management enablers, each of which scored zero. Additionally, the Infrastructure and Culture enablers scored 2/4 and 3/8 points, respectively. These areas of the CPP are in need of improvement in order to enhance the overall maturity of the CPP.
CONCLUSIONS: We developed a clinical pathways maturity matrix to evaluate the various dimensions of clinical pathways\' development and implementation. The goals of this initial work were to develop and validate a tool to assess the maturity and readiness of new or existing pathways and to track pathways\' revisions and improvements.
摘要：
背景：医疗保健系统正在转变为使用数据驱动和研究知情方法来实现持续改进的学习型卫生系统。这些方法之一是使用临床路径，这些工具可以使特定人群的护理标准化并提高医疗质量。评估临床路径的成熟度是必要的，以告知路径开发团队和卫生系统决策者所需的路径修订或实施支持。为了改善发展，实施，以及省级临床路径的可持续性，我们建立了临床路径成熟度评估矩阵.探索矩阵的初始内容和面形效度，我们用它来评估萨斯喀彻温省卫生部门的一个病例路径，加拿大。
方法：通过使用迭代的基于共识的流程，我们收集了包括患者和家庭伙伴在内的利益相关者的反馈，政策制定者,临床医生,和质量改进专家，排名，保留,或删除草案矩阵的启用符和子启用符。我们在当地试点地区的初级保健慢性疼痛路径（CPP）上测试了矩阵，并根据CPP开发团队负责人的反馈修改了矩阵。
结果：最终矩阵包含五个使能者（即，设计,所有权和执行者，基础设施,绩效管理，和文化），20个子推动者，和每个子启用器的三个轨迹定义。为六个子启用者创建了补充文件。CPP在40个可能的成熟点中得到15分。尽管该途径在设计推动者中得分最高(10/12)，这需要在几个方面给予更多关注，特别是所有权和执行者以及绩效管理推动者，每个得分为零。此外,基础设施和文化推动者得了2/4和3/8分，分别。CPP的这些领域需要改进，以提高CPP的整体成熟度。
结论：我们开发了临床路径成熟度矩阵来评估临床路径的开发和实施的各个维度。这项初步工作的目标是开发和验证一种工具，以评估新的或现有途径的成熟度和准备情况，并跟踪途径的修订和改进。
方法：通过使用迭代的基于共识的流程，我们收集了包括患者和家庭伙伴在内的利益相关者的反馈，政策制定者,临床医生,和质量改进专家，排名，保留,或删除草案矩阵的启用符和子启用符。我们在当地试点地区的初级保健慢性疼痛路径（CPP）上测试了矩阵，并根据CPP开发团队负责人的反馈修改了矩阵。
结果：最终矩阵包含五个使能者（即，设计,所有权和执行者，基础设施,绩效管理，和文化），20个子推动者，和每个子启用器的三个轨迹定义。为六个子启用者创建了补充文件。CPP在40个可能的成熟点中得到15分。尽管该途径在设计推动者中得分最高(10/12)，这需要在几个方面给予更多关注，特别是所有权和执行者以及绩效管理推动者，每个得分为零。此外,基础设施和文化推动者得了2/4和3/8分，分别。CPP的这些领域需要改进，以提高CPP的整体成熟度。
结论：我们开发了临床路径成熟度矩阵来评估临床路径的开发和实施的各个维度。这项初步工作的目标是开发和验证一种工具，以评估新的或现有途径的成熟度和准备情况，并跟踪途径的修订和改进。
