Critical pathways: the role of pharmacy today and tomorrow.

Critical pathways represent comprehensive management plans that aim to optimize and streamline patient care. Critical pathways have been referred to in the medical literature by a number of different terms, including care path, care map, clinical pathway, critical path of care, case management plan, multidisciplinary action plan, collaborative care track, plan of care, clinical care plans, and care guides. These plans define key steps in disease management not only to improve the quality of health care, but also to reduce resource utilization. Some of the specific goals of critical pathways include providing continuous quality improvement, decreasing service fragmentation through managed care, optimizing cost-effectiveness of health care delivery, guiding the patient and family through expected treatment and progress, and increasing satisfaction of patients, families, staff, physicians, and third-party payers. Critical pathways create targeted patient outcomes and quality end points, which form a foundation for common expectations, shared responsibility, regular communication, and early problem detection and intervention among all members of the health care team. Further, they identify specific time frames and desired outcomes associated with each care step, with the goals of minimizing delays and maximizing resource utilization. The critical pathway can serve not only as a monitoring tool for identifying and addressing quality issues in a timely fashion, but also as a tool for educating health care providers to recognize the efficient and clinically appropriate use of resources. Although the importance of critical pathways remains somewhat controversial, since the first American College of Clinical Pharmacy (ACCP) White Paper was published in 1996 they have been shown to improve patient outcomes and to reduce health care expenses in various settings. Critical pathways should be distinguished from clinical treatment guidelines, as the latter may be intended to define appropriate care for a specific indication (e.g., community-acquired pneumonia). Development of critical pathways has been promoted in evidence-based clinical practice guidelines, as critical pathways include elements meant to track compliance, patient outcomes, or continuous quality improvement. The main difference, therefore, between critical pathways and disease-specific guidelines is that critical pathways focus on targets of care for the clinical management of patient groups instead of addressing decisions regarding individual patient management.