Effects of clinical pathways in stroke management: A meta-analysis

Objective: To assess the implementation effects of clinical pathways, compared with usual care, among patients with stroke. Methods:Two investigators independently searched PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database and Wanfang Database for studies published before December 2014. Jadad methodological approach was applied to assess the quality of included studies and RevMan software (version 5.2.7) was used for meta-analysis. Results: A total of 11 RCTs involving 913 patients were included in this meta-analysis. The overall results showed that a shorter average length of stay [MD = -2.92; 95% CI (-4.06, -1.78); P < 0.001] and a lower inpatient expenditures [SMD = -1.64; 95% CI (-1.80, -1.48); P < 0.001] in clinical pathways group comparing with the usual care group. The higher score of patient satisfaction was also seen in clinical pathways group. Conclusion: clinical pathways may reduce the average length of stay, reduce the inpatient expenditures, increase patient satisfaction and improve the quality of care in stroke management. Neurology Asia 2015; 20(4) : 335 – 342 Address correspondence to:Kehu Yang, Professor of Medicine, Chief, Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou730000, Gansu Province, China. Tel: +86-18394170221, e-mail: [email protected] INTRODUCTION Stroke is a global epidemic and a major public health-care concern as mortality rates are known to vary greatly between countries and geographic regions. Annually, 15 million people worldwide suffer an episode of stroke. Of these, 5 million die and another 5 million are left permanently disabled, with added burden to the family and community. Clinical pathways (CPW) originated in the United States in the 1980s; these were developed through the collaborative efforts of physicians, nurses, pharmacists, and others to improve the quality and value of patient care. CPW map a patient’s journey, providing coordination of services for users and aim to have “the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome”. It is a tool to provide standard care with little variability. Several researchers have shown that the implementation of clinical pathways reduce the variability of clinical practice and improve outcomes. In the United States. CPW have been applied to health care management since the 1980s to improve efficiency of care and reduce hospitalization costs. CPW is increasingly being implemented in many countries to improve the care of stroke patients, but the effects of CPW on stroke management are not clear. This meta-analysis aims to assess the effects of CPW on stroke management in the hospital, and to evaluate whether CPW improve the outcomes of patients who have a stroke.