Towards a New System for the Assessment of the Quality in Care Pathways: An Overview of Systematic Reviews

Clinical or care pathways are developed by a multidisciplinary team of healthcarepractitioners, based on clinical evidence, and standardized processes. The evaluation of theirframework/content quality is unclear. The aim of this study was to describe which tools and domainsare able to critically evaluate the quality of clinical/care pathways. An overview of systematic reviewswas conducted, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses,using Medline, Embase, Science Citation Index, PsychInfo, CINAHL, and Cochrane Library, from 2015to 2020, and with snowballing methods. The quality of the reviews was assessed with Assessment theMethodology of Systematic Review (AMSTAR-2) and categorized with The Leuven Clinical PathwayCompass for the definition of the five domains: processes, service, clinical, team, and financial.We found nine reviews. Three achieved a high level of quality with AMSTAR-2. The areas classifiedaccording to The Leuven Clinical Pathway Compass were: 9.7% team multidisciplinary involvement,13.2% clinical (morbidity/mortality), 44.3% process (continuity-clinical integration, transitional),5.6% financial (length of stay), and 27.0% service (patient-/family-centered care). Overall, none ofthe 300 instruments retrieved could be considered a gold standard mainly because they did notcover all the critical pathway domains outlined by Leuven and Health Technology Assessment.This overview shows important insights for the definition of a multiprinciple framework of coredomains for assessing the quality of pathways. The core domains should consider general criticalaspects common to all pathways, but it is necessary to define specific domains for specific diseases,fast pathways, and adapting the tool to the cultural and organizational characteristics of the healthsystem of each country.