Use of a clinical pathway to facilitate the translation and utilization of AHRQ EPC report findings FY2018 dissemination pilot : early diagnosis, prevention, and treatment of Clostridium difficile
BACKGROUND: Clinical pathways are one method of promoting the uptake of evidence into clinical practice. The ECRI Institute-Penn Medicine EPC incorporated the updated 2016 AHRQ EPC report on Early Diagnosis, Prevention, and Treatment of Clostridium difficile in the development of a clinical pathway...
| Main Authors: | , , , |
|---|---|
| Corporate Authors: | , |
| Format: | eBook |
| Language: | English |
| Published: |
Rockville, MD
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
2018, December 2018
|
| Series: | Methods research report
|
| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | BACKGROUND: Clinical pathways are one method of promoting the uptake of evidence into clinical practice. The ECRI Institute-Penn Medicine EPC incorporated the updated 2016 AHRQ EPC report on Early Diagnosis, Prevention, and Treatment of Clostridium difficile in the development of a clinical pathway for treatment of Clostridium difficile infection (CDI) in the acute care setting. This EPC report was selected as it complements other CDI initiatives currently being undertaken at the University of Pennsylvania Health System (UPHS). The objective of this pilot project was to assess the incremental value of including AHRQ EPC report findings in the pathway development process, as well as examine the value these reports may contribute to the process, and the time and resource requirements for this activity. METHODS: UPHS is a multicenter academic health care system in the Philadelphia region. We reviewed these two evidence products with the stakeholder group (step 5) and found that the EPC report was beneficial in that it provided a common understanding of the evidence, which was especially useful for stakeholders less familiar with the current evidence. During the stakeholder review, we identified several differences between the EPC report and recommendations from existing guidelines, which prompted important internal discussions regarding evidence-based treatment. In this respect, the EPC report served as an evidence standard. The CDI treatment clinical pathway was approved by the clinical stakeholders and disseminated through our PennPathways site on April 16, 2018. As of August 31, 2018, the pathway has been viewed 325 times. Total direct project hours were 331. The two project activities with the highest number of direct hours were the rapid evidence review (272 hours) and pathway development (37 hours). The CDI clinical pathway was also deposited to the CDS Connect website to facilitate dissemination and development of computer readable content across other health systems and settings. DISCUSSION: This pilot suggests that AHRQ EPC reports can provide value in the process of developing clinical pathways, but that inclusion of guideline recommendation summaries and guideline quality assessments and pathways from professional organizations, governments and major academic medical centers, will be necessary to meet their full potential. Our findings also suggest that providers utilize clinical pathways when available We recruited a clinical owner and a representative multidisciplinary stakeholder panel to participate in the development of a clinical pathway, including experts from infectious diseases, infection control, antimicrobial stewardship, pharmacy, hospital medicine, and the UPHS CDI initiative, as well as clinical informatics. This process was facilitated by the PennPathways Program Manager and Director of the Penn Medicine Center for Evidence-based Practice (CEP). ECRI Institute was responsible for conducting a rapid evidence review. CEP used their existing 10-step framework for developing and disseminating clinical pathways across a geographically distributed health system. Steps include: 1. Identifying an engaged clinical owner;2. Recruiting representative stakeholders;3. Conducting a rapid review of existing guidelines and pathways;4. Developing a prototype pathway;5. Reviewing the rapid review and pathway prototype with stakeholders;6. Conducting additional rapid reviews as necessary;7. Updating the pathway using asynchronous feedback by stakeholders as necessary;8. Quality assurance and finalizing content and meta-data;9. Developing a messaging strategy and disseminating; and10. Monitoring utilization and updating. Steps 4, 7, 9, and 10 are facilitated via a Web-based tool (Dorsata Inc., Washington, DC). RESULTS: We initiated our evidence review (step 3) with a review of the AHRQ EPC report on CDI infection. We noted that the report lacked a synthesis of existing guidelines and pathways--products that are critical to the standard pathway development process at Penn Medicine. To address this gap, our partners at ECRI Institute conducted a rapid review of recent guidelines and pathways (step 3). |
|---|---|
| Physical Description: | 1 volume (various pagings) illustrations |