A Cochrane review [Abstract] 1 included 27 studies with a total of 11 398 subjects. 20 studies compared stand alone clinical pathways with usual care. These studies indicated a reduction in in-hospital complications (OR 0.58, 95% CI 0.36 to 0.94) and improved documentation (OR 11.95, 95% CI 4.72 to 30.30). There was no evidence of differences in readmission to hospital or in-hospital mortality. Length of stay was the most commonly employed outcome measure with most studies reporting significant reductions. A decrease in hospital costs/ charges was also observed, ranging from WMD +261 US$ favouring usual care to WMD -4919 US$ favouring clinical pathways (in US$ dollar standardized to the year 2000). Considerable heterogeneity prevented meta-analysis of length of stay and hospital cost results. An assessment of whether lower hospital costs contributed to cost shifting to another health sector was not undertaken.
Seven studies compared clinical pathways as part of a multifaceted intervention with usual care. No evidence of differences was found between intervention and control groups.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding).
Primary/Secondary Keywords