Background
Methods
Combining systematic review, concept analysis and bibliometric analysis
Information sources and search strategy
Eligibility criteria
Assessment of methodological quality
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For qualitative studies: the JBI Qualitative Assessment Research Instrument (QARI) [41]
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For surveys: the Center for Evidence Based Management (CEBMa) Appraisal Questions for a Survey [44]
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For descriptive cross-sectional studies: the Institute for Public Health Sciences 11 questions to help you make sense of descriptive/cross-sectional studies [45]
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For mixed-method: the scoring system for appraising mixed methods research [46]
Data extraction and analysis
Results
Description and methodological quality appraisal of studies
Author(s), year | First author country | Study design | Terminology used | Target patient population | Level of the concept | Setting | Participant demographics | Type of data | Methodological quality appraisal |
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Aspland et al., 2020 [49] | United Kingdom | Literature review | Clinical pathway | NA | Organizational | NA | NA | Number studies (n = 175) | NA |
Bergin et al., 2020 [2] | Australia | Literature review | Optimal care pathway | Cancer care | Systemic | NA | NA | NR | NA |
Busari et al., 2020 [50] | The Netherlands | Qualitative | Care pathway | Decubitus ulcer | Organizational | St. Elisabeth Hospital, Curaçao | Medical specialist Nurse Paramedical professional Management & educational staff | Participants (n = 33) Interviews (n = 10) | Medium |
Carayon et al., 2020 [24] | United States of America | Perspective article | Patient journey | NA | Systemic | NA | NA | NA | NA |
Cherif et al., 2020 [42] | France | Qualitative | Patient journey | Breast cancer | Systemic | National forum for breast cancer patients | Breast cancer patients | 967 reviews were collected over a year | Medium |
Devi et al., 2020 [51] | India | Literature review | Patient journey | Non-communicable Diseases | Systemic | NA | NA | NR | NA |
Elkhuizen et al., 2020 [52] | The Netherlands | Survey | Patient journey | Diabetes type 2 | Systemic | diabetes type 2 in a region of The Netherlands | 910 patients | quality of life (EQ5D), service satisfaction, experiences | Medium |
Hutchinson et al., 2020 [3] | Australia | Mixed-method | Care pathway | Refractory epilepsy | Systemic | New South Wales, Australia | Medical specialist, patients | Interviews (n = 22), observations (n = 10), surveys (n = 20) | Medium |
Kempa-Liehr et al., 2020 [43] | New Zealand | Qualitative | Care pathway | Appendicectomy | Organizational | North Shore Hospital, New Zealand | NR | NR | Low |
Ocloo et al., 2020 [53] | United Kingdom | Qualitative | Patient-centred care | Stroke and hip fracture | Systemic | King’s Fund (11 hospitals) | Doctors, nurses, senior managers, service improvement specialists and patient representatives | Participatory action research, documentary analysis, participatory steering groups (n = 7), focus group (n = 8) and interviews (n = 47) | High |
Seguin et al., 2020 [35] | United Kingdom | Literature review | Care pathway | Cardiovascular diseases | Systemic | NA | NA | Number studies (n = 15) | NA |
Alkandari et al., 2019 [5] | United Kingdom | Qualitative | Patient journey | Peripheral Neuropathy | Systemic | Ibn Sina Neurology and Neurosurgery Hospital | Patients | Interviews (n = 25) | Medium |
Ayachi et al., 2019 [54] | Tunisia | Survey | Care process | NR | Organizational | UHC Habib Thameur and Charles Nicolle Hospital | Hospital staff, head of department, engineers and patients. | NR | Low |
De Belvis et al., 2019 [55] | Italy | Descriptive cross-sectional stud | Clinical pathway | Ischemic stroke | Systemic | Italian teaching hospital | 483 stroke patients | Electronic records (n = 483) | High |
Gualandi et al., 2019 [14] | Italy | Qualitative | Patient journey | Hip and knee replacement surgery | Organizational | 250-bed Italian teaching hospital | Patients and professionals | Interviews (n = 20), patient shadowing (n = 8) | High |
Louis et al., 2019 [56] | United States of America | Qualitative | Patient-centered care | Breast cancer | Systemic | Three health systems | Physician, inpatient and outpatient nursing, patient navigation, clinical trials, genetics, and care coordination. | Interviews (n = 30) | High |
Meyer, 2019 [57] | United States of America | Mixed-method | Patient journey | Multiple chronic conditions | Systemic | Large health system and its care partners | NR | NR | Low |
Schildmeijer et al., 2019 [15] | Sweden | Qualitative | Standardized care pathway | Prostate Cancer | Systemic | Midsized hospital in southeast Sweden | Professionals and patients | Interviews (n = 14) | Medium |
Fung-Kee-Fung et al., 2018 [4] | Canada | Mixed-method | Care process | Lung Cancer Care | Systemic | A regional Community of Practice, Ottawa | Professionals, patients and caregivers. | Interviews (n = 68), Quantitative data (NR) | Low |
Kelly et al., 2018 [1] | Australia | Qualitative | Patient journey | Aboriginal patient | Systemic | Adelaide region | Patients and their families, healthcare professionals, managers and support workers | Participatory action research from 2008 to 2015, interviews (n = 21) and focus groups (n = 17). | Medium |
Mohr et al., 2018 [58] | Czech Republic | Qualitative | Patient journey | Schizophrenia | Systemic | Board of the European Psychiatric Association | Representatives of patient and family organizations, health policy and economic experts, and drug companies | Interviews (n = NR) and focus group (n = NR) | Medium |
Ponsignon et al., 2018 [13] | France | Qualitative | Patient journey | Cancer | Systemic | UK Patient Opinion data | Patients | Stories (n = 200) | Medium |
Aziz et al., 2017 [59] | Malaysia | Qualitative | Integrated care pathway | Stroke | Systemic | Ministry of Health, Malaysia | Physicians, nurses and managers. | Focus group (n = 2) | Medium |
Combi et al., 2016 [60] | Italy | Qualitative | Care pathway | Chronic Obstructive Pulmonary Disease | Systemic | Region of Veneto | General practitioner | Focus group (n = NR), expert Interviews (n = NR), users’ input. | Low |
Gillespie et al., 2016 [61] | United Kingdom | Descriptive cross-sectional stud | Patient journey | Stroke | Systemic | Belfast City Hospital | Patient Administration System data | 5-year retrospective dataset (n = 1995) | High |
McCarthy et al., 2016 [30] | Ireland | Qualitative | Patient journey | Hypertension during Pregnancy | Systemic | NR | Multidisciplinary practitioners | Focus group (n = 4) | Medium |
Shaw et al., 2016 [62] | Australia | Survey studies | Clinical pathway | Anxiety and depression in adult cancer | Systemic | Australian oncology and psycho-oncology | Physicians | Dataset (n = 247) | Medium |
Valentijn et al., 2016 [12] | The Netherlands | Literature review | Value-based care | Chronic kidney disease | Systemic | NA | NA | Number studies (n = 26) | NA |
Walker et al., 2016 [63] | New Zealand | Descriptive cross-sectional stud | Patient journey | Breast Cancer | Systemic | North Shore hospital | Wide range of stakeholders | Dataset (n = 72) | Medium |
Beausejour et al., 2015 [36] | Canada | Descriptive cross-sectional stud | Care pathway | Suspected adolescent idiopathic scoliosis | Systemic | Paediatric orthopaedic clinics of south-western Quebec | Children and accompanying parents | Between February 2006 and August 2007, (n = 831) | High |
Grenness et al., 2014 [64] | Australia | Qualitative | Patient-centred care | Hearing aids | Systemic | Victoria | Adults who had owned hearing aids for at least 1 year | Interviews (n = 10) | Medium |
Van Citters et al., 2014 [65] | United States of America | Mixed-method | Clinical pathway | Total joint arthroplasties of the hip and knee | Systemic | County in southeast Sweden | Clinical, academic, and patient stakeholders | Interviews (n = 64), hospital databases (n = 4). | Medium |
Evans et al., 2013 [66] | Canada | Qualitative | Disease Pathway Management | Lung Cancer | Systemic | Cancer Care Ontario | Primary care, public health, occupational medicine, oncology, and supportive services, and patients and caregivers. | Focus group (n = 25) | Medium |
Huang et al., 2012 [67] | China | Qualitative | Patient-centered care | Anemia in pregnancy | Organizational | NR | Professionals | NR | Low |
Tehrani et al., 2012 [68] | United Kingdom | Qualitative | Clinical pathway | Gynecology | Organizational | NR | NR | NR | Low |
Vandborg et al., 2012 [69] | Denmark | Qualitative | Care process | Gynecological cancer | Systemic | Department of Gynecology and Obstetrics, Odense | Patient, general practitioner, and hospitals professionals | Number of cases (n = 6) | Medium |
Yang et al., 2012 [70] | China | Perspective article | Clinical pathway | NR | Organizational | NA | NA | NA | NA |
Manchaiah et al., 2011 [71] | United Kingdom | Qualitative | Patient journey | Hearing impairment | Systemic | Swansea Hard of Hearing Club | Patients (n = 32) | Focus group (n = NR) | Medium |
Yamazaki et al., 2011 [72] | Japan | Qualitative | Clinical pathways | NR | Organizational | Saiseikai Kumamoto Hospital and Fukui General Hospital | NR | Documents analysis, participant observation, and interviews | Low |
Vanhaecht et al., 2010 [25] | Belgium | Literature review | Care pathways | NA | Organizational | NA | NA | Number studies (n = NR) | NA |
Allen et al., 2009 [73] | United Kingdom | Literature review | Integrated care pathway | NA | Systemic | NA | NA | Number studies (n = 9) | NA |
Joosten et al., 2008 [74] | The Netherlands | Qualitative | Integrated care pathway | Mental Health Care | Organizational | Institute of Mental Health Care, Eindhoven | NR | NR | Low |
De Bleser et al., 2006 [38] | Belgium | Literature review | Clinical Pathway | NA | Organizational | NA | NA | Number studies (n = 37) | NA |
Bond et al., 2001 [75] | United Kingdom | Qualitative | Care pathway | Hip surgery | Organizational | Six orthopaedic departments in English hospitals | Managers, medical staff, clinical nurses and other professionals. | Interviews (n = NR) | Low |
Concept analysis results
Concept uses
Defining attributes
Attribute theme 1: The centricity of patients and caregivers
Attribute theme 2: The positioning of professional actors involved in the care pathway
Attribute theme 3: The operation management through the care delivery process
Attribute theme 4: The particularities of coordination structures
Attribute theme 5: The structural context of the system and organizations
Attribute theme 6: The special role of the information system and data management
Attribute theme 7: The advent of the learning system
Related concepts
Antecedents of the concept
Consequences (outcomes) and identification of empirical referents
An integrative definition and conceptual framework of patient-centered care pathways
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prioritizes the centricity of patients and caregivers by analyzing the patient experience through their needs and expectations, taking into account the need for information, education, engagement and involvement and integrates the patient relationships as a fundamental need.
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supports the roles of professional actors involved in the care pathway by developing adherence to the patient-centered care approach; working on interdisciplinarity through the development of skills, both technical and above all relational; the clarification of roles and responsibilities; and by taking into account the experience of professionals both in understanding the organizational constraints and their well-being at work.
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integrates a process of care approach through the modeling and improvement of the care pathway by continuously integrating the latest knowledge and information to support clinical decision-making and by defining feedback loops to continuously improve clinical and non-clinical process supported by operation management contained within process improvement methodology approaches;
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embeds coordination structures through: the implementation of best practices and the translation of guidelines into daily practice; the support of informational continuity through the integration of services at the systemic level; the implementation of knowledge management along the care continuum; and the identification of leaders at each step of the care pathway;
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adapts to the contexts of both the physical and social structures by integrating the human, material, economic and financial resource constraints, as well as the social dynamics of power and trust relationships;
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is supported by information systems and data management, enabled by digitalization, which ensure the flow of information within the right context at the right time and place, and allows the continuous integration of the latest knowledge into the care flow and the management of accessible data in real time to monitor and evaluate variances in practices and outcomes;
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promotes the development of a learning health system to support the care pathway.