Clinical Pathways and Clinical Practice Guidelines

Canada is among the most prosperous nations in the world. Yet when compared to other nations in the Organization for Economic Cooperation and Development (OECD), Canadian children’s health and wellness outcomes are surprisingly poor. Each year almost 25% of Canada’s approximate 9,500,000 children require emergency acute health care resulting in considerable financial and emotional costs for families and society. Clinical practice variation, even for common acute child health conditions, continues to be pervasive despite guidance from research evidence. Poorer health outcomes, unnecessary medical treatments and suffering, and increased strain on the health care system are potential outcomes from practice variation. Strategies that mobilize the use of research evidence to inform children’s health care can reduce health care utilization and high hospitalization rates, which account for 43-62% of health care expenditures and come with inherent risks. Reduction in undesirable practice variation has been a major focus of systematic efforts to improve the quality of the health care system. Clinical practice guidelines (CPGs) and clinical pathways (CPs) have been embraced as one strategy to decrease clinical practice variation through providing the best available research evidence in the form of optimal care recommendations. However, current research highlights that strategies to put CPGs/CPs in clinical practice do not have uniform implementation rates across sites.

Despite the billions annually spent globally and the hundreds of millions spent in Canada on high-quality health research, research transfer is a slow and haphazard process. In fact, it often takes 10 to 20 years for research findings to be ‘translated’ into conventional health care delivery. Regrettably, child health care settings are not immune to the challenges of applying the best available research evidence to clinical practice, also known as knowledge translation (KT). The literature highlights that the effectiveness of KT interventions, such as CPGs/CPs, to facilitate the transfer of research into clinical practice vary by condition, professional group, and context; however, the processes and factors shaping the implementation process are not well studied.