CRITICAL PATHWAYS AS A STRATEGY FOR IMPROVING CARE - PROBLEMS AND POTENTIAL

In an era of increasing competition in medical care, critical pathway guidelines have emerged as one of the most popular new initiatives int ended to reduce costs while maintaining or even improving the quality of care. Developed primarily for high-volume hospital diagnoses, criti cal pathways display goals for patients and provide the corresponding ideal sequence and timing of staff actions for achieving those goals w ith optimal efficiency. Despite the rapid dissemination of critical pa thway programs in hospitals throughout the United States, many uncerta inties remain about their development, implementation, and evaluation. In addition, serious concerns have been raised about their effect on patient outcomes and satisfaction with care, physician autonomy, malpr actice risks, and the teaching and research missions of many hospitals . Underlying these concerns is the absence of data from controlled tri als to evaluate the effects of critical pathways. Physicians should un derstand the potential benefits and problems associated with critical pathways because physicians are increasingly being asked to provide le adership for pathway programs. Physicians and other health service inv estigators should also develop methods to study pathways in evolving h ealth care settings. Although the promise of reduced costs and improve d quality is enticing, the gaps in our knowledge about critical pathwa ys are extensive; therefore, like any new health care technology, path way programs should be fully evaluated in order to understand the cond itions under which that promise may be fulfilled.