Systemic long-term impact of clinical pathways: UPMC experience with hysterectomy patients

Clinical pathways are defined as evidence-based, multidisciplinary care algorithms that outline essential steps in the management of patients. Pathway implementation in healthcare and industries outside of healthcare demonstrated success in reduction of inefficiencies and elimination of waste of financial and other resources by standardizing processes. The UPMC Health System introduced an evidence-based pathway treatment algorithm for hysterectomy in 2012 with an overarching goal of reducing variations in surgical care and abdominal hysterectomy rates, thereby promoting cost containment and decreased patient morbidity. In 2016, we reported on the impact of hysterectomy pathways on the reduction of open hysterectomy rates and improved patient outcomes between 2012 and 2014. In this follow-up commentary, we looked at years 2015 to 2019 to evaluate the continued success of hysterectomy pathway initiative. Initial studies, as well as follow-up results, both led to the understanding that hysterectomy clinical pathways serve as an effective instrument in decreasing the rates of open hysterectomies, thus reducing complications and undesired practice variability while providing consistent care. We concluded that physician and patient factors that impact the utilization of hysterectomy pathways must be continuously monitored to ensure optimal quality of care for hysterectomy patients. Introduction of clinical pathways across health systems represent an opportunity to introduce a systematic and sustainable change with the goal of achieving improved health outcomes locally and globally.