JMIR Publications

ABSTRACT

Background:

Electronic Healthcare Databases (EHD) are increasingly used for informing clinical decision-making. In chronic care, linking and accessing information on healthcare delivered by different providers could improve coordination and health outcomes. Several methods for quantifying and visualizing this information into data-driven Care Delivery Pathways (CDP) have been proposed. To be integrated effectively and sustainably into routine care, these methods need to answer a range of prerequisites covering three broad domains: clinical, technological, and behavioral. Although advances have been made, development to date lacks a comprehensive interdisciplinary approach. As the field expands, it would benefit from developing common standards of development and reporting that integrate clinical, technological, and behavioral aspects.

Objective:

To describe the content and development of CDP methods and propose recommendations for future work.

Methods:

We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. We searched peer-reviewed publications in English reporting CDP methods using chronic care data and extracted data on clinical information and aims; technological development and characteristics; and user behaviors described. Data were summarized in tables and presented narratively.

Results:

Of 2920 records identified, 14 studies were included, of which 13 descriptive reports and 1 validation study. Clinical aims focused primarily on treatment decision making (6 studies), and care coordination (7 studies). Technological development followed a similar process from scope definition to tool validation, with various levels of detail in reporting. User behaviors (3 studies) referred to accessing CDP, planning care, adjusting treatment, or supporting adherence.

Conclusions:

Using EHD for quantifying and visualizing CDP in chronic care is an emerging field. Detailed and standardized reporting of clinical and technological aspects is needed. Early consideration of how CDP would be used, validated, and implemented in clinical practice would likely facilitate further development and adoption.