3Qs for QI | Q&A with Dr. Leigh Anne Bakel
Jan 29, 2025
In an article published in Pediatrics, IHQSE graduate Dr. Leigh Anne Bakel and team set out to understand the landscape of clinical pathway programs in pediatric hospitals. In a survey of 81 Pediatric Research in Inpatient Settings (PRIS) network hospitals, more than half of respondents confirmed that clinical pathways were in place; however, nearly half of those programs were hindered by limited funding and an inability to measure pathway outcomes or improvements in care.
1. Tell us about your approach to this project?
As the Director of the Clinical Pathways program at Children’s Hospital Colorado, I was curious to know how many other pediatric hospitals had similar programs, the characteristics of those programs, and how programs were similar and different in the clinical pathways developed as well as if there was a program and structure supporting this work. We aimed to determine the prevalence of these programs through a cross-sectional web survey through the Pediatrics in the Inpatient Setting (PRIS) network of 111 hospitals. Eighty-one hospitals responded to the survey, a 73% response rate. We surveyed respondents for the existence of a clinical pathways program, number, type, and creation and/or revision of pathways and the characteristics of the programs within the member hospitals.
2. Why is this work important?
Prior to this study, there was no current description in the literature of clinical pathway programs in Pediatrics. This was the first attempt to identify existing clinical pathway programs and describe the similarities and differences between them. More than half of the sites surveyed had a clinical pathways program and most were hospital wide. Freestanding, academic teaching hospitals accounted for the most responses. This suggests that pediatric institutions are using clinical pathways and have a program to support their development though resourcing is likely a challenge that many institutions are trying to overcome.
3. How do you think this will impact healthcare?
Many more pediatric hospitals are creating and using clinical pathways. Very little evidence is available in the literature about formal clinical pathway programs and their role in the effectiveness of building and sustaining clinical pathway use. Over half of the pediatric clinical pathway programs are not financially resourced, and many are unable to measure findings related to their pathways or demonstrate the improvement in value of care. Our study suggests that investing in a resourced clinical pathway program promotes pathway development and implementation. There are still significant challenges in resourcing these programs and measuring process and outcome measures for established pathways. A new national alliance of pediatric clinical pathway programs and professionals are collaborating to overcome these challenges.