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Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation

Cathy Lodewijckx123*, Marc Decramer14, Walter Sermeus23, Massimiliano Panella35, Svin Deneckere23 and Kris Vanhaecht236

Author Affiliations

1 Respiratory Department, University Hospitals Leuven, Leuven, Belgium

2 Department of Public Health, KU Leuven University of Leuven, Leuven, Belgium

3 European Pathway Association, Kapucijnenvoer, Leuven, Belgium

4 Faculty of Medicine, KU Leuven University of Leuven, Leuven, Belgium

5 Department of Public Health, Department of Clinical and Experimental Medicine, Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy

6 Western Norway Research Network on Integrated Care, Helse Fonna, Haugesund, Norway

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Trials 2012, 13:229  doi:10.1186/1745-6215-13-229

Published: 29 November 2012



Optimization of the clinical care process by integration of evidence-based knowledge is one of the active components in care pathways. When studying the impact of a care pathway by using a cluster-randomized design, standardization of the care pathway intervention is crucial. This methodology paper describes the development of the clinical content of an evidence-based care pathway for in-hospital management of chronic obstructive pulmonary disease (COPD) exacerbation in the context of a cluster-randomized controlled trial (cRCT) on care pathway effectiveness.


The clinical content of a care pathway for COPD exacerbation was developed based on recognized process design and guideline development methods. Subsequently, based on the COPD case study, a generalized eight-step method was designed to support the development of the clinical content of an evidence-based care pathway.


A set of 38 evidence-based key interventions and a set of 24 process and 15 outcome indicators were developed in eight different steps. Nine Belgian multidisciplinary teams piloted both the set of key interventions and indicators. The key intervention set was judged by the teams as being valid and clinically applicable. In addition, the pilot study showed that the indicators were feasible for the involved clinicians and patients.


The set of 38 key interventions and the set of process and outcome indicators were found to be appropriate for the development and standardization of the clinical content of the COPD care pathway in the context of a cRCT on pathway effectiveness. The developed eight-step method may facilitate multidisciplinary teams caring for other patient populations in designing the clinical content of their future care pathways.

Critical pathway; Evidence based medicine; Standardization; Cluster randomized trial; Chronic obstructive pulmonary disease