Measuring clinical pathway adherence.

As clinical pathway adoption continues worldwide, it is necessary to establish adherence measurement methods in order to understand the difficulties and results of implementation. Adherence measurement literature mostly provides binary measurements of adherence to guidelines regarding individual medical activities over patient groups. The resulting measurements are of limited value in view of the pathways actually followed by individual patients. We develop and test dynamic programming formulations for adherence measurement in clinical pathways--based on partially ordered data in medical records and pathway definitions. With these new methods at hand, we analyze clinical pathway adherence at the Cardiovascular Center of Maastricht University Medical Center.