American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) Care Pathways

What is an AACPDM Care Pathway?

Care Pathways are clinical recommendations for the health care of individuals with childhood-onset disabilities. Practice recommendations provided by Care Pathways are based on the best available evidence from high quality systematic reviews. Recommendations are graded for their probable accuracy (i.e., quality) and the confidence with which they can be used (i.e., strength) for the purpose of making clinical decisions. The systematic processes used in the decisions and judgments involved with development of the clinical recommendations made by Care Pathways are transparent and explicitly described.

The current concept of Care Pathways has evolved in response to the increasing uptake of methodological standards for the development of clinical practice guidelines from the major international evidence-based practice centers. Tools and procedures recommended by these methodological experts were incorporated into the latest instructions for Care Pathway development.

How are Care Pathways Developed?

The 2017 Guidelines for Developing an AACPDM Care Pathway were used for the development of the six original Care Pathways posted January 2016-May 2020. These will be revised using the latest Instructions.

The current Instructions for AACPDM Care Pathway Development 2020 Edition describes the Phases of Care Pathway development and details the updated methodology, tools ,and procedures. This document also serves as a resource for those interested in developing a systematic review. It is considered a living document, and will undergo regular updates and revisions. The Instructions have a companion document that is a customized version of the McMaster Guideline Development Checklist (GDC). The GDC-CP is used by Care Pathway teams for detailed guidance and documentation of all steps involved in the Pathways development process.

How are Care Pathways Organized?

The Care Pathways currently available may look different depending on which methodology was used for their development.

Care Pathways Developed (or Revised) using the 2020 Instructions are Organized into Presentation and Reporting Items (all of which can be accessed on the webpage for complete transparency):

Presentation Items:

  • A statement (or statements) of recommendation, using standardized wording based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework: Weak or conditional recommendation (for or against), or strong recommendation (for or against). These 4 possible recommendations are accompanied by specification of the strength of the recommendation and quality of evidence.
  • An interpretation aid
  • A plain language summary

Reporting Items:

  • Links to systematic review(s) used in the evidence synthesis
  • Quality assessments (methods and reporting) of systematic reviews used in the evidence synthesis
  • Evidence Profiles and Summary of Finding Tables
  • Evidence-to-decision framework including all sources used to formulate judgements
  • Quality appraisals of the Care Pathway by internal (Council) reviewers
  • Other documents produced by the Care Pathway Development Team (e.g., documentation of group processes in decision-making activities)
  • Acknowledgement of all involved in Care Pathway development with itemized contributions
  • Conflict of interest declarations of Care Pathway Development Team

Care Pathways Developed using the 2017 Instructions are Organized into Four Main Sections:

  1. Evidence Summary: A ‘bottom line’ summary provides key information to the health professional on a specified health condition. This is paired with an ‘Algorithm’ outlining a logical path from assessment to treatment. The ‘Algorithm’ is color-coded with the level of treatment evidence: Green = Effective; Purple = Recommended by clinical expert opinion; Yellow = Probably/possibly effective; Red = Not effective
  2. Published Evidence: Links to peer-reviewed published evidence (systematic reviews and clinical practice guidelines) informing the Care Pathway
  3. Practical Tools: Links to helpful practical tools and information for health professionals on the designated ‘Care Pathway’ health condition (e.g. plain language summary, parent handout)
  4. Acknowledgements: This section lists all contributors and institutions that assembled the care pathway, including any potential conflicts of interest.

Current Care Pathways:

How can you Leave Feedback or Comments on a Care Pathway?

Each Care Pathway website has a link to post comments. Transcripts of comments and replies to them by the Care Pathways Developers are available for viewing, including those posted in the initial 30 day external review period.

How do you Cite a Care Pathway?

AACPDM’s Care Pathways use the best available evidence at the time of development, and the information contained could change or be updated with emerging or new evidence. Accordingly, Care Pathways should be cited using the Pathway’s website address which, when accessed, indicates the original posting date and revision due date. Care Pathways developed (or revised) using the 2020 Instructions are due for revision every five years.

Interested in Developing an AACPDM Care Pathway?

If you are interested in developing a future AACPDM Care Pathway or would like to learn more about the recommended processes for developing a Care Pathway, including those involved in developing a systematic review, please go to the Instructions for AACPDM Care Pathway Development 2020 Edition. The document describes the Phases of Care Pathway development and details the required methodology, tools ,and procedures. The Instructions have a companion document, the GDC-CP, which is a checklist used by Care Pathway teams for detailed guidance and documentation of all steps in the development process.

Please contact the Care Pathways Council for further information on how to submit a letter of interest.

This Care Pathway was developed from the best available evidence at the time of its development, and the information contained could change or be updated with emerging or new evidence. The AACPDM is not liable for any damages, claims, liabilities, or costs arising from the use of these recommendations including loss or damages arising from any claims made by a third party.

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