Creating pathways

Map of Medicine creates evidence-based, practice-informed, and policy-cognisant healthcare pathways.

Topic prioritisation

Topics are prioritised using a bespoke ranking tool that considers clinical, economic, and editorial factors. The aim is to create and maintain pathways that will be of value to our users.

It is important to note that not all clinical topics fit the pathway format. With each topic, an editorial assessment is made as to whether best practice can be well communicated in a pathway.

Evidence search

Once a topic has been prioritised to be turned into a pathway, the scope of the pathway is clearly defined, including the population and care settings being considered. This then informs the search terms to be used in Medline and EMBASE.

Map of Medicine specifically searches for well-reputed secondary evidence – systematic reviews, meta-analyses based on systematic reviews, and guidelines. Only articles in English are considered. The initial search goes back 10 years.

A significant amount of secondary evidence is available only in the “grey literature” - information not included in bibliographic databases. Map of Medicine runs manual searches of organisations that contribute to the grey literature.

Critical appraisal

Inclusion and exclusion criteria are applied to systematic reviews and meta-analyses retrieved from the searches to ensure that only high-quality information is selected. The AGREE instrument is employed to assess the quality of guidelines.

A relevance assessment is then performed to ensure the topic of each retrieved and quality-assessed article is aligned with the scope of the pathway.

Pathway drafting

The result of the evidence search, critical appraisal, and relevance assessment processes is a list of the key literature, relevant to the scope of a pathway, stratified by quality. A judgment is then made as to whether there is sufficient information to draft the pathway, or whether the search must go back further than 10 years.

The information is then applied to a standard pathway template, starting with the highest-quality source of information. Differences between information sources considered to be of equal quality are clearly indicated within the pathway.

Practice-based contributions

Healthcare pathways cannot be solely derived from published information; they must be informed by those with practice-based knowledge. This is especially true in the areas of diagnosis and prognosis where high-quality information is especially sparse.

Map of Medicine works with clinical stakeholders such as Royal Colleges or clinical societies to gather practice-based knowledge for its pathways.

Contributors from stakeholder organisations are asked to ensure pathways follow a logical flow and contribute to the content where gaps in knowledge are apparent. This is achieved by appointing a specialty-specific Clinical Facilitator tasked with convening a multidisciplinary group, which may include nurses and allied health professionals.

Contributors are encouraged to add articles to the evidence used in a pathway, especially if it is primary research. Such information in clearly marked as being chosen by the contributor group.

All contributors complete a conflicts of interest declaration. As of February 2010, the names of the contributors and their declarations will be published within the Provenance certificate accompanying each pathway.

For topics where stakeholder organisations are unavailable, Map of Medicine identifies independent experts to contribute practice-based knowledge to its pathways.

Information classification

Every source of information is classified, whether it is an article found through the search and appraisal process or the views of the contributors from a clinical stakeholder.

Articles added by contributors are classified by both the article type and the fact that they were selected by the contributors, rather than the defined search and appraisal process.

Peer review

Every pathway is peer-reviewed. Peer-reviewers are asked to consider the evidence base used, the practice-based knowledge added, and the clinical usability of the pathway.

Pathways created with a clinical stakeholder are usually reviewed by a separate body within the same organisation. Such review leads to the pathway being accredited by that organisation.

All peer reviewers complete a conflicts of interest declaration, which is held on file at the editorial office.

Click here for the Map of Medicine Medication Policy.