Definition – What is a Care Pathway?

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The most successful businesses often achieve growth, reaching milestones and goals, because they often meet and exceed certain expectations held by their customers. Employees can achieve that consistently when they have a “road map” of sorts to define their role. Think of it like standard operating procedures. In health and social care, that SOP is called a Care Pathway.

On the effectiveness of care pathways in healthcare:

In the review by Van Herck et al11 62.2% of the studies reviewed reported a positive effect on patient satisfaction.CPA

Care pathways are also known as clinical pathways, integrated care pathways, case management plans or care maps. The European Pathway Association (EPA) defines an ICP as:

“a methodology for the mutual decision making and organization of care for a well-defined group of patients for a well-defined period.”

Another definition is that an ICP is:

“a multidisciplinary management tool based healthcare plan for a specific group of patients with a predictable clinical course, in which the different tasks by the professionals involved in the patient care are defined, optimized and sequenced.”

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The Role of Care Pathways in Healthcare

Hospital and care facilities utilizes care pathways to map out the palliative care journey for each individual patient. Each care pathway is unique to the individual and acts as a prompt for care. Most importantly, they are multi-professional and can be used in multi-site operations to cross organizational boundaries.

A care pathway creates a consistent standard of documentation that provide the basis for ongoing audit. Not only do these multidisciplinary tools improve the quality and efficiency of patient care, they are effective communication tools between healthcare professionals to maintain standardized outcome-oriented care.

Of course, a well-defined care pathway used properly acts as a guide to treatment, documenting the patient progress, and displaying what an individual can expect on their care journey.

Why Care Pathways Were Created

Keeping patients informed is a critical part of healthcare – think ‘informed consent’. Looking at it from an organizational/operational standpoint, healthcare as a business implements care pathways as a means to ensure that every patient receives the absolute best standard of care available, as defined by the care pathway.

The Effectiveness of Care Pathways

Studies have questioned the effectiveness of care pathways over the years, such as one deep dive into the care pathways used in Liverpool (Neuberger et all, 2013.) In that review of care pathways for end of life care, researchers questioned the use of care pathways. Their primary concern was a lack patient-centric care. More specifically, care pathways were compared to check lists. As such, they fail to sufficiently account for unique patients conditions such as complex co-morbidities.

Skepticism has seen care pathways questioned from a number of angles. From the patient’s perspective, there would be a marked increase in clinical outcomes. The patient would see improved levels of care, quality of life, and communication surrounding their treatment, including post-hospital care where applicable.

For healthcare administration, while also seeking to improve outcomes and palliative care for patients, the effectiveness is often measured in reduction of overhead cost as well as tracking reduced resource and personnel waste.

It’s difficult to state whether care pathways are or are not effective. Primarily because care pathways are so complex. Rather than being regional in scope, they are often developed at the local level to meet the needs of local facilities, medical control protocols, circumstances, and expectations. Even for the same type of care, pathways are likely to differ not only in their content but also in how effective they are when you consider how unique each patient’s condition is.

Because of that uniqueness, a key component indicating a well-designed care pathway is the inclusion of an evaluation or assessment process as part of the pathway. This allows healthcare professionals and administrators to continually monitor the effectiveness of the pathway.

According to Allen, Gillen and Rixson (2009), in a systematic review of care pathways, it was determined that they are most effective in circumstances where the trajectory of care is predictable.

Care Pathway: Expanded Use Over Time

Over the years, care pathways have expanded globally in adoption. In one study from Hindle and Yazbeck examining clinical pathways in 17 European countries, seen in the graph below, there’s a marked rise in the estimated levels of pathway use between 2004 and 2009.

 

Developing Care Pathways

Developing a care pathway should never be treated like the development of a standard operating procedure. Where one defines the duties and workflow as a standard order moving forward, with no real deviation and little auditing, care pathways are built on the concept of constant improvement and variance analysis.

Guidelines have been written to help hospital staff and administration develop integrated care pathways as part of the constant improvement of patient care. These guidelines generally follow an outline published by the NHS Institute for Innovation and Improvement, split into six phases.

  • Prepare
  • Diagnose
  • Design
  • Plan
  • Implement
  • Refine

Refining a care pathway is key, specifically around variance analysis. It goes back to what we mentioned regarding the uniqueness of each patients and considerations for complex care plans. Variance analysis is used to measure what happens to the patient along the care pathway. This includes paying close attention to points in which the patient deviates from the expected pathway and if so, why that deviation occurred. Furthermore, measuring the results of typical and atypical progress on the pathway provides insight for improving patient care of the specific procedure to which that pathway was developed.

The Key Benefits  and Areas of Improvement

The benefits of forming well-documented care pathways extend beyond excellent documentation of the care process. Here are some of the key benefits to developing improved integrated care paths:

Improved Team Work

Team work and communication among team members, departments, and facilities is encouraged as the path defines how each work together to provide the best patient care for specific procedures.

Uplift in Personnel Value

Involved healthcare professionals may not have fully appreciated how their role fits into the entire progression of patient treatment and care. As a result, they may feel undervalued or may even undervalue the contribution of fellow team members. Well-documented care paths reveal the depth to which staff interact with and support the patient along the way.

Empower Patients

Because patients are often involved in the development of care pathways, and are active participants in laying the framework and information for various stages of treatment, they often feel more empowered. This has been shown in previous studies during the 90’s by Coulter and Street to show increased satisfaction with treatment and improved outcomes.

Deviations Tracked and Addressed

With variance analysis, it’s much easier to find issues or deviations in patient care, and see how they influence the outcome. Since the pathway predicts the standard journey, any variances may impact the end result.

The variances could be from failure to complete a task, to delays in discharge with social services or communication breakdowns. Any deviation that impacts patient care can be quickly addressed and, if necessary, the care path updated.

Workflows are Established

A key component of care pathway development is laying out staff deployment – much the same way organizations develop automated workflows to define who functions in a specific job role. In healthcare, administration identifies which member of staff can most appropriately perform individual tasks as part of the pathway, such as designating nursing staff for follow-up of care rather than physician consult.

Conclusion

Those who argue against care pathways may take the stance of being patient-centric, and there is little time to step back from real clinical work to generate pathways. However, a well-documented and refined care pathway ultimately leads to better patient care, and can improve the efficiency as each healthcare professional performs the role for which they are best suited. This results in fewer missed tasks, and far less duplication of or overlap of work.

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