Journal articles on the topic 'Health care pathway'
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1
Bronkhorst, Babette, and Brenda Vermeeren. "Safety climate, worker health and organizational health performance." International Journal of Workplace Health Management 9, no. 3 (September 12, 2016): 270–89. http://dx.doi.org/10.1108/ijwhm-12-2015-0081.
Abstract:
Purpose The purpose of this paper is to investigate the relationship between organizational safety climate and organizational health performance outcomes (i.e. absenteeism, presenteeism, health care utilization) mediated by individual worker health. The authors used three pathways to examine this relationship: a physical pathway starting with physical safety climate and mediated by musculoskeletal disorders (MSDs), a psychosocial pathway starting with psychosocial safety climate and mediated by emotional exhaustion, and a combined pathway starting with psychosocial safety climate and mediated by both MSDs and emotional exhaustion. Design/methodology/approach Three mediational multilevel analyses were conducted using a sample of 8,761 employees working in 177 health care organizations. Findings Although the findings did not support the hypothesized physical pathway, they showed that the psychosocial pathway worked satisfactorily for two of the three health performance outcomes (absenteeism and presenteeism). The combined physical and psychosocial pathway explained differences in the third outcome: health care utilization. Originality/value This is one of the few studies to include both physical and psychosocial pathways that lead to employee health and organizational performance. The results underscore the importance of paying attention to psychological health and safety in the health care workplace. Not only for the psychological health of employees, but also to improve their physical health and subsequent organizational health performance.
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Kingdon, D., and A. Gregoire. "Mental health care pathways." European Psychiatry 26, S2 (March 2011): 546. http://dx.doi.org/10.1016/s0924-9338(11)72253-2.
Abstract:
IntroductionThe term, care pathway, has been used to describe multidisciplinary/ multi-agency outline of anticipated care, placed in an appropriate timeframe, to help a patient with a specific condition or set of symptoms move progressively through a clinical experience to positive outcomes. In practice, a multitude of disparate projects have produced outputs ranging from pages of interconnected boxes and arrows with rather basic entries to thick and indigestible wads of paper. Certainly the idea of a ‘mental health care pathway’ accessible and used by the general public, service users, carers, primary and secondary care has seemed overwhelmingly complex and unworkable.Aims & objectivesTo make relevant service and clinical information available when and where in a person's progress or a clinician treatment path it was needed.MethodWebsite hyperlinks allow linkage within websites and to other websites with relevant information (e.g. ICD10, NICE guidelines, and Patient information leaflets). A development prototype funded by the UK NHS has been established to form the basis for a website to be launched in mid-2011 (www.mentalhealth.southcentral.nhs.uk).ResultsThe prototype contains links to evidence-based information on maintaining mental health and on ‘coping with problems’. Service Pathways describe detail of processes occurring in mental health care. Diagnostic care pathways start as broad categories [Kingdon et al, 2010] with links to diagnosis, medication (e.g. connects to the National Formulary) and psychological management sites.ConclusionsWeb technology allows information about mental health care pathways to be accessed more systematically and readily and has application internationally.
3
Rady, Mohamed Y., and Joseph L. Verheijde. "Liverpool Care Pathway: life-ending pathway or palliative care pathway?" Journal of Medical Ethics 41, no. 8 (July 18, 2014): 644. http://dx.doi.org/10.1136/medethics-2014-102314.
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Glass, Katherine, Chad W. Cummings, Marc A. Shapiro, Dennis Urbanek, and Brian James Bolwell. "Data collection for care pathways in the Cleveland Clinic Health System." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 115. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.115.
Abstract:
115 Background: Care pathways are established methods of reducing healthcare costs and disparities in oncology care. To demonstrate their impact, health systems must measure and report data on care pathway adherence and outcomes in near real-time. Automating data abstraction across a health system for oncology is difficult due to the amount and detail of data required. Manual abstraction of data is considered slow and costly. Many consider Electronic Medical Record (EMR) integration of care pathways essential in order to successfully implement and assess. Methods: 7 medical oncology care pathways and 45 medical oncologists across the health system were selected for a pilot study to assess the feasibility of implementing care pathways throughout the enterprise. The pilot study also allowed for testing of data collection capabilities. Patients eligible for the care pathways were prospectively identified by manual review of physician calendars. A small number of data points were manually abstracted from the patient EMR at the time of identification. Endpoints of interest, such as hospitalization rates, chemotherapy administered, time to treatment, and costs of care were reconciled through pre-existing databases within pharmacy, research, and finance. Tumor registry data identified a retrospective cohort. Results: Over 1,000 patients were prospectively identified for the care pathway pilot between 1/1/2014 and 12/31/2014. The tumor registry identified 700 additional retrospective patients. The rapid analyses possible as a result of these efforts demonstrated physician adherence, improved patient outcomes, and significant cost savings. In one example, a care pathway for metastatic non-small cell lung cancer reduced charges by more than $98,000/patient by recommending patients receive one standardized chemotherapeutic regimen. Conclusions: Timely data collection for oncology care pathways is feasible and cost effective without EMR integration. Manual identification of patients combined with pre-existing data sources allowed for near-real time analysis of care pathways and provided valuable information about care pathway impact. Institutions can implement and assess care pathways with resources already available to them.
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Olsen, Cecilie Fromholt, Astrid Bergland, Jonas Debesay, Asta Bye, and Anne Gudrun Langaas. "Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People." Qualitative Health Research 31, no. 9 (May 19, 2021): 1710–23. http://dx.doi.org/10.1177/10497323211003861.
Abstract:
Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.
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Hally, Jennifer D., and Nigel B. Pitts. "Developing the First Dental Care Pathway: The Oral Health Assessment." Primary Dental Care os12, no. 4 (October 2005): 117–21. http://dx.doi.org/10.1308/135576105774342947.
Abstract:
In this paper the authors define the concept of care pathways and explain what they are and how they have been applied in various areas of healthcare. The authors discuss the benefits of the care pathway approach and outline the first national dental NHS (clinical) care pathway and its link to National Institute for Clinical Excellence (NICE) guidance on dental recall intervals. The authors go on to explain that as a result of one of the key recommendations of Options for Change, the concept of care pathways will be extended to the primary dental services of the NHS. The first care pathway will be the Oral Health Assessment (OHA). The authors describe the development of, and rationale for, the OHA and provide details of its planned introduction. The authors conclude that the OHA should act as the initial interface between the primary care team and the dental patient. In so doing it should enable a change in the focus of care, from treatment-based to more prevention-led, personalised care appropriate to the specific needs of individual patients.
7
Rosique, Ricard. "Do we need electronic support for pathways: the Spanish experience." International Journal of Care Pathways 13, no. 2 (November 2009): 67–74. http://dx.doi.org/10.1258/jicp.2009.009010.
Abstract:
Care pathways are excellent tools for quality management in health care concerning the standardization of care processes, as they promote organized and efficient patient care established on evidence-based practice. The implementation of a care pathway project at any health-care setting means a change of the organizational culture. E-pathways (electronic pathways) are strategic resources in order to get the successful implementation of a care pathway project. The concept of e-pathway is recent enough and there are some different experiences worldwide. In 2000, the first electronic pathways were implemented at Hospital de Mataró, in Barcelona, Spain. The benefits of using e-pathways (Eira Healthcare Server) are very clear at Hospital de Mataró: immediate records with no transcriptions, information in the palm of your hand, no prints, and rigour and reliability. Another recent and interesting experience is the development and introduction of e-pathways at Hospital General de l'Hospitalet, in Barcelona, Spain, using an SAP integrated health-care solution. The strategy planning of hospital managers should take into account the need and priority of any pathway project linked to e-pathways. Some experiences in Spain have proven that we do really need electronic support for pathways. Electronic pathways are a basic support and should not be postponed when implementing care pathways.
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Reymond, Liz, Fiona J. Israel, and Margaret A. Charles. "A residential aged care end-of-life care pathway (RAC EoLCP) for Australian aged care facilities." Australian Health Review 35, no. 3 (2011): 350. http://dx.doi.org/10.1071/ah10899.
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The objective of this study was to develop, implement and evaluate an end-of-life (terminal) care pathway and associated infrastructure suitable for Australian residential aged care facilities that improves resident and health system outcomes. The residential aged care end-of-life care pathway was developed by a multidisciplinary collaboration of government and non-government professionals and incorporated best clinical management for dying residents to guide care and increase palliative care capacity of generalist staff. Implementation included identifying and up-skilling Link Nurses to champion the pathway, networking facilities with specialist palliative care services, delivering education to generalists and commencing a Palliative Care Medication Imprest System in each facility. The primary outcome measure for evaluation was transfer to hospital; secondary measures included staff perceived changes in quality of palliative care provided and family satisfaction with care. Results indicated that the pathway, delivered within a care framework that guides provision of palliative care, resulted in improved resident outcomes and decreased inappropriate transfers to acute care settings. What is known about the topic? Residential aged care facilities (RACFs) are the hospices of today. Many RACF staff are not confident in the delivery of high quality palliative care, resulting in inappropriate transfers of dying residents to acute care facilities. Needs-based palliative care pathways are being used increasingly to direct care in a variety of healthcare environments. What does this paper add? Provides the first evidence in Australia that a residential aged care end-of-life care pathway (RAC EoLCP) improves outcomes of care for dying residents and results in fewer residents being inappropriately transferred to acute care facilities. What are the implications for practitioners? Use of the RAC EoLCP will improve resident and health system outcomes by guiding the delivery of high quality palliative care and improving the palliative care capacity of generalist health providers.
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Deneckere, S., M. Euwema, C. Lodewijckx, M. Panella, W. Sermeus, and K. Vanhaecht. "Improving interprofessional teamwork with care pathways: challenges for pathway researchers and health-care managers." International Journal of Care Pathways 16, no. 2 (June 1, 2012): 37. http://dx.doi.org/10.1258/jicp.2012.012m05.
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Kwok, Chun Shing, David Waters, Thanh Phan, Phyo Kyaw Myint, and Gregory Y. H. Lip. "Should Audits Consider the Care Pathway Model? A New Approach to Benchmarking Real-World Activities." Healthcare 10, no. 9 (September 19, 2022): 1798. http://dx.doi.org/10.3390/healthcare10091798.
Abstract:
Clinical audit is a method to assess the quality of healthcare services based on whether standards are met or not met. This approach is limited because it fails to recognize how decisions that take place over time and the natural progression of disease has an impact on what happens to patients and the care they receive. The aim of this paper is to introduce the concept of care pathway and explain how care pathways can be audited to better understand care. The care pathway is defined by clinically relevant events that take place within one or more healthcare institutions. The process begins with defining an ideal care pathway which is created by considering local expertise and guidelines. It is then possible to audit against the extent to which this ideal care pathway is achieved. This care pathway audit can enable identification of patterns in real-world care which can help with the of design interventions to help shift patients from the less to more desirable pathways. We conclude that through the process of the care pathway audit cycle, it is possible to learn about real-world activities, better utilize resources, promote safer care, improve quality of care, and help develop more effective interventions.
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Cairns, Rebecca, and Stephen Guy. "Clozapine initiation in the Belfast Health and Social Care Trust (BHSCT)." BJPsych Open 7, S1 (June 2021): S177. http://dx.doi.org/10.1192/bjo.2021.482.
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AimsThe aim of this project is to improve the quality of documentation and recording of the assessment and monitoring of patients commencing clozapine in BHSCT.BackgroundClozapine is an effective treatment for patients with schizophrenia who have not responded to at least two other antipsychotics. Due to clozapine's significant side effect profile patients must be carefully assessed prior to treatment initiation with close monitoring of their physical observations and reported side effects during initiation.The BHSCT Clozapine Pathway currently uses a Clozapine Assessment Integrated Care Pathway (ICP) common to inpatient and outpatient clozapine titrations and a Clozapine Titration ICP which varies slightly between inpatient and outpatient titrations.MethodThe Clozapine ICPs of patients commenced on clozapine in BHSCT in a 9 month period commencing January 2019 were reviewed. Handwritten clinical records were used to collect data on rates of completion of all aspects of the pathway.These results were used to identify areas of the pathway that were being poorly completed and the “Method for Improvement Model” used to trial changes to the pathway using Plan-Do-Study-Act (PDSA) cycles.Result20 patients in BHSCT were commenced on clozapine in the 9 month period. 1 Clozapine Initiation Pathway could not be located; therefore data were collected on 19 patients. 2 patients were initiated in the community and 17 patients initiated as inpatients.The results showed that sections of the Clozapine Assessment ICP were poorly completed; for example only 27% of the “Patient Baseline Preparation Checklist” were complete, with 60% partially complete and 13% completely blank.In the inpatient clozapine titration ICP the physical observations record was complete in only 20% of patients and the side effects monitoring record complete in only 13% of patients. Conversely the physical observations and side effects monitoring records were complete in 100% (n = 2) of patients.ConclusionBHSCT Clozapine Pathways were being poorly completed, with outpatient pathways being completed better than inpatient pathways. Analysis of the data shows that repetition of information in various parts of the pathway leads to gaps in documentation.Parts of the pathway that were poorly completed have been redesigned and the impact of these changes assessed using the PDSA cycle method. It is hoped that this along with education of staff will lead to an improvement in the assessment and monitoring of patients being commenced on clozapine.
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Kmietowicz, Z. "Health professionals defend the Liverpool care pathway." BMJ 345, no. 06 2 (November 6, 2012): e7511-e7511. http://dx.doi.org/10.1136/bmj.e7511.
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Nefasi, Mlambo. "Exploring Pathways to Care in the Zimbabwean Mental Health Sector." International Journal of Research and Innovation in Social Science VIII, no. II (2024): 2447–52. http://dx.doi.org/10.47772/ijriss.2024.802175.
Abstract:
This study investigated pathways to care in mental health treatment in Zimbabwe. Survey method was used to gather data through interviews and focus group discussions. For a period spanning over one year, the researcher randomly interviewed service providers, clinic staff, patients, caregivers/parents and community leaders. 20 Patients and 40 parents/caregivers were randomly selected as they seek services while 80 urban clinic staff, 50 from farm clinics, 50 from peri-urban clinics. 20 major referral hospital staff and 10 ATR practitioners, 30 FBO practitioners were purposively sampled making a total number of 300 participants. Results from these encounters revealed that people seeking mental health services use more than one treatment mode. Others use two while the majority use all three. There are varying factors contributing to their choice of pathway to care. Some notable factors revealed were that demographic and socioeconomic characteristics as well as health status shape how one enters mental health care and the subsequent perceptions of the effectiveness of that chosen path. additionally, the pathway to mental health care is associated with perceptions about the effectiveness of treatment. Additionally, severity of a mental illness has a strong bearing on the choice of pathway to treatment. Findings also revealed that only the medical pathway is used during daylight while half consulted faith based healers during daytime. For ATR the majority visit clandestinely after consulting hospitals during the day. It was concluded that mental health service in Zimbabwe is provided by three means which constitute pathways to care. These are the medical model, the traditional healers and the faith based practitioners. Results were inconclusive as to the efficacy of these pathways to care since some are concurrently used. From the above conclusions, the following recommendations are proposed: multi sectoral collaboration should be encouraged, evidence based practices to be enforced and further research into FBOs and ATR efficacy as well as the correlation between these pathways to care.
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Ellershaw, John, and Deborah Murphy. "The National Pathway Network of Palliative Care Pathways." Journal of integrated Care Pathways 7, no. 1 (April 2003): 11–13. http://dx.doi.org/10.1177/147322970300700104.
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Kalucy, Deanna, Janice Nixon, Michael Parvizian, Peter Fernando, Simone Sherriff, Jennifer McMellon, Catherine D’Este, Sandra J. Eades, and Anna Williamson. "Exploring pathways to mental healthcare for urban Aboriginal young people: a qualitative interview study." BMJ Open 9, no. 7 (July 2019): e025670. http://dx.doi.org/10.1136/bmjopen-2018-025670.
Abstract:
ObjectivesTo explore the perceptions of Aboriginal Community Controlled Health Service (ACCHS) staff involved in providing mental healthcare to Aboriginal young people of the current and ideal pathways to mental healthcare for urban Aboriginal young people attending ACCHSs, and to identify what additional supports staff may need to provide optimal mental healthcare to Aboriginal young people.DesignQualitative interview study conducted during May 2016–2017.SettingPrimary care, at two ACCHSs participating in the Study of Environment on Aboriginal Resilience and Child Health in New South Wales.ParticipantsPurposive sampling of staff involved in mental healthcare pathways of Aboriginal young people, including general practitioners (GPs), nurses and Aboriginal Health Workers (AHWs).ResultsAll individuals approached for interview (n=21) participated in the study. Four overarching themes and seven sub-themes were identified: availability and use of tools in practice (valuing training and desire for tools and established pathways), targeting the ideal care pathway (initiating care and guiding young people through care), influencing the care pathway (adversities affecting access to care and adapting the care pathway) and assessing future need (appraising service availability).ConclusionsParticipants desired screening tools, flexible guidelines and training for healthcare providers to support pathways to mental healthcare for Aboriginal young people. Both GPs and AHWs were considered key in identifying children at risk and putting young people onto a pathway to receive appropriate mental healthcare. AHWs were deemed important in keeping young people on the care pathway, and participants felt care pathways could be improved with the addition of dedicated child and adolescent AHWs. The ACCHSs were highlighted as essential to providing culturally appropriate care for Aboriginal young people experiencing mental health problems, and funding for mental health specialists to be based at the ACCHSs was considered a priority.
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Trivedi, JK, and AbdulQadir Jilani. "Pathway of psychiatric care." Indian Journal of Psychiatry 53, no. 2 (2011): 97. http://dx.doi.org/10.4103/0019-5545.82530.
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Toy, Jennifer M., Adam Drechsler, and Richard C. Waters. "Clinical pathways for primary care: current use, interest and perceived usability." Journal of the American Medical Informatics Association 25, no. 7 (February 26, 2018): 901–6. http://dx.doi.org/10.1093/jamia/ocy010.
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Abstract Objective Translating clinical evidence to daily practice remains a challenge and may improve with clinical pathways. We assessed interest in and usability of clinical pathways by primary care professionals. Methods An online survey was created. Interest in pathways for patient care and learning was assessed at start and finish. Participants completed baseline questions then pathway-associated question sets related to management of 2 chronic diseases. Perceived pathway usability was assessed using the system usability scale. Accuracy and confidence of answers was compared for baseline and pathway-assisted questions. Results Of 115 participants, 17.4% had used clinical pathways, the lowest of decision support tool types surveyed. Accuracy and confidence in answers significantly improved for all pathways. Interest in using pathways daily or weekly was above 75% for the respondents. Conclusion There is low utilization of, but high interest in, clinical pathways by primary care clinicians. Pathways improve accuracy and confidence in answering written clinical questions.
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Melby, Line, Kristine Gjermestad, Ingrid K. L. Solem, and Ragnhild Halvorsrud. "On track on the care pathway: Care coordination, information, and communication needs among Norwegian cancer patients." International Journal of Integrated Care 23, S1 (December 28, 2023): 597. http://dx.doi.org/10.5334/ijic.icic23229.
Abstract:
Background: Cancer patients may have long-lasting and complex care pathways. These typically involve a wide range of care providers who must coordinate their actions, so that treatment and follow up is experienced as seamless and integrated. Good communication with patients and providing them with the 'right amount' of information is crucial to ensure that patients feel engaged and empowered along the pathway.
The study: This paper reports from an ongoing research study ('Pathway') on the management of patient pathways in Norway, exemplified with cancer pathways. The project aims to give detailed descriptions of the unfolding of pathways, with an emphasis on patients' experiences and needs. These form the basis for the development of a theoretical pathway model and a visual multi-layered modeling language. This paper addresses the research question: What are cancer patients' information- and communication needs from care providers during their patient pathway?
Methods: We conducted three workshops with cancer patients and next of kin (n=35), supplemented with individual interviews (n=6) in June 2022. Participants had various cancer diagnoses. Data collection was conducted on a digital platform. Study participants were asked i.e., about communication with the services, their information needs, and how they keep overview of their appointments and contacts with the services, as well as how they would like to stay informed and engaged.
Results: A 'regular' cancer pathway was described to involve a wide range of providers, like regional and local public hospitals, private medical imaging centers, general practitioners, municipal care providers (i.e., physiotherapy, home care services), as well as the labour and welfare office. For the most complex cancers, and for multimorbid patients, the pathways could be even more complex. Study participants unanimously agreed that knowing as much as possible about the disease, its treatment, and follow up is critical to feel in control. Even though the participants mostly were satisfied with the cancer pathway, they all had experienced breakdowns in care coordination, missing and contradictory information, and providers lacking overview of their situation. Most participants had experience with taking on the task of collecting and aligning information and taking responsibility for coordinating their own follow up and care. Specifically, this was true when patients were discharged from hospital and from the standardized cancer patient pathway (CPP). The participants had invented various creative ways of keeping track of all the information they were given, and they frequently acted as messengers between providers.
Learning and next steps: The study underscores the challenge of ensuring integrated care for patients. Cancer is among the diseases that has evidence-based treatment protocols, and in Norway diagnostics and treatment is organized in standardized care pathways. Nevertheless, also these patients struggled with keeping track of their 'simple' pathways. Such findings remind us about the need to keep on working for improving integration across disease specific pathways, and that good communication and access to information for all the involved actors are means for achieving this. The next step in our study is to map patients' touchpoints with the services over time, in detail.
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Petit-Steeghs, Violet, Tjerk Jan Schuitmaker-Warnaar, Ciska A. Pruijssers, Gerard van Oortmerssen, and Jacqueline EW Broerse. "A qualitative research on co-creating care pathways for Sarcoma and GIST by stimulating reflection." International Journal of Care Coordination 23, no. 1 (March 2020): 24–32. http://dx.doi.org/10.1177/2053434520907743.
Abstract:
Introduction Care Pathway Management intends to enhance the quality of care by restructuring care services. As recipients of care, patients have relevant experiential knowledge on the provision of care, but they are rarely involved in Care Pathway Management due to various barriers. This study aims to acquire insights into how patients can be meaningfully involved in Care Pathway Management. Methods A case study was conducted to assess the implementation of patient involvement in the co-creation of the care pathways of Soft Tissue Sarcoma and Gastrointestinal Stromal Tumour at Erasmus MC Cancer Institute (the Netherlands), using the Interactive Learning and Action methodology. Within the pathways, seven patients and eight health professionals were involved. To overcome expected and encountered barriers to involving patients, reflection was stimulated on the care pathways and the development process. Qualitative data were collected via interviews, participatory observations and informal conversations. For analysis, a patient involvement evaluation framework and criteria for knowledge co-creation were used. Results Patients indicated specific improvements for current pathways regarding communication, the assistance of a nurse and integrated care. However, the co-creation process encountered several barriers, including limited opportunities to overcome patients’ knowledge gap on medical care services, limited time and uncertainties about responsibilities. Moreover, participatory reflection to enhance the co-creation process was constrained by power imbalances between patients and health professionals and health professionals’ restricted perceptions of their role. Discussion To enhance the meaningful involvement of patients in Care Pathway Management, constraints in joint reflection on the co-creation process must be overcome.
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Anderson, K. K., R. Fuhrer, and A. K. Malla. "The pathways to mental health care of first-episode psychosis patients: a systematic review." Psychological Medicine 40, no. 10 (March 18, 2010): 1585–97. http://dx.doi.org/10.1017/s0033291710000371.
Abstract:
BackgroundAlthough there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.MethodWe searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).ResultsIncluded studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.ConclusionsAdditional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.
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Breckons, M., S. M. Bissett, C. Exley, V. Araujo-Soares, and J. Durham. "Care Pathways in Persistent Orofacial Pain." JDR Clinical & Translational Research 2, no. 1 (November 17, 2016): 48–57. http://dx.doi.org/10.1177/2380084416679648.
Abstract:
Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the “fluidity of the care pathway,” in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a “failure to progress,” where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the “effects of unmanaged pain,” where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.
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Hall, Julie, Robert Grant, and Roger Pritlove. "Is Everything in the Garden Rosy? An Integrated Care Pathway for Acute Inpatient Mental Health Care, from Development to Evaluation: Part 1." Journal of integrated Care Pathways 9, no. 2 (August 2005): 67–73. http://dx.doi.org/10.1177/147322970500900204.
Abstract:
This paper is the first of two which consider the development, use and evaluation of an integrated care pathway (ICP) for acute inpatient mental health care. The care pathway discussed is in use on seven inpatient wards within a UK mental health trust. Pathway development began in January 2003, and after a pilot period the pathway was fully implemented in June 2003. Since that time the pathway has been revised twice and the current version can be viewed at http://www.nimhe-em.org.uk/pages/integrated_care_pathways/index.shtml . This paper describes ICP development and implementation, with extracts from variance reports, compliance audits and concluding with lessons learnt from the process. Paper 2 of the series, which follows, describes an evaluation of the pathway's impact upon securing interventions.
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Lombardo, Dawn, Tania V. Bridgeman, Nathalie De Michelis, and Molly Nunez. "An academic medical centre's programme to develop clinical pathways to manage health care: focus on acute decompensated heart failure." Journal of integrated Care Pathways 12, no. 2 (September 2008): 45–55. http://dx.doi.org/10.1258/jicp.2008.008007.
Abstract:
Heart failure (HF) is a major public health issue and acute decompensated heart failure (ADHF) is a leading cause of hospitalization in the USA. The United States health care delivery system is bound by regulatory agencies requiring strict compliance to key clinical indicators, which are publicly reported. Clinical pathway development is a systematic approach to managing health care that involves a high degree of collaboration between patients, physicians, nurses and various health-care team professionals. The University of California, Irvine Medical Center (UCIMC) developed an evidence-based multidisciplinary pathway for patients with ADHF. This clinical pathway incorporates universally proven assessment and treatment measures in ADHF. Adjunctive to this process are patient and nursing guides to the ADHF pathway. Utilization of this pathway has been shown to significantly impact clinical performance by early identification of potential negative clinical outcomes. Clinical pathways, such as the ADHF pathway, promote clinical excellence in caring for acute and chronic diseases states.
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Pawłowski, T., and A. Kiejna. "Pathways to psychiatric care and reform of the public health care system in Poland." European Psychiatry 19, no. 3 (May 2004): 168–71. http://dx.doi.org/10.1016/j.eurpsy.2003.09.009.
Abstract:
AbstractObjectiveSince 01.01.1999 a reform of the health care system in Poland has been realised based on the general health insurance act. We attempt to use the pathway method, especially measuring of time intervals along pathways, as a way of making accessibility to mental health services operational.MethodIn a period of 2 months all patients aged 15 and over who had not sought care from any public or private psychiatric service during the previous 365 days, were interviewed by psychiatrists, using the Polish version of the WHO Encounter Form.ResultsA total of 228 patients were seen. The study reveals that the median interval between first seeing a primary care giver and arrival at a mental health service was 12 weeks, which is much longer than all other European centres in previous studies.ConclusionMaking use of the pathway method and, in particular, median interval analysis between the onset of the mental health problem and seeing mental health professionals (MHPs) has shown practically limited access of patients, with a new episode of care to psychiatric services in both epidemiological catchment areas. This method seems to be a simple and inexpensive way of monitoring the accessibility to MHP in the period of health care reform.
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GAUTHIER, PASCALE. "HEALTH CARE DIGITALIZATION, THE STRAIGHTEST PATHWAY TO PERSONALIZATION." FARMACIA 69, no. 2 (April 20, 2021): 238–45. http://dx.doi.org/10.31925/farmacia.2021.2.7.
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Butler, Stuart M. "A Pathway to Equitable Health Care in America." American Journal of Public Health 111, no. 4 (April 2021): 610–11. http://dx.doi.org/10.2105/ajph.2021.306192.
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Delgadillo, Jaime, and Wolfgang Lutz. "A Development Pathway Towards Precision Mental Health Care." JAMA Psychiatry 77, no. 9 (September 1, 2020): 889. http://dx.doi.org/10.1001/jamapsychiatry.2020.1048.
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Fernández-Peña, Rosario, Carmen Ortego-Maté, Francisco José Amo-Setién, Tamara Silió-García, Antoni Casasempere-Satorres, and Carmen Sarabia-Cobo. "Implementing a Care Pathway for Complex Chronic Patients from a Nursing Perspective: A Qualitative Study." International Journal of Environmental Research and Public Health 18, no. 12 (June 11, 2021): 6324. http://dx.doi.org/10.3390/ijerph18126324.
Abstract:
A care pathway constitutes a complex care strategy for decision-making and the organization of processes in the care of complex chronic patients, avoiding the fragmentation of care. Health professionals play a decisive role in the implementation, development, and evaluation of care pathways. This study sought to explore nurses’ opinions on the care pathway for complex chronic patients three years after its implementation. The study participants were thirteen nurses with different roles who were involved in the care pathway. Thematic content analysis of the semi-structured interviews resulted in four major themes: (a) the strengths of the route; (b) the impact of the route on caregivers; (c) the weaknesses of the route; and (d) the future of the route. Overall, the pathway was positively valued for the benefits it provides to patients, the caregiver, and the administration of professional health care. Participants voiced their concerns regarding: communication and coordination difficulties among professionals across the different levels of care, the need for improved teamwork and consensus among professionals at the same center, and human and material resources. The ongoing evaluation and monitoring of facilitators and barriers is necessary throughout the implementation process, to ensure continuity and quality of care in the health system.
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Gray, Jenny. "Care pathway quality scorecards." Journal of integrated Care Pathways 12, no. 2 (September 2008): 61–66. http://dx.doi.org/10.1258/jicp.2008.008010.
Abstract:
This paper describes the rationale and methodology for three exercises used to critically appraise the quality of the two main tools supporting implementation of the care pathway continuous improvement methodology. The Venture care pathway journey quality scorecard and the Venture care pathway paper-document quality scorecard builds a greater understanding of the value provided by different components of content and layout. In addition, the Venture paper care pathway document template provides a basic design guide for teams, based on 20 years of experience in developing, implementing and evaluating care pathway documents.
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Evans, Katy, and Robert Fox. "Amniocentesis Integrated Care Pathway." Journal of integrated Care Pathways 9, no. 1 (April 2005): 37. http://dx.doi.org/10.1177/147322970500900107.
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Wiest, Matheus Joner, Judith Gargaro, and Mark T. Bayley. "What Is the Pathway to the Best Model of Care for Traumatic Spinal Cord Injury? Evidence-Based Guidance." Topics in Spinal Cord Injury Rehabilitation 29, suppl (November 16, 2023): 103–11. http://dx.doi.org/10.46292/sci23-00059s.
Abstract:
Introduction People with traumatic spinal cord injury (tSCI) experience lifelong physical and emotional health impacts, needing specialized care that is complex to navigate. The non-standardized care pathways used by different jurisdictions to address these needs lead to care inequities and poor health outcomes. Purpose To develop an evidence-based integrated tSCI Care Pathway, from time of injury to life in the community. Methods and Analysis Eighty key partners engaged in planning, providing, and receiving tSCI care (1) identified existing guidelines, pathways, and care models; (2) created the tSCI Care Pathway with key elements or building blocks (“the what”), not specific recommendations (“the how”) for each care stage (Acute, Rehabilitation, and Community), with elements highlighting the role of primary care and equity considerations on the pathway; (3) identified regional gaps in the tSCI Pathway and prioritized them for implementation; and (4) developed quality indicators. Outcomes The tSCI Pathway was drafted in overarching and detailed formats. For Acute Care, building blocks focused on appropriate assessment, initial management, and transition planning; for Rehabilitation, building blocks focused on access to specialized rehabilitation and assessment and planning of community needs; for Community, building blocks focused on follow-up, mechanisms for re-access, and holistic support for persons and families; and for equity considerations, building blocks focused on those at-risk or requiring complex supports. Team-based primary care and navigation supports were seen as crucial to reduce inequities. Conclusion This is the first comprehensive care pathway for tSCI. The Pathway is grounded in person-centred care, integrated care and services, and up-to-date clinical practice guidelines. The tSCI Care Pathway is flexible to regional realities and individual needs to ensure equitable care for all.
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Alikaj, V., and A. Suli. "Pathways to Psychiatric Care in Child and Adolescent Mental Health - Tirana." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71011-9.
Abstract:
There has been almost no mental health service research in Albania. A pathway study provides a quantitative description of the filters in the help-seeking and investigate the relative contributions of child, parents, pediatrics, GP etc. in determining service use.Aims:To investigate the process of help seeking for child and adolescent psychopathology at Child and Adolescent Mental Health Service (CAMHS) in UHC “Mother Teresa”, Tirana.Method:Participants were 5-18years old, newly referred children/adolescents in CAMHS during 2006. Measures: Strengths and Difficulties Questionnaire for parents/children, Pathways Encounter Form. Pathway diagram was drawn showing the main routes of care seeking. Patterns of care seeking, durations and previous treatments for diagnosis within ICD-10 groups were prescribed. Analysis: Comparisons between groups, diagnosis and predictive factors influencing help seeking care.Results:The main pathway of seeking care resulted to be from hospital doctors or to be direct access. General practitioners have a limited role as ‘gatekeeper’ for patients. 72% of individuals resulted with conduct, hyperactivity, depressive and some anxiety disorders, but fewer than 30% of individuals with specific phobias, separation anxiety and eating disorders.Conclusions:A clear picture of pathway of seeking care in mental health for children/adolescents coming in CAMHS is provided. Findings highlight areas that require further attention if aspirations for community-oriented mental health care are to be realized in Tirana and Albania. Declaration of interest: None.
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Mæhle, Per Magnus, Ingrid Kristine Small Hanto, Victoria Charlotte Simensen, and Sigbjørn Smeland. "Mind the Differences: How Diagnoses and Hospital Characteristics Influence Coordination in Cancer Patient Pathways." International Journal of Environmental Research and Public Health 18, no. 16 (August 21, 2021): 8818. http://dx.doi.org/10.3390/ijerph18168818.
Abstract:
Integrated care pathway (ICP) is a prevailing concept in health care management including cancer care. Though substantial research has been conducted on ICPs knowledge is still deficient explaining how characteristics of diagnose, applied procedures, patient group and organizational context influence specific practicing of ICPs. We studied how coordination takes place in three cancer pathways in four Norwegian hospitals. We identified how core contextual variables of cancer pathways affect complexity and predictability of the performance of each pathway. Thus, we also point at differences in core preconditions for accomplishing coordination of the cancer pathways. In addition, the findings show that three different types of coordination dynamics are present in all three pathways to a divergent degree: programmed chains, consultative hubs and problem-solving webs. Pathway coordination also depends on hierarchical interaction. Lack of corresponding roles in the medical–professional and the administrative–institutional logics presents a challenge for coordination, both within and between hospitals. We recommend that further improvement of specific ICPs by paying attention to what should be standardized and what should be kept flexible, aligning semi-formal and formal structures to pathway processes and identify the professional cancer related background and management style required by the key-roles in pathway management.
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Clare, S., and S. Kausar. "Transient Ischaemic Attack Care Pathway." Journal of integrated Care Pathways 11, no. 1 (April 2007): 11–15. http://dx.doi.org/10.1177/205343450701100102.
Abstract:
A transient ischaemic attack (TIA) is a common medical encounter, which is often managed suboptimally in the acute phase. A TIA should be treated as a medical emergency as studies have shown that high-risk patients can go on to have a stroke within seven days of a TIA. An audit was completed looking at referrals to the TIA clinic. Results prompted the production of a TIA care pathway, which prompted health-care teams on the appropriate management of these patients.
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Bhogal, Sanjit K., Jean Bourbeau, David McGillivray, Andrea Benedetti, Susan J. Bartlett, and Francine M. Ducharme. "Adherence to Pediatric Asthma Guidelines in the Emergency Department: A Survey of Knowledge, Attitudes and Behaviour among Health Care Professionals." Canadian Respiratory Journal 17, no. 4 (2010): 175–82. http://dx.doi.org/10.1155/2010/274865.
Abstract:
BACKGROUND: Despite strong evidence for using clinical care pathways to manage acute pediatric asthma, adherence remains suboptimal.OBJECTIVES: To elicit information from health care professionals regarding their knowledge, attitudes and use of a care pathway for acute childhood asthma.METHODS: A cross-sectional, self-administered survey of physicians, nurses and respiratory therapists who worked in the emergency department at the Montreal Children’s Hospital (Montreal, Quebec) from August to December 2007 was conducted. The survey assessed knowledge, attitude toward and agreement with the care pathway, as well as its use four years after its implementation.RESULTS: Of the 128 health care professionals surveyed, 72 (56%) responded. Of these, 99% reported being familiar with the pathway, more than 90% agreed with its use for mild and moderate asthma, while 79% agreed with its use for severe asthma. For 99% of health care professionals, the advantages of using the pathway outweighed the disadvantages; however, 64% admitted to making variations to the pathway. Although 92% of respondents reported that they were quite comfortable with using the asthma severity Pediatric Respiratory Assessment Measure, only 53% and 36% correctly identified the severity score cut-offs for moderate and severe asthma, respectively. Seventeen per cent of respondents underestimated the delay of onset of action of oral corticosteroids, while 36% of physicians incorrectly believed that a higher than necessary dose was recommended for ipratropium bromide.CONCLUSIONS: Results of the survey confirmed that the health care professionals queried had a positive attitude toward the pediatric asthma care pathway. Knowledge gaps and the balance between standardization versus individualization of care may be key elements to explain suboptimal adherence to the pathway.
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Miller, Alicia S. "Neonatal Intensive Care Unit Pathway." Hospital Pharmacy 38, no. 8 (August 2003): 794–97. http://dx.doi.org/10.1177/001857870303800803.
Abstract:
This continuing feature will inform readers about the process of implementing, maintaining, and supporting computerized prescriber order entry (CPOE) at the Ohio State University Medical Center. (By “pre-scribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of CPOE at the Medical Center.
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Agius, Mark. "A care pathway for schizophrenia." British Journal of Psychiatry 197, no. 6 (December 2010): 500. http://dx.doi.org/10.1192/bjp.197.6.500.
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Alahmar, Ayman, Mohannad AlMousa, and Rachid Benlamri. "Automated clinical pathway standardization using SNOMED CT- based semantic relatedness." DIGITAL HEALTH 8 (January 2022): 205520762210897. http://dx.doi.org/10.1177/20552076221089796.
Abstract:
The increasing number of patients and heavy workload drive health care institutions to search for efficient and cost-effective methods to deliver optimal care. Clinical pathways are promising care plans that proved to be efficient in reducing costs and optimizing resource usage. However, most clinical pathways are circulated in paper-based formats. Clinical pathway computerization is an emerging research field that aims to integrate clinical pathways with health information systems. A key process in clinical pathway computerization is the standardization of clinical pathway terminology to comply with digital terminology systems. Since clinical pathways include sensitive medical terms, clinical pathway standardization is performed manually and is difficult to automate using machines. The objective of this research is to introduce automation to clinical pathway standardization. The proposed approach utilizes a semantic score-based algorithm that automates the search for SNOMED CT terms. The algorithm was implemented in a software system with a graphical user interface component that physicians can use to standardize clinical pathways by searching for and comparing relevant SNOMED CT retrieved automatically by the algorithm. The system has been tested and validated on SNOMED CT ontology. The experimental results show that the system reached a maximum search space reduction of 98.9% within any single iteration of the algorithm and an overall average of 71.3%. The system enables physicians to locate the proper terms precisely, quickly, and more efficiently. This is demonstrated using case studies, and the results show that human-guided automation is a promising methodology in the field of clinical pathway standardization and computerization.
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Aeyels, Daan, Luk Bruyneel, Deborah Seys, Peter R. Sinnaeve, Walter Sermeus, Massimiliano Panella, and Kris Vanhaecht. "Better hospital context increases success of care pathway implementation on achieving greater teamwork: a multicenter study on STEMI care." International Journal for Quality in Health Care 31, no. 6 (September 19, 2018): 442–48. http://dx.doi.org/10.1093/intqhc/mzy197.
Abstract:
AbstractObjectiveTo evaluate whether hospital context influences the effect of care pathway implementation on teamwork processes and output in STEMI care.DesignA multicenter pre–post intervention study.SettingEleven acute hospitals.ParticipantsCardiologists-in-chief, nurse managers, quality staff, quality managers and program managers reported on hospital context. Teamwork was rated by professional groups (medical doctors, nurses, allied health professionals, other) in the following departments: emergency room, catheterization lab, coronary care unit, cardiology ward and rehabilitation.InterventionCare pathway covering in-hospital care from emergency services to rehabilitation.Main outcome measuresHospital context was measured by the five dimensions of the Model for Understanding Success in Quality: microsystem, quality improvement team, quality improvement support, high-level organization, external environment. Teamwork process measures reflected teamwork between professional groups within departments and teamwork between departments. Teamwork output was measured through the level of organized care. Two-level regression analysis accounted for clustering of respondents within hospitals and assessed the influence of hospital context on the impact of care pathway implementation on teamwork.ResultsCare pathway implementation significantly improved teamwork processes both between professional groups (P < 0.001) and between departments (P < 0.001). Teamwork output also improved (P < 0.001). The effect of care pathway implementation on teamwork was more pronounced when the quality improvement team and quality improvement support and capacity were more positively reported on.ConclusionsHospitals can leverage the effect of quality improvement interventions such as care pathways by evaluating and improving aspects of hospital context.
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Campbell-Crofts, Sandra Joan, and Janet Roden. "Primary health care decision making in pre-dialysis chronic kidney disease." Chronic Illness 14, no. 4 (September 8, 2017): 297–309. http://dx.doi.org/10.1177/1742395317729001.
Abstract:
Objectives This qualitative descriptive study explored the primary health care decisions of a group of 12 Australians in Stages 3B to 5 with chronic kidney disease in the preservation of kidney health. Methods Questioning within the qualitative interviews focused on gaining an understanding of the participants’ perceptions of their kidney health and the decisions made as a consequence of their interaction within the Australian primary health care system. Results Participants were dependent on their General Practitioner to recognise their symptoms, make the correct diagnosis and authorise the correct referral for specialist nephrology care. Three pathways in this process were identified: ‘easy’; ‘difficult’ and ‘protracted’. Clinician failure to correctly attribute symptoms to chronic kidney disease influenced the ‘difficult’ pathway, while failure to adequately communicate kidney health status influenced the ‘protracted’ pathway. Use of the language of ‘recovery’, ‘stability’ and ‘protection’ held meaning to the participants in gaining an understanding of their kidney health. Discussion Identifying pathways to diagnosis and referral can raise awareness of the challenges kidney health consumers face in their participation within the primary health care arena. Using consumer meaningful language improves the capacity of these consumers to engage in their own primary health care agenda.
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Seys, D., M. Panella, R. VanZelm, W. Sermeus, D. Aeyels, L. Bruyneel, E. Coeckelberghs, and K. Vanhaecht. "Care pathways are complex interventions in complex systems: New European Pathway Association framework." International Journal of Care Coordination 22, no. 1 (March 2019): 5–9. http://dx.doi.org/10.1177/2053434519839195.
Abstract:
Care pathway implementation is characterised by a dual complexity. A care pathway itself represents a complex intervention with multiple interacting and interdependent intervention components and outcomes. The organisations in which care pathways are being implemented represent complex systems that need to be directed at change through an in-depth understanding of their external and internal context in which they are functioning in. This study sets out a new evidence-based and pragmatic framework that unpacks how intervention mechanisms, intervention fidelity and care context are converge and represent interacting processes that determine success or failure of the care pathway. We recommend researchers looking to increase the effectiveness of care pathway implementation and accelerate improvement of desired outcomes to adopt this framework from inception to implementation of the intervention.
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Thompson, Juliana, Glenda Cook, Claire Masterman, Mark Parkinson, and Lesley Bainbridge. "Rapid evidence review to understand effective frailty care pathways and their components in primary and community care." International Journal of Health Governance 27, no. 1 (November 11, 2021): 54–75. http://dx.doi.org/10.1108/ijhg-09-2021-0090.
Abstract:
PurposeDifferent pathways of frailty care to prevent or delay progression of frailty and enable people to live well with frailty are emerging in primary and community care in the UK. The purpose of the study is to understand effective frailty care pathways and their components to inform future service development and pathway evaluation in primary- and community-care services.Design/methodology/approachA rapid evidence review was conducted: 11 research publications met the inclusion criteria and were analysed using narrative thematic synthesis.FindingsThere is strong evidence that resistance-based exercise, self-management support, community geriatric services and hospital at home (HAH) improve patient health and function. In general, evaluation and comparison of frailty care pathways, components and pathway operations is challenging due to weaknesses, inconsistencies and differences in evaluation, but it is essential to include consideration of process, determinant and implementation of pathways in evaluations.Originality/valueTo achieve meaningful evaluations and facilitate comparisons of frailty pathways, a standardised evaluation toolkit that incorporates evaluation of how pathways are operated is required for evaluating the impact of frailty pathways of care.
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French, Melissa G. "Health literacy and palliative care." Public Health Forum 25, no. 1 (March 1, 2017): 94–95. http://dx.doi.org/10.1515/pubhef-2016-2129.
Abstract:
Abstract Health literacy and palliative care have been receiving more attention within health care organizations and systems in recent years. Both can offer a pathway to care that is better for patients and has the potential to be of high value. A health literate approach to palliative care provides patient-centered care that is better aligned with patient preferences and needs.
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Clare, S., and S. Kausar. "Transient ischaemic attack care pathway." International Journal of Care Pathways 11, no. 1 (April 1, 2007): 11–15. http://dx.doi.org/10.1258/j.jicp.2007.153.
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Csik, Valerie Pracilio, Michael J. Ramirez, Adam F. Binder, and Nathan Handley. "The value of pathways on drug costs." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 327. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.327.
Abstract:
327 Background: Oncology care represents a significant portion of US healthcare spending. Cost of Part B drugs has increased at a rate 5.7x that of overall Medicare spending. As a participant in the Oncology Care Model, drug costs represent a majority of our total costs. Pathways are a clinical decision-support tool that use evidence-based care maps accounting for efficacy, toxicity and cost. Our NCI-designated cancer center implemented pathways in July 2018 to reduce care variation and decrease costs. Methods: We reviewed costs related to pathway utilization over a two year period, analyzing differences in total annual drug cost for patients in three categories: On-Pathway (aligned with pathway recommendation), Off-Pathway (not aligned with recommendation), and No Pathway (not used). Per Member Per Month (PMPM) costs were calculated and a weighted average applied to account for changes in annual drug costs. Results: PMPM drug costs decreased -8% in year 1 (FY19) and -4% in year 2 (FY20) when pathways were used (On- and Off-Pathway). When pathways were followed (On-Pathway) in making treatment decisions, the drug costs were 11% lower than when pathways were not used. The annual impact on drug costs when pathways were used amounted to $2.45 million in year 1 and $1.77 million in year 2 (Table). Conclusions: Pathway use reduced drug costs, a significant variable in oncology value-based care models. This finding highlights the value of clinical decision support tools in reducing care variability, a known contributor to health care costs, in making treatment decisions. Further assessment is needed to determine if these results are similar at other cancer centers to fully realize the impact of pathways on drug costs.[Table: see text]
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Mull, Nikhil, Brian Leas, Matthew Mitchell, Julia Lavenberg, Neha Patel, Austin Williams, and Craig Umscheid. "OP68 An Evidence-Based Clinical Pathways Program Reduces Low-Value Care." International Journal of Technology Assessment in Health Care 33, S1 (2017): 29–30. http://dx.doi.org/10.1017/s0266462317001490.
Abstract:
INTRODUCTION:Misdiagnosis of asymptomatic bacteriuria as catheter-associated urinary tract infection (CAUTI) leads to unnecessary tests and other low-value care. We used this topic as the prototype to develop a clinical pathways program to promote evidence-based decision making in a multi-hospital system.METHODS:We convened a task force including hospital and critical care physicians, nurses, laboratory staff, and informatics specialists. Our Health Technology Asessment (HTA) center completed a rapid systematic review on guidelines and algorithms for diagnosing CAUTI. Additional rapid reviews were completed as necessary to address specific follow-up questions. A draft pathway based on the guidelines was developed, and then the task force edited it in an iterative process.We used the Dorsata platform (Dorsata Inc., Washington, DC) to create, distribute and maintain the pathway. Dorsata has both desktop and mobile interfaces that guide clinicians through decision algorithms. Individual pathways include links to references and a portal for direct user feedback. Pathway owners have access to a real-time pathway utilization dashboard.A standardized order set with the pathway was added to our electronic health record system. We also held educational meetings for residents and provided “huddle sheets” to nurse educators at each hospital. Posters and computer screen savers were also used to raise awareness of the new pathway.RESULTS:We now have a total of 111 pathways on Dorsata, developed following the same model as the CAUTI evaluation pathway. Some topics, like breast cancer, have as many as sixteen pathways, addressing different clinical questions like first- and second-line therapy. Over 600 individuals have registered for the mobile app, including attending and resident physicians, nurses, and medical students. The pathway site had 1,619 views in December 2016, the most recent month for which complete records are available. The pathways are proving to have an effect on clinical decision making. For example, the annualized number of unnecessary urine cultures avoided as a result of the pathway is 4,474; resulting in estimated direct cost savings of USD67,110.CONCLUSIONS:Using pathways to present HTA information at the point of care is feasible and can improve the value of care.
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Miller, Rory, Joanna Young, Garry Nixon, John W. Pickering, Tim Stokes, Robin Turner, Gerard Devlin, et al. "Study protocol for an observational study to evaluate an accelerated chest pain pathway using point-of-care troponin in New Zealand rural and primary care populations." Journal of Primary Health Care 12, no. 2 (2020): 129. http://dx.doi.org/10.1071/hc19059.
Abstract:
ABSTRACT INTRODUCTIONAccelerated diagnostic chest pain pathways are used widely in urban New Zealand hospitals. These pathways use laboratory-based troponin assays with good analytical precision. Widespread implementation has not occurred in many of New Zealand’s rural hospitals and general practices as they are reliant on point-of-care troponin assays, which are less sensitive and precise. An accelerated chest pain pathway using point-of-care troponin has been adapted for use in rural settings. A pilot study in a low-risk rural population showed no major adverse cardiac events at 30 days. A larger study is required to be confident that the pathway is safe. AIMSTo assess the safety and effectiveness of an accelerated chest pain pathway adapted for rural settings and general practice using point-of-care troponin to identify low-risk patients and allow early discharge. METHODSThis is a prospective observational study of an accelerated chest pain pathway using point-of-care troponin in rural hospitals and general practices in New Zealand. A total of 1000 patients, of whom we estimate 400 will be low risk, will be enrolled in the study. OUTCOME MEASURESThe primary outcome is the proportion of patients identified by the pathway as low risk for a 30-day major adverse cardiac event. Secondary outcomes include the proportion of low-risk patients who were discharged directly from general practice or rural hospitals, the proportion of patients reclassified as having acute myocardial infarction by the pathway and the proportion of patients with low and intermediate risk safely managed in the rural hospital.
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Gautam, Santosh, Gosia Sylwestrzak, John Barron, Xiaoxue Chen, Michael Eleff, David Debono, Ann Nguyen, and Michael Fisch. "Results From a Health Insurer's Clinical Pathway Program in Breast Cancer." Journal of Oncology Practice 14, no. 11 (November 2018): e711-e721. http://dx.doi.org/10.1200/jop.18.00157.
Abstract:
Purpose: Pathway regimens are value-driven, evidence-based therapies that aim at high-quality, affordable cancer care. There are few real-world data to support the value of such regimens, especially for patients with breast cancer. Materials and Methods: Using nationally representative claims data from Anthem, together with clinical data from its Cancer Care Quality Program, we identified patients with breast cancer for whom chemotherapy was initiated between January 2015 and October 2016. On the basis of demographic and clinical characteristics, patients receiving a pathway regimen (on-pathway cohort) were matched to those who did not (off-pathway cohort) using 1:1 propensity score matching. We compared post–6-month quality-of-care outcomes including hospitalization, emergency department visits, need for supportive drugs such as granulocyte colony-stimulating factor, and cost outcomes between the cohorts. Results: There were 959 patients in each cohort after matching. Patients in both cohorts had a similar age distribution (median age, 52 years in the off-pathway cohort v 53 years in the on-pathway cohort), and most presented with stage II disease (49.4% in the off-pathway cohort v 49.8% in the on-pathway cohort); nearly two thirds of each cohort had hormone receptor positive cancer (67.3% in the off-pathway cohort v 64.9% in the on-pathway cohort). The two cohorts had similar rates of hospitalization and emergency department visits; however, the rate of granulocyte colony-stimulating factor use was significantly lower in the on-pathway cohort (72.5% in the on-pathway cohort v 82.8% in the off-pathway cohort; odds ratio, 0.55; P ≤ .0001). The average post–6-month cost of care was $16,176 lower (95% CI, −$24,291 to −$8,061; P ≤ .0001) in the on-pathway cohort. Conclusion: Pathway regimens for breast cancer demonstrate an example of high-value care. They are associated with a reduced cost of care without compromising quality of care.
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Kuwornu, John Paul, Fernando Maldonado, Gary Groot, Elizabeth J. Cooper, Erika Penz, Leland Sommer, Amy Reid, and Darcy D. Marciniuk. "An economic evaluation of chronic obstructive pulmonary disease clinical pathway in Saskatchewan, Canada: Data-driven techniques to identify cost-effectiveness among patient subgroups." PLOS ONE 19, no. 4 (April 1, 2024): e0301334. http://dx.doi.org/10.1371/journal.pone.0301334.
Abstract:
Background Saskatchewan has implemented care pathways for several common health conditions. To date, there has not been any cost-effectiveness evaluation of care pathways in the province. The objective of this study was to evaluate the real-world cost-effectiveness of a chronic obstructive pulmonary disease (COPD) care pathway program in Saskatchewan. Methods Using patient-level administrative health data, we identified adults (35+ years) with COPD diagnosis recruited into the care pathway program in Regina between April 1, 2018, and March 31, 2019 (N = 759). The control group comprised adults (35+ years) with COPD who lived in Saskatoon during the same period (N = 759). The control group was matched to the intervention group using propensity scores. Costs were calculated at the patient level. The outcome measure was the number of days patients remained without experiencing COPD exacerbation within 1-year follow-up. Both manual and data-driven policy learning approaches were used to assess heterogeneity in the cost-effectiveness by patient demographic and disease characteristics. Bootstrapping was used to quantify uncertainty in the results. Results In the overall sample, the estimates indicate that the COPD care pathway was not cost-effective using the willingness to pay (WTP) threshold values in the range of $1,000 and $5,000/exacerbation day averted. The manual subgroup analyses show the COPD care pathway was dominant among patients with comorbidities and among patients aged 65 years or younger at the WTP threshold of $2000/exacerbation day averted. Although similar profiles as those identified in the manual subgroup analyses were confirmed, the data-driven policy learning approach suggests more nuanced demographic and disease profiles that the care pathway would be most appropriate for. Conclusions Both manual subgroup analysis and data-driven policy learning approach showed that the COPD care pathway consistently produced cost savings and better health outcomes among patients with comorbidities or among those relatively younger. The care pathway was not cost-effective in the entire sample.
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Skouw-Rasmussen, Naja, and Laura Savini. "Future Care Pathways – A report from the 1st workshop of the EHC Think Tank Workstream on Future Care Pathways." Journal of Haemophilia Practice 10, no. 1 (January 1, 2023): 74–81. http://dx.doi.org/10.2478/jhp-2023-0013.
Abstract:
Abstract Introduction A care pathway is defined as “a complex intervention for the mutual decision-making and organisation of care processes for a well-defined group of patients during a well-defined period.” The European Haemophilia Consortium (EHC) established a Think Tank Workstream on Future Care Pathways to identify and address key challenges in shaping future pathways that meet the needs of people with rare diseases while remaining practicable and affordable to healthcare providers in countries with different budgets and resources. This workstream is particularly timely as the introduction of innovative therapies is adding to the complexity of care pathways in some rare conditions. Identifying key challenges During the first virtual workshop of the Future Care Pathways Workstream on 14 February 2023, stakeholders, including healthcare providers, patient groups, researchers, and industry representatives, agreed to focus on four workable themes/challenges: 1. Prioritisation (cost and evidence); 2. Agreeing on a baseline; 3. Digital health; 4. Fragmentation of healthcare. Summary Prioritisation relates to economic and financial challenges in justifying the optimisation of a care pathway for a rare disease within the context of other healthcare priorities. Currently, there is too much emphasis on costs to healthcare systems, and not enough on real-life patient experience and indirect costs to patients and their families. Innovation in pathways is generally considered unaffordable, and cost-effectiveness models are difficult to apply to rare diseases. Agreeing on a baseline for a minimum standard of care in a pathway should take into account variability in patient needs, agency and healthcare system resources. A baseline needs to be agreed upon for each stage of a pathway: first clinical presentation, diagnosis, treatment, and monitoring and follow-up. Lack of awareness, gender and resource inequalities and gaps in evidence are among the issues that need to be addressed. Digital health holds promise but also brings challenges for future care pathways and must be considered from the viewpoint of all major stakeholders: patients, healthcare providers, tech companies and payers. Digital health systems are often developed in silos and do not allow for effective integration and sharing of data. Collaboration from the beginning is essential to the successful integration of digital tool as in healthcare. Fragmentation of healthcare can arise because people with rare diseases may access care pathways through multiple entry points in primary and secondary care, and they may not experience holistic care that takes account of all their needs. Poor communication at multiple levels (e.g. between clinical stakeholders and between clinicians and patients) is a common problem leading to inadequate treatment and care. Fragmentation may also arise when care pathways do not allow for a patient’s evolving needs when he/she is already on a pathway.