Care pathways: the lubricant for integrated care [6 tips]

Care pathways: the lubricant for integrated care [6 tips]

We have been working with care paths in health care for many years. It provides insight into how the care surrounding a patient is organised and how the various care providers involved coordinate with each other. Especially in hospitals care paths are widely used. But interest in the use of care paths is also increasing in primary care. The added value of using care paths has been demonstrated in research. This is a good development, but we need to go a step further for chronic care and the growing group of multimorbid patients. In order to offer these people the right care in an efficient way, the first line and the hospital should join forces and develop integrated care paths together. This is a bit tricky, but certainly not impossible. In this blog we show what it takes to achieve integrated care through collaborative care pathways.

What is a care path?

A care path – also known as a clinical path – describes the organisation of the care for a patient with a specific clinical picture. A care pathway describes step-by-step what is done, when, by whom and what the expected results are. It also states how to register. A care path therefore focuses on logistics and coordination of responsibilities and activities. This has several advantages, such as:

• the patient receives better coordinated care;
• It is clear which care provider is responsible for what;
• better (quality) care is provided;
• fewer hospital admissions are necessary and/or the length of stay is reduced;
• there is less administrative burden (fewer things are duplicated);
• the waiting times for patients are shorter;
• the patient is more quickly ‘out of care’.

Care pathways prevent you from seeing the patient?

That working with care paths offers many advantages is beyond dispute. The method used to develop the care paths is also very sound. That said, there are points of criticism. Especially if we focus the use of care pathways on chronic care and especially on the growing number of multimorbid patients. Care paths, as we know them now, are disease-specific. If a patient has several disorders at the same time, he or she can ‘walk’ in several care paths at the same time. Thus, the solution has become the problem. The sum of care paths for individual patient groups is not necessarily better at the organisational level. Integrated care requires a broader people-centered rather than disease-centered focus.

In addition, the Netherlands lacks two essential preconditions. Firstly, in the area of financing. If you want to roll out care paths throughout the chain, you need integral financing between, for example, the general practitioner and the medical specialist. We do not (yet) have this construction in the Netherlands. There is also a lack of shared electronic health records (EHRs). This makes it difficult to share information between different healthcare providers.

Conditions for success

In order to provide integrated care, the trick is to draw up care paths that cross the various organisational silos and in which the needs of the patient are central, also referred to as person-oriented care. But how do you get it done? There are a number of conditions that need to be met for integrated care pathways to have a chance of success:

1. Professionals with an open mind and helicopter view

An integrated care path must be coordinated by professionals in the field with expertise. A multidisciplinary team, preferably from primary care, can act as the core team. These people need to be at home in care, but also outside of it. So that they are able to oversee all the factors that can influence the health of, for example, a patient with one or more chronic diseases. Officially, this role has been assigned to the general practitioners. In difficult words, we call this the gatekeeping and coordination of care function of primary care. It is essential that the professionals involved are open-minded and have a helicopter view. They must be able to look beyond the boundaries of their own silo, be open to other ways of working and be able to appreciate and use the knowledge and skills of colleagues.

2. Manpower and financial resources

To make integrated care paths a success, sufficient manpower is needed. All phases of the process – from development and implementation to evaluation and improvement – are labour intensive. People have to be freed up for this if you want to be successful.

It is also important that the financial conditions are in place. Integral care pathways require integral (outcome) financing.

3. Good mutual relationships

Various studies have shown that a good mutual relationship within a multidisciplinary team leads to better outcomes. Therefore, in order to successfully create and work with care paths, accessible contact and a good mutual understanding between the professionals involved are essential. If all that is correct, a care pathway will be widely supported and will therefore achieve better results.

4. Access to the same systems

A very important condition is that all involved have access to the same patient data collected on the basis of corresponding criteria. This is also a major stumbling block at the moment. In the Netherlands, data collection is incomplete and fragmented. This makes it virtually impossible to gain insight into the current demand for care and future trends. There are countries, such as Sweden, where this is well regulated. It would be a good first step if the government decides to make data widely accessible.

5. Network resilient ICT

In addition, more use should be made of digital platforms that link databases. A condition is that these databases are open (see condition 4). In addition, there are various useful tools for applying care paths efficiently, but they are not widely used. There is still a lot of room for improvement here.

6. Support

Integrated care pathways are new and if you want to make a success of new developments, you have to get the board and management on board. You achieve this by making the results of your interventions transparent. If you can show the added value for all parties involved, the management will automatically follow.

How can you turn the tide?

These conditions form the basis of integrated care pathways. Some conditions are easier to influence than others. For example, being open to and accepting of the knowledge of other professionals is usually easier to put into practice than opening up data systems and organizing integrated financing. But these last two aspects can also be influenced. By thinking up alternatives as a healthcare professional and taking the lead, you can turn the tide. Go to health insurance companies and let them know which contracts you want to work with. Go to IT suppliers and set conditions for data collection. Do this together. Because: alone you go faster, but together you get further.

Creating and implementing a care pathway

If the conditions are met, then the way is open to a structured approach to integrated care. But how do you walk that road? In other words, how do you go about drawing up and then implementing an integrated care pathway? You can do that by using checklists. The Rainbow Model can also serve as a starting point. In this model, the needs of the patient are central. After these are determined, look at what the desired outcomes of the assistance are. You will then adjust your interventions accordingly. You opt for a broad approach in which you involve the first and second line and possibly other agencies as well. What professionals do you need? What should they do when and with what desired result? In this way, you create a care path that is tailored to the patient, consisting of components that are more or less standardised. By proceeding in this way, you abandon the disease-specific approach of the care pathway and opt for a person-oriented approach. This enables you to provide integrated, customised care in a way that is clear to everyone, making efficient use of manpower and resources. This will have a positive influence on the quality of care, patient satisfaction and costs.

Read more about how person-centered care can be implemented using the Rainbow Model in our white paper.

Do you want to know more about this and get started yourself? Download our ebook Network Care for more background information. Or take a look at our knowledge page. In our masterclass Carefree Network Care you will learn what and how!