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

We have been working with care pathways in healthcare for many years. It gives an insight into how the care around the patient and the coordination between the caregivers that are involved is organized.

Especially in hospitals, care pathways are widely used. But the interest in the use of care pathways has also increased in primary care. The added value of the use of care pathways has been demonstrated in research. A good development, but for chronic care and the growing group of multimorbid patients, we have to take it a step further. To offer these people the right care tailored to their needs, primary care providers and hospitals need to work together to create integrated care pathways. This comes with a few challenges, but it certainly isn’t impossible. In this blog we will explain what is needed to transform care pathways towards an integrated care approach.

What is a care pathway?

A care pathway – also called a clinical pathway – describes the organization of healthcare for a patient with a certain disease. A care pathway consists of a step by step description of what is done when and by whom and what the expected results are. It also lays down how (clinical) activities should be registered. A care pathway is aimed at the logistics and coordination of responsibilities and tasks. This has a number of advantages,such as:

  • Better alignment of care for patients;
  • Clarity about which caregiver is responsible for whatpart of thecareprocess;
  • Improvement in the quality ofcare;
  • Reduction of unnecessaryhospitalizations;
  • Less administrative burdens (we don’t have multiple people doing the same thing);
  • Shorter waiting times for patients;
  • Patients are‘out of care’ faster.

Do care pathways mean we won’t see our patients anymore?

We can undoubtedly say that care pathways offer lots of advantages. Even the way in which care pathways are developed are beneficial. However, this doesn’t mean there is no criticism whatsoever. Especially when we focuson the use of care pathways for people with chronic diseases and the growing number of multimorbid patients. Care pathways as we know them now are so called ‘disease-specific’. If you are suffering from multiple conditions, this means you can find yourself in several care pathways at the same time. That turns the solution back into the problem it’s trying to solve. Different care pathways for different patient groups aren’t necessarily better on an organizational level. For integrated care, we will need to focus on people’s needs instead of on their diseases.

In addition, there are two essential preconditions missing in many countries. Firstly, when it comes to financing. If you want to expand care pathways over the entire network of care providers, you need an integrated budget between for example your general practitioner and your medical specialist. These so called bundled payments or shared savings contracts are notyetcommon practice.Furthermore,there are not enoughinteroperableelectronichealth records (EHR’s). This makes itextremelydifficult to share information between the different care givers.

Conditions for success

To offer integrated care, the trick is to set up the care pathways on top of the different organizational silos, in which the patient’s needs are leading. This is also called person-centeredcare. But how do you achieve that? There areseveralconditions thatmustbe met to turn integral care pathways into an integratedsuccess:

1. Professionals with an open mind and helicopter view

An integrated care pathway must be coordinated by professionals in the field that know what they’re talking about. A multidisciplinary team, preferably from primary care, can be your core team. These people need to know the needs of an individual as well as the community they are serving. That way they can spot all factors that could influence the health of for example a patient with one or more chronical illnesses. Officially this role is assigned to the general practitioners. We sometimes call these people the gatekeepers and coordinators of the care function in primary care. What is essential here, is that the concerned professionals are openminded and have a helicopter view. They need to be able to surpass the boundaries of their own silos, be open to other ways of working and be able to appreciate and make use of the knowledge and skillset of their co-workers.

2. Man power and financial means

To turn integrated care pathways into a success, you need plenty of man power. All the phases in the process- from development and implementation to evaluation and improvement – are labor-intensive. You need to make sure you have the people to put in that work if you want to be successful. That is why it is important that the financial conditions are met as well. You need an integrated (result-based) budget for integrated care.

3. Strong mutual relationships

Research has pointed outthat positive relationships within a multidisciplinary team leads to betteroutcomes. It is essential that people are approachable and that there is a goodrelationshipbetween the professionals involved to successfully create and work with care pathways. If all that is right, a care pathway will have wide support and lead to better results.

4. Access to the same systems

A very important condition is that all those involved have access to the same patient data that has been collectedbased onthe agreed upon criteria. This is one of the major obstacles at the moment.Often, data collection is incomplete and fragmented. This mean it is virtually impossible to gain insight into the current demand for care and future trends. There arecountries, like Sweden, where this is well taken care of.

5. Network proof IT

In addition, it is important to make more use of digital platforms that link databases to each other. One condition is that these databases have been opened up (see condition 4). There are also various convenient tools that can be used to efficiently apply care pathways, but they are not widely used. There is much to be gained there.

6. Support

Integratedcare pathways are new and if you want to make your new developments successful, you need your board’s and management’s support. You can achieve this by making the results of your interventions easy to grasp. If you can show the added value for all parties involved, management will soon follow suit.

The conditions mentioned are the basis of integrated care pathways. It is easier to influence some conditions than it is others. It is easier to be open to and accept other professionals’ knowledge than it is to unlock data systems or arrange integral financing. But even these last to can be influenced. By thinking of alternatives and taking the lead as a health care professional, you can make a difference. Go to health insurers or governments and let them know which contract you want to work with. Go to IT providers and set criteria that data collection needs to meet. Make sure you do this together, though. Don’t forget: you’re faster alone, but you get further together.

Setting up and implementing a care pathway

If the conditions are met, the path to structurally handling integrated care is clear. But how do you walk that path? How do you set up and implement an integrated care pathway? You can do that by using checklists. You can also use the Rainbow model as your starting point. This model puts the needs of the patient first. After these have been determined, you look at the desired quality, health and cost outcomes. You then adapt your interventions to those desired outcomes by using a wide approach in which you involve the necessary stakeholders. Which professionals do you need? What do you want them to do and what is the desired result? That way, you create a care pathway that is tailored to the patient, which consists of components that are more or less standardized. By working this way, you let go of the disease-focused approach of care pathways and you focus more on the needs of a person. It allows you to offer customized integrated care for everyone and you use your man power and other resources efficiently. This will have a positive influence on the quality of care, patient satisfaction and costs.

Do you want to know more and start working on it? During our masterclass ‘Value-based Healthcare: together we can make things better & cheaper’ you learn what to do and how to do it! Click here for more information about the masterclass, or below for the brochure.

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Pim Valentijn

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