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Provider insights

Using care pathways to improve health systems

Filed under: Hospitals, Operations, Outpatient care, Payment & delivery innovation

One of the core missions of any health system is to improve the health status of its population. To do this, it must take appropriate actions to prevent illness as well as to ensure the efficient delivery of high-quality primary, secondary, tertiary, and rehabilitative care. Selecting which interventions to prioritize can be difficult, however. It can be even more difficult to determine how to set up the health system to ensure that the appropriate interventions are deliv¬ ered efficiently.

To address these problems, many leading health systems (and the payors and providers within them) are adopting a new approach based on care pathways to map the steps in a patient’s journey through the entire health system. The pathways are organized by the stages of care (from prevention and primary care to acute care and rehabilitation) and include the full range of interventions that may be offered at each stage. Because the pathways are based on the best available clinical evidence, they enable health systems to determine the interventions’ relative importance, prioritize how resources are allocated, and identify the outcome metrics that will help ensure optimal care delivery. Some pathways focus on specific diseases, such as diabetes or coronary heart disease (CHD); these pathways include all treatments, from primary prevention to rehabilitative services, that may be offered to patients with those diseases. However, a care pathway can also cover a group of conditions with similar treatment requirements, such as chronic diseases, or even a phase of life (e.g., pregnancy); in these cases, the pathway maps the clinical steps taken at each stage of care. The pediatric care pathway, for example, includes routine vaccinations and other well-child services, primary and community care services for sick children, specialist care for more severely ill children, and palliative care for the terminally ill.

Both types of care pathways rely heavily on clinical evidence. As a result, clinicians tend to find them intuitive to use. And because clinicians are intimately involved in the pathways’ creation, they often become champions of the resulting recommendations for change.

In this article, we focus on the use of disease-specific care pathways. We describe why these pathways can be so valuable and outline how they are developed. In addition, we provide several case examples of how health systems have used disease-specific pathways to improve care quality, reduce costs, or both.

This originally appeared in Health International

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