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Introduction to Care PathwaysIntroduction to Care Pathways
Walter SERMEUS, RN, PhDWalter SERMEUS, RN, PhD
Center for Health Services and Nursing Center for Health Services and Nursing ResearchResearch
Katholieke Universiteit LeuvenKatholieke Universiteit LeuvenBELGIUMBELGIUM
MIM conference26 April 2007, buiding Belgacom, Brussels
ContentContent
What are care pathways ?What are care pathways ? Impact of care pathways? Impact of care pathways? Use of care pathways in Use of care pathways in
BelgiumBelgium
Business Process OrientationBusiness Process Orientation((Mc CormackMc Cormack & Johnson& Johnson , 2001, 2001))
Source: BANDOLIER, juli, 2003
Clinical
pathway
Many definitionsMany definitions
National Library of Medicine (MeSH: critical pathway)National Library of Medicine (MeSH: critical pathway)– Schedules of medical and nursing procedures, including diagnostic Schedules of medical and nursing procedures, including diagnostic
tests, medications, and consultations designed to effect an efficient, tests, medications, and consultations designed to effect an efficient, coordinated program of treatment.coordinated program of treatment.
National Pathway Association UK (1998)National Pathway Association UK (1998)– An integrated care pathway determines locally agreed, An integrated care pathway determines locally agreed,
multidisciplinary practice based on guidelines and evidence where multidisciplinary practice based on guidelines and evidence where available, for a specific patient/client group. It forms all or part of the available, for a specific patient/client group. It forms all or part of the clinical record, documents the care given and facilitates the evaluation clinical record, documents the care given and facilitates the evaluation of outcomes for continuous quality improvementof outcomes for continuous quality improvement
BelgianDutch Clinical Pathway Network (2002) BelgianDutch Clinical Pathway Network (2002) – A clinical pathway is a collection of methods and tools to guide the A clinical pathway is a collection of methods and tools to guide the
members of a multidisciplinary and interdisciplinary team towards members of a multidisciplinary and interdisciplinary team towards patient focused collaboration for a specific patient population to assure patient focused collaboration for a specific patient population to assure qualitative and efficient carequalitative and efficient care
Literatuurreview (Debleser et.al., 2006): Literatuurreview (Debleser et.al., 2006): – 84 definitions found84 definitions found
Definition of a Care Definition of a Care PathwayPathway Care pathways are a Care pathways are a methodology methodology for the mutual decision for the mutual decision
making and organization of predictable care for a well-making and organization of predictable care for a well-defined group of patients during a well defined period. defined group of patients during a well defined period.
Defining characteristics of care pathways include: Defining characteristics of care pathways include: – an explicit statement of the an explicit statement of the goals and key elementsgoals and key elements of care of care
based on evidence, best practice, and patient expectations. based on evidence, best practice, and patient expectations. – the facilitation of the communication, the facilitation of the communication, coordination of roles, coordination of roles,
and sequencingand sequencing the activities of the multidisciplinary care the activities of the multidisciplinary care team, patients and their relatives. team, patients and their relatives.
– the documentation, monitoring, and the documentation, monitoring, and evaluation of variances evaluation of variances and outcomesand outcomes; and ; and
– the the identification of the appropriate resourcesidentification of the appropriate resources. . The aim of a care pathway is to enhance the quality of care The aim of a care pathway is to enhance the quality of care
by improving patient outcomes, promoting patient safety, by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of increasing patient satisfaction, and optimizing the use of resources.”resources.”
Source: European Pathway Association, 2006, www.E-P-A.orgSource: European Pathway Association, 2006, www.E-P-A.org
Care pathways may mean Care pathways may mean different things …different things …
Model pathway: Model pathway: Prospective description of Prospective description of the the ideal and expected care process for a ideal and expected care process for a group of patientsgroup of patients
Assigned patient pathway: Assigned patient pathway: Prospective Prospective description of the description of the ideal and expected care ideal and expected care process for an individual patientprocess for an individual patient
Completed pathway: Completed pathway: Retrospective Retrospective description of the description of the real care process of an real care process of an individual patientindividual patient
How are they related ?
Documentation in Patient record
What, why Model Clinical Pathway
How, who, when, where
Complete care pathway
EB Clinical Practice
Guidelines
Thinking globally
(Inter)national
EB Management
Accreditation &
Financing
Evaluation
Results
FEED
BAC
K
Assigned Patient pathway
Local protocols / procedures
Organisation / Management
Acting LocallyWithin organization
source: K. Deluc, Harrogate, 2002source: K. Deluc, Harrogate, 2002
Care Pathway TemplateCare Pathway Template
Care pathway for Hip surgeryCare pathway for Hip surgery
Care pathways for patientsCare pathways for patients
ContentContent
What are care pathways ?What are care pathways ? Impact of care pathways?Impact of care pathways? Use of care pathways in Use of care pathways in
BelgiumBelgium
Literature Review 2000-2002Literature Review 2000-2002
Effect of care pathwaysEffect of care pathways 613 publications on care pathways; 208 publications (1/3) is evaluating effect of
Care pathways
Positive effect NoDifference
Negative effect
Clinical outcome (N= 136) (65%)
65,6% 32% 2,4%
Service(N= 39) (19%)
62,2% 29,7% 8,1%
Process(N=105) (50%)
86% 6,9% 6,9%
Team(N=50) (24%)
83,3% 6,3% 10,4%
Financial(N=131) (63%)
82,5% 13,5% 4%
(Source: Van Herck P, Vanhaecht K, Sermeus W, JICP, 2004)
Bron: Vanhaecht et.al., Acta Orthop. Belg., 2005
Hernia Inguinalis PathwayHernia Inguinalis Pathway
Panella et.al., Reducing Clinical variation by clinical pathways: Do pathways workInternational Journal for Quality in Healthcare, 2003, p.509-521
Heart failure PathwayHeart failure Pathway
Panella et.al., Reducing Clinical variation by clinical pathways: Do pathways workInternational Journal for Quality in Healthcare, 2003, p.509-521
ContentContent
What are care pathways ?What are care pathways ? Impact of care pathways? Impact of care pathways? Use of care pathways in Use of care pathways in
BelgiumBelgium
Care Pathways in BelgiumCare Pathways in Belgium
Pathway NetworkKULUCLCBO
Fed. Gov. Study
Surgery
Dementia
ObesityKCE studies
Riziv/Inami
Nat. RaadConseil Nat.
KBS/FRBonco
Others
ExperienceKnowhow
Both Government & CliniciansHospitals & Primary Care
Multidisciplinary
Pathway projects in BelgiumPathway projects in Belgium(in 69 organisations in Pathway Network)(in 69 organisations in Pathway Network)
66.45%
33.55%
Status of projects (n=629)
In use
Under develop.© BelgischNederlands Netwerk Klinische Paden, 2007© BelgischNederlands Netwerk Klinische Paden, 2007
Most common clinical Most common clinical areasareas
Orthopa
Gynaec
Cardio
Urology
Endocri
Abdom.
Neurolo
Neuros
Geriatric
NoseEa
Pulmon
Psychia
Max. Fa
Nephrol
Ophtalm
Gastro
Chemoth
Other
Palliativ
Thorac
Paediatri
Anesthe
Oncolog
0
10
20
30
40
50
60
70
80
90
100
110
120
Number of pathways per discipline (incl. status) (n= 629 projects)
Under develop.
In use
© BelgischNederlands Netwerk Klinische Paden, 2007
Most common Most common pathwayspathways
Row 2
Row 1
Row
Row
Row
Row
Row
0 5 10 15 20 25 30 35 40 45
Number of pathways
In use Under develop,
These 20 patient groups (n=345 pathways) represent 55% of all pathways
© BelgischNederlands Netwerk Klinische Paden, 2007
Lessons ….Lessons ….
Main goal is not to implement care Main goal is not to implement care pathways but to solve quality and pathways but to solve quality and efficiency problemsefficiency problems
Success rate is dependent fromSuccess rate is dependent from– Involvement of senior managementInvolvement of senior management– Clinical ownershipClinical ownership– Systematic approachSystematic approach
•Source: Bower, K, 2005, Sermeus et al, 2005
Bandolier, July 2003
