Care pathways for the organization of patients' care

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Care pathways for the organization of patients' care

Care pathways, also known as clinical pathways, critical pathways or integrated care pathways, are used all over the world. Although they are used internationally, numerous misunderstandings still surround them. The goal of this paper is to provide an overview of the history of these pathways, of care pathway development, the effectiveness of care pathways, and of some of the challenges facing current healthcare.

Pathways are more than just a document in the patient record. They are a concept for making patient-focused care operational, and for supporting patient group modelling with different levels of predictability. Care pathways are a method within the field of continuous quality improvement and are used in daily practice as a product in the patient record. This paper explains these different issues.

Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building A Safer Health System. Washington: National Academies Press, 1999.

Committee on Quality of Health Care in America IoM. Crossing The Quality Chasm: A New Health System for the 21 st Century. Washington: National Academies Press, 2001.

Zander K. Integrated Care Pathways: eleven international trends. J Integrated Care Pathways 2002; 6: 101-7.

Bailey EJ, Morris PS, Kruske SG, Chang AB. Clinical pathways for chronic cough in children. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006595. DOI: 10.1002/14651858.CD006595.pub2.

Vanhaecht K, Bollmann M, Bower K, Gallagher C, Gardini A, Guezo J, et al. Prevalence and use of clinical pathways in 23 countries - an international survey by the European Pathway Association J Integrated Care Pathways 2006; 10: 28-34.

Vanhaecht K, De Witte K, Sermeus W. The care process organisation triangle: a framework to better understand how clinical pathways work. J Integrated Care Pathways 2007; 11: 1-8.

Vanhaecht K, De Witte K, Sermeus W. The impact of clinical pathways on the organization of care processes. Leuven: ACCO; 2007.

Vanhaecht K, Van Gerven E, Deneckere S, Lodewijckx C, Janssen I, Van Zelm R, et al. The 7-phase method to design, implement and evaluate care pathways. Int J for Person Centered Medicine, 2012 (in press).

Deming, WE. Out of the crisis Syndicate of the University of Cambridge, Melborne, 1982.

Pearson SD, Goulart-Fisher D, Lee TH. Critical pathways as a strategy for improving care: problems and potential. Ann Intern Med 1995; 123(12): 941-8.

Kwan J, Sandercock PAG. In-hospital care pathways for stroke. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD002924. DOI: 10.1002/14651858.CD002924.pub2.

Lemmens L, Van Zelm RT, Vanhaecht K, Kerkkamp H. Systematic review: Indicators to evaluate effectiveness of clinical pathways for gastrointestinal surgery. J Evaluation in Clinical Practice 2008; 14: 880-7.

Chudyk AM, Jutai JW, Petrella RJ, Speechley M. Systematic review of hip fracture rehabilitation practices in the elderly. Arch Phys Med Rehabil 2009; 90(2): 246-62.

Rotter T, Kinsman L, James EL, Machotta A, Gothe H, Willis J, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD006632. DOI: 10.1002/14651858.CD006632.pub2

Barbieri, A, Vanhaecht K, Van Herck P, Sermeus W, Faggiano F, Marchisio S, et al. Effects of clinical pathways in the joint replacement: A meta-analysis. BMC Medicine 2009; 7: 32.

Neuman MD, Archan S, Karlawish JH, Schwartz JS, Fleisher LA. The Relationship between Short-Term Mortality and Quality of Care for Hip Fracture: A Meta-Analysis of Clinical Pathways for Hip Fracture. J Am Geriatrics Society 2009; 57: 2046-54.

Van Herck P, Vanhaecht K, Deneckere S, Bellemans J, Panella M, Barbieri A, et al. Key interventions and outcomes in joint arthroplasty clinical pathways: a systematic review. J of Evaluation in Clinical Practice 2010; 16, 1: 39-49.

Chan R, Webster J. End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD008006. DOI: 10.1002/14651858.CD008006.pub2.

Lodewijckx C, Sermeus W, Panella M, Deneckere S, Leigheb F, Decramer M, et al. Impact of care pathways for in-hospital management of COPD exacerbation: a systematic review. Int J Nurs Stud 2011; 48: 1445-56.

Leigheb F, Vanhaecht K, Sermeus W, Lodewijckx C, Deneckere S, Boonen S, et al. The Effect of Care Pathways for Hip Fractures: A Systematic Review. Calcif Tissue Int. 2012 Apr 3. [Epub ahead of print]. DOI: 10.1007/s00223-012-9589-2.

European Respiratory Society. European Respiratory Roadmap: Recommendations for the future respiratory medicine. Available 10.11.2011 on:

Smith MT, Francis MD, Corrigan JM. Health care quality in the 21st century. Clin Exp Rheumatol 2007; 25: 3-5.

Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges ahead. Lancet 2009; 374: 1196-208.

Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff 2001; 20: 64-78.

Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002; 288: 1775-9.

Strandberg-Larsen M. Measuring integrated care. Dan Med Bull 2011; 58: B4245.

Neubauer K, Kidd E. Investing in Europe's Health Workforce of Tomorrow: Scope for Innovation and Collaboration. Summary Report of the Three Policy Dialogues. Leuven: European Observatory on Health Systems and Policies, 2010.

Sonetti DA, Hospenthal AC, Adams SG. Integrated management strategies for chronic obstructive pulmonary disease. J Multidiscip Healthcare 2010; 3: 181-8.

Wagner EH, Austin BT, Von KM. Organizing care for patients with chronic illness. Milbank Q 1996; 74: 511-44.

Berwick DM. Disseminating innovations in health care. JAMA 2003; 289: 1969-75.

Barr VJ, Robinson S, Marin-Link B, et al. The expanded Chronic Care Model: an integration of concepts and strategies from population health promotion and the Chronic Care Model. Hosp Q 2003; 7: 73-82.

Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the Chronic Care Model in the new millennium. Health Aff 2009; 28: 75-85.

Weingarten SR, Henning JM, Badamgarav E, et al. Interventions used in disease management programmes for patients with chronic illness-which ones work? Meta-analysis of published reports. BMJ 2002; 325: 925.

Pearson ML, Wu S, Schaefer J, et al. Assessing the implementation of the chronic care model in quality improvement collaboratives. Health Serv Res 2005; 40: 978-96.

Vanhaecht K, De Witte K, Sermeus W. The Care Process Organisation Triangle: A framework to better understand how clinical pathways work. Int J Care Pathw 2007; 11: 1-8.

Seemungal TA, Hurst JR, Wedzicha JA. Exacerbation rate, health status and mortality in COPD: a review of potential interventions. Int J Chron Obstruct Pulmon Dis 2009; 4: 203-23.

Sermeus W, De Bleser L, Depreitere R, Dewaele K, Vanhaecht k, Vlayen J. An introduction to clinical pathways. In: Devriese S, Lambert M, Eyssen M et al. (eds). The use of clinical pathways and guidelines to determine physicians' hospital fees prospectively: easier said than done. Belgian Healthcare Knowledge Centre (KCE). KCE Reports, Volume 18A. Availabe 20.10.2011 on:

Van Herck P, Vanhaecht K, Sermeus W. Effects of Clinical Pathways: do they work? Journal of Integrated Care Pathways. J Integr Care Pathways 2004; 8: 95-105.

Medical Research Council. Developing and evaluating complex interventions: new guidance. 2008. Available 24.7.2011 on:

Panella M, Vanhaecht K. Is there still need for confusion about pathways? Intl J Care Pathw 2010; 14: 1-3.

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