What is a Care Pathway?
A care pathway is a multidisciplinary plan of care that outlines the sequence and timing of interventions for patients with particular conditions or undergoing specific procedures.1 Care pathways help to ensure that persons served2 receive the appropriate intervention, rooted in best practices, through the standardization of clinical processes. Care pathways clearly define treatment parameters, promote interdisciplinary team-based care, and provide ongoing monitoring to assess the effectiveness of the care pathway.
Defining and implementing care pathways is essential for healthcare providers. A care pathway aims to increase the quality of services and improve outcomes while employing a patient-centered approach to care. For example, does the care pathway help reduce the risk of addiction for a certain population demographic? Care pathways provide clear, consistent guidelines and help staff adapt quickly and perform effectively. When care pathways are well-defined, they can effectively evaluate outcomes such as a reduction in risk, a decrease in symptoms, or an improvement in quality of life. To measure a care pathway’s impact, it is crucial first to define the pathway and its intended goals.
What a Care Pathway is Not
Many concepts in healthcare are used interchangeably with care pathways but vary slightly in meaning. It is important to identify and define these associated terms to ensure consistency in terminology and construct.
Characteristics of a Care Pathway
Care pathways must include a standard set of features or attributes to achieve their purpose. Care pathways must be:
Components of a Care Pathway
Care pathways can range from simplistic, encompassing just a few targeted activities within a single interaction, to complex workflows involving a multidisciplinary team spanning a broader episode of care. Regardless of the complexity, every care pathway should encompass the following:
Implementing a Care Pathway
After understanding the purpose of a care pathway, implementation is the next step. To implement care pathways in healthcare settings, follow the seven steps listed below.
Step One: Identify
The population a care pathway supports can be defined in various ways, including by diagnosis, demographics, or social determinants of health (SDoH). Regardless of the criteria, identification must be systematic and documented well. For instance, a care pathway for individuals with schizophrenia on antipsychotic medications must reliably identify active diagnoses and prescriptions. Additionally, stratification within the subpopulation may be necessary if interventions differ based on factors, such as symptom severity, level of need, or service utilization. Stratification is only necessary if it leads to different interventions based on the categories.
Step Two: Research
Once the target population is identified, a systematic review of best practices is essential. This includes researching appropriate screening tools, evidence-based practices, clinical guidelines, and protocols to inform the care pathway. Some methods, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT), and Motivational Interviewing (MI), may be applicable across multiple care pathways.
Step Three: Define
The next step is to synthesize the findings from the systematic review and define the care pathway, documenting the ideal clinical workflow. This includes identifying each activity and clearly defining roles and responsibilities. When responsibilities shift between staff or departments, a well-defined pathway ensures a seamless transition.
Step Four: Map
This step involves identifying existing components of the care pathway and determining how to transition from the current to the ideal state. A key part of this gap analysis is understanding how each pathway element will be documented and tracked in the electronic medical record (EMR). Key considerations include:
Consult EMR vendors, clinics, and healthcare consultants to learn from similar implementations. Based on the gap analysis, develop an implementation plan outlining the phased steps required to move toward the ideal state.
Step Five: Implement
Using the implementation plan as a roadmap, organizations can begin developing the care pathway, considering timelines and dependencies for each phase. Adjustments may be needed if certain steps take longer than expected, but incremental progress is still moving toward the ideal state. Since training is critical to successful implementation, consider creating a companion guide for staff with detailed instructions, talking points, and additional resources. Depending on the pathway’s scope, it may be beneficial to start implementation in a specific program or department, with expansion in later phases as processes and protocols are refined.
Step Six: Refine
A care pathway should be flexible, adapting as best practices evolve or organizational changes occur. Once implemented, the care pathway should be monitored to ensure each component functions as intended. Key questions to consider include:
Adjustments should be made as needed to ensure consistent positive outcomes.
Step Seven: Evaluate
The final step is developing a plan for evaluation considering the outcomes of persons served. Look for answers to questions like, does the care pathway reduce risk, decrease symptoms, or improve quality of life? Developing clear measures and benchmarks is one way to understand the impact of implementing the care pathway.
