A Guide To Care Pathways With Three Examples Demonstrating Their Implications in Practice

The core aim of a health system is to improve people’s health. To accomplish this, it must be capable of providing care at the right time, at the right place, and to the right patient. 

However, doing this can be challenging. This especially holds in the fragmented care system we are in. Many health systems are adapting care pathways to map the ideal steps in a patient’s journey to address these problems.

Care pathways are planned according to the stages of care and include interventions offered at each stage. These pathways aid in prioritizing interventions based on importance, resources, and outcome for optimal care delivery.

When used appropriately, care pathways can be the best tool to provide quality care for patients. 

What is a care pathway? 

The European Pathway Association defines a care pathway as a complex intervention for the mutual decision-making and organization of care processes for a well-defined group of patients during a well-defined period.

Components of a good pathway include:

• Having clear goals and key elements based on best practice, evidence, and patients’ expectations
• Allowing communication among team members and with patients and their relatives
• Supporting coordination of roles and sequencing the activities of the multidisciplinary care team
• Offering monitoring, documentation, and evaluation of outcomes
• Identifying important resources

The ideal pathway includes adherence to the following four criteria:

1. A structured multidisciplinary plan of care
2. The translation of guidelines or evidence into an algorithm
3. Detailed steps within the pathway along with a timeframe in the course of treatment/care plan
4. Standardized care for a specific population.

All in all, a care pathway defines what happens, when it happens, and who is responsible at a stage. All this holds true at all stages of health care, including diagnosis, treatment, and follow-up.

Care pathways also allow the translation of clinical guidelines or evidence in other forms into local protocols. While clinical guidelines offer generic recommendations, care pathways offer one or more specific treatment recommendations based on a hierarchy of selection criteria. You can think of it as the difference between "could" and "should": guidelines tell oncologists what they could do, pathways tell them what they should. 

However, neither of them tells the oncologist what they must do. Every patient is unique and has their own medical background, so not all care pathways will be appropriate for all patients. Pathways are designed to accommodate about 80% of patients with an on-pathway condition. In their professional judgment, if a doctor does not believe that the pathway recommendation is appropriate for that patient, they may go off-pathway.  

Examples of care pathways

Let’s see how care pathways can be used in different treatment specialties.

Care Pathway In Mental Health

Care pathways in mental health are different from other physical health disorders. A mental health care pathway aims to improve mental health and not just coordinate multidiscipline experts.

A team manages mental health problems, such as counselors, physicians, and psychologists. The focus of a care pathway is also to inform professionals, patients, and families, similar to pathways used in hospitals.

However, mental health pathways are created around health problems such as depression and anxiety. A care pathway may include:

• Reason for seeing a patient (symptoms of the problem)
• Diagnostic tools to be used
• Involvement of experts at different steps
• Referral treatment at appropriate steps

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As you see in the image above, the care pathway outlines steps for patients with depression. It assigns responsibilities at each stage (for instance, primary care provider or nurse), actions taken and diagnoses made (for instance, a depression patient is suicidal), and the indicated treatment (such as medicine or behavioral modifications)

The bottom of the pathway offers to monitor and measure progress.

Care Pathway In Musculoskeletal Conditions

Usually, a patient suffering from musculoskeletal pain gets treatment from a primary care physician. If the patient needs further assessment, they will be referred to a specialist. This is a point of interface between primary and secondary care.

The patients may be recommended for further imaging, investigations, medical devices, physiotherapy, or injections in secondary care. It is seen that a lack of pathway results in inconsistency to manage patients, without uniformity across different regions. This significantly affects patient outcomes.

For the same reasons, care pathways are gaining popularity. It ensures that the patient sees the right expert at the correct stage in their treatment journey.

The pathways are designed keeping the patients’ values and beliefs in mind. For instance, patients with osteoarthritis see surgery as an unattractive treatment. So, pathways are built in a way where patients get to explore conservative treatment options first.

Care Pathway in Oncology

Oncology treatments have seen important developments in recent years. Innovations in tumor detection, advancement in drug discovery, and an increase in targeted therapies have improved outcomes.

However, these breakthroughs have also created complexity in care delivery. Oncologists are spending more time staying updated to offer value-based care. The care pathway is an excellent tool to help professionals achieve this goal by predicting practice patterns and care standardization.

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Conclusion

Health professionals must take appropriate actions at each stage of a patient’s journey to deliver high-quality care. However, a fragmented care system may make it difficult to deliver the required interventions. This is exactly where a care pathway comes in. With a care pathway you can easily manage the full patient journey. It will guide the care team to deliver the right care at the right time for the right patient and eventually improve patient outcomes. All in all, a care pathway defines what happens, when it happens, and who is responsible at a stage. It's a proven intervention to improve the patient journey.

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