Practical Considerations for Pathways

Clinical pathways have applications not only in complex disease states such as oncology but also across the entire health care spectrum. The use of standardized, evidence-based guidelines for care can support improvements in routine practices in hospitals, the provision of primary care services, and emergency medicine as well. Taking a “big picture” approach to pathways, payers and health care system directors can apply these tools to improve the quality of care and control costs in a variety of health care settings.

The success of clinical pathways relies on their being developed and put into practice mindfully, with an eye on taking advantage of the greatest opportunities for improvement, carefully considering which patient populations should be covered by the pathways, and working to encourage participation in and acceptance of pathways among stakeholders. The articles in this issue discuss practical considerations for achieving these goals.

As the cost and quality differences between different sites of care grow, the selection of specific sites of care becomes increasingly important. At the same time, the landscape of treatment sites has become more complex. Leaving the decision about the most appropriate site of care to patients can result in poor clinical and economic outcomes. Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, discusses how clinical pathways have an opportunity to call out specific sites of care that are most appropriate for particular services in order to promote more efficient and effective use of resources (page 35). Clinical pathways that provide guidance on treating conditions in lower cost, more convenient care settings can help to deliver on the Triple Aim for patients, payers, and providers.

Another practical consideration that should be addressed in the development of clinical pathways is the way in which the target population for a particular pathway is defined. Typically, patients are considered eligible for a pathway on the basis of their clinical diagnosis. However, this approach may be insufficient for ensuring that the most appropriate patients are designated as eligible for a pathway. David Hughes, BSN, shares an approach to help to determine a target population that takes into account multiple patient factors (page 39). The author encourages other pathway development teams to be mindful of patient factors beyond diagnosis when determining if a pathway is appropriate for a particular patient.

Finally, there is currently little data available regarding successful approaches to clinical pathway implementation. Before the effects of clinical pathways on clinical outcomes and costs can be investigated, institutions must ensure that clinical pathway programs are being implemented in a way that gives them the best opportunity for success. Tobias Romeyke, PhD, and colleagues point to the field of change management as providing important lessons that can be applied to clinical pathway implementation (page 43). The application of change management models and theories may serve as a useful approach to overcoming obstacles to change in order to ensure successful implementation of clinical pathways in hospital settings.