Care pathways are complex interventions in complex systems: New European Pathway Association framework

Seys, Deborah; Panella, Massimiliano; VanZelm, R; Sermeus, Walter; Aeyels, Daan; Bruyneel, Luk; Coeckelberghs, Ellen; Vanhaecht, Kris

doi:10.1177/2053434519839195

Cited by 33 publications

(39 citation statements)

References 34 publications

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“…This leaves evaluators with the possibility to create comparative or simple pre-post designs, i.e. set ups which allow them to control for potentially confounding factors (Craig et al, 2016;Seys et al, 2019).…”

Section: Big Datawhat Is It?mentioning

confidence: 99%

Big Data and what it means for evaluating integrated care programmes

Kaehne

2019

JICA

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Purpose Big Data is likely to have significant implications for the way in which services are planned, organised or delivered as well as the way in which we evaluate them. The increase in data availability creates particular challenges for evaluators in the field of integrated care and the purpose of this paper is to set out how we may usefully reframe these challenges in the longer term. Design/methodology/approach Using the characteristics of Big Data as defined in the literature, the paper develops a narrative around the data and research design challenges and how they influence evaluation studies in the field of care integration. Findings Big Data will have significant implications for how we conduct integrated care evaluations. In particular, dynamic modelling and study designs capable of accommodating new epistemic foundations for the phenomena of social organisations, such as emergence and feedback loops, are likely to be most helpful. Big Data also generates opportunities for exploratory data analysis approaches, as opposed to static model development and testing. Evaluators may find research designs useful that champion realist approaches or single-n designs. Originality/value This paper reflects on the emerging literature and changing practice of data generation and data use in health care. It draws on organisational theory and outlines implications of Big Data for evaluating care integration initiatives.

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Section: Big Datawhat Is It?mentioning

confidence: 99%

Big Data and what it means for evaluating integrated care programmes

Kaehne

2019

JICA

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“…The scope [2,5,6] and purpose [5,[7][8][9][10] of ICPs have been widely reported in the literature. Historically, the main driving force is the need to reduce the increasing tension between quality and cost-effectiveness of care [11].…”

Section: Introduction 1the Lack Of Contextual Understanding In Cancer Patient Pathway Implementationmentioning

confidence: 99%

“…A CPP is more than a complex intervention. It is a complex intervention in a complex system [9]. This makes it challenging to analyze cause and effect processes [27], which leads to our research question: What traits of cancer diagnoses, patient characteristics and hospitals have a significant impact on cancer patient pathway coordination and how do these differences influence coordination processes and management requirements?…”

Section: Introduction 1the Lack Of Contextual Understanding In Cancer Patient Pathway Implementationmentioning

confidence: 99%

Mind the Differences: How Diagnoses and Hospital Characteristics Influence Coordination in Cancer Patient Pathways

Mæhle

Hanto

Simensen

et al. 2021

IJERPH

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Integrated care pathway (ICP) is a prevailing concept in health care management including cancer care. Though substantial research has been conducted on ICPs knowledge is still deficient explaining how characteristics of diagnose, applied procedures, patient group and organizational context influence specific practicing of ICPs. We studied how coordination takes place in three cancer pathways in four Norwegian hospitals. We identified how core contextual variables of cancer pathways affect complexity and predictability of the performance of each pathway. Thus, we also point at differences in core preconditions for accomplishing coordination of the cancer pathways. In addition, the findings show that three different types of coordination dynamics are present in all three pathways to a divergent degree: programmed chains, consultative hubs and problem-solving webs. Pathway coordination also depends on hierarchical interaction. Lack of corresponding roles in the medical–professional and the administrative–institutional logics presents a challenge for coordination, both within and between hospitals. We recommend that further improvement of specific ICPs by paying attention to what should be standardized and what should be kept flexible, aligning semi-formal and formal structures to pathway processes and identify the professional cancer related background and management style required by the key-roles in pathway management.

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“…8 However, care pathway implementation also comprises a dual complexity, where the care pathway itself represents a complex intervention, while the organisational context upon which the care pathway is being implemented is also a complex system. 9 Acknowledging this twofold complexity includes careful consideration of the interactions between the intervention and the context. 10 One of these concerns upon CCP implementation in Sweden has been crowding out effects.…”

Section: Introductionmentioning

confidence: 99%

Are cancer care pathways associated with longer waiting times. Analysing crowding out effects in radiology, pathology, and surgery

Olsson

2020

International Journal of Care Coordination

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Introduction In 2015, Sweden initiated the implementation of standardised cancer care pathways (CCPs). With short, nationally imposed target times from diagnosis to first treatment, the issue of crowding out effects has been debated. This study investigate whether the implementation of CCPs is associated with longer waiting times for surgery, radiology scans and pathology analyses for other patient groups. Methods Data from the internal computer systems used in radiology, pathology and surgery to plan and follow the production at a county hospital in Sweden during 2014–2017 were analysed. By utilising the different priority categories used in these specialties, changes in waiting times before and after the implementation of CCPs could be analysed. Results The results are consistent with an association between the implementation of CCPs and longer waiting times for the priority category prioritised immediately after the CCP category in all specialties. In addition, none of the lowest priority categories within each subspecialty have experienced increased waiting times after CCP implementation. Discussion These results are consistent with a change in prioritisation where CCP patients are receiving shorter waiting times after CCP implementation at the expense of other patient groups. Crowding out effects related to CCP implementation have not been previously researched. This study therefore fills a gap in present literature. With an increased awareness of these challenges, and a more holistic perspective in the implementation process, actions can be put in place to identify and counteract crowding out effects.

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Care pathways are complex interventions in complex systems: New European Pathway Association framework

Cited by 33 publications

References 34 publications

Big Data and what it means for evaluating integrated care programmes

Big Data and what it means for evaluating integrated care programmes

Mind the Differences: How Diagnoses and Hospital Characteristics Influence Coordination in Cancer Patient Pathways

Are cancer care pathways associated with longer waiting times. Analysing crowding out effects in radiology, pathology, and surgery

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