Systematic review of the effectiveness of integrated care pathways

Abstract

1 For relatively predictable trajectories of care ICPs can be effective in supporting proactive care management and ensuring that patients receive relevant clinical interventions and/or assessments in a timely manner. This can lead to improvements in service quality and service efficiency without adverse consequences for patients. 2 ICPs are an effective mechanism for promoting adherence to guidelines or treatment protocols thereby reducing variation in practice. 3 ICPs can be effective in improving documentation of treatment goals, documentation of communication with patients, carers and health professionals. 4 ICPs can be effective in improving physician agreement about treatment options. 5 ICPs can be effective in supporting decision-making when they incorporate a decision-aide. 6 The evidence considered in this review indicates that ICPs may be particularly effective in changing professional behaviours in the desired direction, where there is scope for improvement or where roles are new. 7 Even in contexts in which health professionals are already experienced with a particular pathway, ICP use brings additional beneficial effects in directing professional practice in the desired direction. 8 ICPs may be less effective in bringing about service quality and efficiency gains in variable patient trajectories. 9 ICPs may be less effective in bringing about quality improvements in circumstances in which services are already based on best evidence and multidisciplinary working is well established. 10 Depending on their purpose, the benefits of ICPs may be greater for certain patient subgroups than others. 11 We do not know whether the costs of ICP development and implementation are justified by any of their reported benefits. 12 ICPs may need supporting mechanisms to underpin their implementation and ensure their adoption in practice, particularly in circumstances in which ICP use is a significant change in organisational culture. 13 ICP documentation can introduce scope for new kinds of error. Conclusions ICPs are most effective in contexts where patient care trajectories are predictable. Their value in settings in which recovery pathways are more variable is less clear. ICPs are most effective in bringing about behavioural changes where there are identified deficiencies in services; their value in contexts where inter-professional working is well established is less certain. None of the studies reviewed included an economic evaluation and thus it is not known whether their benefits justify the costs of their implementation.

An integrative approach to improving patient care pathways

“…Similarly, Allen et al, (2009) report ICPs to be most effective when patient journeys are predictable. Patient pathways that are more variable are less convincing where greater flexibility is required to accommodate more diverse needs.…”

“…The ICPs are an interesting technology, as they are based on standardisation by identifying all necessary care trajectory elements. Variances permits scope for professional judgement (Allen et al, 2009). However, research on the pathway development process indicate agreeing pathway content is not straightforward.…”

“…However, research on the pathway development process indicate agreeing pathway content is not straightforward. Anecdotally there are pathways that are overly long and never used in practice (Allen et al, 2009).…”

“…Both are now well-established improvement technologies in healthcare (e.g. Brandao de Souza, 2009;Burgess and Radnor, 2013;Allen et al, 2009) but until now, have been considered independently. Our aim is to address this gap and explore the synergies and how these two important improvement technologies could be combined.…”

Automated generation of patient-tailored electronic care pathways by translating computer-interpretable guidelines into hierarchical task networks

“…This can improve service quality and e ciency without adverse consequences for patients, providing an e↵ective mechanism for promoting adherence to guidelines [15].…”