What is a care pathway?

After the previous post I have been thinking about the used search key to find some literature. I came to the conclusion that the term care pathway was not completely clear to me. There are some questions that I couldn’t answer. One of these questions was about the definitions of a care pathway. What is a care pathway? How is it defined? And after reading some article about care pathways, I came across some comparable definitions, and I asked myself: Is there a difference between the various definitions or are they all synonyms? So I have been investigating on this point and this is what I found so far. 

According to the E-P-A (European Pathway Association) a care pathway is defined as “A complex intervention for the mutual decision making and organization of predictable care for a well-defined group of patients during a well-defined period.” In other words it is defined as a decision making intervention and as an organization of care processes for an established group within a certain time window. There are also four characteristics that a care pathway should meet, and these are stated by the E-P-A as:

• “An explicit statement of the goals and key elements of care based on evidence, best practice and patient expectations;
• The facilitations of the communication and coordination of roles, and sequencing the activities of the multidisciplinary care team, patients and their relatives;
• The documentation, monitoring, and evaluation of variances and outcomes;
• And the identification of relevant resources”. 

The other, often used terms I ran into are besides care pathway are: clinical pathway (most common), critical pathway, integrated care pathway, and care map. The E-P-A defined them as synonyms (De Bleser et al., 2006, Panella & Vanhaecht, 2010, Vanhaecht, Panella, Van Zelm, & Sermeus, 2010). The E-P-A used the term care pathway, because this was the most accepted term of all the options, and by providing a clear definition they tried to minimize the turmoil around all the definitions. Via the E-P-A LinkedIn group, I asked whether the different definitions were synonyms or whether there were (minor) differences between the various definitions. In one of the reactions they advised me to use the E-P-A definition, but they didn’t give a clear reason why there aren’t any differences. So the E-P-A advices to use the E-P-A definition. Not really surprising, is it? Please let me know what you think about it!

Beside the different terms about care pathways, there are clinical guidelines and individual treatment plan. These three different objects can be classified, resulting in the taxonomy depicted below. The clinical protocols are a result formalized from the clinical guidelines. These guidelines are a recommended way of working, while the clinical protocols are more than a recommendation; these are more imposed ways of working. These clinical guidelines and protocols lead to the clinical pathway, which describe the mutual decision making and organization for a predefined group of patients within a defined time window. The clinical pathway contains some implemented pathways. These implemented pathways lead to an assigned pathway, with all types of individual treatment plans. See the taxonomy below for a graphical interpretation. A dashed line represents the exchange of information where information from the former definition can be used to formalize the latter definition. A solid line shows how a definition is derived from a previous definition. 

This taxonomy is a result from a literature study done by four OML-minor students, which studied the differences between the varieties of definitions used. The taxonomy shows how the definitions vary and how they are based on each other. Their conclusion is that all definitions can be divided into three classes, namely: clinical guidelines, clinical pathways, and individual treatment plans. The definitions within these classes can be seen as synonyms. This literature study done by these four students saves me a lot of time; I can now base my literature study on their study, and I will post my findings as soon as possible.

Graphical representation of the taxonomy

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