Care Pathways in U.S. Health Care Settings: Current Successes and Limitations, and Future Challenges

Authors: Chawla, A; Westrich, K; Kaltenboeck, A; Matter, S; Dubois, RW.
Publication: The American Journal of Managed Care. January 2016.

Care pathways, also known as clinical pathways or integrated care pathways, are typically characterized as a method for managing patient care based on clinical practice guidelines, with the main goals of improving quality of care, reducing variation in clinical practice and increasing the efficient use of health care resources.

Key points of the research

Reasons care pathways are increasing in use:

• High cost/high potential for cost savings (e.g. specialty biopharmaceuticals)
• High disease prevalence
• Availability of multiple branded therapies
• Significant variation in treatment patterns

Trends in the development of care pathways include:

• High-quality evidence is being prioritized and considered in care pathway development, including key data sources such as treatment guidelines and randomized clinical trials.
• Providers are considered the most critical group involved in developing and implementing care pathways, taking increasingly prominent roles in pathway development initiatives and acting as gatekeepers to successful adoption.
• There is flexibility in implementation by physicians to tailor treatment to their patients’ needs, most commonly through electronic medical record systems.

Areas for concern:

• Formal standards are lacking for care pathway development, implementation and evaluation. Transparency is also lacking for all of these areas.
• Little is known about the true impact of pathways on patient outcomes and quality of care, or medical care resource use and cost of treatment.

Recommendations that are key to improving current practices, and ultimately patient outcomes:

• Develop consensus-driven best practices—Creating best practices to guide the development, implementation and evaluation of care pathways will help streamline an otherwise complicated process.
• Create consistent methods for data collection and analysis—The ability to better collect and analyze data will support critical evaluation of care pathway performance against set goals.
• Maintain transparency—All elements of pathway development, implementation and evaluation should be clear to providers and patients.
• Provide patient access to disclosures—Patients should receive information about the development and impact of pathways, know whether treatment plans follow a care pathway and whether the clinical practice in which care is being delivered is subject to pathway-related incentives.