Clinical pathways, a.k.a care pathways, critical pathways, care maps or integrated care pathways, are a widely accepted and highly utilized way to set out all the decisions and services involved in treating a condition. These pathways use the current best evidence and best practice gained from systematic reviews, as well as input from multidisciplinary teams of care providers, to outline the optimal course of care for all patients who have a specific condition or who are undergoing a specific procedure.
The primary aim is to centre the focus on the patient’s overall journey, rather than on the contribution of each specialty or service independently. All care providers are emphasized to be working together as a cross-functional team.
Clinical pathways are important because they help to reduce unnecessary variations in patient care and outcomes. They support the development of care partnerships and empower patients and their care providers. Because pathways prescribe treatment across different care settings, they help ensure that coordinated, quality service is provided over the full continuum of care. Clinical pathways are designed to minimize delays, make best use of resources and maximize quality of care.
It is important to remember when designing and implementing a clinical pathway that it is for the average patient. Variations from the pathway will occur as individual clinician discretion is exercised to meet the needs of the individual patient.
In 2005, a clinical pathway for hip and knee replacement patients was designed by Alberta’s orthopaedic surgeons and the Alberta Bone and Joint Health Institute (ABJHI). The clinical pathway was tested and validated through a year long pilot project. The clinical pathway has since been implemented province-wide in Alberta and has provided a foundation for several successful provincial improvement projects related to hip and knee replacement care.
Alberta’s hip and knee replacement clinical pathway is reviewed annually by a panel of experts to ensure it is consistent with best evidence and practice. Another provincial committee – the Provincial Hip and Knee Working Group – representing all members of the hip and knee replacement care team, monitors and measures ongoing compliance with and effectiveness of the clinical pathway. The Hip and Knee Working Group is part of Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJHSCN). The BJHSCN was formed to lead and support advances in musculoskeletal care and disease prevention across Alberta.
To learn more about ABJHI’s approach to clinical pathway development, see: /services/care-path-design/
Vanhaecht K., Panella M., Van Zelm RT., Sermeus W. (2010) An overview on the concept and history of care pathways as complex interventions. International Journal of Care Pathways.
Middleton S., Barnett J., Reeves D. (2010) What is an integrated pathway? Retrieved from: http://www.medicine.ox.ac.uk/bandolier/painres/download/whatis/What_is_an_ICP.pdf
Health Services Utilization and Research Commission (2001) Getting Started with Integrated Care Pathways.
Alberta Bone and Joint Health Institute. Alberta hip and knee replacement pilot project scientific evaluation report (2007) Retrieved from: /wp-content/uploads/2013/12/Hip-Knee-Scientific-Report.pdf