Clinical Pathways for Primary Care: A Value Proposition

Exemplar articles supporting the development of clinical pathways, and alignment with the Provincial Pathways Unit (PPU) goals.

Different Pathway Types: Physician Experiences

Using care pathways for cancer diagnosis in primary care: a qualitative study to understand physicians' mental models.

Synopsis
An Alberta study that explores primary care physicians' perceptions of a cancer diagnosis care pathway. The main themes are that pathways support patient navigation and referrals. In this way, patient outcomes are improved through timely access to specialty care. The pathway, due to its design, was limited on care options within primary care, but the physicians found utility despite its limited scope. A key learning is that co-design with primary care is important.

PPU Goal
The PPU strives to support robust co-design practices that fosters mutual respect and equal contributions. Pathway scope and focus is continually evolving to include testing and diagnosis pathways.

Relevance
This paper demonstrates that clinical pathways extend beyond primary care management — they can, and can also be designed to support diagnosis and referral decision making. The PPU supports the wide continuum of clinical pathway types.

Reliability & Valued Care

Clinical Pathways: Driving High-Reliability & High-Value Care - ScienceDirect

Synopsis
Abstract outlines the key success dimensions of clinical pathways.

PPU Goal
The PPU clinical pathways support patient-centred care, reducing unnecessary clinical variation, and reducing cost.

Relevance
This article abstract articulates the impacts of clinical pathways within several dimensions of quality.

Care Coordination

Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination

Synopsis
A case-study analysis was conducted to review participants'’' perceptions of their local care pathways and how they supported care coordination. The research discovered how care pathways enhance mutual understanding between primary and specialty (in hospital) care.

PPU Goal
To ensure that patients experience a seamless journey from their primary care provider to the specialty care environment.

Relevance
This paper supports the benefits of bringing relevant partners together in the development and implementation of care pathways.

Team Based Care

Role of clinical pathways in health care provision: Focus on cancer treatment

Synopsis
This article describes how clinical pathways enhance team-based approaches to the complex management of patients with cancer. Clinical pathways "ensure all members of an [interdisciplinary team] follow a consistent approach to patient care" by "identifying sequential goals…and clear benchmarks for treatment".

PPU Goal
To ensure coordination between primary care and specialty care by offering guidance that outlines how primary care can manage conditions, and identifies when those conditions warrant specialty care and assessment.

Relevance
This article outlines how clinical pathways provide consistent guidance for multi-disciplinary teams.

Reducing Clinical Variations

Reducing Clinical Variations with Clinical Pathways: Do Pathways Work? - International Journal for Quality in Health Care

Synopsis
This longitudinal study measured the impact of clinical practices both before and after clinical pathway implementation for several disease conditions.

PPU Goal
The PPU endorses clinical pathways as a way to create system change across many reportable metrics.

Relevance
This article outlines the specific indicators that changed after a clinical pathway was implemented.

Clinical Pathways for Primary Care

Clinical Pathways for Primary care: Current Use, Interest & Perceived Usability - Journal of the American Medical Informatics Association

Synopsis
Clinical pathways were evaluated on a usability scale among multidisciplinary team members.

PPU Goal
The PPU clinical pathways support multidisciplinary team members in Primary Care.

Relevance
This article demonstrates how multidisciplinary approaches are met by clinical pathways.

Additional Evidence

Why Use Clinical Pathways Rather Than Practice Guidelines? - ScienceDirect
Demonstrates early justifications for developing clinical pathways.

Primary Care Support Tools for Digestive Health Care

Synopsis
Utilizing primary care pathways improves referral quality, reduces resource expenditure, and provides fair and equitable access to specialty services.

PPU Goal
The PPU facilitates the co-design of expertise between primary care, specialty care and patient and family advisers.

Relevance
This paper highlights the perspectives of providers within Alberta in relation to the provincial health landscape.

Return on investment of the diabetes foot care clinical pathway implementation in Alberta, Canada - ScienceDirect

Synopsis
Utilizing clinical pathway shows statistically better care for those dealing with a condition as well as better preventative care to avoid developing furthermore costly progression of disease. Additionally, the study demonstrates how pathways help with better self-management of condition.

PPU Goal
Implementing clinical pathways within primary care is a key priority for the PPU and its partners.

Relevance
This paper shows the clinical benefits of preventative care as well as how this translates to reduced health spending by avoiding the progression of disease.

Patient Pathways - Codesigning Pathways with and for Patients

The newly created patient pathways are resources to accompany and mirror a developed clinical pathway. Patient pathways are designed to inform patients on how to be engaged and empowered in their own care.

These outcomes are achieved by:

• Articulating how patients are the most important part of the healthcare team
• Advancing concepts of whole-person health as key components of overall wellness
• Providing example questions to help patients articulate their concerns
• Listing actionable steps patients can take in support of their specific condition
• Providing links to a wide array of resources to support psychosocial aspects of health
• A usability and applicability survey was deployed to assess Albertan’s views on the patient pathways.

Overall, the data demonstrates that Albertans’ value the patient pathways, and that they find them to be relevant to their contexts and interests.