Application project: Impact of integrated clinical pathways on patient outcomes, communication and cost-effectiveness
Leading partner: University of Novo Mesto Faculty of Health Sciences
Partners: Novo mesto General Hospital and the University of Novo mesto, Faculty of Economics and Informatics
Co-financier: Artros, health care d.o.o.
Total value of the project: 400,067.76 EUR
Funding: The project is co-financed by ARRS and Artros, health care d.o.o.
Start: 1 September 2020
End: 31 August 2023
Project manager: dr. Karmen Erjavec
Content description of the project:
Demographic aging is one of the biggest challenges for most European countries, including Slovenia. The proportion of people over 65 is increasing, as is life expectancy. In addition to the challenge of an aging population, the healthcare system is confronted with the constant optimization of the organization of the healthcare system, new technologies and changing treatment methods.
Clinical pathways are a recognized quality tool for standardizing healthcare processes to support the implementation of clinical guidelines and protocols. They provide detailed guidelines for each phase of patient management with the goal of improving continuity and coordination of care across disciplines and sectors. Originally, clinical pathways began with admission and ended with discharge from the hospital, which is still a fundamental feature of clinical pathways in most hospitals worldwide, including Slovenia's, which was introduced in 2002. Many obstacles had to be overcome during the introduction, such as sharing documentation of individual professional groups with others involved in the treatment process, interprofessional collaboration and teamwork, and procedural regulation of clinical work. After the initial rollout, the question is how to evaluate the effectiveness of existing clinical pathways and how to improve them according to the principles of an integrated approach to the development of high-quality integrated health and social care for older people. The challenges associated with implementing clinical pathways in settings with clinical heterogeneity and organizational complexity are expected to increase in the coming years.
Integrated care is a working concept that is gradually but increasingly gaining acceptance in healthcare. It aims to better match health and social care to individual needs, improve the quality of care, and overcome fragmented care through continuous partnership. Clinical integration refers to processes within or between professional groups using common guidelines and protocols; organizational integration refers to coordinated provider networks or contracts that bring together separate organizations; and systems integration involves the alignment of rules and policies at all organizational levels. At all levels of integration, the goal is to bring organizations and professionals together to improve patient outcomes, such as patient experience and quality of care.
The application of integrated care knowledge to the clinical pathway is an integrated clinical pathway (hereafter ICP), which is generally defined as a process for shared decision making and organizing predictable care for a well-defined group of patients over a well-defined time period. It includes explicit definition of goals and key elements of care based on evidence, best practices, and patient expectations; facilitating communication and coordination of roles and continuation of activities among the multidisciplinary group of providers, patients, and their families; documentation, monitoring, and evaluation of variation and outcomes; and identification of appropriate resources.
Social science studies on the impact of clinical pathway implementation on improving the quality of team and patient communication, patient outcomes, and cost-effectiveness are scarce and rely mainly on self-assessments by experts without actually examining their implementation in practice. In this regard, previous research has only addressed the issue from the perspective of individual scientific fields and has remained limited within individual disciplines or even more narrowly, and has not provided comprehensive insight into the issues surrounding integrated care and ICP. Therefore, there is a research gap in the area of comprehensive or interdisciplinary (health, sociology, communication, economics) treatment of integrated care and ICP with a qualitative and quantitative approach to a case study before and after the pilot introduction of ICP.
Aim:
This project aims to fill this research gap in investigating the role of ICP in integrated health and social care by determining the impact of ICP implementation on patient outcomes, communication, and cost-effectiveness through a case study before and after the pilot.
Objectives:
Phases of the project:
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