As the industry shifts toward value-based care, clinical pathways play a major role in efforts to improve quality and lower costs.

The words “clinical pathways” conjure up the image of a physician or other healthcare professional guiding a patient through a winding maze of treatment options.

So, what are clinical pathways?

Clinical pathways are road maps that guide doctors in managing care of a patient at each state in the disease process – from diagnosis through treatment and ongoing management for a given condition. In the EHR, they take the form of algorithms that offer a flow chart format for treatment options in a step-wise sequence.

Who Develops Clinical Pathways?

Several entities develop clinical pathways – physician practices, hospitals, health insurance plans – which can impact how they are designed and what they cover. Typically, healthcare professionals with expertise in a specific disease category lead the pathway development process; with insurers and stakeholders weighing in on their design and implementation.

Why Are They Important?

Pathways can influence the decisions doctors make about the timing of laboratory tests and scans, the sequence and use of specific medicines, and referrals to specialists. When properly designed and implemented, they can be a useful tool for helping clinicians adapt to quickly evolving guidelines and reduce variation in treatments and costs.

With the right pathways in place:

  • Care improves
  • Length of stay and treatment time decreases
  • Patient satisfaction scores increase
  • Readmissions, complications, and mortality rates decrease

How Do I Know Whether a Pathway Will Result in High-Quality Care?

Drawing upon more than 45 years of successful, evidence-based quality interventions; Telligen can help organizations review current care delivery processes and identify areas for improvement. Our pathways consulting services help payers and providers:

  • Facilitate the collection of relevant data
  • Obtain management/clinician support and troubleshoot barriers to success
  • Educate staff who will be using the pathway
  • Establish appropriate quality measures for targeted procedures/conditions
  • Create a framework for evaluating and analyzing results and make necessary adjustments
  • Implement ongoing review and change management processes