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BMC Health Services Research
Published in: BMC Health Services Research 1/2013

Open Access 01-12-2013 | Research article

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

Authors: Sabine Van Houdt, Jan Heyrman, Kris Vanhaecht, Walter Sermeus, Jan De Lepeleire

Published in: BMC Health Services Research | Issue 1/2013

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Abstract

Background

Care pathways are widely used in hospitals for a structured and detailed planning of the care process. There is a growing interest in extending care pathways into primary care to improve quality of care by increasing care coordination. Evidence is sparse about the relationship between care pathways and care coordination.
The multi-level framework explores care coordination across organizations and states that (inter)organizational mechanisms have an effect on the relationships between healthcare professionals, resulting in quality and efficiency of care.
The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary - hospital care continuum.

Methods

This study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results.

Results

The development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other’s roles, expectations and competences and building qualitative relationships.

Conclusion

Care pathways across the primary-hospital care continuum enhance the components of care coordination.
Appendix
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Literature
1.
Nolte E, McKee M: Caring for people with chronic conditions: an introduction. Caring for people with chronic conditions. A health system perspective. Edited by: Nolte E, McKee M. 2008, Berkshire: Open University Press
2.
McDonald KM, Sundaram V, Bravata DM, Lewis R, Lin N, Kraft S, McKinnon M, Paguntalan H, Owens DK: Care coordination. Closing the quality gap: a critical analysis of quality improvement strategies. Edited by: Shojania KG, McDonald KM, Wachter RM, Owens DK. 2007, Rockville, MD: Agency for Healthcare Research and Quality
3.
Porter ME, Teisberg EO: How physicians can change the future of health care. JAMA. 2007, 297 (10): 1103-1111. 10.1001/jama.297.10.1103.CrossRefPubMed
4.
Alter C, Hage J: Organizations working together. 1993, Newbury Park, California: Sage Publications
5.
Barbieri A, Vanhaecht K, Van HP, Sermeus W, Faggiano F, Marchisio S, Panella M: Effects of clinical pathways in the joint replacement: a meta-analysis. BMC Med. 2009, 7: 32-10.1186/1741-7015-7-32.CrossRefPubMedPubMedCentral
6.
Hughes DC, Luft HS: Managed care and children: an overview. Future Child. 1998, 8 (2): 25-38. 10.2307/1602672.CrossRefPubMed
7.
Smith S, Allwright S, O’Dowd T: Effectiveness of shared care across the interface between primary and specialty care in chronic disease management. Cochrane Database Syst Rev. 2007, 10.1002/14651858.CD004910.pub2. CD004910
8.
Valesco-Garrido M, Busse R, Hisashige A: Are disease management programmes (DMPs) effective in improving quality of care for people with chronic conditions?. 2003, Copenhage: WHO Regional Office for Europe
9.
Vanhaecht K, Panella M, van Zelm R, Sermeus W: An overview of the history and concept of care pathways as complex interventions. International Journal of Care Pathways. 2010, 13: 117-123.CrossRef
10.
Hensen P, Ma HL, Luger TA, Roeder N, Steinhoff M: Pathway management in ambulatory wound care: defining local standards for quality improvement and interprofessional care. Int Wound J. 2005, 2 (2): 104-111. 10.1111/j.1742-4801.2005.00098.x.CrossRefPubMed
11.
Rotter T, Kugler J, Koch R, Gothe H, Twork S, van Oostrum JM, Steyerberg EW: A systematic review and meta-analysis of the effects of clinical pathways on length of stay, hospital costs and patient outcomes. BMC Health Serv Res. 2008, 8: 265-10.1186/1472-6963-8-265.CrossRefPubMedPubMedCentral
12.
Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J, Snow P, Kugler J: Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010, 3: CD006632
13.
14.
Atwal A, Caldwell K: Do multidisciplinary integrated care pathways improve interprofessional collaboration?. Scand J Caring Sci. 2002, 16 (4): 360-367. 10.1046/j.1471-6712.2002.00101.x.CrossRefPubMed
15.
Brown JB, Sutton L: A neurological care pathway for meeting the palliative care needs of people with life-limiting neurological conditions. Int J Palliat Nurs. 2009, 15 (3): 120-127.CrossRefPubMed
16.
Van Gerven E, Vanhaecht K, Deneckere S, Vleugels A, Sermeus W: Management challenges in care pathways: conclusions of a qualitative study within 57 health-care organizations. International Journal of Care Pathways. 2010, 14 (4): 142-149. 10.1258/jicp.2010.010029.CrossRef
17.
Sermeus W, Vanhaecht K, Vleugels A: The Belgian-Dutch clinical pathway network. Journal of Integrated Care Pathways. 2001, 5: 10-14.
18.
19.
Gittell JH, Weiss SJ: Coordination networks within and across organisations: a multilevel framework. J Management Studies. 2004, 41 (1): 127-153. 10.1111/j.1467-6486.2004.00424.x.CrossRef
20.
Gittell JH: Coordinating mechanisms in care provider groups: relational coordination as a mediator and input uncertainty as a moderator for performance effects. Manag Sci. 2002, 48: 1408-1426. 10.1287/mnsc.48.11.1408.268.CrossRef
21.
Yin RK: Case study research. 2009, California: Sage Publications
22.
Pearson SD, Goulart-Fisher D, Lee TH: Critical pathways as a strategy for improving care: problems and potential. Ann Intern Med. 1995, 123 (12): 941-948. 10.7326/0003-4819-123-12-199512150-00008.CrossRefPubMed
23.
Vanhaecht K, Sermeus W, Vleugels A, Peeters G: Ontwikkeling en gebruik van klinische paden (“clinical pathways”) in de gezondheidszorg. Tijdschrift voor geneeskunde. 2002, 58 (23): 1542-1551. 10.2143/TVG.58.23.5001477.CrossRef
24.
Bryman A: Social research methods. 2004, Oxford: University Press
25.
26.
Gress S, Baan CA, Calnan M, Dedeu T, Groenewegen P, Howson H, Maroy L, Nolte E, Reaelli M, Saarelma O, Schmacke N, Schumacher K, van Lente EJ, Vrijhoef B: Co-ordination and management of chronic conditions in Europe: the role of primary care–position paper of the European forum for primary care. Qual Prim Care. 2009, 17 (1): 75-86.PubMed
27.
Bodenheimer T: Coordinating care–a perilous journey through the health care system. N Engl J Med. 2008, 358 (10): 1064-1071. 10.1056/NEJMhpr0706165.CrossRefPubMed
28.
Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, McKinstry B, Procter R, Majeed A, Sheikh A: The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med. 2011, 8 (1): e1000387-10.1371/journal.pmed.1000387.CrossRefPubMedPubMedCentral
29.
Buntin MB, Burke MF, Hoaglin MC, Blumenthal D: The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff (Millwood). 2011, 30 (3): 464-471. 10.1377/hlthaff.2011.0178.CrossRef
30.
Allen D: From boundary concept to boundary object: the practice and politics of care pathway development. Soc Sci Med. 2009, 69 (3): 354-361. 10.1016/j.socscimed.2009.05.002.CrossRefPubMed
31.
Campbell S, MacDonald M, Carr B, Anderson D, MacKinley R, Cairns S: Bridging the gap between primary and secondary care: use of a clinical pathway for the investigation and management of deep vein thrombosis. J Health Serv Res Policy. 2008, 13 (Suppl 1): 15-19. 10.1258/jhsrp.2007.007015.CrossRefPubMed
32.
Cardoso F, Stordeur S, Vlayen J, Bourgain C, Carly B, Christiaens MR, Cocquyt V, Lifrange E, Neven P, Scalliet P, Schobbens C, Van Goethem M, Villeirs G: Wetenschappelijke ondersteuning van het College voor Oncologie: een update van de nationale richtlijn voor borstkanker. 2010, Brussels: Federaal Kenniscentrum voor de Gezondheidszorg
33.
Christiaens MR, Vlayen J, Gailly J, Neven P, Carly B, Schobbens C, Drijkoningen R, Lifrange E, Cocquyt V, Bourgain C, Villeirs G, Larsimont D, D’Haese S, De Grève J: Wetenschappelijke ondersteuning van het College voor Oncologie: een nationale richtlijn voor de aanpak van borstkanker. 2007, Brussels: Federaal Kenniscentrum voor de Gezondheidszorg
34.
Scottish Intercollegiate Guidelines Network: Management of breast cancer in women: a national clinical guideline. 2005, Edinburgh: NHSScotland
35.
Hunter KF, Moore KN, Cody DJ, Glazener CM: Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev. 2004, 2: CD001843
36.
Scottish Intercollegiate Guidelines Network: Management of urinary incontinence in primary care: A national clinical guideline. 2004, Edinburgh: NHSScotland
37.
Vanhaecht K, Van Gerven E, Deneckere S, Lodewijckx C, Janssen I, van Zelm R, Boto P, Mendes R, Panella M, Biringer E, Sermeus W: The 7-phase method to design, implement and evaluate care pathways. The International Journal of Person Centered Medicine. 2012, 2 (3): 341-351.
38.
Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW: Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007, 297 (8): 831-841. 10.1001/jama.297.8.831.CrossRefPubMed
39.
Tearl DK, Cox TJ, Hertzog JH: Hospital discharge of respiratory-technology-dependent children: role of a dedicated respiratory care discharge coordinator. Respir Care. 2006, 51 (7): 744-749.PubMed
40.
Staiger PK, Serlachius A, Macfarlane S, Anderson S, Chan T, Young G: Improving the coordination of care for low back pain patients by creating better links between acute and community services. Aust Health Rev. 2010, 34 (2): 139-143. 10.1071/AH08634.CrossRefPubMed
41.
Grol R: Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 2001, 39 (8 Suppl 2): II46-II54.PubMed
Metadata
Title
Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination
Authors
Sabine Van Houdt
Jan Heyrman
Kris Vanhaecht
Walter Sermeus
Jan De Lepeleire
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-13-296

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