Abstract
BackgroundCare 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.MethodsThis 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.ResultsThe 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.ConclusionCare pathways across the primary-hospital care continuum enhance the components of care coordination.
Highlights
Care pathways are widely used in hospitals for a structured and detailed planning of the care process
A multiple case study design [21] was used to provide an in-depth analysis of the relationship between care pathways and care coordination
ASEL provides a platform of consultation to assist and extend home care, beyond the boundaries of the own organization, office or discipline. bCare pathways in these cases were developed in cooperation with different hospitals but with partially overlapping primary care
Summary
Care pathways are widely used in hospitals for a structured and detailed planning of the care process. 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. Patients with chronic diseases often need long-term, complex care from different caregivers who are becoming more and more interdependent for their overall quality of care [1]. This leads to an increasing need for improved care coordination [2]. The choice of a coordination strategy depends upon the degree of uncertainty and the complexity of care [2,4]. More clarity about care coordination and the underlying concepts is needed to develop an effective strategy in daily practice [2]
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