The Institution of Care Pathways in Nephrology Patient Care: A Response to the Changing Health Care Climate

Abstract

The development of managed health care in the United States has provided an impetus for new strategies that promote efficiency, streamline healthcare delivery, and maintain quality care. The increasing number of end-stage renal disease patients, their complexity of care, and a looming manpower shortage in nephrology strain the present system trying to meet these demands. One mode of healthcare delivery that may address specific needs in the nephrology population is case management. This approach to medical care uses a care pathway that serves as a multidisciplinary blueprint for patient care. Such pathways eliminate duplicated services and maximize efficiency by keeping the healthcare team focused. In response to market forces in our community, we implemented care pathways for percutaneous renal biopsy and vascular access surgery. Costs per procedure and hospital length of stay were reduced. Patient outcomes and procedure success rates were unchanged from pre-pathway years. Moreover, patients preferred the care pathway care for their problems. Case management and care pathways are tools that are effective in their scope for helping deliver better care for nephrology patients. While they should not be considered a panacea for the problems facing renal care providers, these tools should be considered as part of nephrology healthcare delivery in the future.