One of the tools to improve efficiency and effectiveness in healthcare are the Integrated Care Pathways (ICPs), also referred to as clinical care pathways or critical care pathways (Biringer, Størkson, Hartveit, Aßmus, &... [ view full abstract ]
One of the tools to improve efficiency and effectiveness in healthcare are the Integrated Care Pathways (ICPs), also referred to as clinical care pathways or critical care pathways (Biringer, Størkson, Hartveit, Aßmus, & Vanhaecht, 2017). ICPs may be defined as ‘structured multidisciplinary care plans that detail the essential procedures and interventions in the care of patients with specific health conditions (N. Campbell et al., 2007; Rotter et al., 2010).
ICPs were introduced in the healthcare sector in 1980s in the US, but nowadays their use has extended across the world (Allen, Gillen, & Rixon, 2009). Some studies have been conducted to verify the impact of this methodology on performance in healthcare organizations in terms of efficiency and effectiveness (Barbieri et al., 2009; Kwan & P., 2004).
The paper reports on a case study of the Local Health Authority of Cagliari, Sardinia, where six ICPs, have been developed with a mixed inter-professional team. The ICPs were selected as they are the standardized care processes with the highest social and health impact in the studied context. The paper first describes how to integrate this approach with a high level of quality services and subsequently reports on the achieved outcomes: the optimization of the decision-making process through the constant use of evidence. In doing so, the approach used is based on the theory of Nudge (Thaler & Sunstein, 2008). The Nudge was used to facilitate the changing of behavior of physicians to induce them agree on a common pathway for a specific treatment, working within a community of practice.
The first four ICPs were implemented in 2015: Delivery, Chronic Obstructive Pulmonary Disease, Thigh-bone fracture and Dual diagnosis. Another two ICPs were introduced in 2016: heart failure and diabetic foot.
The comparison of the results achieved before and after the implementation of the ICPs shows a significant improvement in the outcomes. In particular improvements range from + 4.7% for heart failure, to 80% for Thigh-Bone fracture.
In a context of limited financial resources, monitoring the efficiency of human resources and its abilities and skills to cooperate with the management, has been the best tool to achieve relevant results. The conclusions are that the ICPs are a powerful tool to increase the level of effectiveness and efficiency in healthcare, because they allow to investigate, understand and re-engineer health processes and to increase patient’s satisfaction.
Spano.Aroni.Cannas_IRSPM.2018.pdf 