CLINICAL PATHWAYS IN 17 EUROPEAN UNION COUNTRIES: A SURVEY OF EXPERT OPINIONS
Abstract
Background. The main focus of the survey is on the extent to which clinical pathways are being used, and whether it might provide a basis for improved service planning and consequently strategic asset planning in health care.
Methods. In the first stage, our aim was to make contact with one agency in each country (the primary agency below) that would be able to provide contacts within that country with a mix of experts from each of the following types of agencies: Health sector government regulator, Health care purchasing (insurance) agencies, Senior clinical managers in hospitals, Senior clinical managers in non-hospital care provider agencies (eg, home care, or primary medical care), Health professional societies (preferably medical and nursing), Accreditation or audit agencies, Consumer associations and Public or private agencies concerned with health facilities development. Definitions of these agencies and other terms were attached to the questionnaire itself. We would then ask the primary agency to choose the experts that were most likely to be aware of clinical pathway use. The persons thus contacted would then be asked to complete the questionnaire and send it back to the researchers. The aim was not to attempt to establish a random sample, but rather to target well-informed people.
Results. 51 completed questionnaires were provided by largely self-selected experts from 17 EU countries. Respondents reported that pathways are important and becoming increasingly widely used (although the rate of progress is highly variable), the main constraints to their use are a cultural aversion among doctors and little encouragement from external parties, and there is growing recognition that multi-setting pathways have the greatest potential value.
Conclusions. More needs to be done to achieve a common understanding of the ideas of pathways, strategic asset planning, and the interrelationships. Systems problems need systems solutions. In the case of clinical pathways, this means not only increased education in medical schools. It also means including pathways in licensing and accreditation activities; linking them to product classifications like diagnosis related groups (DRGs); specifying their use in purchaser provider contracts; encouraging health care provider agencies to use pathways as the basis for internal resource allocation; promoting the use of pathways as the framework for improving the quality of health care, internal clinical auditing; running clinical teambuilding workshops; and so on.
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