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Knowledge Point Articles   

September 2005

Clinical Pathways Lead to Positive Outcomes

We all know that health care has undergone many changes over the past years. The combination of PPS and the population’s increasing age has forced health care providers to re-examine the methods of health care delivery. One concept of health care delivery rapidly gaining attention in home care is disease management programs, and one of the essential components of a disease management program is a clinical pathway.

Disease management may be defined differently, but most programs are typically aimed at a specific disease condition, such as Chronic Obstructive Pulmonary Disease, Congestive Heart Failure or Diabetes Mellitus. Though disease management programs may differ, the goal is always the same; providing appropriate care in an effort to reduce health care costs while improving patient outcomes.

Clinical pathways represent disease-specific standardized documentation for achieving desired outcomes. Pathways identify the health status of a patient at any point in time, quantify areas of improvement, including stabilization or decline, and identify standards of practice at each visit. The two most compelling reasons for including pathways as part of a disease management program are the potential for cost savings and improved outcomes. Pathways have demonstrated significant savings in the acute care setting, and the case management model has also demonstrated the ability to deliver primary care in a cost-effective manner while improving outcomes.

To better understand the cost savings perspective, think of how inpatient pathways traditionally work. In general, cost savings in health care have been aimed at tightening supply usage, and inpatient pathways do this by reducing the length of stay. For example, this limits use of diagnostic procedures and tests.

In home care, disease management programs and pathways work together to reduce costs by decreasing resource utilization. Pathways make disease management programs more effective, and as a result, more cost effective. A pathway can decrease the demand of health care resources by promoting prevention and optimizing self care management and health care resources within the specific areas of the disease. A successful disease management program that utilizes pathways can reduce costs by reducing re-hospitalization, physician visits and skilled visits.  

Pathways can also lead to significant improvements in patient outcomes. Pathways usually include a tool for variance analysis, which provides a feedback loop to assist in evaluating outcomes and identifying areas of potential improvement. Providing ongoing variance analysis can work toward optimizing outcomes while improving cost effectiveness.

Many agencies are finding that a pathway, as part of a disease management program, appears to have been a successful tool for the effective management of a chronic disease. As a key component of disease management, the pathway improves its efficiency and effectiveness. Pathways can play a vital role in reducing the overall cost of providing care by reducing the number of visits made. As reimbursement becomes more important with the talk of Pay for Performance (P4P), there will be increasing pressure on home care agencies to produce favorable outcomes in a more cost-effective manner. Disease management programs, which include the use of pathways, will be powerful tools in home care agencies today.

Cyndi Rohret, RN, CRNI, CHPN
Clinical Consultant, Briggs Corporation

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