Locations:
Search IconSearch

Which Way to Value? Care Paths Transform Delivery by Promoting Consistent, Evidence-Based Management

29 neurological care paths and counting

carepath-690×380

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

The journey from volume-based to value-based care requires clear pathways. That was the idea behind the Neurological Institute’s recent efforts to produce a collection of disease-specific Cleveland Clinic Care Paths.

Now, more than two years and a couple dozen care paths into the initiative, the institute has found that care paths provide more than just a road map to evidence-based and efficient care. The process of developing them is a cultural transformation in itself. “Our caregivers are being engaged across the care continuum to solve problems in multidisciplinary, patient-centered ways that promote value over the volume-based tradition,” says Neurological Institute Chairman Michael T. Modic, MD.

Much more than guidelines

Cleveland Clinic care paths are more than just practice guidelines. They are instead process-based tools designed for integration into the electronic medical record (EMR) to guide clinical work flows and assist providers in making guidelines operational.

Care paths start as evidence- or consensus-based guides developed by multidisciplinary teams of clinical experts for the management of a specific condition (see Figure for sample work flow excerpt). The aim is to standardize care around the best evidence, clearly identify meaningful outcomes of care and identify relevant process metrics.

The care paths are then analyzed for opportunities for practice transformation and efficiencies. “We are using care paths as the organizing principle to align our services to reduce unnecessary variation from the most evidence-based, patient-focused and efficient standard of care,” explains Dr. Modic.

Advertisement

The right provider at the right time

One focus is to match patients to the most appropriate level of clinician for their needs at various stages of care. For instance, initial management of acute back pain without red flags may be best provided by a specialized physical therapist or nurse practitioner rather than a medical spine specialist, who is engaged for more persistent or complicated cases.

Following care process analysis, care paths are piloted for work flow studies and improvements at select Cleveland Clinic health system facilities. Then they are translated into the EMR to guide — and ideally improve — clinical work flows. This is achieved through standardized documentation templates, order sets, and clinical decision-support and predictive analytical tools.

Standardization, measurement — and culture transformation

Embedding care paths in the EMR enables outcomes and process monitoring, such as the ability to generate condition-specific metrics for individual physicians, departments and facilities to drive continuous quality improvement.

“The aim is to standardize and measure care across time, venues and provider types,” says Dr. Modic. “But we are finding that participation in care path development is transforming our teams to work together in new ways that optimize outcomes over cost — in other words, to deliver value-based care.”

29 care paths and counting

As of mid-2014, the Neurological Institute has 29 disease-specific care paths completed or under development, as follows:

Advertisement

Completed

  • Low back pain
  • Radiculopathy
  • Neck pain
  • Obstructive sleep apnea
  • Concussion
  • Multiple sclerosis
  • Alzheimer disease
  • Glioblastoma
  • Ischemic stroke
  • Transient ischemic attack

In review and/or piloting

  • Headache
  • Epilepsy
  • Delirium
  • Brain metastases
  • Hemorrhagic stroke
  • Vertebral fracture
  • Post-acute stroke management
  • Physical therapy for low back pain
  • Depression
  • Parkinson disease
  • Autonomic disorders
  • Multiple sclerosis comprehensive care

In development

  • Insomnia
  • Spine metastases
  • Pediatric headache
  • Spine surgery
  • Chronic pain
  • Normal pressure hydrocephalus
  • Pediatric obstructive sleep apnea

The initiative has since spread to the overall Cleveland Clinic enterprise, with dozens of additional care paths currently in development or completed organization-wide. Next steps include exploring opportunities to make Cleveland Clinic care paths available to outside providers and health systems.

carepath-inset

Figure. Excerpt of a work flow from Cleveland Clinic’s Obstructive Sleep Apnea Care Path. This portion focuses on deciding when to use home sleep testing vs. polysomnography.

Advertisement

Related Articles

20-NEU-1915483 Navigated TMS to guide management of refractory epilepsy_CQD_650x450
How Navigated Transcranial Magnetic Stimulation Is Advancing Epilepsy Care

A noninvasive approach to map eloquent areas before surgery

17-CCC-4475-Telehealth-650×450
Behind the Scenes in Telehealth Amid COVID-19: Physicians Help Shape the Narrative of Patient Care During the Pandemic

Physician reimbursement policy experts join forces with IT and coders to enable digital transformation

minority-stroke-program-650×450
Tailoring Stroke Treatment and Prevention to Populations Who Need It Most

Minority Stroke Program focuses on outreach to racial and ethnic minority communities

geriatric-patient_650x450
About the Recent AAN Cognitive Screening Guidelines for Older Adults

Metrics support proactive cognitive care, demand more research

botulinum toxin injection for pediatric migraine
Botulinum Toxin Injections Are Bringing Relief for Intractable Pediatric Migraine

Excellent response seen with ongoing use in patients as young as 11

19-NEU-5592-AltinayTransgenderPsychiatry-650×450
Caring for Transgender Adults: Essentials for Behavioral Health Providers

Q&A with a psychiatrist in Cleveland Clinic’s Transgender Surgery and Medicine Program

19-NEU-5594_back-on-trek-650×450
Multidisciplinary Chronic Back Pain Program Identifies – and Addresses – Risk Factors for Noncompletion

Time constraints, language barriers, substance misuse, mood disorders targeted for improvements

19-NEU-3981-pediatric-epilepsy-650×450
Charting a Course for the Future of Pediatric Epilepsy Care

Project draws $1.6M to leverage telemedicine to create medical home, ease transition to adult care

Ad