Which criteria to prioritize the healthcare problems to be treated through the Integrated Care Pathways?

Background\r\nAn Integrated Care Pathway (ICP), also known as Care or\r\nClinical or Critical Pathway is a multidisciplinary care plans\r\nwhich detail the essential steps of a specific clinical problem.\r\nThe introduction of ICPs in healthcare organizations should\r\nprovide better healthcare to patients and reduce unnecessary\r\nvariations in practice. While there is a huge literature on\r\ndefinition, design and managing of an ICP, criteria to select the\r\nhealth problems are lacking. Therefore we aimed to define\r\nthose prioritization criteria useful to define ICPs in healthcare\r\norganizations in Europe.\r\nMethods\r\nA systematic review was performed in Pubmed, Scopus,\r\nCINHAL and Medline web search databases, using a Boolean\r\nsearch by the following mesh terms and free text word: clinical\r\npathway, critical pathway, integrated care pathway, health\r\npriority, health problem, health issue and plan. The Delphi\r\ntechnique, as a structured process using a series of questionnaires\r\nto gather information, held until group consensus is\r\nreached, was applied to select and validate criteria useful for\r\nICPs’ health problems selection. Results\r\nBecause no articles, dealing with ICP prioritization criteria,\r\nwere found, a second review was performed, focusing on\r\npriority setting of health interventions as a whole. 32 of the 327\r\narticles resulting from the second review were included. Several\r\ncriteria dealing with different dimensions (eg. feasibility, health\r\ndistribution, health level, responsiveness, social and financial\r\nrisk protection) were identified. Then, a Delphi panel,\r\ncomposed by European experts on ICPs implementation, was\r\nestablished. Preliminary results suggest that high priority\r\nshould be assigned to health care problems characterized by\r\na high need/demand volumes, wired evidences available, social\r\nand technological pressure, debate on literature.\r\nConclusions\r\nAgainst the growing interest in ICPs implementation as suitable\r\ntools to minimize delays and resource utilization and to\r\nmaximize quality of care, no universal criteria useful to\r\nprioritize and plan ICPs implementation in healthcare organizations\r\nare available. Our framework, composed by dimensions,\r\ncriteria and weights, should assist healthcare organizations’\r\ndecision makers in planning activities and resource allocation.\r\nKey messages\r\n Selection of health problems to be faced through ICPs\r\nimplementation should be guided by several validated and\r\nshared criteria in order to ensure a better answer to health\r\nproblems.\r\n Priority setting in a comprehensive ICP selection has policy\r\nimplications on resources allocation, strategic planning and\r\noverall governance and management, with undoubted\r\neffects on equality, too.