Clinical Pathways Vs Disease Management

I am not a fan of Clinical Pathways. Let’s get that out of the way. The pathways I have seen offer arbitrary steps to achieve a goal that may or may not be appropriate for a patient in an arbitrary sequence that is in no way related to the individual disease process of the patient and do not take into consideration comorbidities of the patient.

But a serious, almost pathological aversion to Clinical Pathways doesn’t mean that we can’t improve upon disease state management.

In traditionally offered, academic exercises, we identified a patient with a specific disease process and followed a recipe for care. Thus clinical pathways were born. Disease Management is a little different. When I mention disease management, I assume that a patient has one or more illnesses that has been studied sufficiently to determine best practices. And those best practices, whether they are written for MD’s or nurses should be a part of our practice.

Diabetics should have a Hemoglobin A1c, feet inspections, dilated eye exams, etc. at determined time points. So, if I ask you to tell me when the last time your diabetic patient had a dilated eye exam, could you tell me? If I read your arthritic patients chart, would I find anything other than pain medicine for pain relief? What about your CHF patient? Are you certain that all of your CHF patients are on an ACE Inhibitor? If the MD did not order PT/INR’s for your Coumadin patient, are you certain they are having lab drawn at the MD’s office?

Yes, these are medical interventions. But coordination of care means coordinating care with other providers. Furthermore, this attention to detail will likely appeal to physicians and other referral sources. If I were referring a diabetic patient to your agency, I would want the one who keeps up with everything whether they did it or simply provided reminders to other health care providers.

In fact, a short fax could be generated to the MD upon admission stating that their patient has been identified as having a high risk of complications related to (name your disease) and you are interested in incorporating certain information in the clinical record. And then ask for it. Date of last eye exam, last A1C, weight range, last lab, etc.

Anything not provided by the physician can be arranged by the agency. And if the physician is not interested in playing along with you, it might just be time to find other referral sources.

So ask yourself if you want to improve care to your patient. An overlooked foot inspection or PT/INR is caught and complications are avoided. That gives me a warm feeling inside. It also protects the MD because they have outcomes that are measured for certain disease processes as well. That gives him or her warm feeling a possibly more cash at the end of the year. It distinguishes you from one of the agencies where nurses go in, grab some vitals and teach the same thing 82 visits in a row notifying the MD only when the patient is really bad.

And you get more business. How’s that?