Pathway Evaluation – Clinical Improvement, Audit or Service Redesign

Pathway Evaluation – Clinical Improvement, Audit or Service Redesign

> > > >

Pathway Evaluation – Clinical Improvement, Audit, or Service Redesign

Following the launch of a new pathway, case-by-case audits of patient cohorts can help assess if outcomes are as expected.

This is meticulous work and ideally your programme normally collects metrics automatically. In practice, the data often sits in multiple systems or on paper, and requires manual extraction.

This sample evaluation could also be expanded to track a clinical suite of pathways.

Key questions or programme aims

Does the pathway conform with current best clinical practice?
Has the wider health system been consulted, and feedback incorporated?
Were a clinical valuation and impact assessment conducted before the change was implemented?
Establish a data baseline.
What improvements or outcomes has the service redesign or clinical improvement made?
Quantify the benefits of the change.
Has the patient journey improved?
Review the outcomes and system redesign process.

Indicators

Audits of patient flow and outcomes (pre and post)
Referral audit
Review feedback
Pathway-dependent

Methods

Patient flow using a hypothetical clinical pathway
Referral audit
Clinician surveys
Pathway-dependent

Publication database examples

Pathway Evaluation – Clinical Improvement, Audit, or Service Redesign
Key questions/Programme aims What questions will identify if the programme is achieving its aims?	Outcomes/Programme logic What difference do we aim to make? What do we expect to achieve? Who will benefit?	Indicators How will we know if progress is tracking well? What changes will we look for? What indicators will help answer our key questions?	Methods/Data sources What data will we collect and how?
Does the pathway conform with current best clinical practice? Latest guidelines National/state health priorities Locally accepted best practice	Identify if the pathway is clinically accurate and up to date: Reflects best practice and local agreement Contains accurate local referral information Log all issues being addressed via HP team/SME negotiation or the CWG process Identify barriers Identify possible improvements	Pathway-dependent Audit selected pathways for: Clinical quality Referral accuracy Review feedback	Pathway audits: Clinical audits Referral options Feedback: CWGs SMEs/CEs Clinicians HP programme team
Has the wider health system been consulted, and feedback incorporated?	Resolve all identified issues or report them to the governance group, stakeholders, and/or CWGs	Review feedback	CWGs SMEs/CEs Clinicians Allied health
		Interviews with key clinical and non-clinical leaders	Interviews Surveys
		Patient perspectives	Feedback from patient experience units
Were a clinical valuation and impact assessment conducted before implementing the change?	Understand patient flow and the consequences of redesigns Review hypothetical patient outcomes (pre and post) Identify and rectify or mitigate any adverse outcomes before implementation Understand change impact on: Patient flow Patient journey The wider health system	Pathway-dependent Consider: Referral decline rates Quality of referral information First specialist assessment, surgery, and follow-up rates Wait times Did not attend (DNA) rates	Pseudo pathway – Analyse patient flow using a hypothetical pathway Referral audit
Establish a data baseline	Develop audits and surveys, and obtain baseline data for care within the clinical streams undergoing evaluation Log all issues being addressed via team/SME negotiation or the CWG process Referral quality	Review feedback Pathway-dependent Consider: Referral decline rates First specialist assessment, surgery, and follow-up rates Quality of referral information Reduced testing Wait times Did not attend (DNA) rates Community care rates	Feedback: Key clinical and non-clinical leaders CWGs HP programme team Hospital metrics (pre and post) Referral audit (pre and post)
What improvements or outcomes has the service redesign or clinical improvement made?	Improved: Patient outcomes Patient flow Health equity Clinical relationships (primary, secondary, tertiary) Reduced: Costs Variations of care	Pathway-dependent Consider: Referral quality Patient experience Resources used, e.g. testing Community care rates	Feedback: Allied health Hospitals SMEs/CEs Clinicians Health-system metrics Hospitals NGOs Allied health Referral audits
Quantify the benefits of the change. Is the service aligned with best practice? Has referral quality improved? Have costs reduced? Has care in the community increased?	Identify improvements in: Referral quality E-referrals The wider health system Health equity Identify reduced variations of care	Review feedback Pathway-dependent Consider: Referral decline rates First specialist assessment, surgery, and follow-up rates Quality of referral information Reduced testing Wait times Did not attend (DNA) rates Community care rates	Feedback: Key clinical and non-clinical leaders CWGs HP programme team Hospital metrics (pre and post) Referral audit (pre and post)
Has the patient journey improved? Has patient access to specialist care improved? Have patient outcomes improved?	Patient perspectives	Pathway-dependent	Feedback from patient experience units
	Patient outcomes	Pathway-dependent	Hospital metrics (pre and post)
	Clinician feedback	Qualitative feedback from clinicians	Surveys Interviews Feedback
	Has patient access to specialist care improved?	Wait times Did not attend (DNA) rates First specialist assessment, surgery, and follow-up rates	Hospital metrics (pre and post)
Review the outcomes and system redesign process Were the desired or expected outcomes achieved? What lessons were learned during the process? Can they be shared? Was this the correct approach? Would you change anything if you had to do it again?	Patient perspectives	Pathway-dependent	Feedback from patient experience units
	Impacts and outcomes Differences between the actual and pseudo pathway	Pathway-dependent	Pathway-dependent
	Clinician feedback	Interviews with key clinical and non-clinical leaders Qualitative feedback from clinicians	Surveys Interviews Feedback: Allied health Hospitals SMEs/CEs Clinicians