Connect Care Builders - Care Path Utilization

Metrics Definition - Care Path Utilization

Care Path Best Practices

Care Paths are advanced clinical decision-support tools that can help clinicians coordinate evidence-informed care across person, place and time. Care Paths are keyed to specific health conditions. They match relevant patient information to Alberta-validated clinical guidance, while aligning multidisciplinary care with workflow-friendly recommendations. Connect Care Care Paths express best practice recommendations from Alberta's Strategic Clinical Networks.

Care Paths have been shown to reduce unhelpful practice variation, prescribing errors, length of stay, readmission rates, patient mortality, and healthcare costs. They also improve patient follow-up with primary care providers, specialists, and specialty clinics.

Care Path feedback metrics are designed to help clinicians recognize missed opportunities for leveraging the potential positive impact of these tools.

Care Path Metrics

Care Path Enrolment

Although all patients with a relevant chronic health condition can benefit from use of an appropriate care path, an early priority is to increase the number of patients enrolled to available and appropriate care paths where patients are specifically admitted for management of the relevant health condition. Enrolment metrics are keyed to admission diagnoses.

Enrolment metrics reflect the proportion of encounters with a health condition admitting diagnosis where the prescribers respond to a best practice advisory by adding the recommended Care Path to the patient encounter.

Care Path Utilization

Enrolling a patient by adding them to a Care Path does not mean that Care Path tools are used or recommendations heeded. Prescriber response to the ready for discharge best practice advisory within a particular Care Path provides a rough marker of continued attention to an activated Care Path throughout a patient's hospital stay.

Use metrics reflect t he proportion of inpatients added to a Care Path who remain on the Care Path until the "ready for discharge" step.

Workflow

Care Path Workflows are described in the Connect Care Clinician Manual.

Data

Care Path metrics focus on prescriber behaviors when responding to Best Practice Advisories (BPAs) associated with a particular Care Path. Whether a user accepts or cancels a BPA instance, and what reason(s) are selected for such choices, are recorded in-system and available for analysis.

Metrics

Care Path Enrolment

Description

Percentage of inpatients admitted with a relevant diagnosis who are added to the associated Care Path with an appropriate response to an enrolment best practice advisory (BPA).

Denominator

Number of unique Patient Encounters where:
- Admission diagnosis (EPT 10150) OR Principal Problem List entry is included in the relevant Care Path diagnosis grouper
  - VCG 115226 for COPD
  - VCG 114910 for Heart Failure

Numerator

Number of Patient Encounters from denominator where:
- Health condition relevant Care Path enrolment BPA fires
  - LGL 4677 BASE AHS ADD TO AECOPD CARE PATH
  - LGL 4634 BASE AHS ADD TO HEART FAILURE CARE PATH
- AND action taken to place patient on the associated Care Path

Calculation

Numerator over Denominator expressed as proportion so that the denominator is visible.

Grouping (Denominator Subsets)

Hospital Service (hospital specialty)
- Patients attached to selected Hospital Admitting Service: ADT 70 - CATEGORY - (e.g., General Internal Medicine [106])
Hospital Unit (hospital "department")
- Effective Department (EPT 87316) is used instead of Encounter Department. This column contains encounter data that’s more reliable, which are used for drilling down to the department summary. The department is found by returning the first department to have a value in the following order: 1) Hospital Unit, 2) Procedure Pass Department (the effective department of linked appointment or admission), 3) Hospice Intake Department, 4) Appointment Department, 5) Waiting List Department, 6) OR Department.
Hospital Facility ("revenue location")
- Patients attached to selected Hospital Facility: EPT 18883 - CATEGORY - (e.g., EDM WMC University of Alberta Hospital [101094])

Analytics Definitions

Care Path Use

Description

Percentage of inpatients admitted with a relevant diagnosis who are added to the associated Care Path with an appropriate response to an enrolment best practice advisory (BPA) and subsequently remained on the Care Path until its "ready for discharge" step.

Denominator

Number of unique Patient Encounters where:
- Health condition relevant Care Path enrolment BPA fires
  - LGL 4677 BASE AHS ADD TO AECOPD CARE PATH
  - LGL 4634 BASE AHS ADD TO HEART FAILURE CARE PATH
- AND action taken to place patient on the associated Care Path

Numerator

Number of Patient Encounters from denominator where:
- Care Path Ready for Discharge BPA fires
  - LGL 4803 for AECOPD
  - LGL 4766 for Heart Failure

Calculation

Numerator over Denominator expressed as proportion so that the denominator is visible.

Grouping (Denominator Subsets)

Hospital Service (hospital specialty)
- Patients attached to selected Hospital Admitting Service: ADT 70 - CATEGORY - (e.g., General Internal Medicine [106])
Hospital Unit (hospital "department")
- Effective Department (EPT 87316) is used instead of Encounter Department. This column contains encounter data that’s more reliable, which are used for drilling down to the department summary. The department is found by returning the first department to have a value in the following order: 1) Hospital Unit, 2) Procedure Pass Department (the effective department of linked appointment or admission), 3) Hospice Intake Department, 4) Appointment Department, 5) Waiting List Department, 6) OR Department.
Hospital Facility ("revenue location")
- Patients attached to selected Hospital Facility: EPT 18883 - CATEGORY - (e.g., EDM WMC University of Alberta Hospital [101094])

Analytics Definitions

Limitations

Admitting Diagnosis

Care Path enrolment metrics relate to patients admitted with an admitting diagnosis or problem list entry that matches an available Care Path (e.g., AECOPD, Heart Failure). Consequently, the metric denominator may exclude patients with the health condition where the normative problem list management has not occurred (minimum use norm). Admitting diagnoses are entered (inconsistently) at the time admission orders are placed. They are rarely revised afterwards (complex workflow). The admitting diagnosis may not be specific enough (e.g., exertional dyspnea) to fit the health problem grouper applied to admitting diagnoses to determine whether an encounter fits the enrolment metric definition.

Membership in a Care Path enrolment denominator is contingent upon conditions being met to trigger a best practice advisory. Those can be adjusted over time, possibly affecting the validity of metric denominators when comparing different time periods.

Best Practice Advisory Limitations

Care Path enrolment metrics reflect whether clinicians interact with (or ignore) best practice advisories (BPA) recommending placing a patient on a specific Care Path. For an inpatient encounter to appear in the numerator, prescribers need to select the "Add Care Path" button within the relevant BPA. However, the BPA does not reflect the presence of competing co-morbidities and other possible reasons why Care Path enrolment may not be possible or appropriate.

Reports

Radar Dashboards

Reporting Workbench

Slicer-Dicer

Components

Care Paths are supported in Connect Care (Epic) with a wide range, and large numbers, of documentation, decision and care coordination supports. These are described in Care Path development records.

Resources

Care Paths

Manual: Care Paths

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