The internet has made global communication part of daily life in the United States—a few clicks on a computer or a phrase typed into a search engine can bring almost any type of knowledge to the user’s fingertips. Doctors half a world away can see each other and communicate as if they were in the same room. But are we making the most of this enhanced access to individuals and knowledge? The articles in this issue of Journal of Clinical Pathways elaborate on ways to truly work together and learn from one another in this new age through shared experiences, novel partnerships, and candid discussions about care and patient values.Clinical pathways have been increasingly implemented by third-party payers and health care institutions. The use of pathways has provided the means to reduce treatment variability, improve patient follow-up and support, and enhance care coordination. But, in the use of the clinical pathways, are we including the patient? Are we making our patients aware of the clinical pathway that is in place, as well as alternative treatment options, as the treatment plan is being developed? Ideally, the treatment plan should be the result of a shared decision process, based upon the best treatment practices integrated with the patient’s values and goals. Elizabeth F Franklin MSW, LGSW, ACSW, and colleagues present their qualitative study that explored cancer patient experience and perspectives regarding clinical pathways and shared decision-making.
Population health, which encompasses the health outcomes of a specific group of individuals, has become an important concept in modern health care systems. Population health goes beyond medical care, extending into the nonmedical determinants of health, their impact on health outcomes, and potential interventions to impact them. Many public policy initiatives in recent years have included population health measures as a key component of optimizing the performance of the US health care system. Broad, lasting improvements across the medical, social, and economic determinants of health will require innovative thinking and the formation of nontraditional partnerships. In the Business of Pathways column, Silas Martin, Robert A Bailey, MD, and Ira Klein, MD, MBA, FACP, provide examples of novel and effective partnerships that have recently been established between health care providers, patients, commercial insurance companies, government entities, academic researchers, pharmaceutical manufacturers, and other stakeholders.
The evolution of care coordination for hematopoietic cellular therapy (HCT) is an area that other providers interested in delivering more value-based care can learn from. The HCT community has offered a patient-centered medical home care (PCMH) model for high-acuity, complex patients for decades though it was never termed a PCMH. These patients have been subject to bundled payments and have had outcomes reported in a national outcomes database. More recently, the protocols for routine HCT care have morphed into clinical pathways and guidelines. James Gajewski, MD, MACP, provides background on and an overview of HCT as an example of how complex clinical care can be coordinated and managed in a medical home model and by using clinical pathways.
