Guest editorial note on integrated care pathways: a basic tool for Triple aim improvement of healthcare by collaborative local action

The organization of the care process pursuing a Triple aim improvement of healthcare is a common interest of clinicians, healthcare managers and policy-makers in this period of financial shortage especially as part of Obamacare in the US [1]. The Triple aim is: 1) better perception of care by the patients e.g. by better clinical continuity, 2) better professional effectiveness e.g. by better planning and coordination of the whole patient pathway and at the same time 3) reducing or at least controlling the cost of care e.g. readmissions. Care pathways, clinical pathways or integrated care pathways have so far been used as synonymous terms for a new approach to such improved organization of health care. The term originates from industrial processes in the late 1990s in the US such as production re-engineering and lean management as explained in the theoretical paper by Guus Schrijvers in the oncoming Special Issue of IJIC on Pathways [2] from which a number of studies deserve a special attention. Clinical pathways have been defined and discussed by the European Pathway Association (EPA) as a response to the growing complexity of care [3]. According to EPA, a care pathway is " A complex intervention for the mutual decision-making and organization of predictable care for a well-defined group of patients during a well-defined period ". An example of the need of clinical pathways is the following: to decide on a specific drug for a stroke patient is from the point of view of organization fairly simple as it is exclusively rooted in medical science personalized in the higher ranking physician. However, the formation of a stroke unit requires multidisciplinary collaboration, e.g. the involvement of different therapists, other specialists and the patient which changes the organizational focus from a vertical to a horizontal perspective. Defining characteristics of clinical pathways are: An explicit statement of the goals and key elements • • of care based on evidence, best practice and patient expectations Facilitation of the communication and coordination • • of roles by sequencing the activities of the multidisciplinary care team, patients and their relatives Documentation, monitoring and evaluation of vari-• • ances and outcomes Identification of relevant resources • • Not all care pathways implicate integrated care. We claim that the term integrated care pathway (ICP) should refer especially to pathways integrated across various health care settings, e.g. hospitals and municipal health services. Hence, multidisciplinary collaboration within a single …