COMMON MYTHS ABOUT CARE PATHS

1. Care paths can be created for any and all Clinical Practice Guidelines.
   Guidelines might be referred to in many care paths (e.g. a guideline for blood transfusion). But guidelines focus on the appropriateness of care selection while care paths focus on the coordination of care delivery. These two do not create information that maps across from one to the other.
2. Care paths are a tool that will solve all your documentation problems.
   If there is a problem with producing standardized documentation for surgical patients, it is better to solve it for all surgical patients and not just for those within one care group. Documentation problems are never isolated to a single patient group. Care path work may help in defining problems with documentation selection and in identifying possible solutions but they are not the most efficient place to develop the solutions.
3. Care paths always take a long time to create.
   If care path development seems to take a long time, perhaps the group members have not agreed on their roles prior to starting the process. Have schedules and responsibilities been clearly defined before the group starts and is the work evenly distributed? Perhaps there is the expectation of an unattainable perfection, or someone in the group is demanding perfection as a subtle way of delaying potential change?
4. Retrospective variance tracking will give you the most powerful practice and system changes.
   Variances should be identified and addressed every day--the power of care paths lies in the fact that they allow proactive changes to be made in a patient's treatment plan or plan of care in response to variances. Retrospective summaries give general information about how you are doing, which is useful for reporting general progress but not for making the day-to-day, patient-by-patient changes that add up to real change.
5. You need sophisticated formulas to find patient groups with practice variability worthy of care path development.
   Get to know the person in the Health Records Department who will be assisting with reports. Indicate that the objective is a summary report of the top Case Mix Groups (CMGs) by conservable days, grouped by physician and giving summaries of Average Length of Stay (ALOS), average age and average RIW (Resource Intensity Weighting, the proxy for cost). Determine whether individual doctors vary from the group averages. The process is simple, but it provides an initial picture.
6. Care paths can be developed for any group of patients who can be clearly described.
   If the group of patients does not move through clearly-defined phases of care and/or recovery, is the information suitable for developing a care path? Perhaps another clinical or care management tool would be more appropriate.
7. Once you have developed a care path, it is final, and you have it forever.
   Changes in practice and new evidence can cause changes to the tool. Conversely, sometimes using the tool causes changes in practice. Patients are sometimes cared for somewhere else or their care is simplified and the path is not needed. Paths cause change and may themselves change or disappear.

This page was created by Jennifer Hockley with contributions from Judith Weinstein, 1999