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