What is care pathway analysis?

The care pathway is the journey that a patient with a specific medical condition takes during an episode of healthcare.  Care pathway analysis (CPA) facilitates the identification and mapping of medical decisions within the current pathway for a certain condition.  These decisions are often presented graphically using a flow diagram.  Initially, CPA can involve a guideline review to identify and synthesise the relevant national and international guidelines that describe the care pathway.  The review might be very pragmatic, depending on the amount of literature in the field and the availability of national guidelines for the relevant clinical area.

The guideline review is usually followed by interviews with an independent panel of experts (clinicians and/or other relevant stakeholders) to understand where real-world practices may differ from the published guidance, and why.  These interviews can also capture variations in clinical practice between countries and regions.

When is care pathway analysis useful?

In the early stages of product development, CPA can help determine where a new technology could be embedded within the care pathway.  CPA also acts as an independent verification of the current value proposition and helps early identification of potential barriers and facilitators for future adoption of the new technology.  Findings from the CPA can be used to improve the design of the technology at an early stage or its adoption strategy / marketing approach, increasing the chances of product implementation success.  CPA may also provide an indication of the parameters that need to be collected in future clinical trials and the economic considerations for adoption.

CPA can be useful in other contexts.  For example, in situations where there is a lack of robust data.  This is particularly evident in rare diseases research, where RCTs are limited and often have small populations.  The care pathways associated with these rare diseases are usually not described in the national guidelines and thus are characterised by high variability.  In this context, CPA (often associated with expert opinion elicitation techniques) can facilitate the identification of medical decisions and outcomes in the care pathway to support the development of an economic model, which can reduce uncertainty associated with the model structure and inputs.