P2D127: Leveraging Learning Health Systems Science to Standardize Care Across the Continuum Through Clinical Pathways

Purpose/Objectives: Clinical pathways (CP) utilize improvement and implementation science to align care teams and families to reduce clinical variation, leverage standards from industry sources, reduce costs and improve provider ease of care. The literature on CP compliance is limited, making the identification of benchmarks challenging. This is due to the adaptation of national guidelines to fit institutional needs, and the disconnect between CPs within the same institution. Currently, there is no literature on the development of clinical pathways across the continuum of care or their utilization at an organizational level. The objective is to describe the utilization of learning health systems (LHS) science in the development and operationalization of CPs to promote systemness and standardization of care across the multicenter healthcare continuum within a single organization.

Design/Methods: A clinical standardization initiative was carried out as part of the strategic mission in a pediatric health system with free-standing children's hospitals and outpatient clinics in Florida and Delaware Valley. A CP was defined as the combination of a pathway algorithm, metrics and data monitoring, condition and unit-specific process changes and electronic medical record (EMR) integration. The CP development process involved quality improvement methodology with clinical standard work processes and deliverables using PDSA cycles. The process measure was utilization of CPs in 80% of patients who meet criteria across the organization. CP success was identified as improved patient outcomes exemplified by achieving the target metric.

Results: Bronchiolitis and Gastroenteritis were chosen for standardization across the healthcare continuum of Telehealth, Urgent Care, Primary Care, Emergency Department and Acute Care. Over 100 multidisciplinary associates collaborated in observations across all clinical sites in FL and DV. Over 2169 associates were trained over the span of 90 days thru 40 virtual training sessions, web-based training, and super user education. CP utilization was measured weekly. Scorecards were developed to disseminate CP utilization, outcome metrics, and details at an organizational, regional, clinical site, and provider level. Current CP utilization is around 60%. CP metrics are trending toward improvement.

Conclusion/Discussion: Standardizing care across the healthcare continuum and different regions within the same organization is a daunting and complex, multidisciplinary endeavor. The implementation of LHS utilized internal data and experience to systematically integrate evidence-based medicine and put it into practice. This fluid and dynamic LHS process assisted in the alignment of improved care, by aiding patient and clinician-decision making.