Which criteria to prioritize the healthcare problems to be treated through the Integrated Care Pathways?

Background An Integrated Care Pathway (ICP), also known as Care or Clinical or Critical Pathway is a multidisciplinary care plans which detail the essential steps of a specific clinical problem. The introduction of ICPs in healthcare organizations should provide better healthcare to patients and reduce unnecessary variations in practice. While there is a huge literature on definition, design and managing of an ICP, criteria to select the health problems are lacking. Therefore we aimed to define those prioritization criteria useful to define ICPs in healthcare organizations in Europe. Methods A systematic review was performed in Pubmed, Scopus, CINHAL and Medline web search databases, using a Boolean search by the following mesh terms and free text word: clinical pathway, critical pathway, integrated care pathway, health priority, health problem, health issue and plan. The Delphi technique, as a structured process using a series of questionnaires to gather information, held until group consensus is reached, was applied to select and validate criteria useful for ICPs’ health problems selection. Results Because no articles, dealing with ICP prioritization criteria, were found, a second review was performed, focusing on priority setting of health interventions as a whole. 32 of the 327 articles resulting from the second review were included. Several criteria dealing with different dimensions (eg. feasibility, health distribution, health level, responsiveness, social and financial risk protection) were identified. Then, a Delphi panel, composed by European experts on ICPs implementation, was established. Preliminary results suggest that high priority should be assigned to health care problems characterized by a high need/demand volumes, wired evidences available, social and technological pressure, debate on literature. Conclusions Against the growing interest in ICPs implementation as suitable tools to minimize delays and resource utilization and to maximize quality of care, no universal criteria useful to prioritize and plan ICPs implementation in healthcare organizations are available. Our framework, composed by dimensions, criteria and weights, should assist healthcare organizations’ decision makers in planning activities and resource allocation. Key messages Selection of health problems to be faced through ICPs implementation should be guided by several validated and shared criteria in order to ensure a better answer to health problems. Priority setting in a comprehensive ICP selection has policy implications on resources allocation, strategic planning and overall governance and management, with undoubted effects on equality, too.