Rooney Eric
Dental Public Health, Public Health England, Preston, UK.
Gerodontology. 2014 Feb;31 Suppl 1:52-9. doi: 10.1111/ger.12084.
This paper sets out to discuss the concept of care pathways, review their definition, features and implementation and using an example from the NHS dental system in England guide the development of an elder care pathway.
Care pathways have developed from quality management approaches in industry and focus on a number of steps which are intended to lead to expected outcomes. The existing definition and descriptors of care pathways serve well, but miss the complex process underlying the development of pathways, their structure, implementation and evaluation.
The literature identifies key features of clinical pathways and from the developing field of implementation science, the factors likely to support pathway implementation. Pathways must be generic enough to enable them to be applicable broadly, but specific enough for them to be locally relevant and population specific. The development of care pathways in the National Health Service (NHS) Dental Service in England is described and when compared with the implementation science literature exhibits features identified as positive factors for implementation. As a result a contribution to the pathway definition literature is offered.
Learning from the literature and the practical experience described from England, the process for developing dental care pathways for dependent elders should begin with the creation of a high level pathway, which is cognisant of the clinical and implementation science evidence base.
本文旨在探讨护理路径的概念，回顾其定义、特点及实施情况，并以英格兰国民医疗服务体系（NHS）牙科系统为例，指导老年护理路径的制定。
护理路径源于工业质量管理方法，聚焦于一系列旨在达成预期结果的步骤。护理路径现有的定义和描述虽适用，但未涵盖路径开发、结构、实施及评估背后的复杂过程。
文献明确了临床路径的关键特征，以及实施科学发展领域中可能支持路径实施的因素。路径必须具有足够的通用性，以便广泛适用，但又要足够具体，使其与当地情况相关且针对特定人群。文中描述了英格兰国民医疗服务体系（NHS）牙科服务中护理路径的开发情况，与实施科学文献相比，呈现出被视为实施积极因素的特征。因此，为路径定义文献做出了贡献。
借鉴文献及英格兰所述的实践经验，为依赖他人照料的老年人制定牙科护理路径的过程应始于创建一个高层次路径，该路径要认识到临床和实施科学证据基础。
