Gartner Jean-Baptiste, Lemaire Célia, Côté André
Département de management, Faculté des sciences de l'administration, Université Laval, Québec City, QC, Canada.
Centre de recherche en gestion des services de santé, Université Laval, Québec City, QC, Canada.
Int J Health Policy Manag. 2025;14:8517. doi: 10.34172/ijhpm.8517. Epub 2025 Mar 11.
Although care pathways are a response to the calls for a major change in health system redesign initiatives, very few articles have proposed an implementation method. Indeed, no method exists for large-scale projects of care pathways, as sets of interventions within health systems. Drawing on the systems thinking approach and the pragmatic sociology, we describe the implementation methodology of the Learning Care Pathways (LCP) framework, a method to implement, learn, replicate, and scale up care pathways for and with the patient.
The LCP was conceptually developed through a series of literature reviews on key methodological concepts. As a comprehensive, theory-informed approach, the LCP emerged by linking implementation strategies, research methods, learning mechanisms and outcomes dimensions aimed at optimising care pathways.
Designed around 13 steps grouped into five phases, this framework provides implementation strategies, research methods and learning mechanisms, including levers for patient involvement. The pre-implementation phase enables the selection of the pilot project's receiving environment and the design of the project. The implementation phase is designed to co-construct and implement an optimised care pathway based on a scientific analysis of the patient journey, the care pathway perceived by professionals, the care pathway from data and integrating knowledge from international clinical practice guidelines. The post implementation phase aims to demonstrate value creation and set up a learning cycle. The replication phase is designed to repeat the method locally to develop horizontal learning and to evaluate scalability. Finally, the scale up phase aims to repeat the method in other territories to accelerate knowledge creation and develop horizontal and vertical learning.
This framework is of particular interest to policy-makers, healthcare managers, and researchers alike, and must be the subject of several experiments to conduct reproducible research that can lead to national Learning Health Systems (LHS).
尽管护理路径是对卫生系统重新设计倡议中重大变革呼声的回应，但很少有文章提出实施方法。实际上，作为卫生系统内一系列干预措施的护理路径大规模项目不存在实施方法。借鉴系统思维方法和实用社会学，我们描述了学习护理路径（LCP）框架的实施方法，这是一种为患者并与患者一起实施、学习、复制和扩大护理路径的方法。
LCP在概念上是通过对关键方法概念的一系列文献综述而发展起来的。作为一种全面的、基于理论的方法，LCP通过将旨在优化护理路径的实施策略、研究方法、学习机制和结果维度联系起来而形成。
该框架围绕分为五个阶段的13个步骤设计，提供了实施策略、研究方法和学习机制，包括患者参与的杠杆。实施前阶段能够选择试点项目的接收环境并设计项目。实施阶段旨在基于对患者就医过程的科学分析、专业人员感知的护理路径、数据中的护理路径以及整合国际临床实践指南中的知识，共同构建和实施优化的护理路径。实施后阶段旨在展示价值创造并建立学习循环。复制阶段旨在在当地重复该方法以发展横向学习并评估可扩展性。最后，扩大阶段旨在在其他地区重复该方法以加速知识创造并发展横向和纵向学习。
该框架对政策制定者、医疗保健管理人员和研究人员都特别有意义，并且必须成为若干实验的主题，以进行可重复的研究，从而形成国家学习型卫生系统（LHS）。
