Managed care: Development of an integrated care pathway in neurosciences

Abstract

The concept of managed care is emerging as a multidisciplinary approach to health care in the United Kingdom. It is implemented through an integrated care pathway (ICP) or care map which is created by the multidisciplinary team around a specific diagnostic group. The ICP consists of key interventions which can be evidence-based, incorporating clinical guidelines where appropriate. The aim of managed care is to improve quality of care while reducing length of stay, thus reducing costs. A pilot project was carried out in the neurosciences unit of a London teaching hospital over a six-month period. Lumbar disc surgery was chosen as the diagnostic group. Outcomes were better coordination of care and less variation in length of stay as well as improved communication and collaboration between the multi-professionals involved. Drawbacks were poor compliance by some clinicians and the time-consuming nature of creating the care map. Recommendations are that where ICPs are used this should be a single record replacing all other documentation.