The Healthcare Pathway Management In Organisations Acting As Interfaces Between The Hospital And The Medical And Social Ambulatory Services
Résumé
OBJECTIVES:
The patient centred approach and the use of Information and Communication Technologies (ICT) reveal an
evolution in the practice of coordination in organisations acting as interfaces between the hospital and the
ambulatory medical and social services.
In a Healthcare Network (réseau de santé), the coordinator is in charge of making the connection with all the
medical and social professionals involved in the patient’s caring and monitoring; those professionals usually
take part of the Healthcare Network.
The main goals in the definition of the MAIA (Maisons pour l’Autonomie et l’Intégration des malades Alzheimer)
are the principle of case management and the concept of integration of care.
In the Healthcare Pathways, the patient centred approach implies to manage the coordination of a multidisciplinary
team, which should deal with all the aspects of the patient care, and to display information, advice,
therapeutic education and patient monitoring, aiming at involving the patients in the process.
Through these evolutions, we will try to analyse the function of Healthcare Pathway Manager (HPM), and the
part played by ICT in the management of Healthcare Pathways.
METHODOLOGY:
We intend to outline some relevant evolutions and highlight in an overview the main differences between the
functions of coordinator in a Healthcare Network, assistant in coordination (as nurse of social assistant) in a
hospital, care manager in a MAIA, and in healthcare pathway for elderly people: PAERPA (“Personnes Agées En
Risque de Perte d’Autonomie”).
The recent territorial support platforms (Plateforme Territoriale d’Appui or PTA) also require specific functions
and new professions in coordination.
For this purpose, we will examine both the content of the existing training programs for those functions, and
the methods and tools that are in use in such organisations acting as interfaces between the hospital and the
ambulatory actors, also integrating the patients involvement in an empowerment and co-production of services
perspectives.
EXPECTED RESULTS:
Characterizing the innovative concept of Healthcare Pathway Manager (HPM), this overview aims at clarifying
the effects of the setting up of the function especially for avoiding breaches in the pathway organisation and for
increasing the efficiency of the pathway approach.
Our goal is to outline the consequences of the use of appropriate ICT tools: in this sense, the example of the
PAERPA is significant with the definition of specific forms for recording and sharing essential information about
patients at the different periods and stages of the healthcare pathway in order to avoid any breach.
We will examine how the digital platforms can help to track individual healthcare pathways and improve the
patients’ monitoring and to follow efficiency indicators such as costs and delays.
In those patient-centred approaches, the Patient-Reported Experiences Measures (PREMs) and Patient-Reported
Outcome Measures (PROMs) could also be required for evaluating the efficiency.