Pay for Quality
Pay for Quality
Pay for Quality
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
114 <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong> KCE Reports 118<br />
Table 8: Clinical pathways<br />
II. CLINICAL PATHWAYS<br />
Initiated by Center <strong>for</strong> Health Services and Nursing Research (CZV-KULeuven),<br />
Université Catholique de Louvain in Belgium and the<br />
Kwaliteitsinstituut voor de Gezondheidszorg (CBO) in the<br />
Netherlands<br />
Overall objective To improve and maintain quality of care in a balanced way with<br />
attention <strong>for</strong> all relevant quality dimensions<br />
Date of implementation in Belgium April 2000<br />
Target audience Hospitals, Rehabilitation Centers, Primary Care Organizations<br />
Content A care pathway is a complex intervention <strong>for</strong> the mutual decision<br />
making and organization of care processes by hospital providers and<br />
policy makers <strong>for</strong> a well-defined group of patients during a welldefined<br />
period (e.g. the use of in hospital arthroplasty pathways, the<br />
use of transmural oncology pathways, etc.). Defining characteristics<br />
of care pathways include:<br />
(i) An explicit statement of the goals and key elements of care based<br />
on evidence, best practice, and patients’ expectations and their<br />
characteristics;<br />
(ii) the facilitation of the communication among team members and<br />
with patients / families;<br />
(iii) the coordination of the care process by coordinating the roles<br />
and sequencing the activities of the multidisciplinary care team,<br />
patients and their relatives;<br />
(iv) the documentation, monitoring, and evaluation of variances and<br />
outcomes; and<br />
(v) the identification and use of the appropriate resources.<br />
The aim of a care pathway is to enhance the quality of care across<br />
the continuum by improving risk-adjusted patient outcomes,<br />
promoting patient safety, increasing patient satisfaction, and<br />
optimizing the use of resources.<br />
Currently about 1100 clinical pathways are (being) developed in 106<br />
Primary focus (structure, process<br />
outcome)<br />
participating institutions.<br />
Process is the main focus by identifying and optimizing key<br />
interventions throughout the patient care flow. However, outcomes<br />
are also measured to guide and monitor the process.<br />
Type of indicators used (if any) Process & Outcome indicators are used within a be<strong>for</strong>e after<br />
comparison.<br />
Purpose of indicators used Disease specific outcome indicators and process indicators<br />
measuring the compliance to the key interventions.<br />
Type of incentives Only within organization incentives, no financial incentives from<br />
government except <strong>for</strong> indirect effects (e.g. financial yield of a lower<br />
length of stay).<br />
Results (if available) Improved coordination and follow up of the care process.<br />
Clinical results are disease and case study specific based on actual<br />
Sources (most relevant ones)<br />
bottlenecks which were found in pre-test (as-is phase).<br />
243-245<br />
Total budget Unknown<br />
Table 9: Providers’ accreditation<br />
III. PROVIDERS’ ACCREDITATION (Licensure and certification)<br />
Initiated by Physician-Insurers National Commission of the National Institute <strong>for</strong><br />
Health and Disability Insurance (NIHDI) (INAMI/RIZIV)<br />
Overall objective To support continuous learning with regard to up to date medical<br />
knowledge and competences<br />
Date of implementation in December 13<br />
Belgium<br />
th , 1993<br />
Target audience GPs and specialists, dentists