Pay for Quality

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