A guide for Integrated Care Pathways in Osakidetza-Basque Health Service. Some reflections.

Introduction: After several years of promoting integrated care pathways (ICP), in 2020 Osakidetza published the corporate document for the design, implementation and evaluation of corporate integrated care pathways (CICP) throughout its network of integrated care organisations (ICOs). This paper describes its elaboration, contrast and some reflections on its extension. Aims, Objectives: integrated care continues to be one of Osakidetza's strategic challenges, after having completed the integration of primary care and hospital care throughout the entire service in thirteen ICOs over the past decade. The ICPs are intended to be the operative space in which the various fundamental elements of integrated care come together. It is necessary to standardise the use of this tool in the ICOs as a whole, and to this end it was decided to draw up a reference guide for the entire network. Highlights: Definition of ICP: one of the first issues to be resolved was the concept of ICP, which is often confused with terms like clinical practice guideline, protocol, etc. The definition developed takes a dual perspective, from the professional-managerial point of view and from the point of view of the patient and their relatives. Differential elements of ICP: the proposed concept of ICP inherently entails: - agreement among all actors, including patients and relatives, - explicit description of the goals and key elements of treatments and care based on evidence, best practices and the expectations of patients and their relatives, - coordination of the care process - recording, monitoring and evaluation of variability and outcomes. Checklist: a tool is proposed to enable ICOs to assess their existing ARs and to guide the design of new ICPs. This checklist is composed of 18 questions with a Likert scale of 1 to 7 grouped into six domains: - ICP rationale, shared leadership and institutional momentum - Constitution, functioning, independence of the ICP Elaboration Group - Pathway design (scope, usability and external review) - Incorporation of evidence into the ICP Training, dissemination and implementation - Monitoring and evaluation. Conclusions: The checklist was piloted with the COPD care pathways that several ICOs had been working with previously. The usefulness of the corporate document and its checklist has been confirmed, with both the Corporate level and ICOs stating that they will use it for the design and implementation of new ICPs or for the adaptation of existing ICPs. Implications For Applicability And Limitations: one of the reflections provoked by this process is the as yet unresolved issue of extending the use of this guide to the whole of the Osakidetza's network of ICOs. There are two main alternatives, with intermediate possibilities between, depending on which criterion is given more weight: 1. Under a more centralised and standardising criterion for the creation of CICPs, the development of corporate ICPs to be implemented locally by the ICOs. 2. Under a criterion of greater autonomy for each organisation but based on common characteristics set out in this corporate guide, local ICP developed directly by each ICO. [ABSTRACT FROM AUTHOR]