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    Clinical pathways: A roadmap to medical success

     

    The Medtronic presentation gave examples from Vanderbilt, a large urology group (Metro Urology in metropolitan Minneapolis), and a solo urologist practice. Given the numerous official algorithms that exist (including the AUA’s and the UK’s), creating a pathway shouldn’t be that hard, although getting everyone in the group to agree to it might be.

    One key aspect of the pathway is follow-up. The data suggest that as many as 86% of patients stop using medical treatments for OAB in the first few years due to cost, side effects, or low efficacy (Clin Interv Aging 2016; 11:755-60). With that in mind, these pathways suggest that someone (eg, a nurse care navigator) contacts the patient after each treatment intervention to re-assess. This limits the number of patients who “disappear” after one office visit. By maintaining contact with the patient, we can ensure they are getting good response from their treatment and can verify that those patients who fail first-line therapy are moved down the pathway toward more advanced treatments.

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    Once you have that in place, the next step is to make sure that the pathway is being followed. This involves evaluating how patients were treated and how they are progressing down the pathway. This should not be seen as Big Brother looking over your shoulder. Instead, view it as an opportunity to identify patients who have veered off the care pathway and whose treatment can be maximized by getting them back on it. Creating a standardized pathway—and having the data to show how your group adheres to it—is also something to present to your local insurance companies and streamline the pre-authorization process and maximize reimbursement. Insurance companies manage risk; if you can help to define that risk, you will be rewarded.

    In researching this blog, I quickly learned that the clinical pathways concept is widespread in larger academic centers and in many of the larger integrated urology groups. My hope is you now know that, even with a minimal amount of investment in time and energy, small-town plumbers like us can dramatically improve both patients’ lives and our bottom line.

    If anyone else has experience with clinical pathways or has other ideas about how to combine good medicine with financial success, please write me at [email protected] or sign in below to post a comment. 

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    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.

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