Abstract
Liaison critical pathways (pathways) can be considered a product of incorporating critical path methods for medical collaboration. The Central Kochi medical care area is a regional core city-type area with a population of 570,000. With the objective of improving and making more efficient use of collaborative care for cerebral stroke we developed a liaison critical pathway for application in an entire secondary medical care area. Professionals from various fields at multiple facilities participated in the development and government and medical associations were involved from the start. In July 2008 pathways were introduced with the participation of 5 acute phase hospitals and 27 sub-acute phase hospitals.
We focused on collaborative care for cerebral stroke and developed four types of critical pathways based on collaboration patterns. Critical pathways comprised in-hospital pathways and concurrently executed pathways, and did not delve into the contents of medical care. Specifically, issues related to collaboration were managed using collaboration critical pathways, while the contents of medical care were managed using in-hospital pathways. Each of the four critical pathways consists of an overview and an information sharing form. The information sharing form is divided into four parts: an acute phase, recovery phase, maintenance phase and the primary care physician, and it is similar in format to daily critical pathways of in-hospital pathways. This same form was established in all four critical pathways to enable the use even after future changes in collaboration patterns. The pathways are to be implemented for a one-year period from the onset of the acute phase and scheduled to be revised every two years to reflect revisions to medical service fees. Problems regarding the initial stage of implementation were examined during the development.
Unification of evaluation criteria and standardization of care in the community can often be achieved during pathway development and the initial stage of implementation. However so far, community-wide support for cerebral stroke, that uses collaboration pathways as tools, is limited to inter-hospital collaboration. Collaboration with primary care physicians and homecare services is still an issue.
