Developing care pathways--lessons from the Steele Review implementation in England.
OBJECTIVE
This paper sets out to discuss the concept of care pathways, review their definition, features and implementation and using an example from the NHS dental system in England guide the development of an elder care pathway.


BACKGROUND
Care pathways have developed from quality management approaches in industry and focus on a number of steps which are intended to lead to expected outcomes. The existing definition and descriptors of care pathways serve well, but miss the complex process underlying the development of pathways, their structure, implementation and evaluation.


RESULTS
The literature identifies key features of clinical pathways and from the developing field of implementation science, the factors likely to support pathway implementation. Pathways must be generic enough to enable them to be applicable broadly, but specific enough for them to be locally relevant and population specific. The development of care pathways in the National Health Service (NHS) Dental Service in England is described and when compared with the implementation science literature exhibits features identified as positive factors for implementation. As a result a contribution to the pathway definition literature is offered.


CONCLUSIONS
Learning from the literature and the practical experience described from England, the process for developing dental care pathways for dependent elders should begin with the creation of a high level pathway, which is cognisant of the clinical and implementation science evidence base.
Dental Public Health, Public Health England, Preston, UK.
Eric
E
Rooney
D000368:Aged; D019091:Critical Pathways; D016321:Dental Care for Aged; D004739:England; D055094:Evidence-Based Dentistry; D006284:Health Plan Implementation; D006291:Health Policy; D006295:Health Resources; D006801:Humans; D009909:Oral Health; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D013218:State Dentistry
care pathway development; clinical pathways; elders.; implementation science; primary dental care; steele review