Health Care Reform: the iMpact
on practice, oUtcomes and costs of
New roles for health
pROfeSsionals
(MUNROS)
Deliverable 3.1: Criteria for Choice of Care
Pathways and Short List of Care Pathways
Delivery date: 30th November 2013
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Introduction
WP2 identified the clinical areas in which the new professional roles are employed in
partner countries. WP3 will employ a case study methodology to inform questionnaire
design and content, undertaken in WP4, and to distinguish which clinical areas should
be chosen for final study. From among the clinical areas identified in WP2, four care
pathways, for specific disease groups, have been chosen for the conduct of case studies
in WP3. The case studies are designed to distinguish which, from among the four, are
the three most appropriate for final study.
The case studies will identify the range of activities undertaken along each pathway, the
health professionals involved and the tasks they undertake. The chosen pathways
involve health professionals working in primary, intermediate, secondary and tertiary
care organisations. Eighteen case studies will be conducted: two in each of nine partner
countries.
A list of criteria to inform the choice of care pathways has been constructed. It was
drawn up in consultation with the External Advisory Board in June 2013. Following the
External Advisory Board these criteria and a prospective list of care pathways, were
presented to and discussed by a group of stakeholders at a two-day workshop in Prague
in September 2013. The stakeholders made additional suggestions for the short list of
care pathways.
Criteria for Choice
Based upon the feedback from the External Advisory Board and the stakeholders, the
following criteria were employed to select the care pathways:
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Burden to society.
o The clinical condition is of high prevalence.
o Significant morbidity and mortality are associated with the condition.
Routine data exists on health outcomes.
o Outcomes of processes (follow up).
o Intermediate outcomes (eg patient satisfaction).
o Clinical Outcomes (routine data).
With exception to new professional roles, procedures and clinical management
are similar across different national boundaries.
Care could be delivered by a range of health professionals.
o In at least some of the partner countries, care is delivered by either new
professions or in new roles for existing professions.
o The contribution of different professions varies across partners.
Care is delivered in primary and secondary settings.
o One of the selected care pathways will be mainly located in primary care
setting.
o The other selected care pathway will be mainly in secondary care setting.
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In addition it is desirable that one of the care pathways involves:
o Acute and chronic management and surgical procedure.
o Prevalence among those aged 65 and over.
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Further if possible one pathway might involve:
o Predominantly a need for generalised skills.
o Predominantly a need for specialised skills.
o Issues of prioritisation.
The Short List of Care Pathways
The shortlist of care pathways which resulted is as follows:
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Breast Cancer,
Diabetes Mellitus II,
Cardiovascular disease,
Hip fracture
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