Critical pathway experience at New England Medical Center

At NEMC, critical pathway development started in areas in which we sought managed care contracts. Critical pathways are now developed by specific clinical services as they analyze their high-volume or high-cost case types. Our initial efforts have demonstrated the value of intervention by pharmacists in the analysis of the drug therapy aspects of pathways. To date, our critical pathway development has been focused on inpatient treatment and includes disease treatment methods as well as costs. In time, our PPI-guided development of critical pathways should reflect comprehensive treatment of patients with acute as well as nonacute disease. In this context, educating patients about their disease and drug therapy and monitoring compliance and overall drug treatment are vital to the successful implementation of critical pathways used in a capitated payment environment.