Clinical Pathways are evidence-based clinical guidelines for patients with similar diagnoses that when applied aid in the coordination and delivery of high-quality care to improve patient outcomes while containing costs. Clinical Pathway tools and concepts incorporate patient centered best practices and protocols that are customized and locally defined. Join us as we share the considerations and practical steps leading to successful adoption for your organization. Intended Audience: Multidisciplinary Roles - CMIO, CNIO, Medical Directors, Quality Department, Clinic Managers, Clinical Informatics Managers and Analysts Learning Objectives: -Summarize the fundamental concepts of standardized clinical process leading to improved patient care. -Leadership approaches of cross-functional team collaboration. -Recognize the technology role in sustained improved patient outcomes.

1. 1
Clinical Pathways
©2018 Galen Healthcare Solutions - Proprietary and Confidential
Implementing Tools to Accelerate Performance in Quality,
Cost and Patient Experience

2. 2
Today’s Presenters
Laura Gold
• Lead Consultant
• 30+ years of Healthcare Experience
Bec Matias
• Lead Consultant
• 27 years of Healthcare Experience
©2018 Galen Healthcare Solutions - Proprietary and Confidential

3. 3
You have been automatically muted. Please use the Q&A
panel to submit questions during the presentation
©2018 Galen Healthcare Solutions - Proprietary and Confidential

4. 4
Today’s Agenda
Clinical Pathways
• Definition
• Resources
• Approach
• Demonstration
• Benefits and Challenges
©2018 Galen Healthcare Solutions - Proprietary and Confidential

5. 5
Clinical Pathways Defined
Integrated clinical guidelines used to manage the quality of care for
patients with common diagnosis.
 Multidisciplinary
 Locally Agreed
 Patient-Centered
 Evidence Based
 A Tool & Concept
 Support High Quality Care
Delivery
 Embedded Guidelines &
Protocols
©2018 Galen Healthcare Solutions - Proprietary and Confidential

6. 6
The Process
©2018 Galen Healthcare Solutions - Proprietary and Confidential

7. 7
Evidence Based Guideline Resources
• American College of Physicians
• American Academy of Family Physicians
• American Academy of Pediatrics
• Centers for Disease Control
• American Diabetes Foundation
• American Heart Association
• CDC and NIH
©2018 Galen Healthcare Solutions - Proprietary and Confidential

8. 8
Examples of Clinical Pathways
Adult
Appropriate Antibiotic Use
Cardiac Screening
Chronic Kidney Disease
COPD
Depression
Diabetes
Hypertension
Low Back Pain
Nephrolithiasis
Obstructive Sleep Apnea
Osteoporosis
Pediatric and Adolescent
ADHD
Allergic Rhinitis
Bronchiolitis
Diabetes
Group B Step
Hoarseness
Hypertension in Children
Otitis Media
Tonsillectomy
Contraceptive Use
Labor and Postpartum Care
Group B Strep
Contraceptive Use
VBAC
Cardiac
AFib
CVD Risk
Cholesterol
Hypertension
©2018 Galen Healthcare Solutions - Proprietary and Confidential

9. 9
Diabetes Facts
http://main.diabetes.org/dorg/images/infographics/adv-cost-of-diabetes.pdf
©2018 Galen Healthcare Solutions - Proprietary and Confidential

10. 10
Prediabetes Flow Chart DELETE
©2018 Galen Healthcare Solutions - Proprietary and Confidential
Start
Prediabetes Screening HbA1c < 5.5% Retest 3 years
Patient Education
HbA1c > 5.6%
Retest 6 Months HbA1c Increase
HbA1c Reduction
 Medication
 Patient Education
 Nutritionist Referral
 HbA1c

11. 11
Prediabetes Flow Chart
Start > 5.5%HbA1c Retest 3 years
Patient Education
HbA1c 5.6%-6.4%
Retest 6 Months
HbA1c Reduction
Treatment
- Metformin (unless contraindicated)
- Nutritional Referral
- Annual Dilated Eye Exam Referral
- Annual monofilament foot exam
- BP Check
- Lab Tests (renal function, lipids,
microalbumin)
- Manage Comorbid Conditions
- Immunizations
- Patient Education
- Repeat HbA1c
Support
Lifestyle
Changes
Prediabetes Screening Criteria
- Age ≥45 years without other risk factors
- CVD or family history of DM2
- HDL <35 or triglycerides > 250
- BMI > 25 or physical inactivity
- Hypertension (BP >140/90 mm Hg or on therapy for hypertension)
- Chronic glucocorticoid exposure
- Impaired GT, FBS, and/or metabolic syndrome
- History of gestational diabetes
- PCOS, acanthosis nigricans, non-alcoholic fatty liver disease
- Antipsychotic therapy for schizophrenia and/or severe bipolar
disease
- Sleep disorders in the presence of glucose intolerance
- Member of an at-risk racial or ethnic group
Retest yearly
Diabetes Diagnosis
HbA1c 6.5% to 9.0 %
HbA1c > 9.0%
©2018 Galen Healthcare Solutions - Proprietary and Confidential

12. 12
Diabetes Diagnosis
Diabetes Flowchart
HbA1c > 9.0% Treatment Plan
- Start Metformin
- Repeat HbA1c in 3 months
- Titrate Metformin to maximum tolerated dose
- Address co-conditions
- Hypertension goal <140/90 First line therapy ACE unless contraindicated Lipid management
- Recommend Immunizations
- Continued Patient Education, Hypoglycemic risk, HbA1c goal, lifestyle modification
- Referrals to Nutrition, Endocrinology, Ophthalmology
- If HbA1c is >9% then add insulin (see Medication and Insulin Graphics)
Immunization as Indicated
- Influenza
- Pneumococcal
- Hepatitis B
Lipid Management
- Check Yearly
- Statin Therapy
Referrals
- Ophthalmology-Dilated Eye Exam
- Nutrition
- Endocrinology
Patient Education
HbA1c Goals
©2018 Galen Healthcare Solutions - Proprietary and Confidential

13. 13
Medication Management
http://clinical.diabetesjournals.org/content/35/1/5.figures-only
©2018 Galen Healthcare Solutions - Proprietary and Confidential

14. 14
Insulin Titration
©2018 Galen Healthcare Solutions - Proprietary and Confidential

15. 15
DEMO

16. 16
Implementation Planning

17. 17
Reporting & Maintenance
Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
On-Pathway Off-Pathway Linear (On-Pathway) Linear (Off-Pathway)

18. 18
Benefits & Challenges
Is this potential pathway practical at this
time?
• Do we have the capacity?
• Would all of the stakeholders have buy-in?
Do we have the resources to support this
potential pathway?
• To perform an analysis of the current
state/weigh pros and cons
• To develop and support the pathway -
includes data analysis, project plan
development & dashboard
What evidence is available?
• Is this an existing (In-house) clinical
effectiveness guideline?
• Is there peer-reviewed, published
evidence?
• Do any of our peer institutions have a
clinical pathway or guideline?

19. 19
Resources
American Diabetes Association: http://www.diabetes.org/
The Global Initiative for Chronic Obstructive Lung Disease
http://www.goldcopd.org/Guidelines/Resources.asp
GI Clinical Guidelines: http://gi.org/clinical-guidelines/clinical-guidelines-sortable-list/
National Institute of Mental Health: https://www.nimh.nih.gov/health/publications/depression
American Academy of Family Physicians: https://www.aafp.org/home.html
CDC: https://www.cdc.gov/

20. 20
Q&A Session
©2018 Galen Healthcare Solutions - Proprietary and Confidential

21. 21
Thank You!
Thank you for joining us today. To access the slides from today’s
presentation, please visit:
http://wiki.galenhealthcare.com/Category:Webcasts
For additional assistance or to request information about our many
services and products, please contact us through our website:
www.galenhealthcare.com

22. 22Confidential © 2016 Galen Healthcare Solutions
OUR PHILOSOPHY

23. 23©2018 Galen Healthcare Solutions - Proprietary and Confidential