Regional Integrated Cardiovascular Risk Management Care Pathway in the Netherlands: Benefits and Working Mechanisms.

Abstract

Background: Integrated cardiovascular risk management care pathways are initiated nationwide to decrease the morbidity, mortality, and costs of cardiovascular diseases. However, evidence on cardiovascular risk management care pathways is needed to support broader scaling up of these initiatives.

Aim: To evaluate a Dutch cardiovascular risk management care pathway to identify benefits for patients and professionals and determine working mechanisms for upscaling integrated care initiatives.

Methods: Process and clinical indicators: retrospective cohort design combined with quasi-experimental time-series design with longitudinal data (2014 to 2019, n = 3779) examined using an ANOVA with contrasts. Team indicator: a survey. Working mechanisms: multidisciplinary focus groups and interviews with patients.

Results: Process, team, and clinical indicators showed that cardiovascular risk management care pathway is beneficial for enhancing quality of care and inter-professional collaboration. Six working mechanisms were identified: boundary spanners, boundary objects, network platform, continuous learning and improvement, mixed-methods evaluation, and multilevel connection for upscaling.

Conclusion: Vertical integration formalized in a care pathway benefits both patients and professionals in primary and secondary care settings. Also, evaluation with multiple research methods enables a more comprehensive understanding of the context in which care pathways are implemented and working mechanisms, which is essential for scaling up integrated care initiatives.