Care pathways: a strategy for integrating care

Fragmented care is one of the biggest challenges facing health systems. When care is scattered, clinical information gets lost and the patient struggles to move between the different levels of care.

The concept of care pathways (CPs) exists to minimize this fragmentation: it is a tool that helps map out a safe, continuous care path for the patient to follow.

In this article, understand what care pathways are, their technical basis in the SUS (Brazil’s public health system) and their strategic importance for private healthcare.

What are care pathways?

Unlike an approach centered only on the acute episode of illness, the care pathway focuses on the patient journey. It organizes the care flow, coordinating actions that range from health promotion and risk prevention to diagnosis, treatment and rehabilitation.

According to Ordinance No. 4,279/2010, which sets the guidelines for Health Care Networks (RAS), the care pathway works as the operational axis that connects the points of care.

Care pathway and clinical protocol: what are the differences?

These two terms are often confused, but although they are complementary, they serve different functions:

• Clinical protocol: focuses on standardizing technical and drug-related conduct for a specific condition within a service (for example, a sepsis management protocol in an ICU).

• Care pathway: a network management tool. It defines the responsibilities of Primary Care, the referral flow to specialists and the criteria for hospital discharge, ensuring that care is not interrupted.

In practice: the example of mental health

The Psychosocial Care Network (RAPS) is a good illustration of how a care pathway is implemented. The goal is to replace the old model of isolated hospital admissions with an integrated system:

1. Primary Care: responsible for initial intake and management of mild cases, using matrix support to improve the quality of care.
2. Specialized Care (CAPS): handles more complex cases; this is where the Individual Therapeutic Project (PTS) is drawn up, prioritizing the person’s rehabilitation and autonomy.
3. Emergency and hospital: step in only during acute crises, with a commitment to reconnect the patient to the outpatient network once they are stable.

Examples of care pathways in Brazil

The Ministry of Health recognizes and regulates several priority care pathways. The main ones include:

Cancer care pathway

The cancer care pathway organizes the patient’s path from prevention and screening to treatment and palliative care.

It is regulated, among other rules, by the National Policy for Cancer Prevention and Control.

This pathway involves:

• primary care (screening and early diagnosis);

• specialized care (biopsies, staging);

• hospital treatment (surgery, chemotherapy, radiotherapy);

• rehabilitation and palliative care.

Source: Ministry of Health – Ordinance No. 874/2013

Chronic disease care pathway

Care pathways for chronic diseases such as diabetes and hypertension are structured to ensure longitudinal follow-up, prevention of complications and treatment adherence.

They are aligned with the Strategic Action Plan to Tackle Chronic Noncommunicable Diseases (NCDs) in Brazil.

Source: Ministry of Health – NCD Plan

Maternal and child care pathway

The maternal and child care pathway brings together prenatal care, childbirth, the postpartum period and child care, with a focus on reducing maternal and infant mortality.

In the SUS, this pathway is put into practice mainly through Rede Cegonha (the Stork Network).

Source: Ministry of Health – Ordinance No. 1,459/2011

Efficiency and sustainability in healthcare management

Adopting care pathways is also a financial sustainability strategy. The Pan American Health Organization (PAHO) points out that integrated systems drastically reduce avoidable costs.

Main benefits for healthcare management

• Rational use of resources: reduces duplicate tests and consultations by centralizing information and defining precise workflows.

• Better clinical outcomes: continuous monitoring can prevent complications from chronic diseases, reducing emergency admissions, which are costly.

• Patient safety: by ensuring that the transition between levels of care (from hospital to home, for example) is coordinated, it reduces medication errors and failures in continuity of treatment.

Conclusion

Care pathways represent the evolution from a reactive model of healthcare to a preventive, coordinated one. In Brazil, with its aging population and rising chronic noncommunicable diseases, this strategy helps make the health system both effective for the patient and viable for the manager.

Technological integration, through interoperable medical records, and clinical governance are the next steps for care pathways to reach their full transformative potential in public and private healthcare.