Learning Care Pathways Framework: A New Method to Implement, Learn, Replicate, and Scale up Care Pathways for and With the Patient

Background: Although care pathways are a response to the calls for a major change in health system redesign initiatives, very few articles have proposed an implementation method. Indeed, no method exists for large-scale projects of care pathways, as sets of interventions within health systems. Drawing on the systems thinking approach and the pragmatic sociology, we describe the implementation methodology of the Learning Care Pathways (LCP) framework, a method to implement, learn, replicate, and scale up care pathways for and with the patient. Methods: The LCP was conceptually developed through a series of literature reviews on key methodological concepts. As a comprehensive, theory-informed approach, the LCP emerged by linking implementation strategies, research methods, learning mechanisms and outcomes dimensions aimed at optimising care pathways. Results: Designed around 13 steps grouped into five phases, this framework provides implementation strategies, research methods and learning mechanisms, including levers for patient involvement. The pre-implementation phase enables the selection of the pilot project's receiving environment and the design of the project. The implementation phase is designed to co-construct and implement an optimised care pathway based on a scientific analysis of the patient journey, the care pathway perceived by professionals, the care pathway from data and integrating knowledge from international clinical practice guidelines. The post implementation phase aims to demonstrate value creation and set up a learning cycle. The replication phase is designed to repeat the method locally to develop horizontal learning and to evaluate scalability. Finally, the scale up phase aims to repeat the method in other territories to accelerate knowledge creation and develop horizontal and vertical learning. Conclusion: This framework is of particular interest to policy-makers, healthcare managers, and researchers alike, and must be the subject of several experiments to conduct reproducible research that can lead to national Learning Health Systems (LHS).