Path Clinic: Palliative and Therapeutic Harmonization

Abstract

Those who care for older adults face an increasingly common “tipping point” where human vulnerability—or “frailty”—meets complex care options. At these times, the current model of specialized health care, which enables older adults to live longer with a greater burden of chronic disease, fails to provide coordinated care, especially at the end of life. Palliative and Therapeutic Harmonization (PATH) is an innovative model designed to improve appropriateness of decision-making and resource utilization across the health-care continuum. PATH places frailty at the forefront of evidence-informed decision-making and trains teams to assemble the “big picture” of each patient’s health story. Using this big picture, PATH follows a structured process that empowers patients and families to make decisions tailored to their specific frailty burden—to remediate the remediable and palliate the irreversible. The approach has been translated into clinical programs that help clinicians and patients reach decisions about surgery, medical interventions, dialysis, nursing home placement, and end-of-life care. Programs include a hospital-based consultation service, presurgical assessment clinics, PATH for home care, and PATH for long-term care. The PATH frailty screen routinely identifies frailty in outpatient clinics with a high prevalence of frailty and that tend to recommend interventional treatments such as cardiology and nephrology, and implements the full PATH process for those identified as frail.A peer-reviewed publication about PATH indicates the program reduces the demand for medical and surgical interventions by 75% and results in high patient/caregiver satisfaction.Promulgation of PATH principles is made possible through an innovative training program called Standardized Team Education Program (STEP), which helps health teams to reorganize and build capacity.By and large, the PATH program works on a systems level, because it identifies and responds to frailty using a consistent approach across the health-care continuum that streamlines, triages, and builds efficient care. On a practitioner level, the program fosters true collaboration, reduces redundancy of assessment, and improves overall efficiency. On a provider level, the PATH process helps practitioners to avoid poor patient outcomes and identifies alternatives to aggressive care. The result is better care with fewer (reorganized) services.