Mapping the HealthPathways literature: a scoping review protocol

Introduction

HealthPathways is a free to access, password protected online tool that contains localised information about clinical care and available referral options in the format of ‘pathways’. The pathways are aimed primarily at General Practitioners, although access is available for any healthcare worker. The pathways come in three types, clinical, referral or resource pathways. They differ from guidelines as they are more concise and practically focused (McGeogh et al., 2015). The intent is that the pathways can be used during a patient consultation as a clinical decision support tool and a directory of local available health related services.

HealthPathways originated in 2008 in Canterbury New Zealand as an initiative between the Canterbury District Health Board and Streamliners, the software vendor company (McGeogh et al., 2015). The program was deemed successful in Canterbury (McGeogh et al., 2015) and has been made commercially available for other geographical areas. The program is used in 50 health systems across New Zealand, Australia, and the United Kingdom (Streamliners, 2022a).

There are a variety of espoused values that HealthPathways brings to healthcare. These are potentially avoiding unnecessary hospital presentations, higher quality and more relevant referrals, support for General Practice to work to the extent of their scope of practice, and potential financial savings for the hospital system.

Arguably the most frequently voiced trait is that HealthPathways supports GPs so that patients get the right care, at the right place, at the right time, however, more research is required on the process, outcomes and impacts of HealthPathways (Robinson et al., 2015).

Integrated Care has been defined by the European Union’s Expert Group on Health Systems Performance Assessment (2017, p14) as:

HealthPathways can be placed within an integrated care system for multiple reasons. When used by General Practitioners (GPs), HealthPathways contributes toward putting patients at the centre of care and supporting the right care, at the right place, at the right time (Timmins & Ham, 2013).

HealthPathways programs also aim to meet the needs of population health, with local decisions made as to which pathways should be developed when, based on local needs (Chow et al., 2020).

The pathways support GPs to work to the extent of their scope of practice, which in turn has potential to support the hospital system through more appropriate referrals and admissions (Robinson et al., 2015).

Other ways HealthPathways fits within integrated care are that the program forms partnerships between local organisations with collaborative funding and governance arrangements (Chow et al., 2020). Pathways are developed through working in partnership with both the larger HealthPathways community, and at the local level through collaboration between local GPs and hospital specialists. While developing pathways, collaboration occurs between clinicians, which has potential to identify limitations or gaps in service provision. This process improves and formalises referral pathways between primary, specialist and hospital services (Timmins & Ham, 2013).

Significant resourcing (time, financial and staffing) is required to run each HealthPathways program. Various evaluations across the HealthPathways community have been conducted (Senanayake et al., 2021) to attempt to show the value of the program, however published work that has been able to measure changes to referral patterns, quality of referrals, or patient outcomes have been less common. This is a risk for programs that may need to demonstrate why they need to continue resourcing the program, or for areas that don’t yet have HealthPathways and want to make evidence-based funding decisions. To date there are no peer reviewed studies that bring together all of the available evidence, identify gaps in the research, and make recommendations for future research so that it can cover the gaps in the literature. This will assist funders, researchers and managers with decisions related to HealthPathways programs.

The Streamliners ‘Research and Evaluation Hub’ (Streamliners, 2022b) have undertaken a body of work to make available all HealthPathways related documents (both published and unpublished) on their website to facilitate ease of information sharing. The Research and Evaluation Hub separates HealthPathways publications into two categories, ‘support for system improvement’, and ‘impact of specific pathways’ (Streamliners, 2022b). They have also grouped studies by ‘research outcomes’: community care; evaluations; evidence into practice; referral improvements; system improvement; and variations of care.

This body of work will be the foundation on which this scoping review will be built on. The difference and importance of this scoping review is that it will provide a peer reviewed approach to collating and disseminating the evidence on HealthPathways, as well as highlighting areas for future research.

Objectives

This scoping review aims to identify, map and describe all published literature on HealthPathways, identify common themes, and make recommendations for the focus of further research in this area.

The objectives of the review are to determine:

Protocol

The scoping review will follow the Joanna Briggs Institute JBI methodology for scoping reviews (Peters et al., 2015) as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)(Tricco et al., 2018).

Any deviations from the method will be documented in the scoping review.

Search strategy

The search will include both published and unpublished literature.

Initially a restricted search was undertaken in Medline and CINAHL to gain an understanding of the extent of the literature and improve the full search strategy.

The initial search took place on 26 October 2021 using the MEDLINE (PubMed) database using an English language filter and returned 19 results. The results are displayed in Table 1.

Table 1. Search results from initial search.

The full search strategy was discussed with a medical librarian and will utilise MEDLINE (PubMed), CINAHL, Cochrane, Embase, Web of Science, Emerald and Google Scholar, and will be adapted for each database. Grey literature will be identified through searching relevant credible organisations, sites, and databases. Reference lists of all articles included will be searched and relevant articles considered.

Conclusions/Discussion

It is important that the breadth of HealthPathways research is easy to find and synthesised for healthcare managers and policy makers with an interest in HealthPathways.

This protocol outlines a systematic, transparent process for conducting the scoping review. Through creating a mapped synthesis of available research, the scoping review will assist healthcare managers and policy makers understand the breadth of evidence currently available on HealthPathways. It may also identify gaps in the literature for future research.

This research will also provide direction for further research into spread and scale of HealthPathways and integrated care initiatives.

Study status

The study is currently in the initial stage of exploring and charting included literature.