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What is 'Care Pathways'?

The NHS 'Care Pathways' pilot programme has been implemented by PCTs in several EXACT practices around the UK , with the aim of finding a better method of assessing patient need, increasing access to services, delivering preventative care appropriately and fair performance management of dental services.

The pilot programme uses the methodology outlined in the following sections. The general idea is as follows:

Patients will be asked standardised clinical, social, and medical questions.
The responses to the questions are entered as scores in custom screens and /or Quick Plans, against services created for this purpose. The data entry date is also recorded.
(Due to the flexibility of implementation by practices, the screens and plans can be customised, if required).
Based on the answers to the questions, and what services are charted, patients are given a score (Green, Amber or Red), for each of the Social and Clinical categories, and Green or Amber for the Medical category. While these are all determined automatically, the user can override them by clicking on the appropriate radio button.
An overall 'Calculated Assessment' is also given, calculated from the scores: if any one of them is Red, the 'Calculated Assessment' will be Red. If any of them is Amber, then the 'Calculated Assessment' will be Amber. If all three items are Green, then the 'Calculated Assessment' will be Green.
The assessments have an implication for future treatment for the patient, in that if the score is Red or Amber, the patient's future recall date intervals may be decreased, so the patient receives more frequent care until such time as their dental health improves.
The Care Pathways recall interval (if enabled) is a prompted recommendation only, and overrides the usual patient recall only if accepted by the user.

Care Pathway Setup Wizard

The Care Pathways data (services, custom screens, quickplans, etc.) will have been automatically added to your system with the latest EXACT upgrade. However, to ensure that you have the latest data, you will need to run the 'Care Pathways Setup Wizard' before the first time you use Care Pathways. Furthermore, if your practice has - as an early adopter of the pilot scheme - previously used Care Pathways, some of the custom screens such as the 'Care Pathways Indicators' window have been updated in EXACT 10.12 and later versions. The wizard will also be run the first time you access the Care Pathways report.

See below in the "Custom Screen" section for details of the new 'Care Pathways Indicators' window.

NOTE: If for any reason you have changed any of the original settings for Care Pathways - for example, hidden any services - the Care Pathways Setup Wizard will return these services to their default settings, and you will need to check them after the upgrade process.

To configure Care Pathways, you need to be an admin user. Select the Configure > Care Pathways menu option, to display a 'wizard' screen like the following example:

CarePathways Wizard1

Although your version of EXACT should already include most - if not all - of the software and data required to run Care Pathways, you can click the button to ensure you have the most up-to-date data.

When this has finished importing the data, click the button, to display the next setup screen:

CarePathways Wizard2

If you tick the 'Enable care pathway recalls' checkbox, this will allow EXACT to use the "Calculated Assessment" from Care Pathways data to make recommendations for patient recalls, based on which care pathway (Green, Amber or Red) the data indicates, and the recall intervals entered here. Generally the intervals for Amber and Red will be shorter than a patient would normally have if they had good dental health. Note that these recall intervals are not compulsory, but rather suggestions to improve the patient's dental health, and can be overridden if required at the time the recall prompts appear when completing a course of treatment.

To set the Care Pathway Recall Intervals, first the 'Enable care pathways recalls' checkbox must be ticked. Then click in each box and overtype the defaulted number of months with the recall interval you think is appropriate for that option. If you do not wish to use the Care Pathways recall intervals, the 'Enable care pathways recalls' checkbox should be unticked.

The last screen of the Care Pathways Setup Wizard has only one option, which allows you to choose whether or not to display a patient's current care pathway at the top of the Patient Details screen, in the window header. If the default of "View current care pathways" is accepted (that is, the checkbox is left ticked),

Services, Quick Plans and Custom Screens

Services

Care Pathways services are identified by a prefix of "CP·" , e.g., CP·FLV for the "Fluoride Varnish" service. Some of the services (and their custom screens) were previously introduced as part of the April 1^st 2010 NHS changes for PDS Plus.
All Care Pathways services are assigned to the "Care·Pathways" category. However, if you happened to have an existing "Care·Pathway" category that had been created manually for the pilot scheme, the services will be assigned to that instead.

If for any reason, you need to manually create a Care Pathways service, below is a list of all the Care Pathways services. The prefix of "CP·" includes a special character to uniquely distinguish a Care Pathways service from other services; you can enter this character either by using "copy and paste" from another Care Pathways service, or by holding down the key on your keyboard, and typing 0183, then releasing the key.

Note that if a service does not include the "CP·" prefix, it will not be recognised by EXACT as a Care Pathways service.

Care Pathways Service Codes

Code	Description	Category
CP·CARACT	Caries Active	Base Chart
CP·CARARR	Caries Arrested	Base Chart
CP·ABR	Abrasion	Base Chart
CP·ATT	Attrition	Base Chart
CP·ERO	Erosion	Base Chart
CP·ALC	Alcohol Consumption (Weekly)	Care·Pathways
CP·BPE	Basic Periodontal Examination	Care·Pathways
CP·CREF	High Risk Child Off Site Referral	Care·Pathways
CP·DA	Diet Advice	Care·Pathways
CP·FIS	Fissure Sealants	Care·Pathways
CP·FLR	Fluoride Rinse	Care·Pathways
CP·FLS	Fluoride Supplement	Care·Pathways
CP·FLV	Fluoride Varnish	Care·Pathways
CP·LSS	Signposted to Local Stop Smoking Service	Care·Pathways
CP·OHI	Oral Health Instruction	Care·Pathways
CP·SCA	Smoking Cessation Advice	Care·Pathways
CP·TBI	Tooth Brushing Instruction	Care·Pathways
CP·TOB	Tobacco Use (Weekly)	Care·Pathways
CP·TP-2800	Toothpaste 2800ppm	Care·Pathways
CP·TP-5000	Toothpaste 5000ppm	Care·Pathways
CP·CPG	Care Pathway GREEN	Care·Pathways
CP·CPA	Care Pathway AMBER	Care·Pathways
CP·CPR	Care Pathway RED	Care·Pathways

Important Notes:

The CP·FLV service should have been set up automatically for you. If however you need to set it up manually, it must be set up as a Band 1 service, and also requires a 'Fluoride Varnish' data set category assigned to it. If this category does not exist, it will need to be created before the CP·FLV service is assigned to it.
CP services can be charted only on an NHS course of treatment; if you attempt to chart them to a COT using a non-NHS payor, it will cause an error message to be displayed in EXACT.

Care Pathway Report

Selected Care Pathway information is able to be printed and also exported if required. The report is only available to be printed for the first time once up-to-date Care Pathways data has been imported into EXACT. You will be prompted to import the data, or can also run the update manually at any time from the Configure > Care Pathways menu item if you have admin security privileges. In either case, the Care Pathways Setup Wizard will be run to ensure that your Care Pathways data is the latest.

The Care Pathway Report is accessible from the Reports menu. When selected it displays a dialog like the following example:

Print Care Pathway Report dialog

Fields and buttons are as follows:

Sort Patients By	By default, the report will sort patients in order of their Code. Click the drop-down to view other options to sort the report by.
From Patient To Patient	The 'From' and 'To' fields allow you to limit the report to a specified range. Click in the field to enter the appropriate values or select them using the up/down arrow keys, or the list button. The values displayed will reflect what was chosen in the Sort by field (for example, if you chose 'Sort by DOB', these two fields will show dates). You can leave these blank, or set to the defaulted values in order to include all patients.
Select Patients	This field allows you to select patients for the report by using an existing Query template. Click in the field and use the up/down arrow keys, or the list button to choose a Query.
	Note: If you choose a Query, the report will be run so that it uses a patient's status as of today. For example, if your query selected patients who are <18 years of age, it will select patients who are <18 as of today. If you selected a date range covering the 3 months up to today, there may be patients who were under 18 at the time of treatment who are excluded because they turned 18 during the three month period.
Provider(s)	To run the report for patients of all providers, leave this field blank; this will then default to all active providers. To select only those patients with a particular provider, use the up/down arrow keys, or the list button to select the provider's name. To select multiple providers, click the button. Note: If all providers are selected for this field, no provider details will be shown on the report.
From (date) To (date)	These two fields allow you to select only treatment covering a specified date range. The date range defaults to the last three months prior to today, but you can change this. Click in the field to activate the drop-down menu and display the calendar button. You can then either enter a specific date in each field, or use the drop-down to select terms like, "Three Months Ago" and "Today".
	Click this button to open the 'Group By' dialog, then select the age range required. The report will be split into sections corresponding to whatever age groups exist. Standard options are 0-17 years, and 18+ years, but if required these may be edited or a new range created using the and buttons. For example, to add a new upper age range, select '18+ years' then click the button: In this example, '30' has been entered; this will change the '18+ years to '18-30 years' and create a new '31+ years' age range: To change the age at which a split occurs, select the age range (for example, '0-17 years'), then click the button: Type in the new age or use the buttons to select the required age. For instance, if we change '17' to '21', the result is this: The last thing you can do is delete a range altogether. For example, if we highlight the newly created '22-30 years' age range, and click the button, we get this result: Note: You cannot edit or delete the upper age range, only change it by adding a group above it, or editing the one below it.

Report Output

An example of part of the report from the 'Preview' option, is shown below:

Care Pathway Report example

The details listed show the number and percentage of the patients selected by your parameters, matching the criteria listed in the description column on the left. This is broken down into columns for each of the Red, Amber and Green scores.

Note the following:

Inactive patients will be counted if they were active at some time during the specified period.
Patients marked as "Failed to Arrive" will not be included in the overall statistics (i.e., only treatment marked as completed is included in the report).
COT dates relate to the first planned item in the COT and the date the COT was completed.
If patients fall into a report category twice they will be counted only once.
A warning will be displayed if there are patients with no date of birth recorded, and they will be excluded from the report statistics.
Other report options (Print, Preview, Export, etc.) are outlined in the "Printing Reports" Help topic.

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