Short Info: »mipp› (Switzerland)

The "Model of Integrated Patient Pathways" was developed by the Aarau Cantonal Hospital (KSA). Since 1995, clinical pathways are jointly developed by physicians and nurses using this method1 which was inspired by the PMC model.2 The initial starting point for these works was the calculation of standard case costs. For this purpose, clinical guidelines, nursing data (based on the LEP system3), and accounting system data were gathered and compiled into standardized pathways of specified clinical conditions or therapeutic procedures while applying a consensus process. Meanwhile, this undertaking emerged into an important interdisciplinary project, which allows for optimization of both quality and costs.

A clinical pathway – called "patient's pathway" in »mipp› – consists of the list of all services rendered in relation to a given treatment as defined in the hospital's own clinical guidelines.4

Each service has its specific cost value attributed, allowing for standard costs of the pathways to be calculated.

In addition, certain quality parameters are defined for each pathway, which are considered and verified either continuously, or merely on interest.5

Pathways are structured hierarchically. The elements of pathways are called components. Examples are: "visit in day-clinic, in laparoscopic surgery", or "emergency admission, nursing, in cholecystitis".

A pathway can be divided into several partial pathways. These then represent different therapeutic processes that are (to an estimated degree) likely to be administered to the patient.

In turn, each component is divided into individual service units. The LEP system6 was used to describe the nursing service units.

When developing these service units, it turned out that some of the services do not occur in all, but only in a given number of cases. A flexible solution was then found for this problem: These services were weighted by an occurrence probability factor.7