International Journal of Health Policy and Management

International Journal of Health Policy and Management

Learning care pathways: Real promise but real impact?

Articles in Press

Document Type : Commentary

Author
Matthew Menear
Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
Abstract
This commentary presents a critical review of the paper proposed by Gartner and colleagues that describes a novel
method and framework for implementing care pathways that incorporate key mechanisms from the learning health
system (LHS) concept. The authors’ five-phased and 13-step method has several strengths, including the extent to
which it is theory-informed, emphasizes patient involvement as a core design principle, and is oriented towards the
creation of value in health systems. However, the paper also raises several critical questions related to the feasibility
of the method’s faithful application in real-world settings and its consideration of issues related to health equity. In
sum, the paper advances knowledge on care pathway implementation but the framework’s potential for real-world
impact remains unclear.
Keywords
Care Pathways
Learning Health Systems
Patient Involvement
Value-Based Care
Implementation Science
References
1.               Vanhaecht K, Ovretveit J, Elliott MJ, Sermeus W, Ellershaw J, Panella M. Have we drawn the wrong conclusions about the value of care pathways? Is a Cochrane review appropriate?. Eval Health Prof. 2012;35(1):28-42. doi:10.1177/0163278711408293
2.               Pinder R, Petchey R, Shaw S, Carter Y. What's in a care pathway? Towards a cultural cartography of the new NHS. Sociol Health Illn. 2005;27(6):759-779. doi:10.1111/j.1467-9566.2005.00473.x
3.               Centre for Policy and Ageing (CPA). The effectiveness of care pathways in health and social care - Rapid review. CPA; 2014.
4.               Hunter B, Segrott J. Re-mapping client journeys and professional identities: a review of the literature on clinical pathways. Int J Nurs Stud. 2008;45(4):608-625. doi:10.1016/j.ijnurstu.2007.04.001
5.               Jerjes W, Harding D. Enhancing primary care through integrated care pathways: a convergence of theory and practice. Front Health Serv. 2024;4:1432901. doi:10.3389/frhs.2024.1432901
6.               Schrijvers G, van Hoorn A, Huiskes N. The care pathway: concepts and theories: an introduction. Int J Integr Care. 2012;12(Spec Ed Integrated Care Pathways):e192. doi:10.5334/ijic.812
7.               Bergin RJ, Whitfield K, White V, et al. Optimal care pathways: A national policy to improve quality of cancer care and address inequalities in cancer outcomes. Journal of Cancer Policy 2020;25:100245. doi:10.1016/j.jcpo.2020.100245
8.               Gartner JB, Abasse KS, Bergeron F, Landa P, Lemaire C, Côté A. Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review. BMC Health Serv Res. 2022;22(1):558. doi:10.1186/s12913-022-07960-0
9.               Gartner JB, Lemaire C, Côté A. Learning care pathways framework: a new method to implement, learn, replicate, and scale up care pathways for and with the patient. Int J Health Policy Manag. 2025;14:8517. doi:10.34172/ijhpm.8517
10.           Ellis LA, Fisher G, Saba M, et al. Charting progress in learning health systems: A systematic review of 5 years of definitions, models, and frameworks. Learn Health Syst. 2025;9(3):e70006. doi:10.1002/lrh2.70006
11.           Vanhaecht K, Van Gerven E, Deneckere S, et al. The 7-phase method to design, implement and evaluate care pathways. The International Journal of Person Centered Medicine. 2012;2(3):341-51.
12.           Giacomantonio R, Dunn S, Rubenstein D, et al. The role of patients, caregivers, and communities in Learning Health Systems: a narrative review. Front Health Serv. 2025;5:1606124. doi:10.3389/frhs.2025.1606124
13.           Menear M, Blanchette MA, Demers-Payette O, Roy D. A framework for value-creating learning health systems. Health Res Policy Syst. 2019;17(1):79. doi:10.1186/s12961-019-0477-3
14.           Seys D, Panella M, VanZelm R, et al. Care pathways are complex interventions in complex systems: New European Pathway Association framework. International Journal of Care Coordination. 2019;22(1):5-9.
15.           Nundy S, Cooper LA, Mate KS. The quintuple aim for health care improvement: a new imperative to advance health equity. JAMA. 2022;327(6):521-522. doi:10.1001/jama.2021.25181
 
International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 22 September 2026

  • Received Date 13 July 2026
  • Revised Date 10 September 2026
  • Accepted Date 10 September 2026
  • First Published Date 22 September 2026
  • Published Date 22 September 2026