Patient-oriented medical care: features and prospects of the patient’s pathway map implementation

The healthcare system operates under defined key performance indicators that must be met. However, its structure remains inherently fragmented, divided into hierarchical tiers of care delivery. Currently, the quality of care is assessed through disease-specific clinical guidelines. There is a critical lack of comprehensive systems capable of evaluating the quality of an individual patient’s journey across the entire healthcare continuum, particularly for those with multiple comorbid conditions. Patient Journey Mapping (PJM) emerges as a potential solution to this challenge. PJM serves as a methodological tool to consolidate patient-centric data generated during care delivery. Its primary benefit lies in enabling multidimensional assessments of the patient’s health status, the healthcare system’s performance, and the appropriateness of prescribed therapies. A foundational requirement for constructing PJM is robust clinical data, which integrates patient-reported outcomes with objective clinical status indicators. Structured medical registries represent the most reliable source of such data. This non-systematic literature review examines the development of patient pathway models based on medical registries and explores their potential applications for stakeholders, including healthcare systems, private clinics, pharmaceutical enterprises, clinicians, and patients. The analysis highlights PJM’s capacity to enhance care coordination, inform value-based healthcare strategies, and facilitate personalized therapeutic interventions.

1. Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 2013;70(4):351-79. DOI: 10.1177/1077558712465774.

2. Haggerty JL, Reid RJ, Freeman GK et al. Continuity of care: a multidisciplinary review. BMJ. 2003;327(7425):1219-21. DOI: 10.1136/bmj.327.7425.1219.

3. Wall EM. Continuity of care and family medicine: definition, determinants, and relationship to outcome. J Fam Pract. 1981;13(5):655-64.

4. Rogers J, Curtis P. The concept and measurement of continuity in primary care. Am J Public Health. 1980;70(2):122-7. DOI: 10.2105/ajph.70.2.122.

5. Liu S, Yeung PC. Measuring fragmentation of ambulatory care in a tripartite healthcare system. BMC Health Serv Res. 2013;13:176. DOI: 10.1186/1472-6963-13-176.

6. Joo JY. Fragmented care and chronic illness patient outcomes: A systematic review. Nurs Open. 2023;10(6):3460-73. DOI: 10.1002/nop2.1607.

7. Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med. 2010;7(9):e1000326. DOI: 10.1371/journal.pmed.1000326.

8. Committee on the Learning Health Care System in America; Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Smith M, Saunders R, Stuckhardt L, McGinnis JM, editors. Washington (DC): National Academies Press (US); 2013. DOI: 10.17226/13444.

9. Balas EA, Boren SA. Managing Clinical Knowledge for Health Care Improvement. Yearb Med Inform 2000;(1):65-70. PMID: 27699347.

10. Zomerdijk LG, Voss CA. Service design for experience-centric services. Journal of Service Research. 2009;13(1):67–82. DOI: 10.1177/1094670509351960.

11. Walter S. User journey mapping. SitePoint; 2022.

12. Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care. 2006;15(5):307-10. DOI: 10.1136/qshc.2005.016527.

13. Sijm-Eeken M, Zheng J, Peute L. Towards a Lean Process for Patient Journey Mapping — A Case Study in a Large Academic Setting. Stud Health Technol Inform. 2020;270:1071-5. DOI: 10.3233/SHTI200326.

14. Roustán G, Loro M, Rosell Á et al. Development of a Patient Journey Map for Improving Patient Experience and Quality of Atopic Dermatitis Care. Dermatol Ther (Heidelb). 2024;14(2):505-19. DOI: 10.1007/s13555-024-01100-8.

15. Simonse L, Albayrak A, Starre S. Patient journey method for integrated service design. Design for Health. 2019;3(1):82–97. DOI: 10.1080/24735132.2019.1582741.

16. Bulto LN, Davies E, Kelly J, Hendriks JM. Patient journey mapping: emerging methods for understanding and improving patient experiences of health systems and services. Eur J Cardiovasc Nurs. 2024;23(4):429-33. DOI: 10.1093/eurjcn/vae012.

17. Kalbach J. Mapping experiences: A guide to creating value through journeys, blueprints and diagrams. Sebastopol, CA: O’Reilly Media Inc.; 2009.

18. Joseph AL, Monkman H, Kushniruk A, Quintana Y. Exploring Patient Journey Mapping and the Learning Health System: Scoping Review. JMIR Hum Factors. 2023;10:e43966. DOI: 10.2196/43966.

19. Joseph AL, Monkman H, Kushniruk AW. An Evaluation Guide and Decision Support Tool for Journey Maps in Healthcare and Beyond. Stud Health Technol Inform. 2022;295:171-4. DOI: 10.3233/SHTI220689.

20. Joseph AL, Kushniruk AW, Borycki EM. Patient journey mapping: current practices, challenges and future opportunities in healthcare. Knowledge Management & E-Learning. 2020;12(4):387-404. DOI: 10.34105/j.kmel.2020.12.021.

21. Arias M, Rojas E, Aguirre S et al. Mapping the Patient’s Journey in Healthcare through Process Mining. Int J Environ Res Public Health. 2020;17(18):6586. DOI: 10.3390/ijerph17186586.

22. Davies EL, Bulto LN, Walsh A et al. Reporting and conducting patient journey mapping research in healthcare: A scoping review. J Adv Nurs. 2023;79(1):83-100. DOI: 10.1111/jan.15479.

23. Collen MF. Computer Medical Databases: The first six decades (1950-2010). London: Springer-Verlag London Limited; 2012.

24. Mans RS, van der Aalst WMP, Vanwersch RJB, Moleman AJ. Process mining in Healthcare: Data challenges when answering frequently posed questions. In: Proceedings of the 2012 international conference on Process Support and Knowledge Representation in Health Care (BPM’ 2012). Springer-Verlag, Berlin, Heidelberg, p.140-153. DOI: 10.1007/978-3-642-36438-9_10.

25. Martsevich SYu, Navasardyan AR, Lobastov KV, et al. Systematic review and meta-analysis: a critical examination of the methodology. Rational Pharmacotherapy in Cardiology. 2023;19(4):382-97. (In Russ.) DOI: 10.20996/1819-6446-2023-2923.

26. Gliklich RE, Leavy MB, Dreyer NA, editors. Registries for Evaluating Patient Outcomes: A User’s Guide. 4th ed. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Sep. Report No.: 19(20)-EHC020.

27. Schastlivtsev IV, Navasardyan AR, Lobastov KV. Registers, Their Place in Scientific Hierarchy and Clinical Significance on the Example of the RIETE Register. Journal of Venous Disorders. 2022;16(3):22737. (In Russ.) DOI: 10.17116/flebo202216031227.

28. Lobastov KV, Navasardyan AR, Schastlivtsev IV. Treatment and Secondary Prevention of Venous Thromboembolism in Real Clinical Practice Based on Health Care Professional Survey. Rational Pharmacotherapy in Cardiology. 2021;17(3):376-85. (In Russ.) DOI: 10.20996/1819-6446-2021-06-01.

29. Rockart JF, Hofmann PB. Physician and patient behavior under different scheduling systems in a hospital outpatient department. Medical Care. 1969;7(6):463-70.

30. Junod Perron N, Dao MD, Righini NC et al. Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized controlled trial. BMC Health Serv Res. 2013;13:125. DOI: 10.1186/1472-6963-13-125.

31. Nwabuo CC, Dy SM, Weeks K, Young JH. Factors associated with appointment non-adherence among African-Americans with severe, poorly controlled hypertension. PLoS One. 2014;9(8):e103090. DOI: 10.1371/journal.pone.0103090.

32. Karter AJ, Parker MM, Moffet HH et al. Missed appointments and poor glycemic control: an opportunity to identify high-risk diabetic patients. Med Care. 2004;42(2):110-5. DOI: 10.1097/01.mlr.0000109023.64650.73.

33. Whear R, Thompson-Coon J, Rogers M, et al. Patient-initiated appointment systems for adults with chronic conditions in secondary care. Cochrane Database Syst Rev. 2020;4(4):CD010763. DOI: 10.1002/14651858.CD010763.pub2.

34. Zhao P, Yoo I, Lavoie J, et al. Web-Based Medical Appointment Systems: A Systematic Review. J Med Internet Res. 2017;19(4):e134. DOI: 10.2196/jmir.6747.

35. McDonagh TA, Metra M, Adamo M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36):3599-3726. DOI: 10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021; 42(48):4901. DOI: 10.1093/eurheartj/ehab670.

36. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e876-94. DOI: 10.1161/CIR.0000000000001062.

37. Joseph AL, Borycki EM, Kushniruk AW. Alert fatigue and errors caused by technology: A scoping review and introduction to the flow of cognitive processing model. Knowledge Management & E-Learning. 2021;13(4):500-21. DOI: 10.34105/j.kmel.2021.13.027.