Implementing Digital Care Pathways and Changes in Contact Volume, Contact Distribution, and Outpatient Costs in Specialized Health Care: Retrospective Longitudinal Observational Study

BACKGROUND: Health care systems increasingly promote patient engagement and self-management through digital health services. Digital care pathways, which support coordinated care delivery across the patient journey, have emerged as a promising approach, although evidence regarding their impact on resource use and costs remains limited. OBJECTIVE: The aim of this study was to examine the implementation and impact of digital care pathways specifically designed to reduce or replace physical contacts or phone consultations in specialized health care. METHODS: We analyzed the 10 most widely used digital care pathways by user volume. The selection criteria were (1) more than 1500 users per digital care pathway and (2) the aim of replacing or reducing in-person contacts. Descriptive analyses quantified digital contact volumes, average contacts and costs per patient, and inflation-adjusted expenditures using the consumer price index, both overall and by patient group. Ecologic group-level correlations were examined to assess whether the 2024 proportion of digital contacts was associated with changes in physical contacts and total costs from 2018 to 2024. RESULTS: Digital care pathways were progressively adopted between 2018 and 2024, increasing from no use to accounting for 19.1% (34,837/182,188) of all outpatient contacts among the studied patient groups. Physical visits declined from 74.8% (99,201/132,622) to 54.1% (98,642/182,188), while contacts per patient rose by 7.6% on average. Conditions with the highest uptake of digital pathways showed the strongest reductions in the share of physical visits per patient, with declines of up to 39.7% (0.73/0.44). Average outpatient costs per patient decreased by 18.2% (€421/€515; €1=US $1.12 as of Oct 16, 2026) in real terms, with a 39.3% (€233/€384) reduction in the costs of physical contacts and a 15.4% (€135/€117) increase in the costs of phone visits. Digital pathway contacts accounted for 12.6% (€53/€421 per patient) of total outpatient costs in 2024; however, only 8.8% of the variance in total cost levels was explained by digital pathway adoption, suggesting that the shift toward digital care pathways did not substantially drive overall cost changes. CONCLUSIONS: Digital care pathways expanded rapidly, reaching nearly one-fifth of all outpatient contacts by 2024 in the included patient groups and contributing to a notable reduction in physical visits. However, their overall cost impact remains uncertain, as there have also been other factors impacting the development of outpatient costs.