Identification of invariant determinants to improve care pathways: a qualitative study among healthcare professionals

Introduction Care pathways support the coordination and delivery of care, but their optimization requires a better understanding of the factors that influence their organization and evolution. This study aimed to define determinants of care pathways (DCPs) and identify invariant determinants of care pathways (IDCPs). Methods A qualitative study was conducted using semi-structured interviews with 21 French healthcare professionals, including clinicians, academics, and institutional stakeholders. Data were analyzed thematically in accordance with COREQ guidelines. Results Two main themes were identified. The first concerned the characteristics of DCPs and comprised three subthemes: their distinction from health determinants (HDs), the relevance of identifying DCPs, and their contribution to care-pathway modeling. Participants characterized HDs as factors influencing individual or population health status, whereas DCPs were described as factors primarily shaping the organization, accessibility, continuity and progression of care. Both may vary and interact over time. The second theme concerned the identification of IDCPs and comprised four categories: health status, systemic and organizational determinants, social and environmental determinants, and individual and psychological determinants. These categories were considered to be systematically present across care pathways, although their specific manifestations and effects varied according to the patient, context and stage of care. Conclusions IDCPs provide a common analytical framework for analyzing and optimizing CPs. Systematically considering these categories, together with HDs and specific DCPs, may help identify modifiable points of disruption and support the design, evaluation and modeling of more coordinated and patient-centered care.