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Care Plan definition

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Return to: Care Plan Project page.

Contents

Introduction

There is some degree of debate and confusion over the components used in the Care Plan Project. There is a structure referred to as the care plan, one labeled the plan of care, and another which focuses on treatment plan.

This wiki uses the term “care plan”; however, the phraseology currently used differs slightly between professions/sectors. For example medicine generally refers to “management plans” or “treatment plans”, midwifery has “birthing plans”, social care has “support plans” and nursing and many other health and social care professions refer to “care plans”, “intervention plans” or “management plans” . Increasingly guidance is using “care plan”. Application functionality and descriptions may need to reflect these varying needs, whilst bringing the record together as an integrated care record.

Outstanding issues

Care planning is a conceptual framework with many interrelated dependencies and antecedents. A complete understanding of the real world processes is required to specify and build and/or configure a system that supports clinical care planning. These processes include assessments, predefined care plans, bespoke care plans, integrated care pathways and may include care plan elements or combinations of the afore mentioned concepts. Currently there is no standardisation of the content of care plans across health and social care organisations; each organisation follows locally driven processes for the development of care plans. Development may be organisation-wide or for use by a single professional group or clinical speciality.

Electronic care planning can enable multi-professional care plans used by teams across organisational boundaries (primary, secondary and social care). A universal approach to care plan content (Care Plan Templates, Activity Bundle Templates ) will give a broad base to inform care plans and this approach should reduce the variation in care planning to support consistent, high quality, evidence based delivery of care.

Any organisation implementing care planning functionality should have access to experienced clinical, technical and terminological input to any project team.

ISO 13940 and ISO 18104 are approaching their final stages and SHOULD be significant influences to this area of functionality


Background articles on Weed's Problem Oriented Medical Record (POMR)


Type of Plan


The PCWG Care Plan project identifies three type of Plan according to the ONC/LCC work:

  • Care Plan
  • Plan of Care
  • Treatment Plan



References to the ONC/LCC identification of these 3 different concepts and their definitions can be accessed from the following link:


The differences between engineering and clinical perspectives

  • The Engineering Perspective

The problems software try to solve often involve elements of inescapable complexity. The complexity is compounded by changing or even fuzzy requirements. the task of software engineers often involves engineering the illusion of simplicity. One strategy to achieve "simplicity" is only to represent concepts as different entities/classes when differentiating characteristics (as attributes and behaviours) can be identified.

When designing Care Plan from engineering perspective, it is acceptable to create a single structure/model to support the instantiation of different types of plans (care plan, plan of care, treatment plan) if the structure:

includes attributes and behaviours that allows the differentiation of the different types of plan
capable of supporting the various use cases defined by the user community



How workflow affects the use of different types of plan


Lisa's Input: "Same or Different?" My thoughts on how a Care Plan, a Plan of Care, and a Treatment Plan represent information that is the same in some ways and different in other ways.



Gordy's Input: Using Plan of Care & Treatment Plan will decrease semantic interoperability with little offsetting benefit

File:Proposed Revision to Care Plan Conceptual Model - VERY rough draft.pdf

I propose we sidestep the issue of what is a care plan, what is a plan of care, and what is a treatment plan. Even if we can come up with a semantically unambiguously definitions for each term, folks will use their own definitions and semantic interoperability will be degraded. Moreover, we don't need these terms -- in reality they do not carry any real clinical content. Instead I propose that we just use one term -- Care Plan -- and differentiate care plans via a set of attributes describing the clinically relevant differences between plans.

The enclosed is a rough pictorial view of what I'm thinking. The key piece of course is the self-referential arrow on the lower left (meaning that smaller care plans can be incorporated into larger care plans). Exactly what the attributes of a care plan would be, and what allowable values they would have, would need to be thought through and vetted with the larger community. My very rough first attempt is:

   Type:  Comprehensive, or Partial
   Scope:  Organization, Discipline, Clinician, Setting, Procedure, or Problem
   Mood (or some other term):  Generic or patient-specific (EVN vs INT)
   Status:  Active, Completed (and other HL7 Act Statuses?)
   Patient Involvement Level:  Approved, Reviewed without objections, Reviewed with objections, Not Involved.
   Possibly Duration or Anticipated Duration or something about timing, though I'm not clear that is needed.
   Owner or Responsible Clinician or some such, perhaps

By focusing on answering specific clinically relevant questions posed as attributes (instead of trying to shoehorn them into the definition of three broad terms), uncertainty will be reduced and the ability to exchange, incorporate, extract, and manipulate care plans without loss of meaning will be increased.



Care Plan

48x48px This subsection includes: clear definition and identification of defining attributes/characteristics of "Care Plan"


Definition/Description

(extract from Care Plan DAM)



Testable criteria


Who (entity or role/type of person) participates in it besides the patient (record target)


The subject
  • The Patient (subject of care / record target)
  • Can a fetus be the subject of a Care Plan?


Author


Authorizer (authenticator)


Responsible authority for approval (legal authenticator)


Responsible party (responsible for assuring action)?


Custodian (responsible for maintaining the record/care plan)


Performers of actions/intervention


Care Plan Components


Inclusions


  • What structures/components does it contain as components?


  • Can it contain other components of the same type?


  • What structure/component can contain it?



Exclusions
  • What can it never contain?


  • What structure/component can never contain it?


Properties and Context


  • What context or properties does it have based on the containing component?
  • What kind of reasons does it have?
  • How is it associated with a Goal?
  • Does it include (specify) criteria for termination (completion)?
e.g. criteria which would terminate action and render the status of it completed
  • Does it include (specify) outcome criteria specifications?
e.g. what metrics are applied to it
  • Does it include (specify) criteria required for it to become active?
e.g. defining criteria for a standing order, such as "if temperature is > 38 degC administer 1000 mg acetaminophen PO q6h"



Scope


  • when is this used and how is it used?
  • What are the limits?


Explanation


Plan of Care

48x48px This subsection includes: clear definition and identification of defining attributes/characteristics of "Plan of Care"


Definition/Description

(extract from Care Plan DAM)



Testable criteria


Who (entity or role/type of person) participates in it besides the patient (record target)


The subject
  • The Patient (subject of care / record target)
  • Can a fetus be the subject of a Care Plan?


Author


Authorizer (authenticator)


Responsible authority for approval (legal authenticator)


Responsible party (responsible for assuring action)?


Custodian (responsible for maintaining the record/care plan)


Performers of actions/intervention


Care Plan Components


Inclusions


  • What structures/components does it contain as components?


  • Can it contain other components of the same type?


  • What structure/component can contain it?



Exclusions
  • What can it never contain?


  • What structure/component can never contain it?


Properties and Context


  • What context or properties does it have based on the containing component?
  • What kind of reasons does it have?
  • How is it associated with a Goal?
  • Does it include (specify) criteria for termination (completion)?
e.g. criteria which would terminate action and render the status of it completed
  • Does it include (specify) outcome criteria specifications?
e.g. what metrics are applied to it
  • Does it include (specify) criteria required for it to become active?
e.g. defining criteria for a standing order, such as "if temperature is > 38 degC administer 1000 mg acetaminophen PO q6h"



Scope


  • when is this used and how is it used?
  • What are the limits?


Explanation


Treatment plan

48x48px This subsection includes: clear definition and identification of defining attributes/characteristics of "Treatment Plan"


Definition/Description

(extract from Care Plan DAM)



Testable criteria


Who (entity or role/type of person) participates in it besides the patient (record target)


The subject
  • The Patient (subject of care / record target)
  • Can a fetus be the subject of a Care Plan?


Author


Authorizer (authenticator)


Responsible authority for approval (legal authenticator)


Responsible party (responsible for assuring action)?


Custodian (responsible for maintaining the record/care plan)


Performers of actions/intervention


Care Plan Components


Inclusions


  • What structures/components does it contain as components?


  • Can it contain other components of the same type?


  • What structure/component can contain it?



Exclusions
  • What can it never contain?


  • What structure/component can never contain it?


Properties and Context


  • What context or properties does it have based on the containing component?
  • What kind of reasons does it have?
  • How is it associated with a Goal?
  • Does it include (specify) criteria for termination (completion)?
e.g. criteria which would terminate action and render the status of it completed
  • Does it include (specify) outcome criteria specifications?
e.g. what metrics are applied to it
  • Does it include (specify) criteria required for it to become active?
e.g. defining criteria for a standing order, such as "if temperature is > 38 degC administer 1000 mg acetaminophen PO q6h"



Scope


  • when is this used and how is it used?
  • What are the limits?


Explanation



Others

  • Any other relevant materials?

Care planning content and standard proposals (UK)