Types of Plan - Differentiation and Definitions

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Introduction

There are significant confusion and extensive debates over the three different types of [care] Plans defined within the Care Plan Project:

  • Care plan
  • Plan of Care, and
  • Treatment Plan.

The PCWG Care Plan project 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 aforementioned 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)


Types of Plan


Based on harmonization efforts with the ONC S&I LCC, the PCWG May 2013 Care Plan DAM ballot content includes three type of Plan:

  • 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:


Stakeholder Perspectives on Types of Plan

There are different terms that are applied to the concept of "Care Plan". They include: "treatment plan", "plan of care", "care plan", "comprehensive care plan", integrated care plan" ... etc

Different stakeholders/groups tend to use some of these terms interchangeably. It is evident after the lengthy debates that a consensus is unlikely, at least in the short and intermediate terms.

The PCWG Care Plan project team acknowledges the differences in view. The current decision is to document all these perspectives and to define a set of distinct characteristics which can be applied to the "Care Plan" concept according to different clinical or business practices.

It will be the responsibility of the user/stakeholder community to determine how the concept of "care plan" is used and labelled based on the set of characteristics.




Types of Plan and Defining Characteristics - Archive

The initial objective was to develop a set of defining characteristics and arrive at consensus on definitions on the three types of plans: "Care Plan", "Plan of Care", and "Treatment Plan".

It becomes obvious that this objective is not attainable given the disparities in opinions.


The framework for organizing this work is now archived:




Storyboards

The HL7 PCWG Care Plan team and other contributors have developed a set of "Care Plan" storyboards. These storyboards describe typical patient health care journeys and the clinical/business workflow for managing collaborative care of patient with complex/long term conditions.

It is anticipated that the description of patient journeys and clinical/business workflows may help discern how the different types of plan are used in different contexts.


  • Patient Journey - PCP care and Use of Care Plans Storyboard:
File:PatientJourney-PCP care-and-Types of CarePlan v-2013-11-27 SChu LCCv2.docx
File:CarePlan-and-PlanOfCare JointCommission-Perspective.docx




Stakeholder/Team Member Contributions

Input from Lisa Nelson

"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.

  • Post by Lisa Nelson 20131103:
File:Care Plan visualization 20131103.pdf



Input from Gordy

Using Plan of Care & Treatment Plan will decrease semantic interoperability with little offsetting benefit



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.