Open Access Highly Accessed Research article

Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination

Sabine Van Houdt1*, Jan Heyrman1, Kris Vanhaecht23, Walter Sermeus2 and Jan De Lepeleire1

Author Affiliations

1 Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 blok J, box 7001, 3000 Leuven, Belgium

2 Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, 3000 Leuven, Belgium

3 Western Norway Research Network on Integrated Care, Haugesund, Norway

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BMC Health Services Research 2013, 13:296  doi:10.1186/1472-6963-13-296

Published: 6 August 2013



Care pathways are widely used in hospitals for a structured and detailed planning of the care process. There is a growing interest in extending care pathways into primary care to improve quality of care by increasing care coordination. Evidence is sparse about the relationship between care pathways and care coordination.

The multi-level framework explores care coordination across organizations and states that (inter)organizational mechanisms have an effect on the relationships between healthcare professionals, resulting in quality and efficiency of care.

The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary - hospital care continuum.


This study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results.


The development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other’s roles, expectations and competences and building qualitative relationships.


Care pathways across the primary-hospital care continuum enhance the components of care coordination.

Critical pathways (mesh); Care pathways; Multi-level framework; Coordination; Primary health care (mesh); Hospitals (mesh); Quality of care; Multiple case study