Cultura

Integrated Clinical Service Pathways In Modern Healthcare Systems: A Comprehensive Review Of Coordination, Diagnostics, And Emergency Response

VOLUME 21, 2024

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Jameel Sami Bukhari, Adel Hamed Almalki, Shahad Ahmed Akran AlShubayli, Ashwag Radad Alzahrany, Wafa mater Albeladi
Yasamiyan Hamed Saleem, Ameera Mousa khoja, Ahmed salem ibrahim, Abdulmohsin Brrak ALmowallad, Hosam saeed Alghamdi

Abstract

Modern healthcare systems are increasingly challenged by fragmentation across clinical services, leading to delays, duplication, and variability in patient outcomes. Integrated clinical service pathways have emerged as a strategic approach to enhance coordination, streamline diagnostic processes, and strengthen emergency response across the full continuum of care. This comprehensive review synthesizes current evidence on system-level integration models that link early patient contact, clinical assessment, diagnostic decision-making, and definitive intervention within cohesive care pathways. Drawing on international literature, the review examines how structured coordination mechanisms, timely diagnostic integration, and responsive entry-point systems contribute to improved efficiency, patient safety, and clinical effectiveness. Key findings indicate that well-designed integrated pathways are associated with reduced response times, improved diagnostic accuracy, better continuity of care, and optimized resource utilization. Digital health infrastructures, interoperable information systems, and standardized governance frameworks are identified as critical enablers of successful integration. Despite these benefits, persistent challenges remain related to organizational silos, data fragmentation, and variability in implementation maturity. This review highlights best practices, identifies system-level gaps, and proposes an integrated conceptual perspective to support healthcare leaders and policymakers in advancing coordinated, high-performing healthcare systems.

Keywords : Integrated care pathways; healthcare systems integration; clinical coordination; diagnostic processes; emergency response; patient safety; care continuum.
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty