Conceptual Modeling for Cooperation-Based Evolution of Medical Treatment

Chronic diseases, cross-sectoral treatment chains, variations in lengths of stay and a multitude of treatment options along the treatment chain with significant economic and social impacts characterize the domain of psychological and psychosomatic treatment. This kind of treatment sector is facing major challenges like evaluating the treatments by economic criteria whilst ensuring at the same time a certain quality level, to facilitate coordinated cross-sectoral cooperation and to promote systematic exchange of knowledge. On the basis of analyses of structured interviews with different stakeholders of the psychological and psychosomatic sector, we designed a framework for the evolutionary development of Clinical Pathways. This framework covers a novel organizational paradigm derived from managerial theories and adapted for cooperative health care provision. Evolutionary reference models should serve as a means of organizational learning and should provide potential for improving both the quality of medical treatment and the cost-benefit ratio. The evolutionary approach contains a permanent generation of organizational experiences from daily care and using them for evaluation and improvement of standardized treatment modalities. Beyond the framework of evolutionary Clinical Pathways we discuss necessary adjustments of conventional modeling approaches applied within the health care sector.