Integrated Care Clinical Pathway Implementation using a Patient Oriented Learning Health System Approach: A Realist Process Evaluation of the Saskatchewan Long COVID Pathway

Clinical pathways (CPW) are designed to organize patient care through the health system and optimize delivery and patient outcomes. However, implementing these processes successfully in practice can be challenging. In Saskatchewan, a Long COVID (LC) CPW, established by the Saskatchewan Health Authority (SHA), aims to improve care for patients suffering with LC. Since LC symptoms are diverse, patients may need to be referred to a range of health professionals across the care continuum and services for diagnosis and treatment. This project aims to evaluate how, why, under what circumstances, and for whom the LC CPW works in order to scale it up across all 38 Health Networks in Saskatchewan. In partnership with SHA, we will continuously learn and improve as we apply a realist research approach to our evaluation of the operation of a patient-oriented Learning Health System. By taking a realist research approach, our team can provide our SHA partner with evidence to understand what makes a successful, economically efficient, and sustainable LC CPW. The Implementation Science Team (IST) for the project is comprised of patient partners, researchers, health care providers, and health system leaders who will complete an evaluation through five phases: 1) Planning, 2) Initial Theory Development, 3) Theory Testing, 4) Learning Cycles, and 5) Theory Refinement. We will collaborate and strengthen relationships using inter-agency collaboration and build trainee skills within the IST who are diverse in their backgrounds, expertise, age, sex, and ethnicity. The project will ensure research findings are relevant to patients by engaging patient partners at all phases of the research. Our key stakeholders and SHA partner will use evidence from the evaluation to inform policy decisions to scale-up the LC CPW across the province and develop a sustainable framework for future CPWs in Saskatchewan and Canada.