care plan

Definition

dynamic, personalized plan including identified needed healthcare activities, health objectives and healthcare goals, relating to one or more specified health issues in a healthcare process

This is a concrete item and can be implemented directly

Term: care plan;
Synonym: healthcare plan;
Plural: care plans;
Deprecated term: programme of care;

Notes

NOTE 1 A care plan may be recorded in one or more health records.

NOTE 2 A care plan could be subdivided from different perspectives by different constraints. One example is uniprofessional care plan, for example, a nursing care plan with the constraint of only one specific healthcare professional involved. Other examples of specific constraints for a care plan are: care plan to address one health issue, one health condition, one contact, one clinical process, healthcare activities to be performed by one healthcare provider, etc.

NOTE 3 care plans are reviewed repeatedly during a healthcare process, each review based on a new healthcare needs assessment.

NOTE 4 The healthcare activities in a care plan follow a life cycle. Examples of statuses of such a life cycle are: 'planned', 'performed', 'cancelled', etc.; all of these statuses are included in the care plan.

NOTE 5 In EN 13940-1:2007 programme of care was the preferred term for this concept.

Examples

EXAMPLE A care plan for retinopathy in diabetics by video-retinoscopy, which involves the GP and an ophthalmologist and implies specific mobile equipment (video-retinoscope) with a camera.

Required associations

one or more healthcare actors applies a number of care plans
a number of care plans one or more healthcare activities
a number of care plans is result of one or more healthcare plannings
a number of care plans addresses one or more health issues
one or more care plans targets one or more healthcare goals
one or more care plans targets one or more health objectives

Optional associations

a number of healthcare activity managements changes statuses of healthcare activities in exactly one care plan
a number of healthcare processes is planned in a number of care plans
a number of care plans implements a number of protocols
a number of care plans complies with a number of clinical guidelines
a number of care plans a number of care plans
a number of care plans a number of care plans
a number of care plans is based upon a number of core care plans
a number of care plans addresses a number of health threads
a number of care plans is recorded in a number of health records
a number of care plans a number of healthcare activities bundles
a number of healthcare appointments is scheduled in up to one care plan

care plan

Definition

Notes

Examples

Diagrammatic representation

Required associations

Optional associations

Generalisations

Specialisations

Definition

Notes

Examples

Diagrammatic representation

UML Diagram

Simple graph - care plan

Required associations

Optional associations

Generalisations

Specialisations