Care Pathway

A care pathway provides a clear process for practitioners to follow in order to optimize patient care when access to resources and expertise may be limited. This care pathway strategy represents a promising approach to ensuring equitable care for all patients, and moves towards standardizing screening, diagnosis and treatment. IHDR, in partnership with orthopaedic surgeon, Dr. Kevin Shea, and the Pediatric Orthopaedic Society of India (POSI), are working to create a care pathway for hip dysplasia applicable to varying health care systems. Application of the care pathway framework to health care systems in other countries will work towards the goal of minimizing the effects of missed DDH diagnosis.

The Idaho working group, headed by Dr. Kevin Shea, has developed a DDH care pathway specific to the state’s health care system. The pathway serves to guide primary practitioners and pediatricians in an algorithmic screening and management approach with the state’s particular geographic characteristics and rural population base in mind.

However, a care map developed for specific regions may not be relevant in other practice settings, particularly those in developing countries, and alternative pathways may need to be considered. Countries in the developing world often have limited resources and access to ultrasound as a primary screening tool, thus preventing early detection of DDH. Consequently, these countries have a greater prevalence of walking-age DDH, whereas the Global North has a higher prevalence of infantile DDH.

Toward the goal of identifying best practices and standardizing global diagnosis and management decisions in DDH, it will be important to understand the existing variability between surgeons and centers to promote discussion and consensus development 


IHDR has worked to distribute a survey to investigate the variability in screening, diagnosis, treatment, and current practice patterns for DDH in North American, Indian, and Chinese centers.

By identifying the variability in treatment plans for DDH patients, we can better understand the scope of options available to surgeons and primary care physicians (PCP), the outcomes and risks associated with those treatments and develop an algorithm for DDH management to optimize clinical and functional outcomes. Subsequently, this knowledge will aid in developing an alternate DDH care map pathway to account for procedural screening variations in various health care systems with varying resources and practice guidelines.