Module 10 · Care Pathway Management · 10.2 · ORCHESTRATE

Pathway Studio

The authoring surface: variant model, node model, and engine parameters that every conformance figure derives from. Edits here would regenerate the cohort — the numbers are never hand-placed. Scoped to Full portfolio.

Variant model · deterministic first-match · MECE

#	Variant	Assignment rule	Cohort	Mean
1	V4 · Complex / Complications	Any active micro/macrovascular complication, or Charlson ≥ 4, or comorbid moderate-severe depression	55	64.2
2	V3 · Established–Uncontrolled	HbA1c ≥ 9.0, or 8.0–8.9 with rising trajectory over two results	92	71.4
3	V1 · New Diagnosis	T2DM diagnosis < 6 months, no prior cycle	52	69.8
4	V2 · Established–Controlleddefault	Residual: diagnosis ≥ 6 months, HbA1c < 8.0, no active complication	141	82.6

Authoring

Guideline version-change impact. 3 nodes bind requirements modified in ADA 2027 — N04 · ADA-2026-013 · N09 · ADA-2026-004 · N11 · ADA-2026-016. Review before the next Draft fork.

Variant tab · assignment-rule strip

V4 · Complex / Complications — Any active micro/macrovascular complication, or Charlson ≥ 4, or comorbid moderate-severe depression. 55 episodes · mean 64.2% · 26 nodes.

Node model · 22 nodes · grouped by timing anchor · click a node to edit

Decision points & conditional branches · 4

N04Medication intensification decisionCritical30d from qualifying HbA1c

N19Decision: month-3 HbA1c responseDecisionMonth 3

N20Decision: month-6 reassessmentDecisionMonth 6

N21Endocrinology referral (conditional)CriticalIf N20 persistent ≥ 9.0; 30d

Onboarding & baseline · 6

N01Enrollment & assignment reviewSupplementaryDay 0–7

N02Baseline HbA1c + metabolic panelCriticalDay 0–14

N03Medication adherence reviewCriticalDay 0–30

N05Dietitian referral (closed loop)StandardDay 0–45

N06Self-management education blockStandardDay 0–60

N07Depression screen (PHQ-9)CriticalDay 0–30

Recurring cadence · 6

N08BP captureSupplementaryEvery encounter

N09HbA1c retestCriticalq3mo (±3wk grace)

N10Follow-up encounterCriticalq3mo (±3wk grace)

N15Hypoglycemia safety checkStandardq3mo

N16Glucose self-monitoring reviewSupplementaryq3mo

N18Care plan update & goalsStandardq6mo

Annual · 5

N11Retinal exam (closed loop)CriticalAnnual, window 60d

N12Comprehensive foot examCriticalAnnual

N13Renal panel (uACR + eGFR)CriticalAnnual

N14Lipid panel + statin assessmentCriticalAnnual

N17Immunization reviewSupplementaryAnnual

Scheduled milestones · 1

N22Cycle close & re-enrollmentSupplementaryMonth 12

Engine parameters

Node weightsCritical 3 · Standard 2 · Supplementary 1Credit scaleOn-time 1.0 · Late 0.5 · Missed 0.0Cohort gate thresholdCritical-weight conformance ≥ 70%Exception governancePer-node exception rate > 10% → redesign flagDenominator ruleNot-Yet-Due instances excluded from every denominator

Conformance preview · engine-computed

73.1%

critical gate vs 70% (pass)

11.8%

V4 N11 exception (6/51)

58/340

N04 evidenced (cross-cohort)

Funnel (V1 spine)

Diagnosis & classification340

Comprehensive medical evaluation325

Individualized glycemic target254

First-line pharmacotherapy232

Month-6 monitoring block218

Conditional intensification178

Crosswalk · variant × RS-2 tier (row/column margins reconcile)

Variant	Low	Moderate	Rising	High	Σ
V4	5	15	15	20	55
V3	10	30	32	20	92
V1	12	20	15	5	52
V2	60	50	25	6	141
Σ	87	115	87	51	340

Variant	Low	Moderate	Rising	High	Σ
V4	5	15	15	20	55
V3	10	30	32	20	92
V1	12	20	15	5	52
V2	60	50	25	6	141
Σ	87	115	87	51	340

Variant	Low	Moderate	Rising	High	Σ
V4	5	15	15	20	55
V3	10	30	32	20	92
V1	12	20	15	5	52
V2	60	50	25	6	141
Σ	87	115	87	51	340

Variant	Low	Moderate	Rising	High	Σ
V4	5	15	15	20	55
V3	10	30	32	20	92
V1	12	20	15	5	52
V2	60	50	25	6	141
Σ	87	115	87	51	340