The complexity of cancer care and unwarranted variation in treatment can serve as a barrier to improving care quality. As a result, health systems are increasingly turning to clinical pathways as a way to provide standardized, high-quality care.
During a March 18 webinar hosted by Becker's Hospital Review and sponsored by Elsevier, James Weese, MD, FACS, Vice President at Aurora Cancer Care in Milwaukee and Clinical Adjunct Professor of Surgery at the University of Wisconsin School of Medicine and Public Health in Madison, discussed the value of evidence-based oncology pathways and shared success metrics.
Five takeaways:
1. Pathways reduce unwarranted variation in care. "Pathways really give a prescribed recommendation of how patients should be treated as far as the sequencing of therapy and the optimal type of treatment," Dr. Weese explained. This supports oncologists in making evidence-based treatment decisions for their patients, prioritizing the most efficacious and least toxic regimen plan.
2. Integrating evidence-based pathways into the EHR makes them part of the workflow and easier to use. "We have been able to integrate the pathways directly into [the EHR] for the patients to be managed directly off of the doctors' schedule so that it's become a very easy process to run them through the pathway determination," Dr. Weese said. Integrating pathways into the clinical workflow also reduces the manual data entry required and treatment decisions are automatically transitioned to an order set in the EHR.
3. Oncology pathways encourage a team-based approach. “Clinical pathways increase collaboration among physicians,” Dr. Weese said. For example, the health system holds weekly virtual disease specific conferences with an average attendance of 25-40 clinicians. This coupled with the pathways "allow oncologists across specialties to collaborate and devise the best treatment available for a specific patient," Dr. Weese said.
4. Pathways reduce care costs and avoidable ED visits. Aurora Cancer Care found the mean cost of treatment for patients with stage two breast cancer was more than $200,000 for patients treated off-pathway, compared to $111,000 for those treated on-pathway. In addition, 18.8% of the off-pathway patients were seen in the emergency department and had more multiple visits compared to 12.1% of on-pathway patients within 30 days of chemotherapy. Dr. Weese said, adding that pathways to his institution’s practice not only reduced treatment variation, but also decreased cost variation.
5. Embedding clinical trials into pathways boosts enrollment. Within the first two years of introducing pathways, clinical trial volume for cancer patients increased about 400 percent from pre-pathway enrollment. Before pathway implementation, 122 patients were enrolled in clinical trials in 459 days. After pathway implementation, it took just 271 days to enroll 102 patients.
To watch the full webinar presentation, click here.