Clinical pathways—defined as structured, multidisciplinary care plans that incorporate evidence-based guidelines and protocols to standardize care—represent a natural strategy for achieving success in the Oncology Care Model (OCM). Clinical pathways are evolving to go beyond drug treatment regimen guidance to include supportive care and prompts for patient education, shared decision-making junctures, and end-of-life care. Pathways that incorporate, facilitate, and measure these aspects of care are poised to assist facilities in achieving better outcomes at a higher value as required under looming alternative payment models. The articles in this issue discuss executed and theorized strategies for delivering more person-centered care using clinical pathways in the context of OCM.
Clearview Cancer Institute (CCI) is a private, community practice participating in the OCM. To ensure success in the pilot, CCI identified areas for new programming as well as action items to address process improvement and impact patient outcomes. Among other enhancements, CCI has worked to implement nursing triage pathways to streamline patient assessments and reduce emergency department utilization rates. As a follow up to their previously published article “A Community Practice Perspective on Implementation of the Oncology Care Model,” Anne Marie Fraley Rainey, MSN, RN, CHC, provides a deep dive into the process for creating, implementing, and maintaining these pathways, as well as current outcomes of the program.
The oncology arena has a long track record of clinical pathways use with multiple established pathway vendors. We are now starting to see cancer centers developing and implementing their own programs internally. However, applying prior experience in oncology pathways may be insufficient for maximizing performance in OCM for a few reasons. For example, many oncology pathways have focused on surgical aspects of cancer care rather than administration of chemotherapy, which is emphasized in OCM. Nikita V Baclig, MD, MPH, and Joshua M Liao, MD, MSc, FACP, explain how practice leaders have an opportunity to prioritize new features in OCM-focused pathways to drive outcomes and performance. Authors discuss several strategies that can help participants achieve this goal, such as embedding automatic triggers for early palliative care consults, permitting parallel and potentially intersecting curative chemotherapy and palliative processes, and promoting education via patient-facing pathway materials.
This issue also contains exclusive coverage of the 2019 Oncology Clinical Pathways Congress held October 11-13, 2019, including faculty spotlights and detailed results of and commentary on the 2019 Oncology Clinical Pathways Survey.
