A study presented at the conference reported some key tools that can be implemented to improve physician adherence to clinical pathways, which encourage best practices for treatment of a variety of cancer types.
As costs continue to rise for the treatment of cancer, hospitals have worked to implement measures that curb costs and lead to better outcomes. Clinical pathways, now used by over 1000 physicians across the United States, are one of the tools many institutions have tried to implement. Pathways are standardized methods of practice that, when based on the most current evidence, can help manage the quality of care for patients with cancer. However, while many studies have demonstrated that pathways are an effective method of treatment, some institutions have experienced difficulty facilitating physician buy-in.
The UPMC CancerCenter and the University of Pittsburgh Cancer Institute implemented a pathways program in 2003 to standardize care at 19 radiation sites. The program was developed as part of an effort to ensure consistency and rapid adoption of evidence-based care.
Dwight E Heron, MD, University of Pittsburgh Medical Center, PA, presented research on how integrating electronic medical records with the web-based pathway portal could help guide decision-making at the point of care.
A committee of oncologists within the network developed the pathways and met biweekly to review newly available evidence and update treatment recommendations as needed. Evidence was evaluated hierarchically on efficacy, then toxicity, and then cost. Electronic medical records data were integrated into the web-based pathway portal in 2009, allowing for any treatment updates made by the committee to be implemented within 35 days and available to all 38 network providers at the point of care to provide patient-specific decision support.
To determine the effectiveness of the program and judge how well physicians adhered to clinical pathways, researchers analyzed data from over 48,000 visits across the network beginning in 2009. Overall, results revealed that physicians adhered to pathway recommendations in 96% of all visits. Additionally, any decisions deemed to be off-pathway had to be approved prior to treatment by a designated radiation oncologist. All off-pathway decisions were recorded and will be considered for future recommendations as well. Dr Heron also stated that access to the database helped to improve the efficiency of hospital staff and reduced the administrative burdens relating to the accounting of clinical trials.
Dr Heron concluded that clinical pathways are an effective method of standardizing high-value care across a large network and geographic location. In addition, committee process, rapid electronic deployment, and evidence review can help to facilitate high physician buy-in and adherence to clinical pathway recommendations.
