High-quality tools have the ability to utilize sophisticated digital mechanisms to improve patient outcomes while also enhancing data collection, lowering costs, and increasing accountability. Clinical pathways and decision-support mechanisms (CDSMs)—which can sometimes be the same thing or intermingle—are a common strategy many are using to ensure value and evidence-based clinical care are being delivered and can also be measured. While such tools are exciting, they must continually evolve and also not be trusted blindly. Regular evaluation is needed to ensure such tools are accomplishing their aims in the real world. This issue presents two Research Reports: one evaluates the real-world use of a CDSM; the second explores the real-world management and outcomes of a specific population that would benefit from a pathway or CDSM. Column topics include a breakdown of the limitations inherent in pathways as well as how to add patient-specific factors into the early developmental stage of pathway design.
Given new therapeutic advances that are potentially curative in diffuse large B-cell lymphoma (DLBCL), it is important to understand what has been observed to date in this population to assess improvement in outcomes; data from US community practices have been limited. Andrew J Klink, PhD, MPH, and colleagues conducted a study to assess retrospective data to provide greater insight regarding patient characteristics, clinical outcomes, and treatment patterns among patients with relapsed DLBCL. The wide treatment variation for relapsed DLBCL in the real-world setting, authors say, demonstrates a need for clinical pathways in this patient population.
Over the past decade cancer treatment has evolved at an extremely rapid pace. In 2018 alone, the National Comprehensive Cancer Network (NCCN) made over 150 updates to their published cancer guidelines and compendia. Such a dynamic environment reinforces the need for highly accurate pathways and CDSMs to assist practicing physicians in effectively utilizing the latest evidence-based treatment guidelines. eviCore healthcare has a proprietary clinical decision support program that uses the NCCN guidelines to facilitate management of medical oncology drug utilization. Margaret Rausa, PharmD, and colleagues sought to evaluate the pattern of NCCN adherence in regional payer markets during the first year following the launch of eviCore’s Medical Oncology clinical decision support program.
Column editors Gordon Kuntz and Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, provide further commentary on how pathways are used in practice. Mr Kuntz posits that, while oncology clinical pathways are arguably one of the most important tools clinicians have in treating cancer patients, it is important to understand how pathways are built and what the limits of the technology, processes, and recommendations are, so that the results can be better understood. Dr Stefanacci outlines how pathways can ensure provider and payer incentives are aligned and reinforce what is best for patients and members via the lens of population health.
