Pathways That Deliver the Best Patient Care
In this issue, we present a featured article that is an excellent example of the potential for clinical pathways to assist with delivering optimal patient care, based on the medical evidence (page 19). Manohar et al looked at the utilization within their institution of two classes of bone-modifying agents in patients with bone metastases, which have similar scopes of indication; however, they vary significantly in cost, which can be further influenced by dosing intervals that range from every 3 to 4 weeks to every 12 weeks. Although ASCO guidelines in multiple myeloma and breast cancer endorse a 12-week schedule, the authors found this is not universally followed. They concluded that developing and implementing an institutional pathway to align practice with best available evidence would have resulted in a realized substantial cost savings without compromising care quality.
But these aren’t the only factors to consider in clinical pathway development. As I noted in my “Call to Action” in 2022, organizations need to ensure pathways are flexible enough to allow treatment decisions that are consistent with the patient’s needs and desires. In her presentation at the Oncology Clinical Pathways Congress meeting in Boston last year, Deborah Collyar discussed this very topic; in this issue, she goes into more detail in her featured article (page 25) as to how the health care industry can have confidence that the services we are delivering are in the best interest of the patient. Ms Collyar highlights a clear truth that we, as clinicians, frequently overlook: Once a person is diagnosed with cancer, they become a “patient” who often feels like “they have landed on a foreign planet without a roadmap, dictionary, or any type of survival training.” Simply put, patient situations should be recognized and resolved through flexible clinical pathways that assist providers with useful, health-literate tools and techniques that ensure the right care is delivered to each patient at the right time.
Finally, our third feature (page 29) gives us a reality check on the current state of alternative payment models (APMs). While there has been some success in implementing APMs in the primary care setting, there has been little progress in the specialty care space. Shaughnessy and colleagues conducted a multitude of interviews with various stakeholders across different specialties to identify the ongoing challenges with investing in, designing, and scaling specialty APMs, especially for populations covered by commercial insurers. Their conclusion is that specialty APMs will require greater collaboration between payers and providers to support an environment that better enables specialty APMs to be implemented.
In addition, you can read the highlights from the most recent Clinical Pathways Forum presentation (page 9) on a clinical decision support tool that Dana-Farber Cancer Institute and Elimu Informatics Inc are working to implement; and the results of an ACCC survey on multicancer early detection (online exclusive content).
As always, let us know any comments, questions, or suggestions you may have. And if you’d like to submit your data for publication, please visit jcponline.com.
