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Foster Care Quality Improvement Through Comprehensive Pathway Analytics
Introduction
Innovation in diagnostics and therapeutics has helped improve outcomes and quality of life for cancer patients. However, as the pace of change accelerates, so does the challenge of staying abreast with the latest evidence. Oncology pathways embedded in the clinical workflow is one way cancer centers can support their physicians in making consistent, evidence-based treatment decisions for their patients.
Access to accurate and timely data is essential to improve the quality of care that institutions provide and better position themselves for participation in value-based programs. When pathways data is structured and complete, analytics can be used to identify and address unwarranted variation of care, improve workflow operations, and enhance clinical trial research.
Establish a foundation for predictable cancer care
The expansion of new oncology treatment options offers promising opportunities to cancer patients but makes decisions for oncologists increasingly difficult. Even with access to clinical guidelines, their broad presentation results in variation from physician to physician from workup through treatment, with no justification available to explain why multiple approaches to care were taken for seemingly the same type of patient. This increase in care variation leads to unpredictable patient outcomes and costs.
With evidence-based oncology pathways, institutions establish a clinical habit of considering current, evidence-based, multi-disciplinary treatment approaches and their supporting ancillary care. As a natural part of the decision workflow, physicians access pathways directly in the EHR to surface the optimal patient-specific treatment recommendation, supported by latest evidence, to give confidence and guidance to their decision making. Treatment recommendations are prioritized on the hierarchy of efficacy, then toxicity, and finally cost aimed to optimize care outcomes and to remove the negative consequences associated with variation in care – front and center being the cost of cancer care.
Data captured on an EMR-integrated pathway platform provides actionable insights that can help address variation across the cancer network. The data can be used to promote quality improvement initiatives and demonstrate value to key internal and external stakeholders. Cancer centers can identify outliers and variances in treatment decisions on a consistent basis, providing insights at a granular level that can include: how often providers use the pathway in their decision process (utilization/capture rate), how often they select a treatment recommended by the pathway (on-pathway rate), justification for going “off-pathway”, biomarker testing rates, and clinical trial accrual statistics.
A recent study found that only 25% of Stage IV non-small cell lung cancer patients were tested for all appropriate biomarkers, in contrast the study showed that when pathways were used that percentage dramatically increased to 92% of patients being tested for the appropriate biomarkers to guide precision oncology treatment[1]. As the study’s findings illustrate, clinical leaders can utilize data to understand where physicians may be over or under testing patients across their health system.
Optimize clinical and organizational workflow efficiencies
Pathways add platform structure to coordinate care across treatment modalities and support teams as patients move through the care continuum. An effective pathways program enables care teams to standardize referral points between medical, radiation, and surgical oncology.
This multidisciplinary approach to care coordination can help to avoid costly gaps in care. Additionally, embedding pathway tools into the physician workflow supports ancillary care teams who use details of the decision to note supporting pathway information, and patient education to create a more holistic approach to supporting multidisciplinary information needs.
Insight into practice patterns at the enterprise, organization and provider level enables leadership teams to identify areas for operational improvements to make agile adjustments. For example:
- Contracting. With data demonstrating adherence to evidence-based treatment selection, pathways support payer metrics that can help institutions improve their position to negotiate and participate in value-based programs.
- Pharmacy Inventory. Consolidated data reveals drug volume insights, which can lead to revised contract pricing based on use. This allows cancer centers to refrain from high-cost target therapies that may not be appropriate based on the patient presentation.
- Scheduling. Care teams can craft schedules based on patient volume and disease presentation to balance staff support and patient demand.
In addition to optimizing operational efficiencies, pathways data can be used to analyze an institution’s treatment decisions. However, extracting and normalizing this data from existing systems can be cumbersome, and delays in data processing cause blind spots that impact reporting and reimbursement. Dedicated analytics with interactive real-time dashboards allow leadership teams to extract the latest clinical and operational data to better understand how oncologists are using pathways and to drive further usage of the solution. The dashboards also provide access to historical data, with the ability to filter by date ranges to identify past trends and evaluate progress. With flexible and digestible analytics that are stratified across department, provider, and disease, institutions can align with standardized, evidence-based care recommendations to measure and improve clinical and operational performance.
One institution’s study comparing Stage II breast cancer patients found an average 2-year $89K total cost of care savings for patients treated on-pathway, with results of $104k for on-pathway patients vs. $184k for patients treated off-pathway. These patients also visited the emergency department less frequently: 12% vs. 18%, respectively, due to lower toxicities[2]. These data points show that pathways analytics can validate and demonstrate quality of care, allowing health systems to manage costs without negatively impacting patient outcomes.
Leverage clinical research insights to improve performance
While analytic insights can help standardization of care efforts and optimize physician workflows, institutions can also leverage pathways data to elevate their clinical research programs. Detailed analytics provide insights into the number of patient treatment decisions for specific disease presentations and whether available trials were considered when providers made their care decision, enabling leadership teams to make informed decisions about their research portfolio. This level of clinical trial data gives leadership better insight into the performance of their network with analysis of clinical trial accrual, near-real time epidemiology of their cancer case mix, and how physician decisions compare to evidence-based recommendations at the disease and network site level. By raising awareness to trials that might be the right ones to consider adding to the practice portfolio, pathways can position research programs for sustained success. When leaders are given data to inform decisions on which trials to commission and which ones to close, they can better manage a trial portfolio tailored to the patient population they serve, are better positioned to meet revenue targets, and allow a path to NCI designation for practices that seek that level of research integration.
Conclusion
Accessible analytics built on timely, reliable data is a key factor to establishing a culture of quality improvement for cancer centers:
- By providing high-quality analytics that present insights and offer actionable opportunities to promote quality and value, institutions can address unwarranted care variation that can strain their operations.
- Comprehensive reporting available through interactive dashboards presents an opportunity for both clinical and operational optimization that can ultimately drive improved treatment decisions and patient outcomes.
- Pathways data provides opportunities for clinical research programs to build portfolios that are better positioned to treat patient populations, increase the likelihood to meet revenue targets, and achieve NCI designation.
With oncology pathways as an integrated clinical decision support tool, success in these areas of focus can result in optimal financial returns and help physicians provide the highest quality care for the patients they serve.
References
- Actionable biomarkers in a non-small cell lung cancer (NSCLC) clinical pathway (CP), Journal of Clinical Oncology, presented February 26, 2016, https://meetinglibrary.asco.org/record/121367/abstract
- Weese James et al. Use of treatment pathways reduce cost and increase entry into clinical trials in patients (pts) with non-small cell lung cancer (NSCLC). J Clin Oncol 38: 2020 (suppl; abstr e21000)
