The benefits of clinical pathways (CP) for radiation oncology in a large cancer care network.

148 Background: UPMC CancerCenter and the University of Pittsburgh Cancer Institute (UPMC) created a radiation oncology CP program (now incorporated separately as Via Pathways) in 2003 to standardize care at 19 radiation sites. The program exists to ensure consistency and rapid adoption of best evidence-based care in a large, integrated NCI-designated comprehensive cancer center.

METHODS: The web-based CP portal integrates with electronic medical records to provide point-of-care patient-specific decision support. CP content is developed and maintained by committees of oncologists culled from the network. Meetings occur semi-annually to review and update treatment recommendations for the nearly 95% of cancers covered. Evidence is evaluated hierarchically on efficacy, toxicity, then cost. When the committee modifies CP content, the software is updated within 35 days and new recommendations are available to the 38 network providers. Through analysis of the utilization data, leaders can monitor adherence to the CP recommendations and research practice patterns at an unprecedented level of granularity.

RESULTS: Since data collection in the portal began in 2009, UPMC has captured over 48,000 visits and adhered to CP recommendations 96% of the time. Off-pathway decisions were approved prior to treatment by a designated peer review radiation oncologist at UPMC. Reasons for going off pathway and the alternative approach to care were recorded. Efforts to increase efficiencies and trial accruals have been successful due in large part to access to such a vast and comprehensive database.

CONCLUSIONS: CP are an integral part of standardizing to high-value care across large networks and geographic regions. The committee process, rapid electronic deployment, and easy access to evidence reviews have garnered high physician buy-in and consistent adherence to CP recommendations. Other benefits of the program include: a transition from volume to value care models; facilitation of onboarding new physicians, residency trainees, and fellows; providing transparency through peer review, a committee process, and evidence reviews. CP are now used by more than 1000 physicians across the US in a variety of academic and community settings.