A multisite initiative to increase medical oncologists’ utilization of clinical pathways in the selection of systemic cancer treatment.

Abstract

575 Background: The Swedish Cancer Institute (SCI) recognizes that quality cancer care is a systemwide commitment. In 2020, SCI implemented ClinicalPath (formerly Via Oncology). The ClinicalPath tool assists in the selection of systemic treatment protocols. The protocols balance considerations of clinical efficacy, safety, toxicities, and cost. National utilization rate for ClinicalPath ranges between 50-70%. In 2021, ClinicalPath monthly utilization by SCI medical oncologists was 56%. This initiative aimed to increase utilization of ClinicalPath by SCI Medical Oncologists, across the three main campuses, to above 70% by the end of 2022. Methods: The Plan Do Study Act framework was used. Utilization was defined as accessing the ClinicalPath tool. Utilization data was abstracted from an Epic Workbench Report that was filtered to reflect practicing SCI medical oncologists and the 25 diagnoses included in ClinicalPath. An introduction email and meeting request was sent to eight Medical Directors. A fishbone diagram was used to identify the potential causes of low utilization. PDSA 1 interventions included 1:1 meeting with each Medical Director to validate baseline data for cascading to their oncologists and encourage engagement. PDSA 2 included monthly “Quality Messages” with oncologists’ monthly utilization rate. In addition, a public recognition of “Most Improved Utilization” from Q1 to Q2 was done by the SCI Executive Medical Director. PDSA 3 focused on wide dissemination of the initiative through presentations that included a link to a “Tips & Tricks for ClinicalPath” video at SCI executive and department meetings. Public recognition of “Top Performers” from Q3 was published in the SCI newsletter. Results: The process measure of 1:1 meeting with Medical Directors was achieved at 100%. During PDSA 1 the outcome measure of monthly utilization rates improved to 71%. The 2nd PDSA cycle yielded a utilization rate of 84%. The 3rd PDSA cycle monthly utilization rate by the end of 2022 was 86%. At the most recent tracking into 2023, the utilization rate showed sustainability with achieved rates of 83%, 80%, 80% for Jan, Feb, March. Conclusions: Engaging the SCI Medical Directors and sharing individual performance data with the medical oncologists was a simple intervention yet yielded a significant improvement in their ClinicalPath utilization rates. Public recognition, along with addressing common barriers through education resulted in further improvement. This approach serves as a model for increasing utilization of a point of care clinical decision tool.