An innovative approach to “off pathway prescribing” to improve pathway adherence and practice collegiality utilizing a peer-reviewed process and scorecards.

Abstract

37 Background: Blue Ridge Cancer Care (BRCC), part of the US Oncology Network, utilizes Value Pathways, a refinement of the NCCN Guidelines that highlights evidence-based treatment options based on efficacy, toxicity, and evaluation of financial impact to patients and payors. Adherence to evidence-based and cost-effective treatment guidelines are a significant aspect of oncology care. BRCC implemented a monthly meeting that improved patient care and provider adherence to Value Pathways guidelines and increased the understanding of financial toxicity related to various therapies. Incremental cost-effectiveness ratio (ICER) was introduced as a tool to help estimate therapy value. Methods: Monthly virtual/in-person meetings involved the two divisions (9 locations) and included two alternating formats. 1) Journal Club focused on new pathway regimens. 2) Pathways Round Table established open discussions between providers focused on peer review of “off-pathway” treatment decisions. Provider scorecards were shared monthly on individual provider pathway adherence rates. Surveys were conducted prior to and after the interventions to assess knowledge of guidelines, financial toxicity, and overall satisfaction. Results: We compared provider pathways adherence rates from 2018 - 2023 and surveyed providers on the impact of these meetings. Oncologist adherence to Value Pathways prescribing compliance increased 7.5% from 2018 to 2023 with an average of 2400 cancer treatment regimens entered per year. Conclusions: The Journal Club and Pathways Round Table meetings plus scorecards improved pathway adherence, collegiality among providers, normalized financial toxicity discussions with patients, and was considered valuable by most providers. [Table: see text]