Abstract
98 Background: Clinical pathways (CP) is an emerging tool aiming to reduce unwarranted variation and maximize value in cancer care. We describe the preliminary experiences and challenges of developing, implementing and testing pathways at a comprehensive cancer center. Methods: Dana-Farber Cancer Institute (DFCI) partnered with Via Oncology to develop and pilot institution-derived CP in lung cancer. The Via platform tracks usage rate, adherence to the DFCI-designed CP (on-pathway rate), and reasons why off-pathway treatments were chosen. An online satisfaction survey was conducted among providers participating in the pilot. Results: Between 1/27/14 and 5/30/14, 277 chemotherapy treatments were initiated, with 124 new patients. CP was used to generate 98% of new chemotherapy orders; 63% were on-pathway. The most common off-pathway reasons were 1) poor patient performance status and 2) treatment beyond 3rd line. 22 of 41 specialists who participated in the CP pilot at DFCI’s main campus responded to the survey (54% response rate). Respondents ranked the Institute as the stakeholder who most benefits from CP, followed by payers, DFCI network community physicians, DFCI main campus physicians, and patients. Respondents recognized CP reflects appropriate care but are concerned about workflow (Table). Conclusions: Implementation of an institution-derived CP is feasible at a comprehensive cancer center. Physician input into pathway design is essential to build buy-in. Academic specialists perceived more benefit of CP for their community peers and raised concerns about workflow. On-pathway rates were lower than those reported in community settings, due to many potential factors (to be explored with updated data for final presentation). [Table: see text]
Published Version
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