Use of radiation pathways to drive standardization of evidence-based care across a large network.

Abstract

27 Background: UPMC CancerCenter includes 37 academic and community based sites in western Pennsylvania. Consistency and quality of care are critical to such a diverse network. To meet these challenges, UPMC developed clinical pathways for medical and radiation oncology, now marketed as Via Pathways. The program has served UPMC well for over eight years and is now a key foundation for UPMC’s overall healthcare reform strategy for accountable care. Methods: Radiation treatment algorithms for 90% of cancers were developed by committees of academic and community radiation, surgical, and medical oncologists, with current representation from multiple cancer centers across the country. The committees meet semi-annually to interpret the literature and define the most efficacious and least toxic treatments for highly specific disease presentations (e.g., oropharynx, Stage III-IV, primary chemoradiation). Guidance for contouring, planning and delivery are provided along with applicable citations. Clinical trials open at UPMC sites are also imbedded into the algorithms. Converting these algorithms into measureable decision support is accomplished with a web portal that presents the individual pathways status through the physician’s daily schedule. Results: Thirty-one (31) radiation oncologists at UPMC use Via Pathways in their daily practice. For the 12 months ended May 31, 2013, UPMC physicians confirmed a pathways status for 98% of their patient visits (n=9,400) and achieved an On Pathway rate of 95% for their 5,575 treatment decisions. All off pathway treatment decisions were approved prior to treatment by a designated peer review radiation oncologist within UPMC. Reasons for going off pathway were recorded as well as what alternative approach to care was chosen. Conclusions: When appropriately developed and implemented, clinical pathways are a solution to standardizing care across multiple sites and physicians with the potential to improve the quality and cost effectiveness of cancer care. We continue to expand the scope of Via Pathways to include additional cancer types, surveillance protocols, and end of life prompts as well as surgical oncology pathways.