Using a pathways process to ensure measurable evidence-based standardized care in a large cancer network.

Abstract

252 Background: UPMC CancerCenter includes 40 sites of services in a 100 mile radius in Western Pennsylvania. Consistency and quality of care are critical to such a diverse network. In addition, the UPMC mission includes accrual to clinical trials. To meet these challenges, UPMC developed the Via Oncology Pathways. The program has served UPMC well for over seven years to date and is now a key foundation for UPMC’s overall healthcare reform strategy for quality and accountable care. Methods: Treatment algorithms were developed for 90% of cancer types by establishing committees of academic and community specialists. These committees interpret the literature and define the most efficacious, least toxic, and economically efficient treatment regimens appropriate for highly specific disease presentations (e.g., node +, er-, her2 +, PS 0-1). Clinical trials are also imbedded into the algorithms. Quarterly, these algorithms are reviewed by the committees to assess relevance, review network feedback, add newly available trials and address emerging data. Equally important to clinical content is its presentation to the practicing physician in a manner that allows real time usage and adds value to physician workflow. This is accomplished with a web portal that presents the individual pathways status through the physician’s daily schedule. Results: Over 120 oncologists at UPMC use Via Oncology Pathways in their daily practice. In 2011, UPMC physicians confirmed a pathways status for 94% of their patient visits (195,000) and achieved an On Pathway rate of 82% for their 18,000 treatment decisions. The database also includes patient presentations, reasons for going off pathway and reasons for not accruing to clinical trial. Lower hospitalization rates and mandated adoption of personalized medicine were also observed. Conclusions: When appropriately developed and implemented, clinical pathways are a solution to improving the quality and cost effectiveness of cancer care by enhancing physician decision-making, standardizing care and ensuring access to evidence-based personalized medicine. We continue to expand the scope of our pathways to include diagnostic studies, surveillance protocols and end of life prompts.