Implementation of treatment pathways in a large integrated health care system
Weese J L, Citrin L, Shamah CJ, Bjegovich-Weidman M. Implementation of treatment pathways in a large integrated health care system. Journal of Clinical Oncology. 2016;34(15):6613-6613. doi:10.1200/JCO.2016.34.15_suppl.6613 .
ASCO recently addressed the importance and role of treatment pathways in value based medicine. The 35 medical oncologists at QOPI certified Aurora Cancer Care (ACC) are developing its value-based care model around Via Pathways. VIA’s decision support algorithms are evidence based, and updated quarterly by both academic and community oncologists. Regimens are based on efficacy, then toxicity, and finally cost. When available, a clinical trial is the first recommended option. In the 2 years prior to VIA, over 40 different treatment plans were used for first line treatment for Stage II breast cancer. Our initial goal was to determine if pathways would be accepted by a large, diverse and geographically separated group, decrease the number of treatment algorithms used, increase clinical trial enrollment, and reduce ED utilization.
Stage IV non-small cell lung and stage II breast cancer patients who received first chemotherapy by ACC were selected for analysis. Patients were split into two cohorts: one diagnosed between 10/1/13 – 4/30/14 (prior to VIA) and another between 12/1/14 – 6/30/15 (post VIA). Data collected include demographics, diagnosis, treatments (pathway selected), and ED visits. The data were integrated together and filtered by disease site and treatment pathway. Protocol selection and ED visit rates for the two populations were analyzed.
RESULTS: ACC successfully integrated clinical, financial and quality data from its pathway tool with data from other primary systems and demonstrated reporting capabilities. VIA has been well received with a visit capture rate of 81% and on-pathway protocol selection of 82%. Post VIA, clinical trial participation increased 66%. The table below contains a select description of our initial data set.
CONCLUSIONS: Adoption of VIA decision support has been high; the tool was used for 92% of patients in the data set. Although the data set didn’t contain a sufficient number of patients to draw statistically significant conclusions, it will serve as a model for ongoing reporting supporting the development of a value-based care model.
Number of patients with an ED visit within 7 days of chemotherapy. Pre VIA:Post VIA: n:PTs w/ ED:%:n:PTs w/ ED:% Lung: 72 18 25% 30 7 23% Breast: 76 13 17% 69 6 9%