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Many oncology clinical pathways meet criteria for high quality

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February 12, 2018

Most available commercial oncology clinical pathways meet ASCO’s criteria for high-quality development, implementation and use, and analytics, according to a report published in Journal of Oncology Practice.

Due to a shift toward value-based reimbursement, the use of oncology clinical pathways has grown substantially, increasing 42% from 2014 to 2016, according to the report.

“ASCO conducted this assessment to provide more complete information about how current pathway programs are developed, implemented and analyzed by specific pathway vendors,” Bruce E. Johnson, MD, FACP, FASCO, president of ASCO, said in a press release. “Equipped with this information, the oncology community will be better able to evaluate and use these pathways in practice.”

In January 2016, ASCO released its policy statement on clinical pathways in oncology. In March 2017, the society released criteria for high-quality pathways based on development,

implementation and use, and analytics.

Using these criteria, an ASCO task force evaluated pathways from six prominent pathway vendors: Anthem/AIM Cancer Care Quality Program, eviti, eviCore, New Century Health, Value Pathways by National Comprehensive Cancer Network and Via Oncology.

Researchers placed eviti and eviCore in a subcategory of decision support tool vendors based on the service they provided.

The task force used publicly available information and follow-up phone calls to the vendors to evaluate each pathway based on the ASCO criteria.

ASCO criteria states pathways should be developed by oncology providers so that the pathways include the best evidence, encompass tumor-specific expertise of oncologists from various specialties, and reflect clinicians’ understanding of the physician-patient relationship. Results showed the evaluated vendors appeared to have expert-driven and evidence-based pathways that were developed by oncology providers using the latest data.

The task force also considered the degree of integration of pathways into electronic health records for decision support, seamless structured documentation and order entry, and automation of communication with payers for authorization.

Four of the six pathways were integrated into the EHR and many vendors integrated payer authorization and decision support or were developing that capability.

The criteria also recommend that high-quality oncology pathway programs promote adherence reporting and support research and continual quality improvement.

The task force found many of the pathways are geared toward research development and quality improvement by including data on pathway adherence. However, the pathways evaluated met fewer criteria in the categories of having clear and achievable expected outcomes and public reporting of performance.


“We’re encouraged to see that, by and large, prominent pathway programs are adhering to ASCO’s criteria for high-quality clinical pathways,” Robin Zon, MD, FACP, FASCO, oncologist at Michiana Hematology Oncology and chair of ASCO’s Task Force on Clinical Pathways, said in the release. “We hope our assessment of the pathways landscape will help these programs make further refinements, with the ultimate goal of improving the care of our patients.”

The goal of the task force analysis was not to make judgments on specific pathway vendors for specific applications.

“Rather, the task force hopes this work will highlight areas for the continuous evolution of [oncology clinical pathway] programs and invites other pathway programs, including single-institution [oncology clinical pathways], to report on their status vis-à-vis the criteria,” the researchers wrote. “In sharing this assessment, the task force hopes this work illuminates how pathways can progress toward the shared goal of providing the best care for patients with cancer.” – by Cassie Homer

Disclosures: Daly reports employment with Quadrant Holdings; and owning stock or other ownership interests in CVS Health, Johnson & Johnson, McKesson, Walgreens Boots Alliance, Eli Lilly and Walgreens Boots Alliance. Please see the study for all other authors’ relevant financial disclosures.