As pressure mounts to provide high-quality, cost-effective care, methods to achieve this are desperately needed. As a percentage of gross domestic product, the cost of medical care in the United States is 50 percent more than in other developed nations. Annual direct costs for cancer care are anticipated to rise from more than $104 billion in 2006 to more than $170 billion in 2020 and beyond, according to an article in the May 26, 2011, issue of the New England Journal of Medicine.
Moffitt Cancer Center has risen to this challenge. For the past three years, Moffitt has been engaged in a project to integrate clinical care strategies with evidence-based medicine using available technology to standardize, benchmark, measure and improve cancer care through Moffitt’s new Clinical Pathways Program.
The concept of clinical pathways is to create a model for providing evidence-based, consensus-driven, cost-effective cancer care. The pathways offer a systematic tool to help physicians improve patient care, documenting institution-specific best practices that, when shared, provide a rationale for better clinical decision making. Improvements in standardization and measurement of care mean better outcomes for patients.
By utilizing Web technology, Moffitt’s Clinical Pathways Program is designed to be highly interactive, linking to a variety of additional information, graphics, clinical literature and outcome data. The program outlines a consistent approach to personalizing patient care, including information to assist clinicians and practitioners in identifying relevant clinical trials and tailoring therapy based on specific patient and tumor factors and other prognostic indicators.
Clinical pathways provide a patient management tool not only for physicians but also for the entire health care team. The key goals of clinical pathways are to streamline related patient care processes, increase the use of generic drugs for both chemotherapy and supportive care, and assure that patients receive the most appropriate, personalized care to optimize their desired outcomes. Clinical pathways are continually updated to provide a basis for health care providers to evaluate best practices, outcomes information and cost of care, resulting in potential cost savings.
“Moffitt is always looking for ways to improve the quality of patient care and to effectively manage medication and services expenses,” says Jack Kolosky, executive vice president and chief operating officer. “We think our Clinical Pathways Program will demonstrate value-based outcomes through coordinated quality care and treatment standardization that will be an even more important role in the new health care environment.” Cost reduction, although an essential element, is not the top priority for our clinical pathways. It falls after treatment effectiveness, safety and toxicity as a priority for determining the most appropriate clinical options.
Development of the pathways involves a collaborative process of engaging clinicians, administrative leaders, financial departments and other specialists. Research and department meetings, journal clubs, and tumor board discussions were also leveraged to produce a robust clinical result with strong organizational support. So far, Moffitt has 30 clinical pathways for diseases that include many of the most common tumor types, and nearly as many pathways are in various phases of development. Moffitt includes diagnostic evaluation and surveillance strategies, stratification for prognostic and clinical high-risk features, and complications management pathways. Future plans are to include a patient viewable pathway that would assist clinicians in treatment and goal alignment discussions, as well as education.
These clinical pathways are made available to Moffitt Oncology Network physician members outside of Moffitt via the Physician Portal. The Physician Portal helps referring physicians monitor their patients’ progress while they are undergoing treatment at Moffitt. Last year, four network institutions went live with Web access to Moffitt’s Clinical Pathways Program. As a result of pathways access, collaborative discussions take place between network member institutions, bringing the opportunity to discuss practice variations, rationale and evidenced-based medicine strategies.
Working in collaboration with information technology and electronic medical record (EMR) partners, pathways decision support tools are being built into the flow of EMR. This information now forms the basis for our quality benchmarks. Moffitt hopes the pathways become an integral part of not only the treatment planning process, but also in documentation and data collection.
Because of the clinical pathways’ broad utility and novelty, Moffitt filed a United States patent application in 2012.
The Clinical Pathways Program seeks to optimize treatments based on both evidence (science) and consensus (art), as well as to lower costs, for example, by highlighting the likelihood and magnitude of risks and benefits, including costs, and limiting options to best practices.
Mary L. Rivera RN, CNS, AOCNS is the Clinical Nurse Specialist of Clinical Informatics at the Moffitt Cancer Center. She is nationally certified as an Advanced Oncology Clinical Nurse Specialist by the Oncology Nursing Society.
Mary started her career in the US Army Medical Corps and earned her MSN, graduating Magna Cum Laude from Liberty University. Her internship in oncology was conducted at several institutions including Moffitt Cancer Center. Her Oncology experience includes clinical research, inpatient, outpatient, and palliative care for a wide range of cancer diagnoses. She is a member of the Clinical Pathway Author Advisory Committee. She serves as an oncology clinical expert in the production and strategic growth of the Clinical Pathways program and other quality measurement efforts at Moffitt. Special interests include culture change and overall improvement of outcomes for patients.
For more information about the Clinical Pathway Program at Moffitt Cancer Center; email firstname.lastname@example.org.