Improving oncology quality through the implementation of evidence-based clinical pathways in a payer’s oncology network.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 161-161 ◽  
Author(s):  
Daniel McCrone ◽  
Dudley Gill ◽  
Cecilia Tran ◽  
Michael Sturgill
Keyword(s):  
Clinical Pathways ◽  
Treatment Plan ◽  
Clinical Information ◽  
Cost Of Care ◽  
Adherence Rate ◽  
Critical Element ◽  
Evidence Based ◽  
Prior Authorization ◽  
Chemotherapy Treatment ◽  
Treatment Plans

161 Background: Physicians and health plans are collaboratively exploring clinical pathway strategies to improve patient outcomes, reduce treatment variation, and reduce oncology cost. One landmark study found that 33.2% of insured patients did not receive guideline cancer therapy. Additional studies have demonstrated that the use of pathways can lower the cost of care and that oncologist participation is a critical element for success. New Century Health (NCH), in partnership with a leading health plan and one of its Midwestern oncology networks, had two quality goals with the implementation of a chemotherapy prior authorization system: review all chemotherapy regimens for all patients and measure treatment plan adherence to evidence-based clinical pathways. Methods: As one component of a mandatory chemotherapy prior-authorization program, an online prior authorization system was used by oncology practices to submit chemotherapy treatment plans to NCH for approval. The system captured detailed patient clinical information and measured compendium and preferred pathway adherence rates. These data were shared with participating oncology practices on a quarterly basis. For analysis, an average Baseline compendium adherence rate was determined reflecting participating practices for six cancer diagnoses (Breast, Colon, Lung, Lymphoma, Multiple Myeloma, and Prostate). The Baseline rate was compared to the Review period rate. Results: A comparison of the Review and Baseline period metrics indicated a statistically significant increase in the level of compendium-based chemotherapy treatment plans submitted by participating providers. Conclusions: Implementation of an oncology prior authorization system that measures compendia-based adherence rates is associated with increased levels of evidence-based chemotherapy treatment plans by participating providers. [Table: see text]

Improving Medical Oncology Quality Through Peer-to-Peer Consultation

2014 ◽  
Vol 10 (2) ◽  
pp. 105-106 ◽  
Author(s):  
Daniel McCrone ◽  
Dudley W. Gill ◽  
Cecilia Tran ◽  
Jessica Flocco
Keyword(s):  
Health Plan ◽  
Impact Analysis ◽  
Medical Oncology ◽  
Clinical Pathways ◽  
Treatment Plan ◽  
Clinical Information ◽  
Peer To Peer ◽  
Care Quality ◽  
Audit And Feedback ◽  
Prior Authorization

Purpose: This study describes how the use of peer-to-peer (P2P) physician consultation improves medical oncology care quality by preventing non–evidence-based and potentially morbid chemotherapy treatments. New Century Health (NCH) has adapted a physician audit and feedback model to strengthen adherence to clinical guidelines. In the NCH oncology program, P2P consultation complements clinical pathways and an online prior authorization platform. Payers are adopting the use of clinical pathways as a management strategy for managing costs and improving quality. Managing medical oncology is a complex process, because evidence evolves rapidly, and almost one third of chemotherapy is prescribed off label. The use of prior authorization, combined with standardized protocols for patients with specific cancer diagnoses, is one way for payers to reduce unnecessary treatment variation. [Table: see text] Methods: NCH completed a retrospective analysis of the chemotherapy treatment requests (CTRs) submitted by payers' oncologists for prior authorization between January and December 2012. The objectives of the clinical impact analysis were to measure the CTR disposition rate, identify the CTR intervention rate resulting from P2P consultation, and identify the types of drug triggering the interventions. Results: Analysis of the 13,078 CTRs associated with the 1,116 unique Medicare and commercial patients of a national health plan determined that CTRs voluntarily withdrawn or recommended adverse determination (RAD; ie, NCH recommendation to member's health plan to not authorize treatment as requested; after review of health plan policy and compendia, NCH was not able to resolve provider's request through P2P consultation and could not recommend approval of treatment plan as requested, therefore recommending denial of request) by the submitting physician as a result of a P2P consultation with an NCH board-certified oncologist comprised 11.6% of all CTRs. Further analysis identified the types of medication associated with the 1,521 CTRs withdrawn/RAD as a consequence of P2P consultation. Interventions on chemotherapeutic medications and supportive care were evenly distributed at 51.2% and 48.8%, respectively. Interventions on medications that had received US Food and Drug Administration approval within the last 2 years (initial approval or for new indications) represented 12.1%. [Table: see text] Conclusion: Using P2P consultation to complement a pathway-driven prior authorization process improves medical oncology quality. In addition, P2P consultation can be an effective collaborative physician engagement strategy by supporting oncologists with critical clinical information and mitigating concerns about pathway implementation and about payer involvement in drug use management.

Elevating the standard of care: Impact of a regimen-level prior authorization tool on provider adherence to clinical guidelines.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19235-e19235
Author(s):  
Rogelio Alberto Brito ◽  
Geri Kuklinski ◽  
Patricia Angelica ◽  
Anne Claussen ◽  
Diana Fischer ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Quality Care ◽  
Standard Of Care ◽  
Clinical Decision ◽  
Cost Of Care ◽  
Evidence Based ◽  
Prior Authorization ◽  
Total Cost ◽  
Nccn Guidelines ◽  
The Impact

e19235 Background: New developments in oncology therapy continue to grow in complexity, fueling a dramatically rising cost of care. Traditional care models present opportunities to streamline plan sponsor management efforts, expedite therapy, and improve health outcomes. Studies suggest adherence to evidence-based standards results in higher quality care. Current plan sponsor management platforms match medical policy to individual drugs, not to combination therapy regimens and lack real-time access to standard treatment guidelines. 70% of precertification requests are submitted via antiquated, cumbersome methods such as paper and fax. Methods: CVS Health/Aetna developed a comprehensive oncology solution featuring an enterprise web-based clinical decision support prior authorization tool (Novologix) at the regimen level to reduce administrative burden and support quality care. Novologix regimens were updated via collaboration with the National Comprehensive Cancer Network (NCCN) evidence-based guidelines. Groups also entered a value-based payment (VBP) model to help support quality of care by promoting adherence to NCCN guidelines when clinically appropriate and tool utilization. Eligible members were Commercial, fully-insured members newly diagnosed with breast, colorectal, or lung cancer. Providers were offered dedicated, individual training sessions to provide education on the Novologix tool. NCCN-aligned regimens requested through the platform were automatically certified. Any non-NCCN aligned regimens received accelerated medical review by a board-certified medical oncologist with the option for an external peer-to-peer review upon denial. Providers received ongoing quality and cost of care reporting. Results: Primary in progress. N of precertification requests submitted via Novologix ( 28 requests as of 1/23/2020) - (will include graph displaying N of requests by month). N of regimens submitted via Novologix that were automatically certified (46% as of 1/23). Avg turnaround times for modified regimen requests requiring clinical review (TBD). Avg % adherence to NCCN guidelines (100% as of 1/23/20) Secondary: Total cost of care (preliminary/other leading indicator). Conclusions: By engaging oncology practices through an enhanced payer-provider collaboration and implementing an automated regimen-level precertification process we can facilitate higher-quality oncology care. Future studies will be needed to measure the impact of this program on total cost of care.

Development and implementation of an evidence-based malignant hematology clinical pathway program.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 304-304
Author(s):  
Amanda Brahim ◽  
Fernando Manuel Vargas Madueno ◽  
Robert Wilkinson ◽  
Melissa Hardwick ◽  
Yehuda Ethan Deutsch ◽  
...  
Keyword(s):  
Supportive Care ◽  
Task Force ◽  
Clinical Pathways ◽  
Tumor Lysis Syndrome ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Evidence Based ◽  
National Guidelines ◽  
Bone Marrow Biopsies ◽  
Treatment Plans

304 Background: Clinical pathways provide a means to maximize value-based care for cancer patients. They have been associated with decreased costs and outcome improvements. Our institution entered a transformative partnership with an NCI designated comprehensive cancer center for the treatment of hematologic malignancies. As part of the collaboration, a multidisciplinary task force was established to adapt clinical pathways within our system. Given the multiple new drug approvals for the treatment of Acute Myeloid Leukemia (AML), this was the first pathway created. Methods: The taskforce consisted of physicians, pharmacists, nurses, quality manager, and information technology staff. The group met weekly to draft algorithms in accordance with national guidelines, updated evidence and institutional preferences. Electronic Medical Record (EMR) treatment plans were reviewed in a secondary multidisciplinary workgroup and validated to ensure compliance with the AML pathway. When applicable, specific criteria for use were developed to aid in medication use optimization. The finalized pathway and treatment plans were presented and approved at our clinical standards committee meeting. A chart audit was performed one year after pathway implementation to assess adherence, with a goal of 80% or higher. The results were compared to an audit assessing adherence to best available clinical evidence for the year prior to implementation. Results: The group established a consensus on treatment, laboratory testing, and supportive care, including anti-emetic, anti-microbial, and tumor lysis syndrome (TLS) prophylaxis. Electronic order sets were created for bone marrow biopsies, transfusion support, TLS and febrile neutropenia. Thirty-two EMR treatment plans for AML were built and/or revised, while five were inactivated. A total of 88 patient charts were included in the pathway adherence audit (44 before and 44 after implementation). Pre and post pathway adherence was 64% and 89%, respectively (p=0.006). Deviations were categorized by type (table). Conclusions: AML pathway development and implementation resulted in standardization of treatment regimens, supportive care and higher adherence to institutional evidence based practices. [Table: see text]

BIO19-022: Reducing Patient Waiting Times for Treatment Decision Making, Helps in Improving the Treatment Planning Process

2019 ◽  
Vol 17 (3.5) ◽  
pp. BIO19-022
Author(s):  
Naresh Ramarajan ◽  
Farzana Begum ◽  
Gitika Srivastava
Keyword(s):  
Decision Making ◽  
Expert Opinion ◽  
Planning Process ◽  
Treatment Plan ◽  
Waiting Times ◽  
Treatment Decision ◽  
Evidence Based ◽  
High Confidence ◽  
Treatment Decision Making ◽  
Treatment Plans

Background: Availability of care is an important characteristic of effective primary healthcare systems. Imbalanced oncologist to patient ratios (∼1600: 1.8 M in India, ∼23,000: 15 M in USA), impedes access to expertise. On average it takes a week or more to get an online expert review from leading cancer hospitals in the United States and in India. Such delays have an important psychosocial impact on the patient and caregivers. Patients worldwide often race to start treatments at non-expert centers and may experience worse health outcomes from lack of expert tumor board review of their cases. This study aimed to examine the impact of Navya, a health services technology, on reducing the patient wait time in real-time treatment decision making. Methods: Navya generates personalized treatment plans that maps 98.8% within NCCN Resource Stratified Guidelines [SABCS 2017, NCCN 2018]. This is vetted on mobile by oncologists at tertiary centers like TMC NCG to provide expert opinion reports to patients. Since 2015, approximately 25,775 patients from 60 countries have reached out for an online opinion. On the ground, 78% of patients received evidence-based treatments recommended by Navya [ASCO 2017]. The Navya system releases preliminary system-generated opinions for patients whose treatment plans fit high confidence based on NCCN Guidelines and prior expert reviews. The mean reduction in time between a system-generated opinion and an expert-reviewed opinion was studied in a prospective cohort of patients between July 1, 2017, and August 30, 2018. Results: 313 patients received a system-generated treatment plan in the study period. Only approximately 10% of these plans were modified by experts to add additional treatment details since these were cases with high confidence in treatment decision-making. Navya delivered a preliminary treatment plan on an average of 86 hours (SD, 153 hours) prior to the expert response time. Of the 313 patients studied, 44% of patients would have waited an additional 3 days longer to receive an expert-reviewed recommendation. Conclusions: Navya’s NCCN and evidence-based treatment plans reduce the patient waiting times for an expert opinion average by 86 hours. This rapid confirmation of the right treatment plan at the time of patient need has potential to relieve patient anxieties at critical junctures in treatment decision-making and helps improve the treatment-planning process.

Effects of prospective review of medical oncology treatment plans (TPs) on quality of care, payer denial, and cost.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17565-e17565
Author(s):  
William A. Flood ◽  
Erik Yedwab ◽  
Evan W. Alley ◽  
Paul Gilman ◽  
Kevin D. Frick ◽  
...  
Keyword(s):  
Medical Oncology ◽  
Cost Of Care ◽  
Evidence Based ◽  
Safety Issues ◽  
Drug Classes ◽  
Evidence Based Treatments ◽  
Prospective Assessment ◽  
Treatment Plans ◽  
Care Payer ◽  
Oncology Providers

e17565 Background: Retrospective review of chemotherapy TPs for compliance with expected care presents financial and quality risks to providers, patients and payers. Prospective assessment of TPs before oncology care is delivered may limit these risks. Methods: Through the eviti web-based decision support platform, oncologists/staff submit TPs for review. The eviti Evidence-Based Library incorporates all recognized guidelines (ASCO, NCI, ASTRO, NCCN and others), the supporting literature and NCI registered clinical trials. Evidence-based treatments are approved while unexpected variances are not reported to the payer until medical record review and peer to peer (P2P) discussion when records are insufficient. The eviti data base was queried for all off-study treatment plans submitted by medical oncology providers in a single state from January 2011 through October 2012. The nature of variation, results of P2P discussion and final recommendation to the payer were then determined. Net cost differences between the proposed and expected care were calculated using ASP+6% in November 2012. Results: Of a total of 202 TPs submitted on 116 individual patients, 89 TPs (44%) included 92 unexpected variations of care at initial submission, 11 of which (12%) presented safety issues documented in the peer reviewed literature and guidelines. The total net cost difference for one cycle of the proposed care and expected standard was $304,055. Of these 92 unexpected variations, only 29 (32%) of the variations could not be unjustified and referred for probable denial by the payer. After review of medical records, 21 (23%) were referred to the payer as medical justified variations (MJV), while after P2P 17 (18%) were considered MJV’s and 25 (27%) were modified to fit expected patterns of care. Additional analysis by drug classes and cost will be presented. Conclusions: In this TPs set, prospective review of treatment plans decreased the incidence of non-EBM care, the rate of potential denials, and the cost of care. Prospective TPs review can limit risk to all parties in cancer care.

Clinical Pathways for Mood and Anxiety Disorders

CNS Spectrums ◽  
2002 ◽  
Vol 9 (S14) ◽  
pp. 18-24 ◽  
Author(s):  
Waguih William IsHak
Keyword(s):  
Partial Response ◽  
Anxiety Disorders ◽  
Practice Guidelines ◽  
Clinical Pathways ◽  
Clinical Information ◽  
Expert Consensus ◽  
Diagnosis And Treatment ◽  
Evidence Based ◽  
Management Tools ◽  
Consensus Statements

ABSTRACTClinical pathways generally recommend potential steps in the diagnosis and treatment of a condition or procedure for individual patients. Their usefulness in guiding clinicians through the steps of nonresponse or partial response to interventions has been documented. They are predominantly management tools based on clinical information developed from evidence-based psychiatry, practice guidelines, or expert consensus statements. Pathways may not be appropriate for use in all circumstances, nor are they a substitute for the practitioner's experience and judgment. Their applicability must be assessed by the responsible practitioner in light of relevant circumstances presented by individual patients in order to optimize treatment.

Patient-Type Bayes-Adaptive Treatment Plans

2021 ◽  
Author(s):  
M. Reza Skandari ◽  
Steven M. Shechter
Keyword(s):  
Treatment Plan ◽  
Cost Of Care ◽  
Optimal Timing ◽  
Decision Analytic Model ◽  
Patient Type ◽  
Adaptive Treatment ◽  
Patient Health ◽  
Markov Decision ◽  
Treatment Plans ◽  
The Right

Treatment decisions that explicitly consider patient heterogeneity can lower the cost of care and improve outcomes by providing the right care for the right patient at the right time. “Patient-Type Bayes-Adaptive Treatment Plans” analyzes the problem of designing ongoing treatment plans for a population with heterogeneity in disease progression and response to medical interventions. The authors create a model that learns the patient type by monitoring patient health over time and updates a patient's treatment plan according to the information gathered. The authors formulate the problem as a multivariate state space partially observable Markov decision process (POMDP). They provide structural properties of the optimal policy and develop several approximate policies and heuristics to solve the problem. As a case study, they develop a data-driven decision-analytic model to study the optimal timing of vascular access surgery for patients with progressive chronic kidney disease. They provide further policy insights that sharpen existing guidelines.

scholarly journals Role of hysterolaparoscopy in management of infertility a retrospective clinical analysis

2020 ◽  
Vol 9 (11) ◽  
pp. 4437
Author(s):  
Geeta S. Wadadekar ◽  
Dattaprasad B. Inamdar ◽  
Vandana R. Nimbargi
Keyword(s):  
Reproductive Medicine ◽  
Treatment Plan ◽  
Clinical Information ◽  
Clinical Analysis ◽  
Infertility Treatment ◽  
Evidence Based ◽  
Male Factor Infertility ◽  
Male Factor ◽  
Evidence Based Treatment

Background: Diagnosis and treatment of infertility is an elaborate process. The goal of treating clinician is to decide upon the plan of management best suited to the couple by selecting relevant investigations and procedures from available options. Objective was to determine the role of hysterolaparoscopy in the management of infertility.  Methods: This retrospective study was conducted at a tertiary canter (Department of reproductive medicine and surgery) over a period of 12 months-January 2019 to December 2019. Women aged 20-40 years with primary or secondary infertility, except male factor infertility, undergoing hysterolaparoscopy were included. Results: Out of 41 cases, 71.84% patients had primary infertility. Common laparoscopic abnormalities were adhesions (36.5%) and endometriosis (17.07%) Hysteroscopy revealed polyps (9.7%) and intrauterine synechia (4.8%) as common pathologies. The diagnosed pathologies were dealt surgically in the same sitting. Plan of infertility treatment could be outlined in all patients based on intraoperative findings. Conclusion: Hysterolaparoscopy serves both diagnostic and therapeutic purpose. Various pelvic, peritoneal, tubal, endometrial and uterine factors can be diagnosed and treated at the same time. The clinician has to be well versed and skilled in selecting and performing the appropriate surgery. Clinical information gained from hysterolaparoscopy helps in decision making and designing individualized, evidence-based treatment plan can for the patients.

The standardization of skin cancer treatment recommendations through the analysis of clinical pathways data and an evidence-based, physician-driven committee process.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 147-147
Author(s):  
Dwight Earl Heron ◽  
Amanda Barry ◽  
Hans Benson ◽  
Zach Lorinc ◽  
Kathleen Lokay
Keyword(s):  
Cell Carcinoma ◽  
Clinical Pathways ◽  
Treatment Recommendations ◽  
Treatment Recommendation ◽  
Evidence Based ◽  
Similar Frequency ◽  
Specific Patient ◽  
Wide Range ◽  
Utilization Data ◽  
Treatment Plans

147 Background: Clinical pathways (CP) have the potential to improve the quality and safety of care and lead to more predictable outcomes and costs through standardization. Via Oncology’s CP program aims to standardize care at radiation centers across its nationwide network. Created through an evidence-based, physician-driven committee process, CP recommend the best treatment plan for specific patient populations based on a hierarchy of efficacy, toxicity, and cost. In the absence of definitive data, reaching a consensus on the best treatment recommendation is difficult, particularly for disease states such as melanoma, squamous cell carcinoma, and basal cell carcinoma for which a wide range of radiation doses and schedules are considered effective and regional and institutional preferences may vary. Methods: After initial implementation of CP, radiation disease committees meet semiannually to review treatment recommendations and utilization data collected for the prior six months. Data reflect treatment plans selected by physicians for individual patients. At the January 2015 skin pathway committee meeting, committee members reviewed data for each patient presentation to determine which doses and schedules were used most frequently. Results: After reviewing the utilization data, the committee narrowed the recommendations to one or two treatment plans per presentation, typically including standard and hypofractionated schedules. In scenarios where multiple treatment plans were selected at a similar frequency, the committee standardized to the lower dose and fewer fractionation plan. This reduced the number of treatment plans on the pathway from 34 to 15. A decrease in pathway adherence rates was not observed following this change. Conclusions: Data gathered from CP can be used to further standardize clinical care when there are several effective and accepted treatment regimens but a lack of published data. Through a dynamic process of assessing and modifying physician practice and patterns of care, CP provide cancer centers with a platform to ensure delivery of consistent, high-quality care to patients throughout their network.

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

Sign in / Sign up

Export Citation Format

Share Document