Clinical Pathways and Access to Quality Care

Patients are entitled to the best possible health care at the lowest possible cost. Clinical pathways have served to promote evidence-based medicine and value-based care across the medical continuum. The quality of care is chief among the aims of clinical pathways, and this month’s issue of Journal of Clinical Pathways addresses various areas in which researchers are working to ensure implementation and improvement of excellent care.

This month’s Conferences section (page 16) takes a look at the research coming out of the American Society for Clinical Oncology (ASCO) Quality Care Symposium. ASCO has been a leader in the clinical pathways world for many years, and their dedication to broadening the understanding and availability is reflected in the studies that were presented at this year’s meeting. These included three pathway-specific presentations, all of which showed reductions in medical costs without declines in quality of care following pathway implementation.

The articles in this issue continue to build on the theme of quality care. Krithika Rajagopalan, PhD, and colleagues address best practices for hospitalized patients with chronic obstructive pulmonary disease (COPD) requiring breathing treatments (page 37). COPD is a chronic condition that affects nearly 15 million individuals, and the associated costs of care can be staggering. Dr Rajagopalan and colleagues conducted a retrospective analysis of two regularly used COPD treatments—long-acting beta2-agonists, such as arformoterol, and nebulized short-acting beta2-agonists—in order to determine which treatment was associated with more favorable costs and shorter lengths of hospital stay. The researchers found that arformoterol was significantly associated with lower hospital costs and shorter hospital stays, information that can be easily translated into routine clinical practice.

Access to care is a major issue across the United States. Even large metro areas like Charlotte, NC, can lack facilities for specialized medical care, as Belinda R Avalos, MD, and colleagues chronicle in their review of the establishment of a dedicated department for hematologic oncology and blood disorders within the Levine Cancer Institute (page 45). The success of these efforts led to the establishment of a hematopoietic cell transplantation program within the department, which now regularly performs more than 100 transplants per year. Prior to the establishment of these departments, Charlotte residents were forced to travel at least 90 minutes to the closest specialized center, if not farther. The presence of these programs has undoubtedly improved the quality of care for patients residing in Charlotte, and can serve as a model for other underserved areas.