Clinical Pathways: Going Beyond Oncology

Clinical pathways are most often associated with their use in oncology—specifying which drug to use for the treatment of which type of cancer. Yet, they have the potential to extend far beyond that. They can include treatment options for supportive care, such as for medical conditions secondary to cancer like infection, neutropenia, and emesis. Additionally, clinical pathways are increasingly being eyed as a means of determining value-based treatments for other disease states, such as diabetes, cardiovascular disease, and autoimmune diseases like psoriasis. The articles in this issue of Journal of Clinical Pathways demonstrate the various ways in which clinical pathways can be applied to help health care providers achieve the highest quality of care for their patients.

It has been recommended that patients with fever and neutropenia receive antibiotics within 60–120 minutes of emergency department presentation. Despite the importance of prompt antibiotic administration, however, multiple studies demonstrate that individual hospitals are inadequate at consistently meeting this goal in patients who are immunocompromised, such as those receiving chemotherapy. Adam Lamble, MD, and colleagues describe the implementation and outcomes of a novel clinical pathway in the pediatric emergency department (PED) that endorses administering intravenous antibiotics to febrile pediatric patients on chemotherapy before the absolute neutrophil count (ANC) is resulted. In pediatric patients at risk for fever and neutropenia, the implementation of a clinical pathway to endorse administration of antibiotics before the availability of ANC results was effective in reducing TTA for febrile pediatric patients on chemotherapy in the PED.

Psoriasis is a common and significant illness characterized by systemic inflammation. The development of medications specifically targeting the inflammatory process associated with psoriasis has the potential to change the lives of patients with moderate-to-severe disease. However, access to medications can be challenging due to step-therapy protocols and limited formulary options. William Malatestinic, PharmD, MBA, et al. discuss the practical obstacles encountered in optimizing care of patients with moderate-to-severe psoriasis. Implementing psoriasis-centered coverage policies, such as implementing a psoriasis clinical pathway, may give psoriasis patients better access to more clinically effective, and possibly more cost-effective, treatment options.

Also in this issue, researchers from Peidmont Heart Institute in Atlanta, GA, discuss the implementation of a clinical pathway to guide the care of patients during and after transcatheter aortic valve replacement (TAVR) procedures.

The potential for the use of clinical pathways to improve patient care while reducing costs at the same time is now being understood and appreciated in a variety of settings. Our hope is that health care providers will be able to apply lessons from other applications of clinical pathways to their own practices and experiences.