Welcome to Journal of Clinical Pathways

The concept of clinical pathways means different things to different people. Payers view clinical pathways as leading to greater standardization of care as well as improved outcomes. Although some healthcare providers see clinical pathways as limiting their ability to provide the best and most appropriate care for their patients, many physicians, especially those at large group oncology practices, have embraced clinical pathways as a means to ensure consistency of care across the practice. Additionally, clinical pathways enable a multidisciplinary approach to care, leading to smarter, more efficient, and higher quality care for patients with complex illnesses. Thus, as specialty drugs become more costly, clinical pathways are being viewed as a tool for payers and practitioners to find common ground to provide the best quality of care at the highest value for patients, in terms of the health outcome achieved per dollar spent.

In addition to the use of clinical pathways, we’re witnessing the development of a number of initiatives with the aim of increasing the value of care. These include the use of bundled payment or episode-of-care models of pricing for medical services, the creation of integrated practice units, and the increased emphasis on monitoring and evaluating real-world outcomes in order to incorporate this information into future treatment guidelines. Yet, the success of these initiatives relies on the use of consistent, evidence-based approaches to treating patients. In this way, clinical pathways serve as the foundation of value-based care.

For this reason, we are excited to bring to you Journal of Clinical Pathways, which will serve as a forum for the exciting exchange of data, research, insights, and perspectives that will shape the foundation of value-based care. The journal will present educational and informational articles on topics including advancements in real-world data and the development of defined treatment pathways in order to address rising costs, mitigate patient risk, reduce variability, and achieve better, more predictable outcomes.

The topic of clinical pathways will be covered on multiple levels. One is the real-world data (including outcomes, adverse events, and costs associated with a given treatment) that are analyzed and synthesized to determine the treatment approaches with the highest value within a given disease state. There is a good deal of controversy regarding the best approaches for collecting this information, analyzing it, and ensuring its reliability. Journal of Clinical Pathways will feature articles that discuss these challenges and provide suggestions for overcoming them. In this issue, Nanavaty and colleagues discuss the use of incremental cost-effectiveness ratios for comparing the value of different treatments and present suggestions for how their use may be improved (page 29).

Another topic is the development of the clinical pathways themselves. There are multiple approaches being used to compile the evidence from published clinical trials, health economics studies, patient-centered outcomes research, and other sources to determine the best possible approaches to treatment for a particular disease. Additionally, advances in technology make it possible for this information to be provided to practitioners at the point of care to assist them in making treatment decisions. I address many of these issues in my review of the current landscape of clinical pathways in oncology (page 37).

Then there is the bigger picture of determining how the use of clinical pathways affects health outcomes and treatment costs. Measuring the outcomes of using a clinical pathway is a complicated endeavor, and more methodological studies are needed to provide clarity on the best approaches for conducting such studies. Furthermore, how the use of clinical pathways intersects with other approaches to managing the costs of treatment for complex diseases must also be evaluated. An article by Bastian et al. provides a discussion of how risk-sharing agreements for specialty drugs can influence the evaluation of clinical pathways outcomes (page 43).

Finally, not all perspectives are friendly to the idea of using clinical pathways and other value-based approaches to care. Many consider them to be antithetical to initiatives such as personalized medicine, which has recently been gaining traction. We will include medical ethics articles and commentaries from economists, practitioners, and patient advocates to debate the merits and limitations of clinical pathways for providing the highest quality of care as well as for managing the high costs of care for complex, chronic diseases such as cancer.

We hope that you enjoy the first issue of Journal of Clinical Pathways. We encourage you to provide your feedback on the articles presented, and on topics you would like to see covered in future issues, by emailing us at editors@jcponline.com.