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Web-Based Pathways Program Reduces Unwarranted Practice Variation

May 28, 2020

Deployment of a web-based clinical pathways program resulted in greater uniformity in physician practice at the Dana-Farber Cancer Institute (DFCI), according to a study to be presented at the American Society of Clinical Oncology (ASCO) Annual Meeting (May 29-31, 2020).

One of the aims of oncology clinical pathways is to support clinical decision-making and reduce unwarranted practice variation across a cancer care system.

Emily Foster, MPH, DFCI, and colleagues implemented web-based oncology pathways with DFCI-customized content in each disease center and each of its satellite locations. The pre-defined aim was a physician on-pathway treatment decision rate of 70% to 85%; decisions were electronically captured as on- or off-pathway in the web program.

Physicians were categorized into quintiles based on their on-pathway performance during the first 90 days of use of the platform. Then, on-pathway rates were calculated for days 91 through 360 to study changes in behavior over time. Additionally, physician and practice factors were examined to determine any differences by initial on-pathway quintile classification.

Metrics pertaining to usage and on-pathway rate were shared with physicians on a monthly basis, researchers noted.

A total of 122 physicians who navigated the web program at least five times in each study period were included in the analysis. On-pathway rates showed significant variability in the initial 90-day period (Quintile 1 [n = 26], 100%; Quintiles 2-4 [n = 72], 80.2%; Quintile 5 [n = 23], 50%).

However, in the follow-up period, median on-pathway rates shifted into the pre-defined goal range for all groups. Physicians in Quintiles 1 and 5 were more likely to have fewer total navigations compared with physicians in Quintiles 2-4 (P = .003).

Furthermore, researchers acknowledged that physicians in Quintiles 1 and 5 were more likely to be in an academic setting, have a PhD, or navigate fewer pathways. No other physician or practice characteristic differed significantly by on-pathway rate group.

“Over time, the deployment of a web-based clinical pathways program resulted in greater uniformity in physician practice, based on on-pathway rate,” authors of the study concluded. “Familiarity with the pathways platform and its navigation, monthly feedback about usage, and evolution of content over time are some factors that might have played a role.”—Zachary Bessette

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