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A quality improvement program to increase performance with clinical oncology pathways.

65 Background: Several organizations have created oncology pathways (pws) to support evidence-based medicine, and both standardize and improve the quality of care. Information is scarce; however, regarding the requirements for successful implementation of a pws program and monitoring of adherence.


METHODS
We assessed the efficacy of a quality assurance initiative called Practice Pathways Improvement (PPI) program to increase pws adherence to The US Oncology Network's physician-developed Level I Pathways. We queried our electronic health record (EHR) iKnowMed to collect data before and after program initiation. Education was provided to address policies and procedures; leadership roles and responsibilities; integration of pws into the EHR and workflow; and the importance of correct data entry into the EHR. We then measured metrics including levels of assessable data (AD) (complete data, no missing or conflicting elements); On-Pathway adherence (ON-PW); and documented rationale for exceptions (EX) of Off-Pathway treatments. Metric performance reports were distributed monthly.


RESULTS
Since 2010, 10 practices of varying size (6-342 medical oncologists) and sites (2-47) voluntarily participated. Program duration ranged from 6-12 months (mos). There were 42,266 regimens evaluated during the program, covering 19 disease pws. Baseline averages, results at program end, and current averages (avg) for AD, ON-PW, and EX are shown in the Table. As of June 2012, average follow up was 19 mos (range 13-25). A normal approximation shows significance of p < 0.001.


CONCLUSIONS
Implementation of a quality assurance initiative containing operational, leadership, and workflow elements along with continued education is important for successful pws adherence. Tailored program components are necessary to meet individual practice needs. Establishing a foundation for a pws process is important to maintain performance over time. As the reimbursement landscape in oncology evolves, the ability to demonstrate quality of care is essential. [Table: see text].