ASCO’s "Criteria for High-Quality Clinical Pathways in Oncology," is now featured as a special article in the Journal of Oncology Practice. ASCO developed the 15 inter-related criteria to provide an overarching framework for assessing pathway programs in the United States and to guide stakeholders in assessing the quality, utility and integrity of clinical pathways in oncology.
Rising healthcare costs and the overall shift toward a value-based healthcare delivery system have led to the rapid proliferation of clinical pathways in oncology. In fact, an estimated 60 individual health insurance plans in the United States are currently using or developing oncology-specific pathways, and in 2010, approximately 15 percent of oncology “covered lives” were treated according to clinical pathways—a number which was expected to rise to 25 percent in 2015.
ASCO's criteria focus on three key areas: development, implementation and use, and analytics. The criteria are:
- Expert Driven - Do practicing oncology providers play a central role in the pathway development?
- Reflects Stakeholder Input - Is there a way for stakeholders to provide input during the development process?
- Transparent - Is there a clear, consistent process and methodology for pathway development, and is relevant information disclosed to stakeholders and the general public?
- Evidence-Based - Is the pathway based on the best available scientific evidence?
- Patient-Focused - Does the pathway include evidence-based options to account for differences in patient characteristics and/or preferences?
- Clinically-Driven - Is there an established methodology for prioritizing efficacy, safety and cost? Are stakeholder assessments and analysis used to revise the pathway?
- Up-to-Date - Is the pathway updated in a timely way as relevant new information becomes available?
- Comprehensive - Does the pathway address the full spectrum of cancer care? If the pathway is not comprehensive, does it clearly describe the phase and elements of care it is intended to address?
- Promotes Participation in Clinical Trials - Are available clinical trials options incorporated in the pathway?
- Clear and Achievable Expected Outcomes - Is information provided on the specific cancer type that the pathway is intended to cover? Does the pathway address what constitutes on-pathway versus off-pathway treatment, as well as goal adherence rates?
- Integrated, Cost-Effective Technology and Decision Support - Does the pathway comply with federal mandates for meaningful use of electronic health records, and does it offer—or plan to offer—resources that can be integrated into commonly used EHRs?
- Efficient Processes for Communication and Adjudication - Does the pathway provide references that may support pathway variation, inform the provider in real time of pathway compliance, and offer a mechanism for choosing an off-pathway recommendation?
- Efficient and Public Reporting of Performance Metrics - Does the pathway offer providers and the public with reports on provider performance over time and compared with other groups of providers, and do such reports reflect valid occasions when the provider has gone off-pathway?
- Outcomes-Driven Results - Does the pathway have analytics in place to enable a movement over time from adherence-driven compliance to outcome-driven results?
- Promotes Research and Continuous Quality Improvement - Does the pathway demonstrate a commitment to research aimed at assessing and improving the impact of pathways on the patient and provider experience, clinical outcomes, and value?
This publication builds on ASCO’s prior efforts calling for robust criteria to support certification of oncology pathways. In January 2016, ASCO released ASCO Policy Statement on Clinical Pathways in Oncology and an ASCO taskforce then assessed the landscape to develop these criteria.