ASCO has released, "Criteria for High-Quality Clinical Pathways in Oncology," a set of 15 inter-related criteria that provide an overarching framework for assessing pathway programs in the United States. ASCO developed the criteria 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[i] 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.[ii]
"Well-designed and effectively implemented clinical pathways can support the delivery of evidence-based cancer care, while enhancing communication and education between a patient and his or her physician on the complex details of a treatment plan," said ASCO President Daniel F. Hayes, MD, FACP, FASCO. " ASCO seeks to guide the future development and implementation of pathways, while addressing stakeholder concerns that have surfaced following the rapid adoption of pathways in oncology."
Prior to ASCO's criteria, standards defining high-quality pathways did not exist, leading to wide variations among programs. “Although the desired outcome of oncology pathways is to improve care for patients while promoting value, the lack of standards for development and questions regarding implementation raised significant concerns by our members about patient access, quality of care, and transparency,” said ASCO's Task Force on Clinical Pathways Chair Robin Zon, MD, FACP, FASCO.
ASCO's criteria for a high-quality oncology pathway program 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 assessment 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, and on what constitutes on-pathway versus off-pathway treatment and 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?
In January 2016, ASCO released, "ASCO Policy Statement on Clinical Pathways in Oncology," which called for the development of robust criteria to support certification of oncology pathway programs. The ASCO Task Force on Clinical Pathways then conducted a review of the current U.S. oncology clinical pathways landscape, which included meetings with key stakeholders, to develop the 15 criteria—which mark the next step in fulfilling the recommendation made by ASCO’s original policy statement on oncology pathways.
“Our hope is that these criteria will help guide the development and implementation of pathway programs,” said Dr. Zon, “in addition to assisting oncology providers and other stakeholders to better evaluate clinical pathways as they safeguard patient care.”
View the full list of criteria.
[i] DKP Critical Insights®—Clinical Pathways Overview and Provider Perspectives, 2015.
[ii] McKinsey & Company. “Strategies in Oncology: Spotlight on Clinical Pathways.” January 2012.