Abstract:
INTRODUCTION:Unwanted clinical variation is common across the United States health care system and is particularly vexing in oncology owing to the complexity, morbidity, and high cost of the disease. Efforts to standardize care including guidelines and continuing medical education have had only limited impact. Disease-specific oncology clinical pathways hold the promise of reducing variation but have been hampered by a lack of ownership and accountability among oncology providers. MATERIALS AND METHODS:We describe the utility of combining a patient simulation-based clinical variation measurement with the in-house development of multidisciplinary breast cancer pathways at a National Cancer Institute-designated cancer center. RESULTS:At baseline, we found high variation in care decisions across the multidisciplinary team and within individual specialties in the management of simulated patients. Development and introduction of breast cancer clinical pathways combined with individual and group feedback on pathway adherence led to significant increases in pathway-aligned care decisions and decreases in measured variation. Overall quality scores increased from 47.5% to 61.1% (P < .001), with the largest improvement in diagnostic accuracy (+22.1%). Providers also ordered fewer unnecessary tests, saving an estimated $305 per patient case. Adherence to preferred chemotherapy regimens increased for both medical oncologists (+16%) and other members of the multidisciplinary team (+19%). CONCLUSION:Our work shows that a structured process to measure clinical variation and provide personalized feedback to an oncology multidisciplinary team drives adoption of evidence-based pathways, less unneeded spending, and higher quality care for patients.
journal_name
Clin Breast Cancerjournal_title
Clinical breast cancerauthors
Colonna S,Sweetenham J,Burgon TB,Buys SS,Lynch R,Au T,Johnson E,Kubal T,Paculdo D,Acelajado MC,Peabody JWdoi
10.1016/j.clbc.2018.12.010subject
Has Abstractpub_date
2019-04-01 00:00:00pages
e376-e384issue
2eissn
1526-8209issn
1938-0666pii
S1526-8209(18)30349-5journal_volume
19pub_type
杂志文章abstract:INTRODUCTION:Emerging research suggests a substantially greater prevalence of the adverse triple-negative (TN) subtype (human epidermal growth factor receptor [HER]2(-), estrogen receptor [ER](-), and progesterone receptor [PR])(-)) among black patients with breast cancer. No reports however have been generated from a ...
journal_title:Clinical breast cancer
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pub_type: 杂志文章,评审
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pub_type: 杂志文章,多中心研究,随机对照试验
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
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