5 Things to Know About Clinical Pathways

Standardizing treatment, avoiding waste, helping clinical decisions when faced with multiple care options, improving the quality of care, and controlling costs—this is what clinical pathways aim to achieve. However, pathways are a work in progress and the field is concurrently learning and evolving. Here are 5 things on where clinical pathways stand today:

1. Where Are We Now With Clinical Pathways?

Researchers from the Analysis Group and the National Pharmaceutical Council conducted a literature review of the PubMed and Cochrane databases and follow-up surveys and interviews with payers, providers, and pathway vendors to understand pathway design, development, and management. The study concluded that stakeholders expect high-quality evidence of safety and efficacy in pathway development and implementation. Additionally, increased transparency in pathway development and consistency with implementation and compliance measurements are required.

2. Using Evidence to Develop Clinical Pathways

Researchers from the Carnegie Mellon University have developed data-driven clinical pathways to facilitate innovations in practice-based care delivery for chronic disease management. The data source used for the analysis was electronic health records of patients with chronic kidney disease who also suffered from other chronic conditions. The algorithms used by the authors used biochemical measurements from the patients clustered into different subgroups to identify the most probable clinical pathways and predict the future states of the patients.

3. Barriers to the Adoption of Clinical Pathways

Pathways are still a young enterprise so barriers to their adoption are being more readily recognized than the number of problems being solved, according to Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council. Highlighting physician uncertainty as one of the factors that influences adoption, Dr Dubois said in his interview that there definitely is room for flexibility.

To read a Twitter conversation with Dr Dubois on the topic, use #AJMCchat.

4. Finding a Place for Precision Medicine in Care Pathways

Can payers surge ahead of the cookie-cutter approach with pathway development and make pathways more personalized? Foundation Medicine believes they can, and should. In an article published in Evidence-Based Oncology, they write that precision-based care, especially in oncology, can save costs in the long term. To this end, they recommend strategic steps that health plans can take to integrate precision medicine into pathways and payment models.

5. ASCO Unhappy With Current Status of Clinical Pathways

The American Society of Clinical Oncology (ASCO)’s Task Force on Clinical Pathways has asked for greater transparency with pathway development, increased flexibility, and evidence of improved outcomes subsequent to pathway implementation. The task force has expressed concerns with lack of consistency, rigidity, emphasis on cost control, and transparency with the current pathways, and made several recommendations to promote evidence-based, high-value care that respects the demands of patients, payers, and providers.