Dr Alan Balch Describes Ways to Personalize Clinical Pathways

Pathways have a unique ability to bring a personalized experience to the patient if the provider and care team can access the evidence they need to do so, said Alan Balch, PhD, CEO of the Patient Advocate Foundation. Therefore, the subgroups of larger patient populations must be considered closely when constructing those pathways.

Transcript (slightly modified)

What is the importance of clinical pathways being flexible and not expecting 100% adherence?

There are a lot of different approaches to how pathways are constructed, who constructs them. So pathways in and of themselves are not inherently bad or good. They’re designed to reduce variation in the treatment experience of a patient and try to deliver, put the evidence more quickly at the hands of the physician or treatment team so that they can translate the guidelines into evidence that will help the patient before them.

I think where it could end up being more restrictive than it needs to be really comes down to a couple different things. Part of its what’s the denominator for your population. So most of these are designed to try to find what’s the best treatment for 80% of the population. Well, who’s the population that’s in the denominator? So you may be able to derive that for a certain population but what about the subpopulations?

And of course, personalized medicine, what we’re learning more and more with the targeted therapies and the immuno-therapies, that there’s subpopulations within subpopulations. So I think where you can run into pathways may be becoming too restrictive would be a scenario in which you’re not really appropriately designing that 80% to the right denominator.

So what’s the subpopulation? Who are the experts that you’ve convened in that subpopulation so that you have the best information and evidence to determine what is that benchmark, 70-80%? What is the best treatment? What is the subpopulation? What are the exceptions to that so that you can branch your algorithm appropriately and personalize the care.

So I think it depends on the subpopulations. It depends on who are your experts helping you to define, what those subpopulations are and what the best treatments are. It depends on how quickly you can incorporate the pace of the evidence into your clinical pathway algorithm. So if you’re only updating your information in your pathway using a limited set of expertise with a subpopulation or a population that’s probably too big and you’re only updating the evidence once a year, or quarterly, there’s a wave of new treatment and evidence in personalized medicine that’s coming fast and furious. So if you’re not updating that in a robust and rapid way, you might end up steering patients toward treatment that don’t represent the best evidence, which is precisely the point of pathways, is to help put the evidence at the fingertips of the providers right there as they’re sitting with the patient.

So I think those are some factors to consider when you think about pathways and are they going to be restrictive or are they going to actually deliver on what I think ideally pathways can do, which is provide a more personalized experience to the patient. So really giving the provider and their care team an opportunity to access evidence much more rapidly in a systematic way, so that they can make sure for the patient in front of them, based on a certain set of unique characteristics, which again speaks to what’s the subpopulation to which you’ve designed your 80% or whatever the benchmark is for the pathway, that you can bring that evidence to be very quickly and with some robustness in that decision-making conversations.