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Are Integrated Practice Units Working in Breast Cancer Clinical Pathways?

Allison Inserro
Researchers examining how well integrated practice units (IPU) are implemented across 7 cancer centers in Europe found there was no clear, consistent strategy for developing and implementing IPUs, in an analysis that focused mostly on breast cancer clinical pathways.
Researchers examining how well integrated practice units (IPU) are implemented across 7 cancer centers in Europe found there was no clear, consistent strategy for developing and implementing IPUs, in an analysis that focused mostly on breast cancer clinical pathways.

Structuring cancer care into clinical pathways can reduce variability and improve patient outcomes. IPUs are defined as highly coordinated, multidisciplinary care along an entire clinical pathway, including organizational aspects, and is a key concept in creating value-based healthcare by increasing efficiency and lowering costs.

In this study, published in the September issue of the Journal of the National Comprehensive Cancer Network, researchers applied a 13-step measurement method to the cancer centers, all of which are current members of the Organisation of European Cancer Institutes (OECI). Their study is part of the international benchmarking project known as BENCH-CAN. The benchmarking tool is made up of 51 qualitative indicators and 193 quantitative indicators, based on existing literature and expert consensus. Benchmarking, which involves measuring and comparing of results of key work processes against best practices, can help achieve process improvements and improve health.

The analysis focused mainly on breast cancer pathways, so that all of the centers involved were able to provide sufficient data for comparison. The data came from 2012. The research process included an in-person visit to each center to verify data and better understand context.

"We found a wide range of IPU-development stages and characteristics for cancer pathways," said Anke Wind, PhD, Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, in a statement. "The sobering finding is that these are not very advanced in their IPU maturity."

Centers in Europe are in various stages of development of pathways and IPUs, ranging from an informal pathway structure to a full IPU-type of organization, the researchers said.

Most cancer centers only started using official pathways recently. Two had not implemented and formalized all pathways. All centers performed at least mammography, ultrasound, and physical examination before breast surgery, and all perform annual mammographies in the first 5 years of follow-up for all patients. However, there were almost 2-fold differences in mammography use efficiency.

The researchers recommended that the cancer centers explore strategic organizational changes to allow for adequate staffing to both measure and improve their use of IPUs as part of their cancer pathways.

"A more systematic deployment of IPU traits is advised when implementing value-based healthcare in oncology," Wind said.

Although the study focused on Europe, the authors said the findings should be applicable to the United States, where the IPU theory originated. They said their evaluation of an IPU for breast cancer care showed performance improvements in terms of efficiency and finances. Future research focusing on additional patient outcome evaluation over multiple years will allow comparison between IPU-organized and non–IPU-organized cancer centers, to determine whether IPUs add value and actually decrease costs.

The researchers will be following up with a project on Achieving Best Possible Cancer treatment outcomes in treatment pathways through benchmarking (the ABC-Benchmarking project), intended to further validate and develop the benchmark format in order to link outcomes data to benchmark characteristics.

Reference

Wind A, Rocha Gonçalves F, Marosi E, et al. Benchmarking cancer centers: from care pathways to integrated practice units. J Natl Compr Canc Netw. 2018;16(9):1075–1083 doi: 10.6004/jnccn.2018.7035.

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