Clinical Pathways Increasing Used, but Concerns Remain

Clinical pathways (CPs) are increasingly being utilized to improve quality of care and control healthcare costs in the United States. A new report from Avalere Health examines the development of CPs, use of evidence to inform their design, implementation processes, and their impact on quality of care, costs, and outcomes.

CPs have mainly focused on oncology, such as breast, lung, and pancreatic cancer, but the development of CPs in cardiology, gastroenterology, and immunology is gaining traction. Typically providers and third-party vendors develop pathways, and there is often wide variation in patterns of development, testing, and revision, according to the report.

“Looking ahead, stakeholders need to work together to ensure that CP programs support the collective goals of patients, providers, and payers,” said Hillary Kleiner, co-author and director at Avalere. “A useful first step would be developing and instituting principles or standards for the development and deployment of clinical pathways.”

Avalere collected data from published literature, such as The American Journal of Managed Care, publicly available reports, and interviews with stakeholders involved in or affected by CPs. As a result, Avalere was able to highlight a number of limitations that need to be addressed:

• Variable Evidence Standards: Currently, there is limited consistency across evidentiary standards used in CP development.
• Need for Maintenance: CPs are typically refined as often as every 3 to 6 months, or following groundbreaking evidence or an important change in clinical practice.
• Transparency: There is limited information about the CP development process and incentive structures. One way to enhance transparency is through the establishment of a pathway endorsement organization.
• Compliance Requirements: The variability in pathway program requirements is challenging for physicians who are asked to adhere to multiple program designs.
• Quality of Care and Patient Access: Specialty societies and physician and patient advocacy organizations are unsure if CPs inhibit the physician’s ability to tailor care plans to patient needs.

The report suggests some changes for the future of CP development: incorporating quality as well as clinical and patient-reported outcomes measures, and increase patient engagement in CP development or evaluation.

“Although, the use of CPs is expected to expand, many programs are currently operating on a pilot basis and have not been widely implemented,” the report concludes. “This offers an opportunity for stakeholders to come together to identify and discuss best practices and strategies to harness the potential benefits of CPs, while mitigating their possible risks.”