San Diego, CA—The use of virtual patient vignettes to improve adherence to a breast cancer clinical pathway identified correctable variances from a breast cancer clinical pathway with the potential to reduce the cost of care by several million dollars, according to the results of a pilot study reported at the 2013 American Society of Clinical Oncology Quality Care Symposium.
Eliminating a portion of unnecessary diagnostic tests and improving adherence to a chemotherapy pathway resulted in potential savings of $4.4 million. The vignettes helped improve provider awareness of clinical standards and identified areas for quality improvement.
The H. Lee Moffitt Cancer Center “prioritized value for its breast cancer patients by measuring quality and pathway adherence,” said Karen K. Fields, MD, Medical Director, Strategic Alliances, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. “Continuous measurement and feedback with [virtual patient] vignettes can improve compliance with clinical pathways.”
“Measuring compliance can improve provider awareness and compliance with clinical standards, creating opportunities for savings,” she added.
The breast cancer pathway is one of more than 40 that the H. Lee Moffitt Cancer Center has developed, each of which has an adherence target of 80%. Monitoring adherence to the pathways by reviewing patient records proved to be problematic and prohibitively expensive because of the large number of patients and decision points involved in the process, said Dr Fields.
Investigation of more efficient ways to monitor adherence to clinical pathways led the H. Lee Moffitt Cancer Center to partner with QURE Healthcare to use the company’s Clinical Performance and Value virtual patient vignettes. The Moffitt-QURE project evolved as a means to gather feedback regarding adherence, to improve health outcomes, and to lower the cost of care.
Clinical Performance and Value
vignettes are disease-specific online cases (or virtual patients), and have been validated as a means to measure the understanding of and the adherence to clinical pathways. Dr Fields reported the findings from a pilot study to evaluate the vignettes’ effect on providers’ understanding of clinical pathways related to breast cancer.
The pilot study involved 15 providers, including medical oncologists, surgeons, and advanced-practice providers in breast cancer. Participants completed 2 Clinical Performance and Value vignettes every 4 months, and they received individualized feedback regarding their performance. Dr Fields and colleagues applied utilization trends and cost data to the Clinical Performance and Value results to project savings.
The results showed a wide range of variance from pathways in several areas of care. The compliance rates included 83% for radiation therapy, 79% for hormonal therapy, and 69% for surgery. Two areas, in particular, stood out: unnecessary diagnostic tests (50% compliance with standards) and adherence to chemotherapy pathways (40% compliance).
Dr Fields and colleagues determined that providers ordered 1.6 additional diagnostic tests per patient, at an average cost of $2500 per test. During 2012, the H. Lee Moffitt Cancer Center provided care for 2055 patients with breast cancer. Putting the numbers together showed that a 30% decrease in unnecessary tests would reduce the cost of care by $1.6 million.
During 2012, charges for chemotherapy related to breast cancer were approximately $20 million. A 30% improvement in compliance with chemotherapy pathways would reduce charges by $2.8 million.
Dr Fields said that the pilot study will be expanded to include other clinical pathways developed at the H. Lee Moffitt Cancer Center.