The State of Clinical Pathways – 2022 Survey Results

The Journal of Clinical Pathways’ Editor-in-Chief, Winston Wong, PharmD, kicked off the 2022 Oncology Clinical Pathways Congress by presenting the results from the publication’s 5th annual benchmarking survey.

Clinical pathways are continuing to become an integral part of oncology care, although the reasons for the continued interest are changing, said Dr Wong.

The mission of the benchmarking survey is to understand where we are today in the understanding and implementation of clinical pathways to be able to have a vision for tomorrow with alternative care models and value-based care.

Eighty percent of survey respondents this year were direct care providers, including medical oncologists, radiation oncologists, and physician assistant/nurse practitioners. Approximately 57% of respondents were in community practice settings vs 42% in institutional settings.

Results of the survey showed that payment model participation has increased in multiple aspects. Fee-for-service appears to have gained ground in the last year (70% vs 32%) possibly due to the ending of the Oncology Care Model program, suggested Dr Wong. Performance-based and risk-bearing reimbursement arrangements have significantly decreased.

The number of institutions that currently have pathways in place has increased in the last year from 37% to 53%, whereas those planning to implement within 12 months has decreased from 16% to 5%. However, institutions with no current plans to implement pathways climbed from 9% to 12%. Dr Wong believes small-medium practices may account for that increase, as they remain resistant to implementation because of finances and resources, and they refer their more difficult cases to local health systems or cancer centers.

Similar to the 2021 results, social determinants and patient preferences continue to be important considerations as oncology care is refocusing back to the patient. Pathway content is being driven by NCCN guidelines or other recognized compendia, according to 70% of respondents.

According to this year’s results, oncology clinical pathways are continuing to be more comprehensive; increases were seen in radiation oncology, supportive care, predictive and prognostic genomic testing, palliative care, social determinants of health, and nurse navigation.

Additionally, 56% of respondents indicated their pathway includes all cancer types.

Of the total respondents, 57% utilize pathways to track individual prescribing patterns, 54% are not able to prescribe off-pathway without peer review for approval, and 16% are not allowed to prescribe off-pathway at all.

“Clinical pathways are viewed to have a beneficial impact on quality of care, controlling costs, and use as an educational tool on new treatment options,” Dr Wong concluded. “The responses indicate a continued interest in clinical pathways, most likely associated with increased demand for improved quality of care and financial accountability.”