New Century Health, Brea, CA.
Cancer Care Specialists of Illinois, Decatur, IL.
JCO Oncol Pract. 2020 May;16(5):e456-e463. doi: 10.1200/JOP.19.00753. Epub 2020 Mar 20.
Reducing drug spend is one of the greatest challenges for practices participating in the Oncology Care Model (OCM). Evidence-based clinical pathways have the potential to decrease drug spend while maintaining clinical outcomes consistent with published evidence. The goal of this study was to determine whether voluntary use of clinical pathways by a practice can maximize OCM episodic cost savings.
A community oncology practice used evidence-based clinical pathways for OCM-attributed patients. All treatment plans were submitted to the pathway vendor in real time for clinical pathway adherence measurement. Analysis was conducted before implementation and on an ongoing daily and weekly basis to identify cases in which higher cost drugs or regimens were ordered. A clinical data governance committee met biweekly to review clinical pathway performance metrics and drug utilization.
From quarter 1 of 2017 to quarter 1 of 2019, the median drug spend increased less rapidly for Cancer Care Specialists of Illinois (CCSI; 18.6%) compared with OCM (34.4%). Furthermore, the percent difference in drug spend for CCSI relative to OCM decreased from 13.5% to 0.1% ( < .001). Each quarter, there was approximately a 1.7% decrease (95% CI, 1.0% to 2.4%) in drug spend for CCSI relative to OCM. Additional analyses found that, over a 15-month period (October 2017 through December 2019), CCSI achieved an increase in pathway adherence from 69% to 81%.
Reduction in drug spend is possible within a value-based care model, using evidence-based clinical pathways.
对于参与肿瘤护理模式（Oncology Care Model，OCM）的实践而言，降低药品支出是最大的挑战之一。循证临床路径有可能在保持与已发表证据一致的临床结果的同时降低药品支出。本研究的目的是确定实践中是否可以自愿使用临床路径来最大化 OCM 发作成本节约。
一家社区肿瘤学实践使用了基于证据的临床路径来治疗 OCM 归因于的患者。所有治疗计划都实时提交给路径供应商，以测量临床路径的依从性。在实施之前以及每天和每周进行分析，以确定开出了更高成本的药物或方案的病例。临床数据治理委员会每两周举行一次会议，以审查临床路径绩效指标和药物利用情况。
从 2017 年第一季度到 2019 年第一季度，伊利诺伊州癌症护理专家（Cancer Care Specialists of Illinois，CCSI）的药物支出中位数增长速度比 OCM 慢（18.6%对 34.4%）。此外，CCSI 药物支出相对于 OCM 的差异百分比从 13.5%降至 0.1%（<.001）。与 OCM 相比，CCSI 每季度的药物支出减少了约 1.7%（95%CI，1.0%至 2.4%）。进一步的分析发现，在 15 个月的时间（2017 年 10 月至 2019 年 12 月）内，CCSI 的路径依从性从 69%增加到 81%。
在基于价值的护理模式中，使用基于证据的临床路径可以降低药品支出。
