Cotner Cody E, Tramontano Angela C, Post Alex, Finn Brian, Awan Saima, Gwynne Nathaniel, Mwesigwa Sishemo, Lindvall Charlotta, Tulsky James A, Jacobson Joseph O, Jackman David M, Wright Alexi A, Manz Christopher R
Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
JCO Oncol Pract. 2025 Apr;21(4):535-543. doi: 10.1200/OP.24.00311. Epub 2024 Sep 30.
Oncology treatment pathways provide decision support and encourage guideline adherence. Pathway data combined with electronic health record (EHR) data can identify patient populations with poor prognoses, low serious illness conversation (SIC) rates, and high acute care utilization that may benefit from targeted interventions.
We conducted a retrospective cohort analysis among adults with cancer treated at seven affiliated sites of the Dana-Farber Cancer Institute (DFCI) who had navigations within 21 treatment pathways between July 29, 2019, and March 8, 2023. DFCI clinicians previously identified pathway nodes with an estimated survival less than 1 year, termed poor prognosis (PP) nodes. We combined pathway data with EHR data to calculate the median overall survival (OS) and proportion of patients with SICs, acute care utilization (hospitalizations and emergency department visits), and outpatient palliative care 6 months after treatment node navigation for all, PP, and nonpoor prognosis (nPP) nodes. SICs were identified using the EHR advanced care planning (ACP) tab.
There were 15,261 navigations for 10,203 patients (median age 66 years, 55% female, 85% White). The median OS was 13.8 months for all nodes, 7.8 months for PP nodes, and 21.0 months for nPP nodes. The ACP section of the EHR rate 6 months after navigation was 19.6% for PP nodes versus 11.0% for nPP nodes. There was substantial intragroup variability in OS and SIC rates among all nodes. SICs were recorded in the ACP tab for only 34.3% of decedents. Patients who navigated to PP nodes had higher levels of acute care utilization and palliative care encounters.
Treatment pathway data enabled identification of patient populations with poor prognoses, low SIC rates, and high acute care utilization.
肿瘤治疗路径提供决策支持并鼓励遵循指南。路径数据与电子健康记录（EHR）数据相结合，可以识别出预后较差、严重疾病沟通（SIC）率低且急性护理利用率高的患者群体，这些患者群体可能受益于有针对性的干预措施。
我们对在丹娜法伯癌症研究所（DFCI）七个附属机构接受治疗的成年癌症患者进行了一项回顾性队列分析，这些患者在2019年7月29日至2023年3月8日期间遵循了21种治疗路径。DFCI的临床医生先前确定了估计生存期少于1年的路径节点，称为预后不良（PP）节点。我们将路径数据与EHR数据相结合，以计算所有、PP和非预后不良（nPP）节点在治疗节点导航后6个月的中位总生存期（OS）、SIC患者比例、急性护理利用率（住院和急诊就诊）以及门诊姑息治疗情况。使用EHR的高级护理计划（ACP）标签来识别SIC。
10203例患者有15261次路径导航（中位年龄66岁，55%为女性，85%为白人）。所有节点的中位OS为13.8个月，PP节点为7.8个月，nPP节点为21.0个月。导航后6个月EHR的ACP部分使用率，PP节点为19.6%，nPP节点为11.0%。所有节点的OS和SIC率在组内存在很大差异。只有34.3%的死者在ACP标签中记录了SIC。导航到PP节点的患者急性护理利用率和姑息治疗就诊率较高。
治疗路径数据有助于识别预后较差、SIC率低且急性护理利用率高的患者群体。
