Cost and Survival Analysis Before and After Implementation of Dana-Farber Clinical Pathways for Patients With Stage IV Non–Small-Cell Lung Cancer

Jackman, David M.; Zhang, Yichen; Dalby, Carole Kathleen; Nguyen, Tom; Nagle, Julia M.; Lydon, Christine; Rabin, Michael S.; McNiff, Kristen; Fraile, Belen; Jacobson, Joseph O.

doi:10.1200/jop.2017.021741

Cited by 64 publications

(81 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Six studies targeted multiple specialisms; the others focused on one specialism. CDSSs of included studies focused on risk assessment or therapy options to support informed decisions [26][27][28][29][30][31][32], as well as statistical methods and data mining to generate patient-specific recommendations [33,34]. For most studies (7/9), clinical guidelines formed the knowledge base of the CDSS.…”

Section: Eligible Studiesmentioning

confidence: 99%

“…Six studies reported process outcomes ( Table 2). The issues addressed included: use of CSF to control chemotherapy-induced febrile neutropenia [26,27], physician-prescribing behavior [32], clinical trial rate [32], attainment of analgesia [28], time to analgesia [28], frequency of pharmaceutic intervention and pain assessment [28], costs [33] and workload [31]. Comparators included usual care, based on either MDT decisions or clinical guidelines.…”

Section: Process Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Higher Level Computerized Clinical Decision Support Systems on Oncology Care: A Systematic Review

Klarenbeek¹,

Weekenstroo²,

Sedelaar³

et al. 2020

Cancers

View full text Add to dashboard Cite

Background: To deal with complexity in cancer care, computerized clinical decision support systems (CDSSs) are developed to support quality of care and improve decision-making. We performed a systematic review to explore the value of CDSSs using automated clinical guidelines, Artificial Intelligence, datamining or statistical methods (higher level CDSSs) on the quality of care in oncology. Materials and Methods: The search strategy combined synonyms for 'CDSS' and 'cancer.' Pubmed, Embase, The Cochrane Library, Institute of Electrical and Electronics Engineers, Association of Computing Machinery digital library and Web of Science were systematically searched from January 2000 to December 2019. Included studies evaluated the impact of higher level CDSSs on process outcomes, guideline adherence and clinical outcomes. Results: 11,397 studies were selected for screening, after which 61 full-text articles were assessed for eligibility. Finally, nine studies were included in the final analysis with a total population size of 7985 patients. Types of cancer included breast cancer (63.1%), lung cancer (27.8%), prostate cancer (4.1%), colorectal cancer (3.1%) and other cancer types (1.9%). The included studies demonstrated significant improvements of higher level CDSSs on process outcomes and guideline adherence across diverse settings in oncology. No significant differences were reported for clinical outcomes. Conclusion: Higher level CDSSs seem to improve process outcomes and guidelines adherence but not clinical outcomes. It should be noticed that the included studies primarily focused on breast and lung cancer. To further explore the impact of higher level CDSSs on quality of care, high-quality research is required.

show abstract

Section: Eligible Studiesmentioning

confidence: 99%

Section: Process Outcomesmentioning

confidence: 99%

The Effect of Higher Level Computerized Clinical Decision Support Systems on Oncology Care: A Systematic Review

Klarenbeek¹,

Weekenstroo²,

Sedelaar³

et al. 2020

Cancers

View full text Add to dashboard Cite

show abstract

“…In early‐stage breast cancer, receipt of guideline‐based care is associated with improved survival . Implementation of pathway programs based on guidelines also decrease variability in care delivery and reduce health care spending . These benefits have prompted enthusiasm to include the measurement of guideline‐based care within emerging reimbursement models, such as Medicare's Oncology Care Model and the American Society of Clinical Oncology's Patient‐Centered Oncology Payment Model .…”

Section: Introductionmentioning

confidence: 99%

Impact of Guideline-Discordant Treatment on Cost and Health Care Utilization in Older Adults with Early-Stage Breast Cancer

et al. 2018

View full text Add to dashboard Cite

Previous studies lack details about types of deviations from chemotherapy guidelines that occur in older early-stage breast cancer patients. Understanding the patterns of guideline discordance and its impact on patient outcomes will be particularly important for these patients. This study found 16% received guideline-discordant care, predominantly related to reduced intensity treatment and associated with higher costs and rates of health care utilization. Increasing older adult participation in clinical trials should be a priority in order to fill the knowledge gap about how to treat older, less fit patients with breast cancer.

show abstract

“…Implementation of pathways reduced spending on chemotherapy by up to approximately $40,000 in colorectal cancer 52 and more than $12,000 in lung cancer. 53 In contrast, changes in Medicare reimbursement led to a shift towards using more profitable drugs such as docetaxel in lung cancer, suggesting overuse of these agents. 55 …”

Section: Evidence Of Overuse: “What We Know”mentioning

confidence: 99%

“…Among the 30 studies we found documenting medication overuse in oncology, four tested interventions to reduce overuse, of which all were conducted at the institution level. Three studies found reductions in antineoplastic medication overuse for colorectal cancer, 52 lung cancer, 53 and thyroid cancer 94 after pathway implementation. A single study evaluated a quality improvement initiative: Patil et al 30 found that anti-emetic overuse could be reduced at a single institution through enhanced clinician education and peer review by colleague physicians of all anti-emetic prescribing.…”

Section: Mitigating Overuse In Oncologymentioning

confidence: 99%

Medication overuse in oncology: current trends and future implications for patients and society

Schleicher

Matsoukas

Korenstein

2018

The Lancet Oncology

View full text Add to dashboard Cite

Summary: The high cost of cancer care worldwide is largely attributable to rising drugs prices. Despite their high costs and potential toxicities, anticancer treatments may be subject to overuse, defined as the provision of medical services that are more likely to harm than to benefit a patient. We found 30 studies documenting medication overuse in cancer, which included 16 examples of supportive medication overuse and 17 examples of anti-neoplastic medication overuse in oncology. Evaluated drugs were limited to relatively few specific agents, and no studies investigated overuse of the most toxic or expensive medications currently used in cancer treatment. While financial, psychological, or physical harms of medication overuse in cancer could be substantial, there is little literature addressing these harms so their magnitude is unclear. Further research is needed to better quantify rates of medication use, understand its implications, and help protect patients and the healthcare system from future overuse.

show abstract

Cost and Survival Analysis Before and After Implementation of Dana-Farber Clinical Pathways for Patients With Stage IV Non–Small-Cell Lung Cancer

Cited by 64 publications

References 9 publications

The Effect of Higher Level Computerized Clinical Decision Support Systems on Oncology Care: A Systematic Review

The Effect of Higher Level Computerized Clinical Decision Support Systems on Oncology Care: A Systematic Review

Impact of Guideline-Discordant Treatment on Cost and Health Care Utilization in Older Adults with Early-Stage Breast Cancer

Medication overuse in oncology: current trends and future implications for patients and society

Contact Info

Product

Resources

About