title: Development, implementation, and compliance of treatment pathways in radiation medicine.
abstract: BACKGROUND
  While much emphasis on safety in the radiation oncology clinic is placed on process, there remains considerable opportunity to increase safety, enhance outcomes, and avoid ad hoc care by instituting detailed treatment pathways. The purpose of this study was to review the process of developing evidence and consensus-based, outcomes-oriented treatment pathways that standardize treatment and patient management in a large multi-center radiation oncology practice. Further, we reviewed our compliance in incorporating these directives into our day-to-day clinical practice.
  
  
  METHODS
  Using the Institute of Medicine guideline for developing treatment pathways, 87 disease specific pathways were developed and incorporated into the electronic medical system in our multi-facility radiation oncology department. Compliance in incorporating treatment pathways was assessed by mining our electronic medical records (EMR) data from January 1, 2010 through February 2012 for patients with breast and prostate cancer.
  
  
  RESULTS
  This retrospective analysis of data from EMR found overall compliance to breast and prostate cancer treatment pathways to be 97 and 99%, respectively. The reason for non-compliance proved to be either a failure to complete the prescribed care based on grade II or III toxicity (n = 1 breast, 3 prostate) or patient elected discontinuance of care (n = 1 prostate) or the physician chose a higher dose for positive/close margins (n = 3 breast).
  
  
  CONCLUSIONS
  This study demonstrates that consensus and evidence-based treatment pathways can be developed and implemented in a multi-center department of radiation oncology. And that for prostate and breast cancer there was a high degree of compliance using these directives. The development and implementation of these pathways serve as a key component of our safety program, most notably in our effort to facilitate consistent decision-making and reducing variation between physicians.
authors: Department of Radiation Medicine, North Shore-LIJ Cancer Institute, Hofstra North Shore-LIJ School of Medicine New Hyde Park, NY, USA.
authors: Louis
authors: L
authors: Potters
authors: Jadeep
authors: J
authors: Raince
authors: Henry
authors: H
authors: Chou
authors: Ajay
authors: A
authors: Kapur
authors: Daniel
authors: D
authors: Bulanowski
authors: Regina
authors: R
authors: Stanzione
authors: Lucille
authors: L
authors: Lee
keywords: care pathways; protocols; radiation oncology; value-based medicine
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