title: Using Vignettes to Measure and Encourage Adherence to Clinical Pathways in a Quality-Based Oncology Network: An Early Report on the Moffitt Oncology Network Initiative.
abstract: BACKGROUND
  The Moffitt Oncology Network (MON) Initiative demonstrates a way to form a value-based network based upon clinical pathways across a broad geographical area.
  
  
  METHODS
  Moffitt Cancer Center (MCC) has developed various cancer-specific pathways. MCC pathways translate evidence-based guidelines into personalized cancer treatment and set a care standard for evaluation and personalized treatment. MCC is using these pathways with other hospital systems and physician groups throughout the MON. Clinical Performance and Value Vignettes, which are virtual patient cases related to the specific clinical pathways, are used to improve the uptake of pathways in the MON. We report here on the baseline data of 66 breast cancer care providers who took 132 breast cancer vignettes. Using the vignettes, variation in care practice is examined, with special attention to use of clinical breast cancer pathways.
  
  
  RESULTS
  Pathway-based clinical care was measured at baseline across MON sites.The mean distributions at baseline varied across all sites and were not statistically significantly different (P>.05). Scores varied by domain across sites, although history and physical scores tended to be higher than work-up, diagnosis, and treatment scores. Pathway adherence also varied for specific diagnostic evaluations or treatments: surgery; sentinel/axillary lymph node dissection; radiation therapy; chemotherapy; and hormonal therapy, and also for the prevalence of unnecessary testing.
  
  
  CONCLUSIONS
  Our study suggests that fostering the adoption of breast cancer clinical pathways into an oncology network is feasible; however, adherence to pathways in breast cancer is varied and reducing such variation is a priority as oncology networks continue to grow in popularity.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kubal
authors.forename: John W
authors.initials: JW
authors.lastname: Peabody
authors.forename: Eliot
authors.initials: E
authors.lastname: Friedman
authors.forename: Rich
authors.initials: R
authors.lastname: Levine
authors.forename: Steve
authors.initials: S
authors.lastname: Pursell
authors.forename: Doug G
authors.initials: DG
authors.lastname: Letson
mesh_terms: D019091:Critical Pathways; D019983:Guideline Adherence; D006801:Humans; D008495:Medical Oncology; D011785:Quality Assurance, Health Care