Driving Adoption of Best Clinical Practices Through Process Improvement Based Education
Track: Full Session
The rate of growth of knowledge in Oncology is steadily increasing, challenging generalist oncologists to keep abreast of current best practice(s) in managing diverse disease states. The clinician must be well informed not only within his/her own specialty but also in the multidisciplinary fields involved in the optimal care of each patient. The challenge is magnified by the diverse sources of information and varying degrees of quality and validity of the emerging data. Clinicians must evaluate each new point prior to implementation of changes in practice. The near-impossibility of this task slows adoption of emerging best practices in patient care. The evolving paradigm of care delivery further complicates change across multiple disciplines
Educational activities are a key component to changing clinical practice but traditional didactic methods alone have limited efficacy in effecting change. Other strategies are needed to drive adoption of new management paradigms. In this session we will describe a project that focused on the adoption of best practice in the management of women with HER2+ breast cancer in the neoadjuvant setting. The project utilized the context of process improvement, supported by evidence based educational tools in a variety of formats (references, videos, and guidelines) to drive changes in practice to align with best practice(s) across a multidisciplinary care team. Our discussion will focus on the challenges that were overcome, those that were not overcome and the elements that contributed to successful execution.
Many strategies can be utilized to facilitate interdisciplinary learning and process improvement. To define and focus the ultimate goals of the project, a partnerships between the Duke Cancer Network (DCN), Duke Clinical Research Institute-education division (DCRI Education) and CECity, now Premier, Inc was established and supported by an independent educational grant from Genentech. This multi-staged project developed and implemented a custom registry that measured performance through a core set of measures that were defined by an expert panel; engaged diverse stakeholders to support the project; facilitated coordination of care, and provided practitioners with educational interventions geared towards improving the care of patients with HER2+ breast cancer in the community setting. The engagement of diverse stakeholders from administration and clinical personnel was critical to the success of the long-term project and required leveraging individually relevant priorities. The DCN team created several points of contact using a variety of methods throughout the project to ensure ongoing engagement.
In addition, the development of the web-based registry allowed participation from a wide geographic area and diverse clinical settings across the Duke Cancer Network. The registry captured data on individual patients to inform adherence of clinicians to core measures that defined best practice as determined by a key group of breast cancer experts from the Duke Cancer Institute. Data was collected in a HIPAA compliant manner to support the 4 core measures determined to be fundamental to best practices in the targeted area of clinical care: 1. Multidisciplinary evaluation of women with breast cancer; 2. Documented discussions of neo-adjuvant therapeutic options for appropriate patients; 3. Neoadjuvant chemotherapy offered and administered to appropriate patients; and 4. Surgical procedures utilized appropriate to the use of neoadjuvant chemotherapy.