Use of Electronic Health Records to Benchmark Clinical Practice Guideline-Consistent Care in Pediatric Oncology

Measuring clinical practice guideline (CPG)-consistent care through electronic health record (EHR) queries provides a scalable and efficient approach to evaluating quality of care. Template care pathways are used to operationalize CPGs. Goals were to (1) identify care pathway actions for supportive care in pediatric oncology that are amenable to EHR-based evaluation, (2) prioritize five care pathway actions for further assessment, (3) develop EHR queries to identify patients who received care pathway-consistent care, and (4) describe the proportion of pediatric patients with cancer who received care pathway-consistent care.

Within established template care pathways for pediatric cancer supportive care, we identified actions amenable to measurement using structured EHR data. Prioritization was performed by six pediatric oncology clinicians, resulting in five care pathway actions for further evaluation. We created EHR-based queries for each action at one site and applied them to a second site. Once queries were validated at both sites, we described care pathway-consistent care.

The five high-value care pathway actions focused on (1) management of highly emetogenic chemotherapy, (2) chest computed tomography for prolonged fever and neutropenia investigation, (3) antifungal prophylaxis in AML, (4) treatment of Clostridioides difficile infection, and (5) cisplatin ototoxicity prevention. Queries created at one institution were successfully executed at the second institution. Care pathway-consistent proportions ranged from 16% for sodium thiosulfate administration in patients with nonmetastatic hepatoblastoma to 91% for antifungal prophylaxis in patients with AML.

We successfully used the EHR to benchmark care pathway-consistent care. The prevalence of care pathway-consistent care was variable and low for some actions.