Implementation of guidelines and paths in oncology

At the M.D. Anderson Cancer Center, we initiated a disease management program to reduce the variability of practice and increase its effectiveness, using a model that was familiar to the faculty. Professional staff members, including physicians, nurses, and allied health professionals, were divided into groups according to disease site. Each group developed practice guidelines and collaborative care paths based on evidence in the literature and expert opinion. Desired outcomes were defined. The faculty participated in developing and implementing the program, which was viewed as a means of achieving efficient, productive management of care. Nearly 1,000 patients have been entered on the 98 paths outlined to date. Integrated information systems have been an important tool for instituting the guidelines at the point of patient care and for measuring clinical and financial outcomes. A physician-led outcomes management program should permit us to deliver high-quality care and support outcomes research while decreasing costs.