A Novel Clinical Pathways Approach to Delivering Regional-Based Clinical Trials and Patient Care in a Hybrid Academic-Community-Based System


J Clin Pathways. 2018;4(4):52-55. doi:10.25270/JCP.2018.05.00016

Received April 19, 2018; accepted April 27, 2018. 


Levine Cancer Institute, Atrium Health, Charlotte, NC


Edward S Kim, MD, FACP

1021 Morehead Medical Drive, Suite 3100

Charlotte, NC 28204

Phone: (980) 442-3130

Email: edward.kim@atriumhealth.org


The authors report no relevant financial relationships.

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Ongoing Efforts

The EAPathways tool was implemented in 2015, and we have compiled utilization metrics and preliminary data from 2016 and 2017. Adoption has increased since initiation (70% compliance in 2017 among providers), especially with regards to clinical trial enrollments. Despite having a similar number of studies open yearly from 2015 to 2017, clinical trial enrollments have steadily increased, especially at our regional sites. Additionally, there have also been more referrals to patient clinical services (eg, medical genetics, tobacco cessation program, etc.)

In 2016, the American Society of Clinical Oncology (ASCO) released the “ASCO Policy Statement on Clinical Pathways in Oncology” to address the fact that there were no current standards to measure the integrity and quality of clinical pathways. Subsequently, a newly developed ASCO Task Force created a set of criteria for the development and implementation of clinical pathways that focused on 3 main areas: pathway development, implementation and use, and analytics.3,6 The EAPathways currently meets 12 of 15 criteria stated in the ASCO Criteria for High-Quality Clinical Pathways in Oncology.6 However, the EAPathways does not yet meet the following 3 criteria: (1) efficient and public reporting of performance metrics—the EAPathways does not publicly report metrics or utilize analytics to move from compliance-based to outcome-based results yet, as it is too early and we need to collect more data first; (2) outcome-driven results—the EAPathways does not have analytics yet in place to measure outcome-driven results through the EAPathways; and (3) promotes research and continuous quality improvement—we do promote research, but we are still in the process of measuring quality improvement. In the future, LCI hopes to use data captured within the EAPathways to report on patient outcomes and also contribute to research and process improvement projects, if applicable.

Since 2015, LCI has created 68 individual clinical pathways that have been published in the tool for all LCI providers to utilize. These efforts continue as oncology care evolves and new approaches to care are developed. The ability to add new therapeutics or diagnostics in less than 24 hours has enhanced the ability of LCI providers to deliver cutting-edge care. As genomic testing has become mainstream, the EAPathways has helped standardize this process across LCI’s 21 regional locations. Additionally, clinical trials accrual has increased dramatically since implementation of the EAPathways in 2015.


The practice of oncology is an exciting, yet challenging area. The number of new drug and diagnostic indications in the past 5 years is unprecedented. Tools, such as the EAPathways, help empower providers to deliver the very best services and most up-to-date care for patients, especially in regional-based networks. 


1. Daly B, Zon RT, Page RD, et al. Oncology clinical pathways: charting the landscape of pathway providers. J Oncol Pract. 2018;14(3):e194-e200. 

2. DeMartino JK, Larsen JK. Equity in cancer care: pathways, protocols, and guidelines. J Natl Compr Canc Netw. 2012;10(suppl 1):S1-S9.

3. Zon RT, Edge SB, Page RD, et al. American Society of Clinical Oncology criteria for high-quality clinical pathways in oncology. J Oncol Pract. 2017;13(3):207-210.

4. Levine Cancer Institute is the first cancer center in the world to earn top designation for patient-centered cancer care delivery [news release]. Charlotte, NC: Carolinas HealthCare System; January 11, 2017. https://www.prnewswire.com/news-releases/levine-cancer-institute-is-the-first-cancer-center-in-the-world-to-earn-top-designation-for-patient-centered-cancer-care-delivery-300389481.html. Accessed April 25, 2018. 

5. U.S. Food & Drug Administration. FDA approves new, targeted treatment for bladder cancer. 2016. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm501762.htm. Accessed April 20, 2018. 

6. American Society of Clinical Oncology (ASCO). ASCO Criteria for High-Quality Clinical Pathways in Oncology. https://www.asco.org/sites/new-www.asco.org/files/content-files/blog-release/documents/2016-ASCO-Criteria-High-Quality-Pathways.pdf. Published November 29, 2016. Accessed April 30, 2018. 

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