Implementation and Clinical Adoption of Precision Oncology Workflows Across a Healthcare Network.
Implementation and Clinical Adoption of Precision Oncology Workflows Across a Healthcare Network.
复制标题
DOI：
10.1093/oncolo/oyac134
复制
发表时间：
2022-11-03
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
精确肿瘤学依赖于分子诊断，现代医疗保健网络的价值主张承诺在合作伙伴网站之间提供更高标准的护理。我们提出了临床试点的结果，以标准化精确肿瘤学工作流程。工作流程被定义为疾病特异性分子顺序集的开发、推出和更新。我们跟踪了共识会议的时间轴、组成和工作，以确定分子检测的组合。为了评估临床影响，我们检查了所有胃肠道和肝胆胰（GI）恶性肿瘤在两年期间（推出前后）的订单集采用情况，以及网络内的供应商位置。12个疾病中心特定顺序集的开发花费了约9个月，每个适应症的平均测试次数从2.9变为2.8（P = 0.74）。在推出后，我们发现GI患者的要求（17%; P <.001），对检测建议的依从性（9%; P <.001）和“异常”结果的比例（6%; P <.001）显着增加。在1088例GI患者中，只有3例接受了基于非推荐医嘱结果的靶向药物（1例在推出前，2例在推出后）;表明我们的实践对患者治疗没有负面影响。初步分析显示，网络站点中的供应商遵守了99%，证实了整个网络采用了订单集。我们的研究详细介绍了建立精确肿瘤学工作流程的努力，采用模式以及减少非推荐订单不会造成伤害。为分子检测建立一个可修改的通信工具是通过精确肿瘤学优化患者护理的重要组成部分。本文介绍了临床试点的结果，以标准化整个医疗保健网络的精确肿瘤学工作流程。作者描述了一种跨学科的方法，可以在其他机构中反映，以反映特定的需求或重新构建并应用于其他临床场景。
Precision oncology relies on molecular diagnostics, and the value-proposition of modern healthcare networks promises a higher standard of care across partner sites. We present the results of a clinical pilot to standardize precision oncology workflows. Workflows are defined as the development, roll-out, and updating of disease-specific molecular order sets. We tracked the timeline, composition, and effort of consensus meetings to define the combination of molecular tests. To assess clinical impact, we examined order set adoption over a two-year period (before and after roll-out) across all gastrointestinal and hepatopancreatobiliary (GI) malignancies, and by provider location within the network. Development of 12 disease center-specific order sets took ~9 months, and the average number of tests per indication changed from 2.9 to 2.8 (P = .74). After roll-out, we identified significant increases in requests for GI patients (17%; P < .001), compliance with testing recommendations (9%; P < .001), and the fraction of “abnormal” results (6%; P < .001). Of 1088 GI patients, only 3 received targeted agents based on findings derived from non-recommended orders (1 before and 2 after roll-out); indicating that our practice did not negatively affect patient treatments. Preliminary analysis showed 99% compliance by providers in network sites, confirming the adoption of the order sets across the network. Our study details the effort of establishing precision oncology workflows, the adoption pattern, and the absence of harm from the reduction of non-recommended orders. Establishing a modifiable communication tool for molecular testing is an essential component to optimize patient care via precision oncology. This article presents the results of a clinical pilot to standardize precision oncology workflows across a healthcare network. The authors describe an interdisciplinary approach that can be mirrored in other institutions to reflect particular needs or reframed and applied to other clinical scenarios.
登录
查看更多内容
影响因子：
28.4
作者：
Cobain EF;Wu YM;Vats P;Chugh R;Worden F;Smith DC;Schuetze SM;Zalupski MM;Sahai V;Alva A;Schott AF;Caram MEV;Hayes DF;Stoffel EM;Jacobs MF;Kumar-Sinha C;Cao X;Wang R;Lucas D;Ning Y;Rabban E;Bell J;Camelo-Piragua S;Udager AM;Cieslik M;Lonigro RJ;Kunju LP;Robinson DR;Talpaz M;Chinnaiyan AM
通讯作者：
Chinnaiyan AM
DOI：
10.1093/jamia/ocw020
发表时间：
2016-07-01
影响因子：
6.4
作者：
Eubank, Michael H.;Hyman, David M.;Stetson, Peter D.
通讯作者：
Stetson, Peter D.
影响因子：
7.5
作者：
Adar, Tomer;Rodgers, Linda H.;Chung, Daniel C.
通讯作者：
Chung, Daniel C.
DOI：
10.1038/s41568-021-00408-3
发表时间：
2022-03
期刊：
Nature reviews. Cancer
影响因子：
--
作者：
Boehm KM;Khosravi P;Vanguri R;Gao J;Shah SP
通讯作者：
Shah SP
影响因子：
158.5
作者：
Hegi, ME;Diserens, A;Stupp, R
通讯作者：
Stupp, R