Maintaining Clinical Pathways: What Does It Really Take?

305 Background: Building pathways to support clinical decision making is one step, maintaining them is a mountain. Dana-Farber Cancer Institute has built 34 medical oncology (MO) pathways (PWs) and 27 radiation oncology (RO) PWs. These PWs are managed by 28 lead MDs, 8 pharmacists, 6 project managers (PMs), 1 data analyst and 1 coordinator. Once PWs are built, attention shifts to platform and content maintenance. Methods: Maintaining PW clinical and informatics content is complicated and laborious. It requires collaboration amongst clinical and non-clinical experts; these resources form the PW team. PW content is updated quarterly or semi-annually, based on the pace of scientific change in a disease. These review meetings serve as a forum for physicians to review, discuss and revise content. Infrastructure support is provided by the PW team. Supporting the meeting requires a pre-meeting, the formal review meeting, a post meeting, and extensive revisions and content validation along the way. To prepare, PW performance data and emerging relevant evidence is reviewed with the lead MD to establish the meeting agenda. In both MO and RO the PW team is responsible for all content management. Results: We reviewed 6 months of data (2/18-7/18) and analyzed the hours and cost to maintain the pathway portfolio. Conclusions: PW maintenance is costly therefore labor efficiency is critical to overall success. There are 4 strategies for success: building trust; MD engagement; data; and program coordination. The MD/PM relationship is the foundation and consistency is key. MD engagement is crucial; having an influential lead MD sets the tone for the disease center overall. Establishing clear expectations and frequent check-ins keeps the lead MD engaged. Actionable, frequent, and transparent data reports give MDs feedback on their practice patterns. The coordinator is a central point of contact and ensures programmatic execution and success. Though PW maintenance is resource intensive, it facilitates standardized decision-making for the dissemination of cutting-edge cancer care. [Table: see text]