A Network Approach to Standardization of BMT Pathways

Background: The Sarah Cannon Blood Cancer Network (SCBCN) consists of 6 programs in the US performing over 850 HSCTs annually. In the fall of 2012, the SCBCN physician leaders proposed development of standardized disease-based BMT pathways. These included background information on the diseases, indications for transplant and treatment methods to be used. Anticipated benefits included improved quality and efficiency of transplantation throughout network, improved data collection, and a better platform for collaborative research amongst the programs. A Pathways Committee was formed with representation from each program including physicians, Pharm Ds, Clinical Nurse Specialists, and administrative support personnel.

Process: The committee scheduled twice monthly conference calls from January, 2013 through September, 2014 and developed initial pathways. The physicians presented draft pathways based upon expertise and clinical interest which were then modified according to committee and evidence review.  Network experts were consulted as requested by the committee. Once the draft pathways were completed they were circulated to the 22 SCBCN program transplant physicians for comment. Comments were collated and sent to the committee for review for final revisions.

Outcome: Twelve standardized BMT pathways resulted from this process covering acute and chronic leukemias, lymphomas, myelodysplastic syndromes, multiple myeloma, myeloproliferative syndromes, graft-versus-host disease prophylaxis, and stem cell mobilization. Consensus on the treatment pathways was readily achieved setting the stage for further clinical and research collaboration. Final versions of the pathways were published on the Sarah Cannon SharePoint site for program access.  SCBCN members agreed to implement the pathways to guide BMT care. Physicians may choose to treat a patient off-pathway but must submit a variance form for tracking. Variances are reviewed at the SCBCN quarterly Network Quality Committee Meeting.

Implementation of the pathways will require standardized order sets be created and PharmDs from Network programs are creating standardized order sets for each pathway. Pathways will be built into the electronic BMT Patient Management Software and variances tracked electronically.