Analyzing pathways data to reduce unwarranted variation, understand practice patterns, and update pathways.

300Background: A clinical pathways program requires regular updates to pathways content, real-time decision support, and data collection and analysis of decisions made. A goal of Dana-Farber Pathways (DFP) is to analyze data to reduce unwarranted variation and inform granular, warranted variation. Methods: Each of our 31 medical oncology pathways is created and updated by DF experts (clinicians and scientists). DFP is implemented through a web-based portal that provides real-time decision support. DFP captures on- and off- pathway treatment decisions and reasons for off-pathway decisions; this is shared with each disease group monthly. For each interval review meeting we assess on-pathway rates and decisions for each node in the pathway. Low on-pathway rates prompt discussion about possible action, including provider education or pathway modification. Results: In 2017, 7,460 total treatment decisions were collected through DFP; 78% were on-pathway. We have clinical reasoning for 90% of the off-pathway dec...