A Web-Based Decision Support Platform to Reduce Non Evidence-Based Treatment of Hodgkin Lymphoma

Published reports indicate 30–40% of oncology treatments deviate from evidence-based standards. Little is known about the extent of deviation from guidelines in Hodgkin Lymphoma, a highly curable cancer.

eviti is a web-based decision support platform that incorporates all recognized guidelines (ASCO, NCI, NCCN, ASTRO and others) and supporting literature. An automated precertification code is issued if planned treatment is evidence based and meets payer language- Variances may be discussed in a peer to peer (P2P) with staff oncologists. We analyzed all treatment plans submitted for patients with stage I to IV Hodgkin's lymphoma (all pathology subtypes) between 1/1/2011 and 6/30/2012 to understand reasons for non-compliance with practice guidelines. There were six payers with a total of 605,412 covered lives encompassing 22 states.

124 treatment plans were submitted, including 37 with radiation treatment as part of the plan or as primary treatment. 48 (39%) received an automatic code, and another 63 (51%) were given preauthorization codes after submission of medical records. 25 treatment plans (20%) required a P2P and 7 (6% of all cases) were changed to evidence-based treatments as a result. 5 plans were deemed evidence-based as a result of the P2P, while13 plans (10%) did not meet evidence-based standards and did not receive a code for pre-certification even after a P2P. 3 of these were resubmitted with evidence-based plans. The most common deviations were; 1.Use of supportive drugs not consistent with guidelines 6 cases (6%); 2. Non evidence-based therapeutic regimens 2% (2 cases); 3. Non evidence-based variation in dose and/or schedule of chemotherapy 2% (2 cases). 4. Use of IMRT with IGRT.

Decision support for automated pre-certification reduced non- evidence-based treatment of Hodgkin lymphoma from 16% (20 cases) to 8% (10 cases). A Web-based, point of care decision-support platform connecting providers and payers can reduce unwarranted variability, improve quality and reduce payment for unwarranted care. It facilitates analysis of variations from accepted standards of care for any hematologic malignancy at a granular level. Any such tool should promote compliance with evidence-based cancer care but allow flexibility for medically justified variances.

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