Background: Clinical decision support (CDS) tools facilitate value-based cancer care delivery and can enable measurement of guideline concordance. Flatiron Assist is an EHR-embedded and customizable CDS tool that facilitates selection and documentation of NCCN Guideline concordant and NCCN preferred treatment regimens. We assessed patterns of concordant, preferred and non-preferred treatment regimen ordering at one large multi-site community practice. Methods: We reviewed all treatment orders entered through the optional CDS tool from May 1, 2021, through Nov 1, 2021 at one multi-site community oncology practice in the Northeastern US. We assessed NCCN preferred, non-preferred and non-concordant treatment regimen ordering across tumor types, and the degree of ordering where no NCCN preferred regimens exist. Results: All 39 prescribers at the practice (13 MD/DO, 14 NP, 7 PA, 4 PharmD, 1 RN) placed 924 treatment regimen orders via the optional CDS tool during the 6 month observation period. 755 of the regimen orders (82%) were NCCN Guidelines concordant and among those, 323 (43%) occurred in settings where no NCCN preferred option was designated. Among the 431 orders where an NCCN preferred option was available, it was selected in 379 (88%). Lower use of preferred regimens, when available, occurred in rectal cancer (17%), prostate cancer (65%) and CML (67%), relative to higher use of preferred regimens in small cell lung cancer (100%), esophageal cancer (96%) and pancreatic cancer (94%). Figure 1 shows the breakdown of preferred, non-preferred, and preferred N/A orders across the 15 disease-based order sets available at this practice. Conclusions: At a large community oncology practice, prescribers using this CDS tool over a 6-month observation period chose NCCN preferred chemotherapy regimens, if available, in the vast majority of orders. Though orders for non-preferred regimens were empirically low, use was highest in rectal cancer. For many of the 15 tumor types, a sizeable proportion of treatment was given in settings where NCCN has not assigned a category of preference. 18% of orders were non-concordant with NCCN Guidelines, a rate that is in line with prior research and national benchmarks. Further research will characterize workflow time, predictors of non-use, non-preferred and non-concordant orders, and evaluate whether Flatiron Assist improves clinical outcomes. Figure 1.
BPI22-015 Figure 1.
Citation: Journal of the National Comprehensive Cancer Network 20, 3.5; 10.6004/jnccn.2021.7262
