Chapter 04: Multidisciplinary Care and the MD Anderson Algorithms
In this chapter, Dr. Rodriguez defines the MD Anderson algorithms of care and explains how they were created and are continually evolving, based on current research. She explains how they are connected to multidisciplinary care, and how important they are for standardizing care at MD Anderson’s partner institutions.
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Tacey Ann Rosolowski, PhD I wanted to return, just briefly, to multidisciplinary care and kind of going to the issue of future, because I know that an outgrowth of multidisciplinary care, the MD Anderson algorithms of care, which you've been very involved in working on.
Alma Rodriguez, MD Yes.
Tacey Ann Rosolowski, PhD I wonder if you could tell briefly what they are, and then talk about the fact that they're going to be used outside of the institution.
Alma Rodriguez, MD Right. The algorithms of care, some other institutions are now calling pathways, have been part of our culture and [ ] the design of the multidisciplinary care planning model for years. The algorithms are essentially a map of care from diagnosis to, for some cases, unfortunately, end of life care. The map talks about each of the stages of the care delivery process, like I said from diagnosis, i.e. what are the appropriate tests to do, to arrive at the most correct diagnosis, to the treatment delivery based on staging or treatment planning based on staging, to evaluation, what we call surveillance, at each timepoint of the treatment plan, to decide what is the status of the tumor, how is the patient doing, and depending on the outcomes, whether it is a very good response, [ ] in remission and wellness, to unfortunately sometimes recurrences, and management of recurrences.
And if again, disease is not responsive to salvage treatments, then appropriate end of life care. So the algorithms essentially tell us from point A to point Z, this is what we consider the best decision tree, if you will. They're intended to guide people in the thought process, they're not directive. In other words, they don't say you must do this, but these are the best recommended or the best acknowledged processes for this particular phase of the illness. That should drive then, the decision-making process and the conversations with the patient, about you know, this is the recommended best strategy.
Tacey Ann Rosolowski, PhD And this is all based on data that has been collected.
Alma Rodriguez, MD Correct. The algorithms are developed through a [ ] rigorous process of integration of multidisciplinary experts, to discuss the plan of care or to discuss the map of care, and then we also do literature searches to support those decision points. They are meant to be living documents. In other words, they change as the best evidence recommends that if treatment A was the best treatment ten years ago but it no longer is, then it needs to be removed. We have to keep updating these as new evidence emerges. Now, that of course served [ ] as kind of a collaborative map internally, but now that we are [ ] an organization that has other partners beyond our Houston address, one of the questions that the partners have raised is how do we know that we are delivering MD Anderson care, or how would we ensure that we are all delivering MD Anderson care. And of course, then these maps [ ] should be what then guides each of [our] partners. Because the process has only been internal, we are now faced with an interesting, but I think exciting new challenge, which is how do we now engage our partners in true partnership?
That is, in the evolution and development of these tools that guide our practice. And the tools are not just the algorithms, but also order sets for example, that should be standardized in a certain fashion, to ensure that we have all the required elements for each episode of care. In particular, when it comes to chemotherapy, where certain chemotherapy regimens are rather complex, we want to ensure that they are safely designed, that they have integrated all of the components of prevention of side effects and/or appropriate management of side effects as they arise during the treatment, and so on. So designing the tools and collaborating towards the design and implementation of algorithms, I see as an exciting next phase of evolution in how we integrate not only multidisciplinary care, but now multi-institutional, multidisciplinary care.
Rodriguez, Alma MD and Rosolowski, Tacey A. PhD, "Chapter 04: Multidisciplinary Care and the MD Anderson Algorithms" (2017). Interview Chapters. 283.
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