Chapter 08: The Clinical Effectiveness Committee and the MD Anderson Algorithms of Care
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Dr. Buzdar chaired the Clinical Effectiveness Committee from 2007 to 2014, and in this chapter he talks about the committee's role in "spelling out patient care." [The recorder is paused.] The purpose of the Committee's activities was and is to develop the MD Anderson approach for disease management from start to finish, for every disease site, based on evidence. A primary downstream use of this information is to define the rationale behind care to insurance companies. Dr. Buzdar explains that the algorithms were developed by disease center experts, who present their findings to the committee. They are then approved as the institutional standard of care. Dr. Buzdar notes that Medicare has used the MD Anderson model as a national standard. There is also a series of publications based on the algorithms. He explains that the Committee is still in existence and continues to develop and refine the algorithms in real time. There are yearly reviews of all algorithms and there may be immediate reviews in response to a new study or treatment innovation.
Identifier
BuzdarA_01_20170210_C08
Publication Date
2-10-2017
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Discovery and Success; Healing, Hope, and the Promise of Research; Patients; Patients, Treatment, Survivors; MD Anderson Impact; MD Anderson Impact
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey A. Rosolowski, PhD:
And I wanted to ask you about your role on the Clinical Effectiveness Committee. I know that you were part of that activity, where there was the creation of various algorithms of care, to kind of systematize it.
Aman Buzdar, MD:
Yeah, actually, I was the first person who was asked to chair that committee.
Tacey A. Rosolowski, PhD:
Neat, okay.
Aman Buzdar, MD:
I was the one who led the committee for, I don't know, you can look in the CV for how long.
Tacey A. Rosolowski, PhD:
You were on that committee from 2007 to 2014, and how long were you a chair of that?
Aman Buzdar, MD:
From day one.
Tacey A. Rosolowski, PhD:
Oh, okay, so you chaired it the entire time?
Aman Buzdar, MD:
Yeah.
Tacey A. Rosolowski, PhD:
Wow.
Aman Buzdar, MD:
The approach of that thing was that as we talked about it, that the research, everything is spelled out. We wanted to make sure that patient care --care means that how you evaluate a patient with say lung cancer, what is your first treatment, second treatment, and things like that. (phone rings)
Tacey A. Rosolowski, PhD:
Let me just pause real quick. [Pause in Recording]
Tacey A. Rosolowski, PhD:
Let me get it back on. Okay, there we go.
Aman Buzdar, MD:
So the idea of Clinical Effectiveness Committee responsibility was that you need to develop MD Anderson approach for disease management. Disease management means how we evaluate the disease, how we stage the disease, how we treat the patients, how we follow up once the treatment is finished, and how we follow after say the patient is successfully managed, survival, what are the things, you look at it. So we then, disease site by disease sites, just say example, take it for breast cancer, since I worked. So, you have when to do mammograms, how frequently, what are the things you need to look at. If the patient has stage one breast cancer, what are the tests you do, what are the treatments you do, what are the options and what is the evidence behind it? So all these things, and what are the treatments for all these things. There is appropriate reference, with today's -- even when we started it in 2000, questions were that we need to provide the third party, i.e. the insurance companies. If they question, Why are you doing this, here is the rationale, that why it is. Approach was to define what is the standard of care for MD Anderson. So what have we done for this --not only in those six or seven years I was chair of this committee-- for every disease category, from evaluation to treatment to supportive care to long-term follow-up, there is algorithms which were developed by the disease centers, not by us, by the disease experts. They are presented in that committee which I chair, Clinical Effectiveness, discussed, reviewed, approved, are modified. And once they are approved and modified, they become the institutional standard, and they go through the whole review process. They are presented first, approved in the committee, then they go to the Medical Practice Committee, which is the committee which oversees the other practice approach. Then it goes to Executive Committee of the Medical Staff, it means it becomes the institutional standard. So all those things which are now available, if you go to Mdanderson.org, they are available to anybody in the whole world to see, that how things are done at MD Anderson for X disease.
Tacey A. Rosolowski, PhD:
Was there pushback against doing this? Were there certain individuals or departments that said wait a minute, you know?
Aman Buzdar, MD:
I think there was not pushbacks, but there was, in the beginning, since we could see how the things are evolving, and the faculty at times didn't see the need, that why do you need to do it? And now everybody sees the advantage. If you are giving treatment X, even understand standard treatment X, it says reference number this exactly. So if the third party refuses to pay it, you send them, here is the appropriate evidence behind it. So now it is in the beginning, some of the people who were late adopters, came to stand up, that oh, we want our things to be reviewed.
Tacey A. Rosolowski, PhD:
Now, this --
Aman Buzdar, MD:
And the same way like we did, -- this is like another committee which I led, which is called Medical Evaluation Committee, means that as you know, that a lot of these tests, genomic tests, molecular tests and things like that, they started. So John Mendelsohn [oral history interview] asked me to lead a committee which is called Molecular Evaluation Technology Committee, called METC, M-E-T-C, you can see it in my CV. I'm still co-chairing it with Stan Hamilton. There we did the same thing. What are the tests from disease diagnosis, treatment, prognosis, or selection of therapy, which there is enough evidence that they can be considered as a standard of care? This is a committee that we sit, review the evidence. Again, we don't create the evidence. Disease centers come, they present it in front of the committee, the committee reviews it, approves it, and it becomes institutional standard. The impact of that, when we started it, there was even some reservations within the institution, but what is its impact today? A few years ago, Medicare used our model to adopt those things as a national standard.
Tacey A. Rosolowski, PhD:
Wow. Now, the Clinical Effectiveness Committee convened in 2007. I'm curious about the timing of that. You know, was that -- what was going on that made that the time to create a committee to focus on algorithms of that sort?
Aman Buzdar, MD:
The idea was that if a patient is not on a research protocol that is well defined, everything is spelled out, what tests you do, seeing that, we wanted to harmonize that if a patient came to MD Anderson"¦ So the thing is, if a patient came to MD Anderson, just using me as an example, if the patient saw me, Dr. Hortobagyi or Dr. Valero or Dr. X, if the patient is not on a protocol, as a standard approach, there should be a consistent, uniform approach, which would be MD Anderson approach. It shouldn't be that the patient saw Dr. Buzdar or Dr. Hortobagyi or Dr. Valero, the patient gets a different opinion.
Tacey A. Rosolowski, PhD:
Right.
Aman Buzdar, MD:
And it has to be discussed. That's why it was not the Clinical Effectiveness [Committee] which developed those guidelines [ ], it was the disease centers. They agreed, they discussed, they said this is our standard. And that was the whole purpose, that it should be an MD Anderson approach. And subsequently, what we have done actually, took it one step further. Synopsis of these things is already on the website, but we actually published a series of monographs which Dr. Ralph Freedman [oral history interview] and me, who used to be here, I think you must have talked with him.
Tacey A. Rosolowski, PhD:
I did, yes.
Aman Buzdar, MD:
We published a series, it was Cancer Care Series, which had several volumes published, which was let's say, "Breast Cancer: MD Anderson Approach." The whole monograph is how the patient is managed with breast cancer at MD Anderson, from A to Z. Same way for lung cancer, for GYN malignancy. These are monographs which were published, describing all these childhood tumors, brain sarcomas, and so on.
Tacey A. Rosolowski, PhD:
Now, I can tell from the way you're speaking about this, that you're pretty proud of it.
Aman Buzdar, MD:
Well I think I am not only proud of it, but the institution, it puts the institutional approach, we put it in a context. It is not in my mind. It is on a piece of paper. Anybody can touch and feel it and see it, how the cookies crumble at MD Anderson.
Tacey A. Rosolowski, PhD:
And what's the larger significance for MD Anderson? Have other institutions done this with their standards of care, I mean is this an unusual thing for a cancer center to do, to systematize everything?
Aman Buzdar, MD:
I think not only it helped us to harmonize it at MD Anderson, but as you know, MD Anderson has what we call MD Anderson Network. One of the criteria of MD Anderson Network, or being a member, that they have to follow all the guidelines outside the context of research, the way the cookie is spelled out.
Tacey A. Rosolowski, PhD:
Right.
Aman Buzdar, MD:
And also, we provide this to all our sister institutions. So it has a global impact and not just within the walls of MD Anderson. That's why we make it so that people don't have to pick up the phone, talk to doctor X or Dr. Buzdar, that how you do it. Here.
Tacey A. Rosolowski, PhD:
Did this come about as part of the global expansion initiative and the -- I mean, was it part of the rationale that putting everything down in black and white in this way would help disseminate the MD Anderson standard to the sister institutions across the network? It seems like an important thing.
Aman Buzdar, MD:
I think that came later on, but mainly in the beginning was that we should have consistent approach to a disease and every disease, that how we manage it at MD Anderson.
Tacey A. Rosolowski, PhD:
Now, have there been -- what are the challenges that have arisen in transferring this standard of care to the sister institutions or across the network? Have you been involved with that, kind of overseeing that?
Aman Buzdar, MD:
I'm aware of it, but I am not involved with it. They have to meet those standards, they have to comply that they are providing care that is similar to what is our standard of care approach.
Tacey A. Rosolowski, PhD:
What are some of the challenges that arise if another institution across the country or across an ocean is deciding to adopt the MD Anderson standard of care? What might make it difficult for that to happen?
Aman Buzdar, MD:
I think that question, you should ask Amy Hay [oral history interview] or -- they can give you a lot better weight and depth.
Tacey A. Rosolowski, PhD:
Sure, fair enough.
Aman Buzdar, MD:
The thing is that since we have everything now spelled out, that these network affiliations and so on, you could put the microscope and see, what is their compliance rate.
Tacey A. Rosolowski, PhD:
Oh, okay, yes.
Aman Buzdar, MD:
So you can see that whether is it just our name, or are they following it. And it is required and you can see the metrics rate that, yes, they are complying with it very high frequency, with approaches as MD Anderson is doing.
Tacey A. Rosolowski, PhD:
Who convened the Clinical Effectiveness Committee? Was that something that John Mendelsohn requested?
Aman Buzdar, MD:
It was during John Mendelsohn, through Dr. Burke's [oral history interview] office, and Dr. Alma Rodriguez [oral history interview].
Tacey A. Rosolowski, PhD:
Yeah, I remember Dr. Rodriguez talking about this too. Is the committee still in existence?
Aman Buzdar, MD:
Oh yeah, the committee meets every month.
Tacey A. Rosolowski, PhD:
It does, okay.
Aman Buzdar, MD:
I stepped out of it because of the responsibilities, but the committee still meets and these things are -- all these things are not just written in stone. It is any evidence, as it evolves, these things are modified in real time, and as policies have changed, things are deleted or added as the knowledge evolves.
Tacey A. Rosolowski, PhD:
I assume that the committee relies on the disease sites to bring changes to the attention of the committee. So what's the mechanism for keeping that communication going? Are there timelines or how does that all work?
Aman Buzdar, MD:
Everything is reviewed, even though it is approved. Every year it is re-reviewed. That is the minimum requirement, but we encourage that if there is some evidence, say tomorrow there is a meeting or some paper gets published, that here is now this thing has tremendous impact. Usually the disease site, they will bring the evidence and it will be again, discussed, reviewed, either approved or not adopted. And the committee has representation from every discipline, the Clinical Effectiveness Committee, so it is not just a handful of people, but every discipline is represented on the committee.
Tacey A. Rosolowski, PhD:
What a fascinating thing to have done, yeah. Well, would you like to close off for today? This feels like a good time.
Aman Buzdar, MD:
Yeah, I think that's it, thank you.
Tacey A. Rosolowski, PhD:
Sure. Well, thank you very much for your time.
Aman Buzdar, MD:
Okay. Good to see you and I will see you again, hopefully, maybe.
Tacey A. Rosolowski, PhD:
Yes, next week. We are due next week, next Thursday.
Aman Buzdar, MD:
Okay.
Tacey A. Rosolowski, PhD:
Do you want to come here or do I come to your office?
Aman Buzdar, MD:
No, this is fine. It depends. Let me see, is it already scheduled?
Tacey A. Rosolowski, PhD:
It is already scheduled.
Aman Buzdar, MD:
So I didn't even know that this -- I don't look at it in my -- I just look at what is the next meeting I have going.
Tacey A. Rosolowski, PhD:
That's right, of course. Let me just say for the record, I'm turning off the recorder at about three minutes of three.
Recommended Citation
Buzdar, Aman U. MD and Rosolowski, Tacey A. PhD, "Chapter 08: The Clinical Effectiveness Committee and the MD Anderson Algorithms of Care" (2017). Interview Chapters. 569.
https://openworks.mdanderson.org/mchv_interviewchapters/569
Conditions Governing Access
Open
