bluuebunny/crossref_metadata_2025 huggingface dataset:
Benchmarks of quality breast care over 10 years.
Authors: Kaufman Cary Steven , Tucker F. Lee , Rabinowitz Barbara , Heckel Teresa , Gass Jennifer S.
Published: February 2017

272

Background: In 2005, the National Quality Measures for Breast Centers (NQMBC) was initiated as a web-based program to capture breast center performance using process of care measurements. The program participant enters data verified by the breast center director or administrator which was randomly audited. As a center submits data, their results are immediately compared with other similar centers as well as with all submitting centers. Methods: Of the 31 measures, we focus on six pertinent measures of quality breast care; time from diagnostic mammogram to needle biopsy, time from needle biopsy to initial breast cancer surgery, breast conservation rate, use of radiation therapy for breast conserving patients, use of endocrine therapy, and use of chemotherapy. Data was submitted in aggregate form, with each center submitting their average performance for any measure every 6-12 months from 2005 to 2014. Each submission included the number of patients used to calculate their submission. For this report, we have defined the “benchmark” as the average performance of all centers submitting data for a particular time period. Results: At the end of 10 years, the time from diagnostic mammogram to needle biopsy decreased by 2 days (207,425 patients reviewed), while the time from needle biopsy to initial cancer surgery increased by 5 days (86,084 patients). Breast conserving surgery markedly decreased 2.4% per year from 2005 to 2010, yet increased 2% per year from 2010 to 2014 (29,455 patients). For use of adjuvant therapies, we saw gradual increase in use. At 10 years, use of radiation therapy was at 92.5%, had increased at 0.7% per year, 6.5% overall increase (13,202 patients); use of endocrine therapy was 89%, had increased at 1.2% per year, 12% overall increase (12,684 patients); and use of chemotherapy was 97%, had increased at 0.5% per year, 10% overall increase (2,467 patients). Conclusions: Benchmarks of quality breast care are necessary as guideposts for providers. While the use of adjuvant therapies have increased over 10 years as expected, the fluctuations of use of breast conserving surgery as well as changes in time spent prior to surgery were unexpected. Benchmarks may change over time in unpredictable ways which supports ongoing monitoring the level of breast quality care.
Quality assurance metrics in clinical trial conduct.
Authors: Li Jennifer , Sellmann Susanna , Philip Lindsay , Guglielmi Cristina , Degendorfer Pamela , Oza Amit M.
Published: February 2017

274

Background: Quality assurance (QA) in clinical trials is a safeguard against non-compliance, which impacts patient safety and data integrity. On an institutional level, compiling quality findings provides insight to gaps within existing processes, protocol compliance, and educational content. A QA metrics methodology has been implemented, which is streamlined with the ICH-GCP, and institutional Standard Operating Procedures (SOPs) and policies. Methods: Individual findings are assigned an alphanumerical code, based on severity and category, and a reference for each Quality Assurance Review (QAR). Annual data is tracked for all QAR findings. Different data sets are created to allow for analysis of quality gaps and quality changes over time. Results are used in the creation or revision of educational content, SOPs, and to drive process improvement. Results: To date, a total of 1608 QAR observations between 2014 and mid-2015 have been coded and tracked across 22 studies. Areas of quality gaps, such as most-cited categories (e.g. 27% in Source Documentation and 13% in Regulatory) and references (e.g. 30% on SOPs and 14% on guidelines), are communicated to the Quality and Education team regularly and incorporated into training content. This has also prompted the development of new SOPs, processes, and research tools, after which QA metrics continues to be used to monitor program wide quality improvement. For example, following the implementation of Electronic Source Documentation, the proportion of findings on delays in Adverse Event sign off has seen a decline. For individual QARs, a personalized trends summary is provided to the study team with an overview of the quality of the study conduct. The report displays the distribution of findings across different categories and severity levels. Lastly, quality metrics has increased the efficiency of tracking and reporting program wide QA activity. Conclusions: The regular analysis of quality metrics has proven to be a pivotal step in the Quality Management Cycle. It presents a quick snap shot of the quality of individual research studies under review. When implemented on an institutional scale, it offers valuable feedback on the current SOPs, processes, and training content.
Compliance with National Comprehensive Cancer Network guidelines for antiemesis in cisplatin regimens.
Authors: Wolf Terri P. , Little Dana Ann
Published: February 2017

280

Background: The members of a network of community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines. To determine guideline compliance, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting.The community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines for treatment plans. To determine guideline compliance rates, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting. Methods: Prior to a chart audit, medical oncologists were surveyed on their knowledge of NCCN antiemesis guidelines, frequency of prescribing based on guidelines, and reasons for not using guidelines. Auditors identified patient charts through billing records and reviewed cycle 1 day 1 orders of cisplatin regimens. Secondary data was collected on hydration orders and home medications for antiemesis. Results: Guideline adherence varied from 0% to 76% with overall adherence at 28%. Dexamethasone doses ranged from 2-20 mg (guideline 12 mg) as did serotonin antagonists (5HT3) ordered at higher IV doses of 24-32 mg (guideline 8-16 mg). Conclusions: Although cancer centers report following the guidelines, this study did not find consistent adherence. The cancer center with the highest adherence rate works closely with a pharmacist and has built order sets with the guidelines. One cancer center had wide variances among practitioners. The variances increase the potential for error. The cancer center with lowest adherence rate used 10 mg doses of dexamethasone because the drug is delivered in 10 mg vials. This study identified multiple systems issues impacting guideline compliance. Managing nausea and vomiting is important for patient QOL and to manage costs by decreasing hospitalizations, treatment delays, and nutritional deficits. Understanding prescribing habits relative to guidelines provides an opportunity to change practice and reduce variability.
Patient surveys for cancer populations: Initial experiences with Cancer CAHPS.
Authors: Tirodkar Manasi , Friedberg Mark W , Fuld Nasso Shelley , Roth Lindsey M , Smith-McLallen Aaron , Stovall Ellen L. , Scholle Sarah Hudson
Published: February 2017

281

Background: Patient experiences are an important component of quality, but information on how well oncology providers meet the specific needs of patients with cancer is limited. This study reports on the patient experiences among patients undergoing drug therapy treatment for cancer in diverse outpatient settings. Methods: We assessed patient experiences using a modified version of the CAHPS Survey for Cancer Caredeveloped by the American Institutes for Research.The survey has five composites and an overall rating of providers. We used claims data from an insurance plan in Southeastern Pennsylvania to identify all patients who had a paid claim for drug therapy treatment at 26 practices from January 1 through July 31, 2014. The survey was sent to 2,302 patients who met this criteria and 701 patients returned a completed survey for a response rate of 31%. We calculated scores of 0-100 on the composites after adjusting for age, education, self-rating of mental health and response tendency (a measure of level of optimism/pessimism). Results: In general, cancer patients rated their providers highly on patient experience, particularly on access and communication. However, cancer patients rated their providers lower on shared decision-making and helping patients manage their symptoms and care at home. The scaled, adjusted scores on the five composites were: Access (score=91; 95% CI=90-92); Affective communication (score=90; 95% CI=88-91); Exchanging information/keeping patients up to date (score=89; 95% CI=88-90); Shared decision-making (score=78; 95% CI=76-80); Enabling patient self-management (score=69; 95% CI=67-71). We encountered several challenges in fielding the survey related to attributing patients to specific practice sites, identifying patients who had died, and concerns raised by patients/family respondents about the length or content of the survey. Conclusions: Our findings suggest the need for strong efforts to engage cancer patients in decision-making and provide supportive care. Methodology for sampling patients using claims data needs to be more accurate and the survey could be edited for length and comprehension.
Setting quality improvement priorities for women receiving systemic therapy (ST) for early stage breast cancer (EBC) using population level administrative data.
Authors: Enright Katherine , Yun Lingsong , Gonzalez Alejandro , Powis Melanie , Taback Nathan , Booth Christopher M. , Trudeau Maureen E. , Krzyzanowska Monika K.
Published: February 2017

299

Background: Routine evaluation of evidence informed quality measures (QM) can drive improvement in cancer systems by highlighting potential gaps in care. Targeting quality improvement at QMs that demonstrate substantial variation has the potential to make the largest impact on quality at a population level. We aimed to use variation in performance to set priorities for improving the quality of ST for women with EBC. Methods: EBC cases diagnosed 2006 – 2010 in Ontario, Canada were identified in the Ontario Cancer Registry and linked deterministically to multiple health care databases. A panel of QMs, previously developed to be operationalized for administrative data, was applied to reflect the quality of ST. Each QM was evaluated in all patients who met the inclusion criteria for the individual measure. QMs were ranked based on institutional variation in performance using the mean absolute difference (MAD). Results: We identified 28,303 patients, treated at 84 institutions. The performance of each QM is listed in Table 1. Timely receipt of ST, febrile neutropenia (FN) secondary prophylaxis, emergency room visits or hospitalizations, receipt of hormonal therapy (HT) and the use of surveillance imaging represented the 5 QM that demonstrated the greatest variation. Conclusions: Considerable institutional-level variation highlights potentially actionable areas of improvement [Table: see text]
Estimating the cost-savings of a comprehensive hospital-based palliative care program.
Authors: Isenberg Sarina , Lu Chunhua , McQuade John P , Smith Thomas J. , Razzak A. Rab
Published: February 2017

2

Background: In FY 2012, Johns Hopkins Medicine (JHM) established a palliative care inpatient unit (PCU). The PCU received patients as transfers and direct admissions. PCUs can improve care (Roza K, et al. JPM 2015) and lower per diem costs compared to usual care (Smith TJ, et al. JPM 2003; Goldstein J, et al. JPSM 2015). This project studied the financial impact of the PCU and PC program on JHM. Methods: Using one fiscal year of admissions, the team calculated the per day variable cost of pre-transfer in to palliative care (from ED) and palliative care transfer. These fees were multiplied by the number of patients transferred to the PCU (153) and by the average length of stay in the PCU (5.11 days). These variable costs were added together to reach the combined savings. Consultation savings were estimated using established methods (Morrison RS, et al. Arch Int Med 2008; adjusted to 2014 dollars). Results: The PCU operated at 54% occupancy in the first year. The daily loss pre-transfer of $1,672 was reduced 59% to $785 post-transer. Over 60% of transfers came from the ICU, freeing beds. The PCU saved JHM $367,751 in direct costs; additional cost savings for PC consultation were estimated at $4.3M (1,335 live discharges × $2,374, 165 decedent discharges × $6,872) and $370,000 was collected in professional fees, for a total contribution of approximately $5M. Conclusions: The PCU and PC program had a favorable impact on the health system. As JH moves to an acountable care organization model being both provider and insurer, such improved quality, cost savings, and increased ICU availability are desirable.
The well-being of long-term cancer survivors.
Authors: Sullivan Jeffrey , Thornton Snider Julia , van Eijndhoven Emma , Batt Katharine , Okoro Tony , Shah Manan , DeLeire Thomas
Published: February 2017

30

Background: While numerous studies have examined the outcomes of individuals recently diagnosed with cancer, less is known about the well-being of long-term (LT) cancer survivors. Methods: Using the Health and Retirement Study (HRS), a nationally representative survey of US residents over age 50, we defined four cohorts: US residents over age 50, individuals recently diagnosed with cancer (≤4 years from diagnosis), LT cancer survivors (>4 years from diagnosis) and individuals with a chronic condition (diabetes, heart disease, hypertension, lung disease or prior stroke). We compared well-being measures across cohorts. We imputed total medical spending using the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey. Results: We identified 22,034 US residents over age 50; 754 individuals recently diagnosed with cancer; 1,764 LT survivors; and 12,874 individuals with chronic illness. Over the biannual survey waves from 2004-2012, this amounted to 22,034; 3,880; 8,480; and 57,363 person-years, respectively. (The 50+ cohort was analyzed in 2010, the most recent year in which the HRS was nationally representative.) Given the large samples, most differences between LT survivors and other cohorts were statistically significant (p<0.05). However, LT survivors’ outcomes were often closer to those of individuals with chronic illness than to the recently diagnosed. Earnings if employed of the recently diagnosed and self-reported health of the chronically ill were not significantly different from LT survivors. Conclusions: Although cancer has a negative impact on well-being in the short term, over time cancer survivors’ well-being improves, becoming more similar to that of individuals with a chronic condition. [Table: see text]
Cancer registry-survey data linkages to measure patient-centered quality of care: SEER-MHOS and SEER-CAHPS.
Authors: Kent Erin E. , Mollica Michelle , Gaillot Sarah , Halpern Michael T. , Hays Ron D. , Lines Lisa M , Topor Marie A. , Yuan Gigi , Schussler Nicola C. , Ramirez Edgardo , Wilder Smith Ashley
Published: February 2017

303

Background: Limited opportunities exist to conduct population-based surveillance of cancer patient-reported outcomes. Data from the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program has recently been linked with data from two Centers for Medicare & Medicaid Services quality improvement surveys: the Medicare Health Outcomes Survey (MHOS) and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. We provide an overview of the data available, recent findings, and priority areas for future research. Methods: Since 1998, the MHOS has conducted 2-wave/biennial surveys of individuals ages 65+ and individuals with disabilities enrolled in Medicare Advantage (MA) health plans on aspects of health-related quality of life, functional status, comorbidities, and symptoms. Fourteen cohorts are available, representing over 126K patients with cancer and over 1.9 million MA enrollees without a history of cancer. The SEER-MHOS publicly available data resource has produced over 40 data use agreements and 19 publications. SEER-CAHPS links cancer registry data with cross-sectional survey data of Medicare beneficiaries (both fee-for-service and MA) that contain information on patient experiences with care, including access to needed and timely care, doctor communication, health plan customer service, and care coordination. The current linkage contains survey data from 1998 to 2010 and includes over 150K and 570K respondents with and without a history of cancer, respectively. Plans to launch the publicly available resource are underway. Results: Recent findings include the impact of diagnosis and treatment on health-related quality of life in older cancer survivors, physical health impairments and variation of treatment received, the impact of cancer on activities of daily living, and variations in care ratings between participants with and without cancer across the cancer control continuum. Conclusions: The SEER-MHOS and SEER-CAHPS linked data resources provide population-based surveillance data on cancer patient-reported outcomes which allow unprecedented opportunities to evaluate national quality improvement activities.
First-line treatment of metastatic NSCLC (mNSCLC) patients without actionable mutations in U.S. community oncology clinical practice.
Authors: McKay Caroline , Arunachalam Ashwini , Burke Thomas A. , Cao Xiting , Abernethy Amy P , Carbone David Paul
Published: February 2017

307

Background: Benchmarking high quality care requires defining optimally effective practice patterns. As first step, contemporary real-world practice must be detailed. The purpose of this study is to describe patient flow from diagnosis of mNSCLC to initiation of anti-cancer drug therapy in patients without known EGFR/ALK genomic tumor aberrations; the characteristics and first-line (1L) anti-cancer treatment of these patients, including induction and maintenance therapy. Methods: Retrospective database cohort study using data from an oncology EHR system, representing 17% of incident cancer cases from US community setting. Study population includes patients diagnosed with stage IV mNSCLC treated between 11/ 1/12 and 1/31/15 with follow-up to 7/31/15. Treatment patterns include regimen, number of doses, and time to regimen discontinuation. Data are analyzed descriptively, for overall cohort and by histology, with time to treatment discontinuation analyses using the Kaplan Meier method. Results: Of 4441 patients with mNSCLC, 88% had EGFR/ALK negative or unknown status. Of 79% who initiated 1L therapy, 69.5% (n = 2014) of patients (78.4% non-squamous, 21.7% squamous) were included. 55.1% were men; 89.8% were age 65+. 83.4% received induction therapy only; 16.6% received induction and maintenance therapy. 85% received a platinum combination as induction therapy; the majority either received a carboplatin doublet (53.5%) or carboplatin doublet in combination with targeted therapy (23.3%). 14.4% received a non-platinum based regimen. During induction therapy only, mean duration for the most common regimen category (platinum based combination) was 96.9 (IQR 43-129) for squamous and 79.45 (IQR 36-108) days for non-squamous patients. Of non-squamous patients who received induction followed by maintenance, mean duration of therapy was 103.9 (IQR 66-134) and 140.7 (IQR 45-208) days for induction and maintenance, respectively. Conclusions: Results describe treatment patterns in the US community 1L setting, prior to introduction of anti-PD1/PD-L1 inhibitors and new angiogenesis inhibitors. These form a starting point for benchmarking high quality care in mNSCLC.
The impact of guideline treatment nonadherence on survival for colorectal cancer patients: Propensity score calibration via a validation cohort.
Authors: Hines Robert Brooks , Lai Sue Min , Baranda Joaquina Celebre , Engelman Kimberly K. , Dong Frank , Bayakly A. Rana , Collins Tracie
Published: February 2017

308

Background: The quality of cancer care has been the focus of ongoing concern for cancer researchers, providers, and policy makers. The objectives of this study were: 1) to evaluate nonadherence with National Comprehensive Cancer Network treatment guidelines for colorectal cancer (CRC) patients and the impact on survival, and 2) to obtain error-corrected estimates of effect by means of propensity score calibration via a validation cohort. Methods: CRC patients identified by the Georgia Comprehensive Cancer Registry for the years 2000-07 were eligible (N = 18,388). Naïve propensity score (PSn) adjustment and PS calibration (PSC) via a validation cohort were utilized to obtain hazard ratio estimates for the impact of guideline treatment nonadherence on 5-year overall survival. The validation cohort contained additional information on comorbidity and payer status which was used to obtain error-corrected estimates of effect by PSC. Results: Treatment nonadherence conferred a large increased risk of death early in the follow-up period which declined over time (Table 1). Comparison of results from the PSn and PSC models indicated moderate to large bias due to unmeasured confounding in the PSn model (data not shown). Conclusions: PSC produced attenuated estimates and had an impact on study conclusions in the latter follow-up period. For CRC patients, health services research into the quality of care received by cancer patients is necessary to continue the improving trend in CRC-related mortality. [Table: see text]
Regional initiative to use data transparency to improve cancer care.
Authors: Kreizenbeck Karma L. , Fedorenko Catherine R. , Hoopes Teah , Lyman Gary H. , Brown Thomas David , Chen Eric Y. , Conklin Ted , Corman John M. , Lonergan Matt , Lessler Daniel , Martins Renato , Mera Csaba , Rieke John Whitelaw , Saikaly Elie P. , Smith Julie C. , Stewart F. Marc , Whitten Richard , Ramsey Scott David
Published: February 2017

39

Background: In the context of many initiatives aimed at measuring quality and value in cancer care, the Hutchinson Institute for Cancer Outcomes Research (HICOR) has adopted a multi-stakeholder approach to characterize oncology care, prioritize areas for improvement, design programs, and evaluate outcomes. Beginning in 2014, HICOR initiated a process to move towards data transparency in the reporting of regional quality and value metrics. Methods: The HICOR team constructed clinic-level adherence reports for community-prioritized metrics and the 2012 ASCO Choosing Wisely recommendations using a registry-claims linked database. In the fall of 2014, a national external advisory board reviewed methodology for measuring adherence. De-identified regional results were presented at a provider meeting in late 2014 to elicit provider feedback on methodology and on strategies for reporting clinic-identified adherence. Clinics were privately given their own adherence data. In 2015, revised de-identified regional reports were presented at a Value in Cancer Care Summit poster session and made available through HICOR IQ, a regional oncology informatics platform, for further discussion. Results: Results show that no clinic was also the best or worst performing clinic. The table shows the performance by clinic for the 5 Choosing Wisely recommendations. There is now increased demand by clinics to view their own adherence benchmarked with the region as a next step in moving towards full data transparency. Additionally, there is support from provider members in the community to re-identify clinics in order to compare results against their peers. Conclusions: Using an iterative, transparent, multi-stakeholder process, it is feasible build regional consensus towards releasing clinic-level adherence to quality and value metrics. By consulting trusted experts in the field and allowing multiple opportunities to provide feedback, providers are requesting even more transparency in order use the oncology measures to improve care in their practice and the region. [Table: see text]
What is needed to implement Institute of Medicine (IOM) 2013 supportive oncology recommendations in community settings?
Authors: Trosman Julia Rachel , Berardi Rosa , Weldon Christine B.
Published: February 2017

49

Background: The IOM 2013 report recommends supportive oncology services from diagnosis through survivorship and end of life. We examined what community institutions need to implement IOM recommendations. Methods: Survey of 35 institutions in a urban area (13 cancer centers; 14 cancer support centers, 8 hospices). Institutions ranked the top 5 supportive oncology project ideas, that their organization was most interested in participating in, from a list of 27. Results: Survey response rate was 100%. Respondents agreed on 8 of top 10 priorities across the three organization types (Table). Local inter-institutional collaboration leveraging respective resources and facilitating care consistency across sites was the most frequently need. It was followed by the need for stratified care processes based on patient need and improved supportive oncology reimbursement. Priorities differed between Cancer Centers and other institution types on Consolidated screening tools* (p = .05, .09) and Care process for family / caregiver** (p = .006, .04). Conclusions: Supportive oncology care processes and tools are needed to implement IOM recommendations in the community. Our findings inform a roadmap for practical collaborative implementation of the IOM recommendations. Differing priorities across cancer institution types should be further explored and addressed within the roadmap. [Table: see text]
Treatment prices at the point of care: Pilot.
Authors: Henrikson Nora B , Lau Rebecca W. , Tuzzio Leah , Christianson Matthew Alan , Chen Eric Y. , Phan Thanh-Hien
Published: February 2017

4

Background: People with cancer increasingly wish to discuss cancer care costs with clinicians. In our organization all price questions go to a central customer service line with limited capacity to address oncology-specific questions. We aimed to improve clinician access to treatment prices to assist them in responding to patient concerns about prices. Methods: We developed, launched, and evaluated a pilot tool and accompanying workflow for four oncology clinics in an integrated delivery system in WA. The online tool included a series of 50 printable worksheets for the most commonly ordered cancer treatment protocols accessible directly from the electronic health record. The worksheets included codes and prices for all drugs, supportive medications, tests, and professional services for one treatment cycle presented in patient-friendly language. We audited the accuracy of the cost information against patient bills. The worksheets did not provide patient-level cost-shares. We evaluated the resource’s launch, initial use, and acceptability through a convenience survey of initial users. Results: The project was successfully launched. Initial web traffic to price sheets exceeded the number of treatments being ordered during the launch period. A third of survey respondents (33%) reported using the cost sheets at least once a week. Reported most useful features were improved access to cost information, treatment protocol-based layout, and the service of previously unmet patient needs. Seventy percent (70%) reported that the resource had no impact on their workload. The mean value of the resource (1 lowest and 10 highest value) was 7.9 (value to patients); 7.8 (to oncology service line), 7.7 (to Group Health) and 6.5 (to own work or practice). Staff reporting of patient response was generally positive. Suggested improvements included provide patient-level cost share (63%) followed by expanding the project to include more protocols (33%). Conclusions: The pilot was feasible, built capacity to locate price data, and did not adversely impact staff workload. It addressed a clear need and demonstrated high potential overall value, especially its protocol-based format. The resource’s lack of personalized estimates of out-of-pocket charges was the biggest gap reported.
Identifying avoidable terminal oncology ICU hospitalizations.
Authors: Daly Robert Michael , Hantel Andrew , Polite Blase N.
Published: February 2017

56

Background: Eight percent of cancer patients expire in the ICU. There is no association between spending on aggressive end of life (EOL) care and survival outcomes. This aggressive care is also associated with reduced quality of life for patients and families. The National Quality Forum endorses the number of patients admitted to the ICU in the last 30 days of life as a quality of care measure. Our hypothesis is that a significant number of oncology patients suffer avoidable terminal ICU hospitalizations. Methods: Using data from the University of Chicago (UCM) Cancer Registry, we identified patients who died in UCM adult ICU’s in FY2013. Of the 1,388 oncology deaths, 115 were in the ICU. Of those, 72 were established patients having had at least one visit with a UCM oncologist. A physician from oncology, critical care, and hospital medicine directly reviewed the electronic medical record of each patient from 3 months prior to index hospitalization until death. Using a standardized assessment tool, these physicians then determined whether the terminal hospitalization was clinically avoidable through different medical management. The primary outcome was the proportion of terminal oncology ICU hospitalizations identified as potentially avoidable by two or more reviewers. Results: Seventy-one percent of this patient population had a solid malignancy and 53% of those had metastatic disease. The ECOG performance status was ≥ 2 prior to admission in 51% of patients. Eighty-two percent had at least one prior hospitalization. During the index hospitalization, 81% were intubated, 39% had resuscitation, and 22% had hemodialysis. Two or more physician reviewers identified 34 (47%) of terminal oncology ICU hospitalizations as clinically avoidable. All three specialty physicians agreed about the avoidability 43% of the time. Conclusions: A review of terminal oncology ICU hospitalizations demonstrates that most of these patients had an advanced malignancy and poor clinical status and underwent aggressive EOL interventions. A significant number of these hospitalizations were identified as clinically avoidable by two or more physician reviewers. By identifying avoidable terminal oncology ICU hospitalizations, we can design interventions to prevent them.
Bringing person-centered care to practice with CCO’s guideline for person-centred care in adult oncology services.
Authors: Moody Lesley , Nicholls Brett , Shamji Hannah , Johnson Neil , Zwaal Caroline , Stevens Christian , Biddy Rhonel , Griffin Carly , Laroque Gail , Messersmith Hans , Singh Simron
Published: February 2017

65

Background: CCO ensures quality cancer care for 16 million residents in Ontario. CCO has identified person-centered care (PCC) as a top strategy in driving the quality agenda. CCO, in collaboration with the Program in Evidence-Based Care, developed a PCC Guideline to set the standard of care for people experiencing cancer in Ontario. A PCC video was developed as a tool for translating this knowledge to support healthcare providers to integrate Guideline recommendations into their practice. Methods: A Guideline Working Group (GWG), including patients and health care providers, conducted a literature review and assessed the quality, relevance and utility of available evidence. An Expert Panel reviewed the decisions of the GWG and an External Review was conducted to validate the final guideline. The PCC video was developed as a tool for knowledge translation by defining fundamental concepts of PCC with the objective of promoting uptake of the guideline. A 4-question survey based on the Kirkpatrick Model was embedded to evaluate the video’s effectiveness. Results: Of 110 articles, only one guideline was found and was therefore reviewed exclusively. The GWG reviewed 68 recommendations, modifying 48, accepting 13 and rejecting 4; for a final set of 65 recommendations. External Review returned 73 responses. A total of 196 health care providers, 134 administrators, 53 patients and 103 others stakeholders participated in the video survey. The results in the table below compare the educational state of PCC before and after the video. Conclusions: CCO has adapted and endorsed 65 recommendations to create a PCC Guideline for adult oncology in Ontario. The results of the video showed that baseline PCC knowledge is poor, and that the PCC Video initiated significant (p = 0.972) growth in this knowledge. Anecdotal evidence also suggests that the video positively affected health care provider's confidence in adopting PCC. Future work is required to promote uptake and utilization of PCC Guideline at system-level. [Table: see text]
Integrated post-surgical colon cancer care planning at the Rutgers Cancer Institute of New Jersey and Robert Wood Johnson University Hospital.
Authors: Brown Teresa V. , Donohue Kristen , Patella Sondra , Dombrovskiy Viktor Y. , Moss Rebecca Anne , Maloney Patel Nell
Published: February 2017

75

Background: Colorectal cancer is the second leading cause of cancer death in the United States each year. The use of adjuvant chemotherapy after surgical resection of colon cancer has been associated with a survival benefit. Timely initiation of adjuvant chemotherapy has been shown to have an effect on overall and disease-free survival. There is no integrated post-surgical colon cancer care planning for patients who have surgery at our institution. Poor understanding on the part of patients and ancillary providers regarding appropriate follow up may cause delay in time to adjuvant chemotherapy initiation. Methods: Baseline data was obtained for the ASCO Quality Training Program. Chart review was conducted on patients with stage III colorectal cancer that were treated at the Cancer Institute of New Jersey and Robert Wood Johnson University Hospital to identify average time to adjuvant chemotherapy initiation and factors which were thought to have a strong influence on chemotherapy initiation. Time to initiation of adjuvant chemotherapy, pathology report resulting, central access obtainment, and outpatient medical oncology appointment was abstracted from patient charts. Other factors including the presence of intraoperative or postoperative complications, type of surgeon, academic versus private medical oncologist, and the presence of an inpatient medical oncology consult were also identified and reviewed. Results: 128 patient charts were reviewed. Mean number of days from surgery to adjuvant chemotherapy (n = 79) was 49.6, to pathology report resulting (n = 70) was 4.92, to central access obtainment (n = 49) was 40, and to outpatient medical oncology appointment (n = 38) was 30. The presence of intraoperative (p < 0.059) and postoperative complications (p < 0.0155) was found to have a statistically significant effect on time to initiation of adjuvant chemotherapy. Conclusions: While there are some uncontrollable factors like operative complications that delay time to initiation of chemotherapy, engaging the patient may help decrease the time to adjuvant chemotherapy by increasing patient awareness of the importance of seeking aggressive postoperative care.
Using technology to improve patient-provider communication and delivery of quality care.
Authors: Rocque Gabrielle Betty , Hathaway Amanda , Halilova Karina I. , Gaguski Michele , Thomas Kathryn A , Stricker Carrie Tompkins , Hammelef Karen , Panzer SarahLena , Jacobsen Paul B. , Buzaglo Joanne S. , Blayney Douglas W.
Published: February 2017

76

Background: Shared decision making (SDM) is a cornerstone of patient-centered care with 85-90% of breast cancer (BC) patients preferring an active or shared role in decision-making for breast surgery. SDM has been shown to, improve patients’ understanding of treatment options, result in more conservative care choices, and lead to lower healthcare costs. However, implementation is complex as numerous misconceptions exist. Methods: We are conducting a multi-site, quality improvement (QI) project to improve SDM behaviors and adherence to quality measures through a combination of provider education and use of a novel technology platform, the Carevive Care Planning System. This platform elicits patient preferences, concerns, history, and symptoms, and presents these data with algorithm-driven recommendations as part of a treatment plan. We report results from baseline provider surveys assessing perception and knowledge of SDM. Results: Baseline surveys from 28 participants were analyzed; 43% from a university based cancer center and 57% from community based cancer centers. Survey respondents were MDs (43%), NPs (7%) and RNs (46%), all specializing in Hematology and/or Oncology. When asked, “What percentage of breast cancer patients prefers an active or shared role in decision making?”, only 29% believed 85-90% of BC patients desired an active or shared role as suggested by surgical literature; 43% believed between 55-70% of patients wanted to be engaged in decision-making. Commonly reported barriers to SDM are shown in the table below. Conclusions: Physicians may underestimate patient’s desire to participate in shared decision-making. The barriers to implementing SDM in oncology practice will likely require multi-faceted interventions to overcome. We aim to address these gaps through an intervention aimed at enhancing knowledge and patient-provider engagement through treatment summaries. [Table: see text]
Interdisciplinary care rounds in the community: Changing the paradigm of supportive service involvement in cancer care.
Authors: Siegel Robert D. , Crosswell Hal E. , Dillard Terra , Bayne Jennifer , Redenz Tina , Duggan Kyle , Belew Angela
Published: February 2017

83

Background: Although cancer centers have focused on optimizing seamless Multidisciplinary Care (MDC) at tumor boards and/or clinics, there has been little published on effective ways to involve supportive services into the management of cancer patients. Historically, supportive services have been initiated when there is an active need rather than in anticipation of that need. As an alternative to pursuing such "crisis management" in our patients, Bon Secours St. Francis Cancer Center (BSSF) initiated Interdisciplinary Care (IDC) Rounds in an effort to anticipate patient needs, enhance quality of life (QoL), and potentially limit avoidable emergency room and hospital admissions. Methods: We initiated IDC Rounds with participants from the following disciplines: medical oncology, navigation, clinic nursing, palliative medicine, financial counseling, psychology, nutrition, clinical research, adolescent and young adult, and oncology rehabilitation/survivorship (ORS). A database was created to track new patients with malignancies within three weeks of presentation and the subsequent recommendations made by the IDC team. Those recommendations are then forwarded to the primary medical oncologist who has the ability to agree to those recommendations in full or in part before they are actuated. Results: BSSF is a non-academic, community-based cancer program and receives over 1,300 referrals annually from a referral population of 1.32 million in 10 counties. Short term metrics demonstrate a 57% and 100% increase in referrals to ORS and palliative care, respectively. Successes and challenges including sustainability, cost and measurable impact will be discussed. Conclusions: We have shown that it is feasible in the community setting to create a process that will allow early integration of supportive services into the full service care of cancer patients. Results demonstrate an increase in short-term metrics such as referrals to supportive services. Our ultimate goal is that formalized IDC results not only in earlier involvement by needed services but enhanced QoL for our patients with fewer emergency room and hospital admissions. Those data will be compiled as the program matures.
Ambulatory redesign: Strategies for quality improvement in patient care.
Authors: Sinanis Naralys Estevez , Lyons Catherine A. , Smith Nancy , McGlennon Maureen , Parker Terri L. , Truini Carolyn , Major-Campos Maureen , Lacy Jill , Michaels Karen , Dest Vanna , Lisitano Richard , Adelson Kerin B. , Lilenbaum Rogerio
Published: February 2017

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Background: Growing outpatient volume poses patient flow challenges, making it difficult to accommodate the complexities of academic medical practice. Volume increases create operational inefficiencies like delays in lab turnaround time (TAT) and limited rooming capacity resulting in delays in patient access and reduced provider productivity. These bottlenecks negatively impact patient satisfaction. Methods: Four multidisciplinary teams assessed barriers to patient flow in the lab, rooming and scheduling process. We sought to maximize the Advanced Practice Provider (APP) role within clinical programs. Each team was led jointly by an MD and RN and included subject matter experts, advisors and facilitators. The groups met regularly for 2 months to evaluate operational data, national benchmarks and surveyed staff. Monthly progress was presented during the Ambulatory Clinic Committee (ACC) meetings. Number of labs not completed on time, wait-time and APP visit volume were tracked. Results: Recommendations included provider education on lab order process, purchasing a second instrument for chemistries, APP independent visits standards, and realistic scheduling times. Preliminary findings indicate that the lab reduced their average TAT defect rate by 52.3% (CBC) and 76.1% (CMP) compared to January 2014 (baseline) and January 2015 (post implementation). This difference was statistically significant at a 95% CI, with p < .001 for both CBCs and CMPs. In addition, APP total visit volume increased by 81% from FY 2014 to FY 2015. Finally, the overall Press-Ganey mean in patient satisfaction with physician wait time increased from 81.7 to 82.7 (2014 vs. 2015). Conclusions: Multidisciplinary teams recommended valuable process improvement changes to reduce the TAT in the lab and to promote that APPs work within the full scope of their license. Implementation requires extensive project management support and continuous tracking to evaluate outcomes. Opportunities exist to maximize space and room utilization and optimize the scheduling process as the outpatient volume continues to increase.
Using a QOPI-based template to monitor appropriate evaluation of constipation.
Authors: Gulvin Joshua Michael , Lin Bruce S. , Robinson Nanette , Malpass Thomas William , Picozzi Vincent J. , Vishnu Prakash , Taylor Lynne Patricia , Chatta Gurkamal S. , Goetsch Cathleen M. , Aboulafia David Michael , Rosales Joseph K
Published: February 2017

94

Background: A common symptom in patients being treated with opioid analgesics is constipation, which is often underreported by patients and therefore undertreated by providers. The Quality Oncology Project Initiative (QOPI) has identified constipation as one of the benchmark symptoms to be monitored in order to obtain certification. At Virginia Mason Medical Center, we had previously identified constipation as a symptom which was not adequately addressed in the medical record, and implemented a template-based initiative to increase its evaluation. Methods: We identified consecutive patients with advanced cancer undergoing systemic therapy who were also receiving opioid analgesic treatments. These patients were surveyed for constipation, and answered a questionnaire regarding its severity and whether they felt it was adequately handled. We then reviewed the encounter notes for the visit to correlate the provider’s documentation of constipation and its treatment and the patient experience. Results: Results will be presented at the symposium. Conclusions: We aim to describe whether or not the symptom of constipation was adequately captured and/or treated in patients receiving opioid therapy.
Mindfulness-Based Cognitive Therapy in Advanced Prostate Cancer: A Randomized Controlled Trial
Authors: Chambers Suzanne K. , Occhipinti Stefano , Foley Elizabeth , Clutton Samantha , Legg Melissa , Berry Martin , Stockler Martin R. , Frydenberg Mark , Gardiner Robert A. , Lepore Stephen J. , Davis Ian D. , Smith David P.
Published: February 2017

Purpose

Advanced prostate cancer (PC) is associated with substantial psychosocial morbidity. We sought to determine whether mindfulness-based cognitive therapy (MBCT) reduces distress in men with advanced PC.

Methods

Men with advanced PC (proven metastatic and/or castration-resistant biochemical progression) were randomly assigned to an 8-week, group-based MBCT intervention delivered by telephone (n = 94) or to minimally enhanced usual care (n = 95). Primary intervention outcomes were psychological distress, cancer-specific distress, and prostate-specific antigen anxiety. Mindfulness skills were assessed as potential mediators of effect. Participants were assessed at baseline and were followed up at 3, 6, and 9 months. Main statistical analyses were conducted on the basis of intention to treat.

Results

Fourteen MBCT groups were conducted in the intervention arm. Facilitator adherence ratings were high (> 93%). Using random-effects mixed-regression models, intention-to-treat analyses indicated no significant changes in intervention outcomes or in engagement with mindfulness for men in MBCT compared with those receiving minimally enhanced usual care. Per-protocol analyses also found no differences between arms in outcomes or engagement, with the exception of the mindfulness skill of observing, which increased over time for men in MBCT compared with usual care ( P = .032).

Conclusion

MBCT in this format was not more effective than minimally enhanced usual care in reducing distress in men with advanced PC. Future intervention research for these men should consider approaches that map more closely to masculinity.
Current Role of Surgery in the Management of Oropharyngeal Cancer
Authors: Turner Meghan T. , Byrd J. Kenneth , Ferris Robert L.
Published: February 2017

The 1990s saw an increased use of chemoradiotherapy protocols, commonly referred to as organ-sparing therapy, for the treatment of oropharyngeal cancer after the Groupe d'Oncologie Radiothérapie Tête et Cou trial. Since that time, human papillomavirus–associated oropharyngeal squamous cell carcinoma has been identified as a unique disease, with improved survival regardless of treatment modality. The improved outcomes of this population has led to re-evaluation of treatment paradigms in the past decade, with a desire to spare young, human papillomavirus–positive patients the treatment-related toxicities of chemoradiotherapy and to use new minimally invasive surgical techniques to improve outcomes. Numerous retrospective and prospective studies have investigated the role of surgery in treatment of oropharyngeal carcinoma and have demonstrated equivalent oncologic outcomes and improved functional outcomes compared with chemoradiotherapy protocols. Ongoing and future clinical trials may help delineate the role of surgery in the future.